From DRGs to deregulation: New Jersey takes the road less traveled.

Science.gov (United States)

Berliner, H S; Delgado, S

1993-01-01

Following a 1992 court ruling that declared New Jersey's system of financing uncompensated care unconstitutional, the state radically changed its 12-year-old hospital payment system that pioneered the use of diagnostic-related groups (DRGs). In its place, New Jersey lawmakers approved a package of reforms that lets hospitals set their own charges and collect bad debts, uses the state's unemployment insurance trust fund to pay for charity care, and reforms the individual and small group insurance markets. Immediate results of the law include new subsidies for inner-city hospitals, lower bond ratings, and hospital layoffs.

Technological options in regard to reducing harmful environmental effects of road traffic. Fuel cell technology compared with combustion engines; Technische Optionen zur Verminderung der Verkehrsbelastungen. Brennstoffzellenfahrzeuge im Vergleich zu Fahrzeugen mit Verbrennungsmotoren

Energy Technology Data Exchange (ETDEWEB)

Kolke, R. [comp.

1999-05-01

The German Umweltbundesamt (federal environmental agency) commissioned a cost-benefit analysis to be made, testing the practical performance of fuel cell-driven automobiles, for state-of-the-art assessment of their benefits and drawbacks as compared to other available automotive fuel systems. Results available so far of calculations based on the cost-benefit analysis show that the targets involved, such as cutback of emissions and conservation of resources, can be realised within the foreseeable future at much lesser expense through the use of fuel consumption-optimized Otto engines offering lowest emission levels (of the type ULEV, ultra-low emission vehicle, or EURO 4 standard), as compared to the relevant contributions to emission reduction and other targets offered by the fuel cell-driven automobiles.(orig./CB) [Deutsch] Das Umweltbundesamt hat die Brennstoffzellentechnik im Verkehr einer Kosten-Nutzen-Betrachtung unterzogen, um zu ermitteln, welche Vor- und Nachteile sie im Vergleich zu anderen Antriebskonzepten im Verkehr nach derzeitigem Wissensstand hat. Nach den bisherigen Berechnungen am Beispiel einer Kosten-Nutzen-Analyse zeichnet sich ab, dass Emissionsminderungen und Ressourcenschutz fuer die absehbare Zeit wesentlich kostenguenstiger durch verbrauchsoptimierte Fahrzeuge mit Ottomotor mit niedrigsten Abgasemissionen (ULEV-`Ultra Low Emission Vehicle` oder EURO 4-Standard) realisiert werden koennen als durch Fahrzeuge mit Brennstoffzellenantrieb. (orig.)

Eine Zeit der Stille

OpenAIRE

Leibfried, Peter

2013-01-01

Rechtzeitig zu Weihnachten hat das IASB am 18. Dezember 2012 die Ergebnisse seines Agenda-Consultation-Projekts vorgestellt. Für aufmerksame Beobachter waren die Resultate kaum überraschend: Angestrebt werden unter anderem eine "period of calm to let the dust settle" anstatt neuer Regelungen, eine stärker prinzipienorientierte Ausrichtung auf das Rahmenkonzept und eine frühzeitigere Abstimmung mit den Betroffenen mit Blick auf Kosten-Nutzen-Überlegungen. Das 40-seitige Dokument ist die erste ...

Räumliche Aspekte von Transformationsproblemen aus systemtheoretischer Perspektive

OpenAIRE

Klüter, Helmut

2000-01-01

Der mit dem Topos "Transformation von Wirtschafts- und Gesellschaftssystemen" axiomatisch angenommene Unvereinbarkeit sozialistischer und marktwirtschaftlicher Strukturen ist aus raumwissenschaftlicher Sicht nicht nachvollziehbar. Zum einen gibt es in Wirtschaftsgeographie und Infrastrukturtheorie eine ganze Reihe von Gemeinsamkeiten und Berührungspunkten, die man für den konstruktiven Systemumbau nutzen kann. Zum andern benötigt der Umbau selbst eine räumliche Infrastruktur. Und zum dritten ...

Heterogeneity of European DRG systems and potentials for a common EuroDRG system: Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries"

OpenAIRE

Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

2015-01-01

Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring...

The social costs and benefits of Smart Grids; Maatschappelijke kosten en baten van Intelligente Netten

Energy Technology Data Exchange (ETDEWEB)

Blom, M.J.; Bles, M.; Leguijt, C.; Rooijers, F.J. [CE Delft, Delft (Netherlands); Van Gerwen, R.; Van Hameren, D.; Verheij, F. [KEMA, Arnhem (Netherlands)

2012-01-15

Although a reliable social cost-benefit analysis (SCBA) of large-scale introduction of Smart Grids is currently lacking, the rough-and-ready estimates available give the impression that the results of such an exercise would be positive. In the latter half of 2011 and in early 2012 a number of large-scale trials to explore Smart Grids were initiated in the Netherlands: the so-called 'Pilots Smart Grids'. To identify and quantify the social costs and benefits associated with Smart Grids and to assess whether large-scale introduction is indeed desirable, an SCBA needed to be conducted. An additional question concerned the issue to be considered when rolling out large-scale trials aimed at improving the economic impact of Smart Grids in the Netherlands. The key question posed by the commissioning party, the Dutch Ministry of Economic Affairs, Agriculture and Innovation, was to identify and quantify the costs and benefits, both direct and indirect, of a national roll-out of Smart Grids. The present report deals with Phase 1 of the SCBA. [Dutch] De aanleg van intelligente elektriciteitsnetten - ook wel smart grids genoemd - levert een positieve bijdrage aan de toekomstige energievoorziening. Het leidt tot lagere prijzen voor consumenten en bedrijfsleven. Dit wordt geconcludeerd uit een maatschappelijke kosten-batenanalyse (MKBA) die door CE Delft en KEMA is verricht in opdracht van het ministerie van Economische Zaken, Landbouw en Innovatie. In de analyse zijn verschillende energiescenario's tot 2050 doorgerekend. In vrijwel elk toekomstscenario leveren smart grids een positieve bijdrage; of het nu gaat om wel of geen klimaatbeleid, een groot of klein aandeel decentrale energieproductie en andere variaties. Dat komt vooral door de te verwachten gedragsverandering van gebruikers als gevolg van variabele energietarieven en kostenbesparing in de netaanleg en elektriciteitsproductie. Uit de recent gestarte proeftuinen voor Intelligente Netten zal duidelijk

Rapport van het onderzoek naar de kosten, verbonden aan het bewaren van consumptie-aardappelen

NARCIS (Netherlands)

Anonymous,

1941-01-01

Het doel van deit rapport is vast te stellen hoe het verloop van den prijs van consumptie-aardappelen gedurende den winter en het voorjaar moet zijn om de gemaakte kosten en het verlies aan product goed te maken.

De kosten van ontbrekende of ontoereikende veiligheid en gezondheid op het werk: samenvatting

NARCIS (Netherlands)

Weerd, M. de; Tierney, R.; Duuren-Stuurman, B. van; Bertranou, E.

2013-01-01

De kosten van arbeidsgerelateerde letsels en ziekten kunnen hoog oplopen. In de EU-27 deden zich in 2007 5 580 arbeidsongevallen met dodelijke afloop voor en had 2,9% van de arbeidskrachten een ongeval dat resulteerde in meer dan drie dagen arbeidsverzuim. Bovendien hadden gedurende een periode van

The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital.

Science.gov (United States)

Goldfield, Norbert

2010-01-01

Policymakers are searching for ways to control health care costs and improve quality. Diagnosis-related groups (DRGs) are by far the most important cost control and quality improvement tool that governments and private payers have implemented. This article reviews why DRGs have had this singular success both in the hospital sector and, over the past 10 years, in ambulatory and managed care settings. Last, the author reviews current trends in the development and implementation of tools that have the key ingredients of DRG success: categorical clinical model, separation of the clinical model from payment weights, separate payment adjustments for nonclinical factors, and outlier payments. Virtually all current tools used to manage health care costs and improve quality do not have these characteristics. This failure explains a key reason for the failure, for example, of the Medicare Advantage program to control health care costs. This article concludes with a discussion of future developments for DRG-type models outside the hospital sector.

Properties of DRGs, LBGs, and BzK Galaxies in the GOODS South Field

Science.gov (United States)

Grazian, A.; Salimbeni, S.; Pentericci, L.; Fontana, A.; Santini, P.; Giallongo, E.; de Santis, C.; Gallozzi, S.; Nonino, M.; Cristiani, S.; Vanzella, E.

2007-12-01

We use the GOODS-MUSIC catalog with multi-wavelength coverage extending from the U band to the Spitzer 8 μm band, and spectroscopic or accurate photometric redshifts to select samples of BM/BX/LBGs, DRGs, and BzK galaxies. We discuss the overlap and the limitations of these selection criteria, which can be overcome with a criterion based on physical parameters (age and star formation timescale). We show that the BzK-PE criterion is not optimal for selecting early type galaxies at the faint end. We also find that LBGs and DRGs contribute almost equally to the global Stellar Mass Density (SMD) at z≥ 2 and in general that star forming galaxies form a substantial fraction of the universal SMD.

Aspekte van ’n omkeerproses

Directory of Open Access Journals (Sweden)

Sophia (Phia van Helden

2014-03-01

Full Text Available In hierdie artikel word gefokus op aspekte wat deel uitmaak van ’n omkeerproses. Sodanige proses behoort oorweeg te word waar krimpende gemeentes in ’n doodloopstraat verkeer. Alhoewel die kompleksiteit van so ’n proses duidelik na vore kom, is ’n omkeerproses tog moontlik. Die Skrifbeginsels wat so ’n proses moontlik maak, behoort binne elke gemeentelike konteks uniek ontdek en toegepas te word. Die diepgrondige selfleerproses en die voordele wat ’n waarderende taalaanpak (‘Waarderende Ondersoek’ in die proses het, lei tot die besef dat nie net die inhoud nie, maar ook die manier waarop dit gedoen word van ’n omkeer behoort te getuig. Die talle verweefde aspekte waaraan aandag gegee word, kan rigtinggewend wees vir diegene wat erns maak met die moontlikheid om groeiende en gesonde kerkpraktyke daar te stel.This article focuses on aspects regarding a turnaround process. Such a process ought to be considered where declining congregations face a dead end. Although the complexity of a turnaround is clear, such a process is still possible. The scriptural principles regarding the possibility of such a process ought to be discovered and contextually applied by each unique congregation. A deep whole-hearted self-learning process, as well as the positives of an appreciative language approach (Appreciative Inquiry, conclude that not only the contents of the turnaround, but also the manner in which it is done, ought to speak of a turnaround. The many intertwined aspects discussed in this article can direct those who are serious about the possibility of establishing growing and healthy church practices.

Aspekte van ’n omkeerproses

Directory of Open Access Journals (Sweden)

Sophia (Phia van Helden

2014-06-01

Full Text Available In hierdie artikel word gefokus op aspekte wat deel uitmaak van ’n omkeerproses. Sodanige proses behoort oorweeg te word waar krimpende gemeentes in ’n doodloopstraat verkeer. Alhoewel die kompleksiteit van so ’n proses duidelik na vore kom, is ’n omkeerproses tog moontlik. Die Skrifbeginsels wat so ’n proses moontlik maak, behoort binne elke gemeentelike konteks uniek ontdek en toegepas te word. Die diepgrondige selfleerproses en die voordele wat ’n waarderende taalaanpak (‘Waarderende Ondersoek’ in die proses het, lei tot die besef dat nie net die inhoud nie, maar ook die manier waarop dit gedoen word van ’n omkeer behoort te getuig. Die talle verweefde aspekte waaraan aandag gegee word, kan rigtinggewend wees vir diegene wat erns maak met die moontlikheid om groeiende en gesonde kerkpraktyke daar te stel. This article focuses on aspects regarding a turnaround process. Such a process ought to be considered where declining congregations face a dead end. Although the complexity of a turnaround is clear, such a process is still possible. The scriptural principles regarding the possibility of such a process ought to be discovered and contextually applied by each unique congregation. A deep whole-hearted self-learning process, as well as the positives of an appreciative language approach (Appreciative Inquiry, conclude that not only the contents of the turnaround, but also the manner in which it is done, ought to speak of a turnaround. The many intertwined aspects discussed in this article can direct those who are serious about the possibility of establishing growing and healthy church practices.

Produktiwiteit en verantwoordelikheid, enkele sielkundige aspekte

Directory of Open Access Journals (Sweden)

A. P. Venter

1978-11-01

Maslow se motiveringsteorie wat uit die kliniese sielkunde ontspruit het, is ook deur bedryfsielkundiges van nader beskou, veral in hoe verre dit met produktiwiteit verband het. Enkele sielkundige aspekte word bespreek ten einde op die nut van hierdie teorie in die bedryfsituasie te wys. Die vermoede bestaan dat die teorie deur bedryfsielkundiges nie altyd korrek vertolk word soos Maslow dit self uiteensit nie; veral word die verantwoordelikheidsaspek in die selfuitlewingsbehoeftes misken en nie verreken nie; 'n Logiese konklusie is dat selfuitlewing, soos deur Maslow beskryf, wel verband met produktiwiteit het.

What costs the development of renewable energies in power generation actually?; Was kostet der Ausbau erneuerbarer Energien in der Stromerzeugung tatsaechlich?

Energy Technology Data Exchange (ETDEWEB)

Nitsch, Joachim

2013-03-30

Additional costs of the energy transition can only be termed when the present state of the power system is considered as a benchmark for future raised previous achievements. An energy policy that has an effective climate protection goal, must endeavor to change the market design of the energy market so as to align the price signals at the expense of those technologies that are able to provide energy without emissions and significant use of fossil resources. The derivable overall economic benefits of energy transition is significant. This is illustrated by the example of the differential cost for the annex of renewable energies in the electricity sector. A further development of renewable energy sources in combination with an effective electricity market design leads to an overall economic benefit of around 460 billion Euros in 2050. [German] Von zusaetzlichen Kosten der Energiewende kann nur gesprochen werden, wenn der heutige Zustand des Energiesystems als Massstab fuer zukuenftig aufzubringende Vorleistungen betrachtet wird. Eine Energiewende, die einen effektiven Klimaschutz zum Ziel hat, muss jedoch bestrebt sein, das Marktdesign des Energiemarkts so zu veraendern, dass sich die Preissignale an den Kosten derjenigen Technologien ausrichten, die in der Lage sind, Energie emissionsfrei und ohne wesentliche Inanspruchnahme fossiler Ressourcen bereitzustellen. Der daraus ableitbare gesamtwirtschaftliche Nutzen der Energiewende ist erheblich. Es wird hier am Beispiel der Differenzkosten des Zubaus erneuerbarer Energien im Stromsektor erlaeutert. Ein konsequenter weiterer Erneuerbare Energien-Zubau in Kombination mit einem effektiven Strommarktdesign fuehrt zu einem gesamtwirtschaftlichen Nutzen von rund 460 Mrd. Euro im Jahr 2050.

Cost of power generation. The cost and uncertainties of nuclear power and other CO2-emission reduction techniques for large-scale power generation; Kosten van elektriciteitsopwekking. De kosten en onzekerheden van kernenergie en andere CO2-emissie reducerende technieken voor grootschalige elektriciteitsopwekking

Energy Technology Data Exchange (ETDEWEB)

Van Dril, A.W.N. [ECN Beleidsstudies, Petten (Netherlands); Verdonk, M. [Planbureau voor de Leefomgeving PBL, Bilthoven (Netherlands)

2008-09-15

In view of recent social and political discussions on nuclear energy, ECN and PBL have gathered and updated information on the cost of options for reducing CO2 emissions in large scale electricity generation. This memo compares the cost of nuclear energy with other large scale options for electricity generation. Special attention is paid to the uncertainties of the cost of nuclear energy. In addition, some external costs and benefits are examined. This memo does not provide a complete framework for comparing the options for generation of electricity, though. Aspects such as public support, various aspects of sustainability and risks are not addressed in this memo. [mk]. [Dutch] Naar aanleiding van de actuele maatschappelijke en politieke discussie over kernenergie hebben ECN en PBL kosteninformatie over opties om CO2-emissies te beperken bij grootschalige opwekking van elektriciteit verzameld en geactualiseerd. In deze notitie worden de kosten van kernenergie vergeleken met andere grootschalige opties van elektriciteitsopwekking. Daarbij wordt speciale aandacht besteed aan de onzekerheden over de kosten van kernenergie. Aanvullend zijn enkele externe kosten en baten beschouwd. Deze notitie geeft echter geen volledig kader om de opties voor de opwekking van elektriciteit met elkaar te vergelijken. Aspecten als draagvlak, diverse duurzaamheidaspecten en risico's zijn in deze notitie namelijk buiten beschouwing gelaten.

Die Insolvenz – historische, literarische und philosophische Aspekte des wirtschaftlichen Scheiterns / Helmut Zipperer

Index Scriptorium Estoniae

Zipperer, Helmut

2016-01-01

Pankrotiõiguse ajaloolisi (nt XII tahvli seaduste mõju), kirjanduslikke (Gustav Freytagi kaupmeheromaan „Soll und Haben”; Thomas Manni „Buddenbrookid”) ja filosoofilisi aspekte (pankrotimenetlus ja õiglus)

Assessing the impact of DRGs on patient care and professional practice in Switzerland (IDoC) - a potential model for monitoring and evaluating healthcare reform.

Science.gov (United States)

Wild, Verina; Carina, Fourie; Frouzakis, Regula; Clarinval, Caroline; Fässler, Margrit; Elger, Bernice; Gächter, Thomas; Leu, Agnes; Spirig, Rebecca; Kleinknecht, Michael; Radovanovic, Dragana; Mouton Dorey, Corine; Burnand, Bernard; Vader, John-Paul; Januel, Jean-Marie; Biller-Andorno, Nikola; The IDoC Group

2015-01-01

The starting point of the interdisciplinary project "Assessing the impact of diagnosis related groups (DRGs) on patient care and professional practice" (IDoC) was the lack of a systematic ethical assessment for the introduction of cost containment measures in healthcare. Our aim was to contribute to the methodological and empirical basis of such an assessment. Five sub-groups conducted separate but related research within the fields of biomedical ethics, law, nursing sciences and health services, applying a number of complementary methodological approaches. The individual research projects were framed within an overall ethical matrix. Workshops and bilateral meetings were held to identify and elaborate joint research themes. Four common, ethically relevant themes emerged in the results of the studies across sub-groups: (1.) the quality and safety of patient care, (2.) the state of professional practice of physicians and nurses, (3.) changes in incentives structure, (4.) vulnerable groups and access to healthcare services. Furthermore, much-needed data for future comparative research has been collected and some early insights into the potential impact of DRGs are outlined. Based on the joint results we developed preliminary recommendations related to conceptual analysis, methodological refinement, monitoring and implementation.

Heterogeneity of European DRG Systems and Potentials for a Common Eurodrg System; Comment on “Cholecystectomy and Diagnosis-Related Groups (DRGs: Patient Classification and Hospital Reimbursement in 11 European Countries”

Directory of Open Access Journals (Sweden)

Alexander Geissler

2015-05-01

Full Text Available Diagnosis-Related Group (DRG systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals, a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium.

Energy Transition-Index Germany. Costs are increasing steadily; Energiewende-Index Deutschland. Die Kosten steigen weiter

Energy Technology Data Exchange (ETDEWEB)

Vahlenkamp, Thomas; Kropeit, Julia [McKinsey and Company, Duesseldorf (Germany); Ritzenhofen, Ingmar [McKinsey and Company, Koeln (Germany); Gersema, Gerke [McKinsey and Company, Hamburg (Germany)

2017-03-15

How expensive the energy transition truly will be? The question of costs is coming more and more into the focus: The Bundesrechnungshof calls for more transparency, the policy confronted with the complexity of the subject matter is not able to quantify concrete costs. At the same time, all participants are working to curb spending growth. The fact is, the total costs will continue to rise. It is already foreseeable that by 2025 the annual electricity costs will increase by Euro 14 billion - to then Euro 77 billion. The main drivers are grid charges and rising fuel costs. [German] Wie teuer wird die Energiewende wirklich? Die Frage nach den Kosten geraet zunehmend in den Fokus: Der Bundesrechnungshof fordert mehr Transparenz, die Politik sieht sich mit Blick auf die Komplexitaet der Thematik ausserstande, konkrete Kosten zu beziffern. Gleichzeitig treten alle Beteiligten dafuer ein, die Ausgabenentwicklung zu bremsen. Fakt ist: Die Gesamtkosten werden weiter steigen. Bereits heute ist absehbar, dass sich bis 2025 die jaehrlich anfallenden Stromkosten um 14 Mrd. Euro erhoehen werden - auf dann 77 Mrd. Euro. Haupttreiber sind die Netzentgelte und steigende Brennstoffkosten.

Heterogeneity of European DRG systems and potentials for a common EuroDRG system Comment on "Cholecystectomy and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries".

Science.gov (United States)

Geissler, Alexander; Quentin, Wilm; Busse, Reinhard

2015-03-05

Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals), a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium. © 2015 by Kerman University of Medical Sciences.

Combined heat and power generation. A guide for towns and communities, trade and industry; Kraft-Waerme-Kopplung. Ein Leitfaden fuer Staedte und Gemeinden, Gewerbe und Industrie

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-07-01

The brochure describes the cogeneration technology and explains its advantages. Fields of application and potential users are characterized. The technical and economic prospects are outlined, as well as the cost-profit ratios and the chances and problems of this technology. [German] Die vorliegende Broschuere will dem Leser einen Ueberblick ueber die Thematik der KWK geben und einen Beitrag zu ihrer Foerderung leisten. Die Broschuere will: - Ueber KWK informieren, - die Vorteile der KWK erlaeutern, - die Anwendungsfelder und die moeglichen Anwender charakterisieren, - die technisch-wirtschaftlichen Moeglichkeiten fuer die Nutzung der kW aufzeigen, - die Kosten-Nutzen-Relationen und die wirtschaftlichen Chancen und Probleme der KWK verdeutlichen. (orig.)

A comparison of LBGs, DRGs, and BzK galaxies: their contribution to the stellar mass density in the GOODS-MUSIC sample

Science.gov (United States)

Grazian, A.; Salimbeni, S.; Pentericci, L.; Fontana, A.; Nonino, M.; Vanzella, E.; Cristiani, S.; de Santis, C.; Gallozzi, S.; Giallongo, E.; Santini, P.

2007-04-01

Context: The classification scheme for high redshift galaxies is complex at the present time, with simple colour-selection criteria (i.e. EROs, IEROs, LBGs, DRGs, BzKs), resulting in ill-defined properties for the stellar mass and star formation rate of these distant galaxies. Aims: The goal of this work is to investigate the properties of different classes of high-z galaxies, focusing in particular on the stellar masses of LBGs, DRGs, and BzKs, in order to derive their contribution to the total mass budget of the distant Universe. Methods: We used the GOODS-MUSIC catalog, containing ~3000 Ks-selected (~10 000 z-selected) galaxies with multi-wavelength coverage extending from the U band to the Spitzer 8~μm band, with spectroscopic or accurate photometric redshifts. We selected samples of BM/BX/LBGs, DRGs, and BzK galaxies to discuss the overlap and the limitations of these criteria, which can be overridden by a selection criterion based on physical parameters. We then measured the stellar masses of these galaxies and computed the stellar mass density (SMD) for the different samples up to redshift ≃4. Results: We show that the BzK-PE criterion is not optimal for selecting early type galaxies at the faint end. On the other hand, BzK-SF is highly contaminated by passively evolving galaxies at red z-Ks colours. We find that LBGs and DRGs contribute almost equally to the global SMD at z≥ 2 and, in general, that star-forming galaxies form a substantial fraction of the universal SMD. Passively evolving galaxies show a strong negative density evolution from redshift 2 to 3, indicating that we are witnessing the epoch of mass assembly of such objects. Finally we have indications that by pushing the selection to deeper magnitudes, the contribution of less massive DRGs could overtake that of LBGs. Deeper surveys, like the HUDF, are required to confirm this suggestion.

Wind turbine noise reduction. An indicative cost estimation; Sanering windturbinegeluid. Een indicatieve raming van kosten

Energy Technology Data Exchange (ETDEWEB)

Verheijen, E.N.G.; Jabben, J.

2011-11-15

Since the 1st of January 2011 new rules apply for wind turbine noise. The rules include a different calculation method and different noise limits, intended for new wind turbines. In order to tackle noise annoyance from existing wind turbines the government is considering to set up a abatement operation, for which a cost estimate is given in this study. At an abatement limit of 47 decibel L{sub den} (Level day-evening-night) approximately 450 dwellings would be eligible for noise remediation. The costs of this operation are estimated at 4.9 million euro. However, in many of these cases the wind turbine is probably owned by the respective residents. It is possible that public funds for noise remediation will not be allocated to the owners of dwellings that directly profit from the turbines. If these cases are excluded, the abatement operation would cover 165 to 275 dwellings with estimated costs for remediation of 1.6 to 2.6 million euro. A tentative cost-benefit analysis suggests that noise remediation will be cost effective in most situations. This means that the benefits of reduced annoyance or sleep disturbance are in balance with the cost of remediation. Only for the small group of wind turbines that are in use for over fifteen years, remediation will not be cost effective. These wind turbines are nearing the end of their lifespan and are therefore ignored in the above estimates. [Dutch] Sinds 1 januari 2011 zijn nieuwe regels rond windturbinegeluid van kracht. Bij de nieuwe regelgeving hoort een andere berekeningsmethode en normstelling, bedoeld voor nieuw te plaatsen windturbines. Voor de aanpak van de geluidhinder door bestaande windturbines overweegt de overheid een saneringsoperatie op te zetten, waarvoor in dit onderzoek een kostenraming wordt gegeven. Bij een saneringsgrenswaarde van 47 decibel zouden ongeveer 450 woningen voor sanering in aanmerking komen. De kosten voor sanering daarvan worden geschat op 4,9 miljoen euro. Bij een groot deel van deze

Implications of prospective payment under DRGs for hospital marketing.

Science.gov (United States)

Folland, S; Ziegenfuss, J T; Chao, P

1988-12-01

The authors analyze the hospital marketing implications of Medicare's prospective payment system under DRGs. They take an appropriately broad view of marketing and consider related impacts on culture, structure, and management, in addition to the traditional marketing mix. The article serves to present in one place the ideas and discussions on the subject from a wide and disparate literature. The aim throughout is to identify those marketing responses warranting recommendation. The recommendations are assembled in a concluding section. Though many of the ideas are not new, they have yet to be widely adopted by hospitals. Hence they represent untapped marketing opportunities attributable to the advent of the DRG system. The authors conclude with suggestions for future research.

Energy conservation, an economically beneficial air pollution abatement measure. Final report; Energiesparen - Klimaschutz, der sich rechnet. Endbericht

Energy Technology Data Exchange (ETDEWEB)

Ostertag, K.; Jochem, E.; Schleich, J.; Walz, R.; Krenicky, G. [Fraunhofer-Institut fuer Systemtechnik und Innovationsforschung (ISI), Karlsruhe (Germany); Kohlhaas, M.; Diekmann, J.; Ziesing, H.J. [Deutsches Inst. fuer Wirtschaftsforschung, Berlin (Germany); Strebel, H. [Karl-Franzens-Univ., Graz (Australia). Inst. fuer Innovationsmanagement

1998-11-01

The book intends to put the discussion of economic effects of air pollution abatement and energy efficiency increasing measures on a more rational basis. It addresses all parties taking part in the political discussion. ARguments are presented in a clear and transparent form that will also help the layman. The reader is enabled to interpret data and analyze them critically. A very important basis is the recognition of the various decision making patterns in which the cost and benefits of energy efficiency increasing patterns are key arguments. [German] Ziel der vorliegenden Argumentationshilfe ist es, die Diskussion um die wirtschaftlichen Auswirkungen von Klimaschutzmassnahmen, und insbesondere von energieeffizienzsteigernden Massnahmen, zu versachlichen und transparent zu machen. Sie richtet sich insbesondere an Politiker, aber auch an Vertreter von Wirtschaftsverbaenden und anderen Nicht-Regierungsorganisationen, die an dieser politischen Diskussion teilnehmen. Insofern wurde besonderes Gewicht auf eine einfache, klare und anschauliche Argumentation gelegt, die auch fuer betriebs- oder volkswirtschaftliche Laien verstaendlich ist. Die Argumentationshilfe versetzt den Leser in die Lage, die Zahlenangaben zur wirtschaftlichen Bewertung von Massnahmen zur Energieeinsparung zu interpretieren und ihre Herleitung kritisch zu bewerten. Eine erste wichtige Grundlage dafuer ist das Erkennen der verschiedenen Entscheidungszusammenhaenge, in denen mit Kosten und Nutzen von energieeffizienzsteigernden Massnahmen argumentiert wird. Nach einer kurzen Beschreibung und Abgrenzung dieser verschiedenen Argumentationsebenen im Ueberblick (Abschnitt 2) werden anschliessend fuer jede Ebene (Abschnitt 3 bis 5) die zentralen Einflussparameter aufgezeigt, die bestimmen, ob eine eher positive oder eher negative wirtschaftliche Bewertung von Massnahmen zur Steigerung der Energieeffizienz ausgewiesen wird und in welcher Groessenordnung sich die Werte bewegen. Die Annahmen, die in die

Organ transplant AN-DRGs: modifying the exceptions hierarchy in casemix classification.

Science.gov (United States)

Antioch, K; Zhang, X

2000-01-01

The study described in this article sought to develop AN-DRG Version 3 classification revisions for organ transplantation through statistical analyses of recommendations formulated by the Australian Casemix Clinical Committee. Two separate analyses of variance were undertaken for AN-DRG Version 2 and for the proposed Version 3 AN-DRGs, using average length of stay as the dependent variable. The committee made four key recommendations which were accepted and incorporated into AN-DRG Versions 3 and 3.1. This article focuses on the classification revisions for organ transplantation.

Ajakirjandusliku väljendusvabaduse erisused : ajakirjandusvabaduse aspekt sõnavabaduse piiramisel, arvestades Euroopa Inimõiguste Kohtu praktikat : [bakalaureusetöö] / Kristjan Ots ; Tartu Ülikool, õigusteaduskond ; juhendaja: Kalle Merusk

Index Scriptorium Estoniae

Ots, Kristjan, 1976-

2001-01-01

Sõnavabaduse mõiste, koht konstitutsioonis, sõnavabaduse piiramise piirid, tsensuur, ajakirjandusvabaduse eristamine sõnavabadusest, ajakirjandusliku väljendusvabaduse põhimõtted, ajakirjanduse funktsioonid, sõnavabaduse aspekt, teabevabaduse aspekt, teotamine e. difamatsioon, ajakirjandusvabaduse piiramine õigusemõistmise huvides

“As jou broer verkeerd opgetree het teen jou ...”: Enkele aspekte van ...

African Journals Online (AJOL)

p1243322

teen jou ...”: Enkele aspekte van kerklike dissipline uit die Kerkorde van die Nederduitsch Hervormde. Kerk van Afrika. B J (Barry) van Wyk. Hervormde Teologiese Kollege. Universiteit van Pretoria. Abstract. “If a brother sins against you ...”: Certain aspects of church discipline from the Church Ordinance of the. Netherdutch ...

The driver in the 21st century. Demands, applications, aspects of man-machine systems. Lectures; Der Fahrer im 21. Jahrhundert. Anforderungen, Anwendungen, Aspekte fuer Mensch-Maschine-Systeme. Plenarvortraege

Energy Technology Data Exchange (ETDEWEB)

NONE

2003-07-01

A high grade of mobility is the basis of our economic development. The innovations in the automotive- and deliver industry lead to different fulfillments of customer expectations on vehicle operation. Also in the railway sector increasing requirements on the operators involve a change of view within design of man-machine interfaces. The transmission of information and transfer of reactions require advanced and balanced concepts for operating and monitoring of modern automobiles. The integral connection of competence in technology, design and ergonomics, sense- and traffic psychology as well as legal problems lead to new challenges and possibilities. (GL) [German] Der Fahrer im 21. Jahrhundert - Anforderungen, Anwendungen, Aspekte fuer Mensch-Maschine-Systeme - unter diesem Motto wird die interessante Fachtagung ''Der Fahrer im 21. Jahrhundert'' fortgefuehrt. Ein hohes Mass an Mobilitaet ist Grundlage unserer wirtschaftlichen Entwicklung. Die Innovationen in der Automobil- und Zuliefererindustrie fuehren zu einer differenzierten Erfuellung der Kundenerwartungen an die Bedienung der Fahrzeuge. Auch im Bereich Bahn bedingen die steigenden Anforderungen an die Fahrzeugfuehrer ein Umdenken bei der Gestaltung der Mensch-Maschine-Schnittstelle. Die Vermittlung von Informationen und die Umsetzung adaequater Reaktionen erfordern neue und ausgewogene Konzepte fuer das Bedienen und Beobachten moderner Fahrzeuge. Die integrale Verbindung von Kompetenz in Technologie, Design und Ergonomie, Wahrnehmungs- und Verkehrspsychologie sowie rechtlichen Fragestellungen fuehren hier zu neuen Herausforderungen und Moeglichkeiten. Die Tagung moechte wieder visionaere Loesungsansaetze aufzeigen und auch das Machbare diskutieren. Nutzen Sie die Gelegenheit, mit namhaften Referenten aus Industrie und Wissenschaft, Fach- und Fuehrungskraeften zu sprechen und auf dieser Veranstaltung neue Bedien- und Informationskonzepte, Teilloesungen fuer die unterschiedlichen Fahraufgaben

Cost-effectiveness of sustainable measures for water protection; Kosten-Wirksamkeitsanalyse von nachhaltigen Massnahmen im Gewaesserschutz

Energy Technology Data Exchange (ETDEWEB)

Boehm, E.; Hillenbrand, T.; Liebert, J.; Schleich, J.; Walz, R.

2001-08-01

The study continues the project 'Environmental Action Plan for Sustainable Water Resources Management' (UBA-Texte 25/99). The methodological basis in high-priority fields of water protection is improved and the available knowledge with regard to costs and effectiveness of the measures is evaluated systematically. Especially for the fields urban waste water, agriculture and morphological water structures the cost-effectiveness of different measures could be assessed. The results may be an important item for priority setting among different measures on a national basis. On the other hand these methods and data may be helpful for action plans in river basin management as well. (orig.) [German] Das Vorhaben hatte zum Ziel, anknuepfend an das Projekt 'Massnahmenplan Nachhaltige Wasserwirtschaft' (UBA-Texte 25/99), fuer besonders wichtige Zielbereiche des Gewaesserschutzes die methodische Basis fuer die Abschaetzung kurz- bis mittelfristiger Wirkungen zu verbessern und fuer diese Bereiche die aktuellen Kenntnisse zu den Kosten und Wirkungen systematisch auszuwerten. Insbesondere fuer die Schwerpunkte Siedlungsentwaesserung, Landwirtschaft und Verbesserung der Gewaesserstruktur konnten damit Aussagen zur Kosten-Wirksamkeit unterschiedlicher Massnahmen zum Gewaesserschutz getroffen werden, die ein wesentliches Element der Priorisierung denkbarer Massnahmen sein koennen. Gegenstand der Untersuchung waren Massnahmen auf nationaler Ebene, jedoch koennen die erarbeiteten Methoden und Daten auch als Orientierung fuer das Erstellen von Massnahmenplaenen fuer einzelne Flusseinzugsgebiete dienen. (orig.)

Comparison of alternative weight recalibration methods for diagnosis-related groups

Science.gov (United States)

Rogowski, Jeannette Roskamp; Byrne, Daniel J.

1990-01-01

In this article, alternative methodologies for recalibration of the diagnosis-related group (DRG) weights are examined. Based on 1984 data, cost and charge-based weights are less congruent than those calculated with 1981 data. Previous studies using 1981 data demonstrated that cost- and charge-based weights were not very different. Charge weights result in higher payments to surgical DRGs and lower payments to medical DRGs, relative to cost weights. At the provider level, charge weights result in higher payments to large urban hospitals and teaching hospitals, relative to cost weights. PMID:10113568

The trauma registry compared to All Patient Refined Diagnosis Groups (APR-DRG).

Science.gov (United States)

Hackworth, Jodi; Askegard-Giesmann, Johanna; Rouse, Thomas; Benneyworth, Brian

2017-05-01

Literature has shown there are significant differences between administrative databases and clinical registry data. Our objective was to compare the identification of trauma patients using All Patient Refined Diagnosis Related Groups (APR-DRG) as compared to the Trauma Registry and estimate the effects of those discrepancies on utilization. Admitted pediatric patients from 1/2012-12/2013 were abstracted from the trauma registry. The patients were linked to corresponding administrative data using the Pediatric Health Information System database at a single children's hospital. APR-DRGs referencing trauma were used to identify trauma patients. We compared variables related to utilization and diagnosis to determine the level of agreement between the two datasets. There were 1942 trauma registry patients and 980 administrative records identified with trauma-specific APR-DRG during the study period. Forty-two percent (816/1942) of registry records had an associated trauma-specific APR-DRG; 69% of registry patients requiring ICU care had trauma APR-DRGs; 73% of registry patients with head injuries had trauma APR-DRGs. Only 21% of registry patients requiring surgical management had associated trauma APR-DRGs, and 12.5% of simple fractures had associated trauma APR-DRGs. APR-DRGs appeared to only capture a fraction of the entire trauma population and it tends to be the more severely ill patients. As a result, the administrative data was not able to accurately answer hospital or operating room utilization as well as specific information on diagnosis categories regarding trauma patients. APR-DRG administrative data should not be used as the only data source for evaluating the needs of a trauma program. Copyright © 2016 Elsevier Ltd. All rights reserved.

Einmaliges studentisches standardisiertes Training der chirurgischen Händedesinfektion nach EN1500: Quantifizierung des Trainingseffektes, Nutzen der Methode und Vergleich mit klinischen Referenzgruppen [A single standardized practical training for surgical scrubbing according to EN1500: Effect Quantification, value of the standardized method and comparison with clinical reference groups

Directory of Open Access Journals (Sweden)

Wullenk, Katharina

2013-05-01

Full Text Available [english] The standardized training of practical competences in skills labs is relatively new among German Medical Faculties. The broad acceptance and outstanding evaluation results do not provide objective data on the efficiency and cost-efficiency of these trainings. This study aims on the quantification of the teaching effect of the surgical scrubbing technique EN1500 and its comparison with clinical references of OR personnel.Methods: 161 4 year medical students were randomized into intervention and control group. The intervention group received a 45 minute standardized peer-teaching training of practical competences necessary in the OR including the scrubbing according to EN1500. Fluorescence dye was mixed in the disinfectant solution. After hand disinfection, standardized fotographs and semi-automated digital processing resulted in quantification of the insufficiently covered hand area. These results were compared with the control group that received the training after the test. In order to provide information on the achieved clinical competence level, the results were compared with the two clinical reference groups.Results: The intervention group remained with 4,99% (SD 2,34 insufficiently covered hand area after the training compared to the control group 7,33% (SD 3,91, p[german] Die standardisierte Schulung klinisch-praktischer Fertigkeiten in sog. Skills Labs ist erst seit wenigen Jahren an deutschen Universitäten verbreitet. Den zumeist umfangreichen und sehr guten Evaluationsergebnissen stehen kaum Untersuchungen zur Effektquantifizierung und Kosten-Nutzen-Analyse gegenüber. In der vorliegenden Studie soll eine Methode zur digitalen Quantifizierung der Güte der chirurgischen Händedesinfektion vorgestellt werden sowie das Skills-Lab-Training der standardisierten Einreibemethode nach EN1500 auf seinen Effekt hin untersucht und mit OP-Pflegepersonal und Operateuren als klinische Referenzgruppen verglichen werden.Methode: 161

Going for increased recycling. A social cost-benefit analysis; Inzetten op meer recycling. Een maatschappelijke kosten-batenanalyse

Energy Technology Data Exchange (ETDEWEB)

Warringa, G.E.A.; De Bruyn, M.; Bijleveld, M.M.

2013-05-15

reduced resource dependency. In the SCBA the latter benefits were not expressed in monetary terms, however. On balance, the monetary impact is positive: the social benefits of increased recycling are greater than the social costs. A sensitivity analysis shows this to be a robust result [Dutch] De milieuvoordelen van een scenario gericht op meer recycling zijn in eerdere studies overtuigend aangetoond. De vraag dient zich echter aan of een scenario gericht op meer recycling ook economische voordelen biedt. In deze studie zijn daarom de voornaamste economische effecten in kaart gebracht van een toename van recycling in Nederland. De resultaten van de studie kunnen worden gebruikt om de beleidsvorming rondom het dossier recycling verder te helpen. Om de centrale vraag te beantwoorden, hebben we een maatschappelijke kosten-batenanalyse (MKBA) op hoofdlijnen uitgevoerd. Een MKBA is een op de welvaartstheorie gebaseerde afwegingsmethode die alle economische effecten (ook wel welvaartseffecten genoemd) van een project of beleidsingreep in kaart brengt. Welvaart wordt daarbij breed gedefinieerd: het gaat niet alleen om financieel-economische consequenties, maar ook om de gevolgen voor milieu, werkgelegenheid, etc. Alle geinventariseerde milieu-ingrepen, zoals energieverbruik, transport en emissies bij recycleprocessen, zijn per materiaalstroom in SimaPro beoordeeld. De effecten worden binnen een MKBA zoveel mogelijk in geld uitgedrukt zodat deze onderling vergelijkbaar zijn. De belangrijkste maatschappelijke kosten van meer recycling zijn hogere kosten voor gemeenten om het afval gescheiden in te zamelen. Ook zijn er lagere opbrengsten voor AVI's, omdat meer afval uit het buitenland moet worden geimporteerd. Ten slotte zijn er beleidskosten om meer recycling te stimuleren en extra inspanningen voor de burger om afval te scheiden. Deze kosten zijn niet gekwantificeerd. Hier staan positieve welvaartseffecten tegenover. De grootste batenpost is milieuwinst, die in deze studie

Cost-benefit analysis in the public sector. Kosten-Nutzen-Analyse in der oeffentlichen Versorgung

Energy Technology Data Exchange (ETDEWEB)

Schoeller, A [comp.

1986-01-01

The publications in the 'IRB Literaturauslesen' contain citations of journal articles, scientific books, periodicals, research reports and projects, dissertations, company publications, institutes' reports, construction standards, documentation services, and so-called 'grey' literature (i.e. unpublished literature that is difficult to access) on the title subject. The information is derived from the databases of Informationszentrum Raum und Bau of the Fraunhofer-Gesellschaft (IRB). The issue abstracted deals with energy supply systems, the processing of drinking water, waste water treatment, and alternative technologies. With 43 refs..

[Main results of the Swiss study on DRGs (Casemix Study)].

Science.gov (United States)

Casemix, E

1989-01-01

Sponsored by the Health Administrations of nine cantons, this study was conducted by the University Institute of Social and Preventive Medicine in Lausanne in order to assess how DRGs could be used within the Swiss context. A data base mainly provided by the Swiss VESKA statistics was used. The first step provided the transformation of Swiss diagnostic and intervention codes into US codes, allowing direct use of the Yale Grouper for DRG. The second step showed that the overall performance of DRG in terms of variability reduction of the length of stay was similar to the one observed in US; there are, however, problems when the homogeneity of medicotechnical procedures for DRG is considered. The third steps showed how DRG could be used as an account unit in hospital, and how costs per DRG could be estimated. Other examples of applications of DRG were examined, for example comparison of Casemix or length of stay between hospitals.

Die Sprache des Marketings und ihre Übersetzung: Morphologische und semantische Aspekte der Terminologie

OpenAIRE

Konovalova, Anastasia; Ruiz Yepes, Guadalupe

2016-01-01

This article is the English version of “Die Sprache des Marketings und ihre Übersetzung: Morphologische und semantische Aspekte der Terminologie” by Anastasia Konovalova & Guadalupe Ruiz Yepes. It was not published on the print version of MonTI for reasons of space. The online version of MonTI does not suffer from these limitations, and this is our way of promoting plurilingualism. The importance of languages for special purposes in multinational companies grows with each passing day. Simu...

Adopting Thai Diagnosis Related Group for Vietnam Universal Health Coverage: A Case of Ba Vi District Hospital

Directory of Open Access Journals (Sweden)

Pham Le Tuan, M.D., Ph.D.

2015-09-01

Full Text Available Objective: This studyaimedtoclassifyallhospitaldischargescoveredbyhealthinsurancesystem intodiagnosis relatedgroup (DRG to guideproviderpayment reforms of universalhealth coverage roadmap in Vietnam. Methods: Data from Ba Vi hospital from January to December 2012 were grouped into DRGs by Viet-DRG grouperversion1.0developedbasedon Thai-DRG version5methodologies. ThePearsoncorrelation(r wasused to assess the performance of Viet-DRG grouper as against Thai-DRG grouper. A 5-step trimming of individual inpatientdata to achieve thehighest correlations was performed. Results: Dataof12,220inpatientcases wereanalyzedbybothgroupers,84.4% of totalcases wereclassifiedinto 89 DRGs. Thefive mostcommon DRGs werevaginaldelivery withoutcomplicatingdiagnosis (14500; Respira- tory infection/inflammation, no complication and comorbidity (04520; Otitis media and URI, no complication andcomorbidity(03530; Viral illnessexceptdengue,child,nocomplicationandcomorbidity(18610; Bronchitis and asthma, no complication and comorbidity (04590. The performance of Viet-DRG grouper v1.0 compared with Thai-DRG grouper v5.0for 89 DRGs intermsof relative weights as of 0.4 andlength of stay as of 0.5. Conclusion: Validity of thefirst Viet-DRG was at moderate level compared to Thai-DRG due to the limitation ofdata availability andqualityat thehospital.

Comparing EU hospital efficiency using diagnosis-related groups

NARCIS (Netherlands)

Rhodes, G.; Wiley, M.; Tomas, R.; Casas, M.; Leidl, R.

1997-01-01

This article considers the feasibility of comparing the differences in efficiency and price in the provision of hospital products defined on the basis of diagnosis-related groups (DRGs). Two measures of resource use are compared, the length of stay and the administrative price, both independently

Diagnosis Related Groups for DOD: Background of a Competitive Strategy.

Science.gov (United States)

1987-12-01

reimbursement and allowable increases in reimbur - sable costs per discharge. Responding to the State’s dilemma in meeting the costs of their Medicaid...Prospective Reimbursement Z-- - 19 ABSTRT (Continue on reverse if necessary and identify by block number) Public Law 99-661 requires that the...Rates of reimbursement for DRGs, are predicated on the isoresource consumption nature of DRGs. The Federal government has established DRGs as the basis

Ideologiekritik des E-Learnings. Welchen Nutzen hat die Einführung von E-Learning?

Directory of Open Access Journals (Sweden)

Katharina Kaiser-Müller

2015-03-01

Full Text Available Vor etwa sieben Jahren hat das damalige Bundesministerium für Unterricht, Kunst und Kultur (bm:ukk, das seit 2014 Bundesministerium für Bildung und Frauen (BMBF genannt wird, verschiedene Maßnahmen im Blick auf neuen Medien – insbesondere im Blick auf das E-Learning – gesetzt, um einen Beitrag zur Vorbereitung der Lernenden auf eine Informations- und Wissensgesellschaft zu leisten. E-Learning wurde als Erfolgsfaktor für die Zukunft gesehen und mit der Begründung, es fördere das individuelle und selbst gesteuerte Lernen, gefördert. Die zentrale Frage ist dabei: Welchen Nutzen hat die Einführung von E-Learning? In diesem Artikel wird dahingehend aufgezeigt, dass E-Learning nicht wegen pädagogischem Bedarf, sondern durch ministeriell gesetzte Maßnahmen eingeführt wurde und dadurch – wenn auch nicht bewusst und schon gar nicht als solches kommuniziert – neoliberale Strukturen durchgesetzt wurden. Die Einführung von E-Learning hat somit für deren Akzeptanz gesorgt.

Lifting the weight of a diagnosis-related groups family change: a comparison between refined and non-refined DRG systems for top-down cost accounting and efficiency indicators.

Science.gov (United States)

Zlotnik, Alexander; Cuchi, Miguel Alfaro; Pérez Pérez, Maria Carmen

Public healthcare providers in all Spanish Regions - Autonomous Communities (ACs) use All Patients Diagnosis-Related Groups (AP-DRGs) for billing non-insured patients, cost accounting and inpatient efficiency indicators. A national migration to All Patients Refined Diagnosis-Related Groups (APR-DRGs) has been scheduled for 2016. The analysis was performed on 202,912 inpatient care episodes ranging from 2005 to 2010. All episodes were grouped using AP-DRG v25.0 and APR-DRG v24.0. Normalised DRG weight variations for an AP-DRG to APR-DRG migration scenario were calculated and compared. Major differences exist between normalised weights for inpatient episodes depending on the DRGs family used. The usage of the APR-DRG system in Spain without any adjustments, as it was developed in the United States, should be approached with care. In order to avoid reverse incentives and provider financial risks, coding practices should be reviewed and structural differences between DRG families taken into account.

Aspekte der Erwachsenenbildung in qualitativer Forschung Aspects of Adult Education in Qualitative Research

Directory of Open Access Journals (Sweden)

Heide von Felden

2006-03-01

Full Text Available Das Buch gibt interessante Einblicke in verschiedene Projekte, die am Lehrstuhl für Erwachsenenbildung an der Universität Duisburg-Essen entstehen. Untersucht werden insbesondere Karriereverläufe von weiblichen Führungskräften, Aspekte der Arbeit an Volkshochschulen und die Frage, wie Berufsrückkehrerinnen mit dem Faktor Zeit umgehen.The book provides interesting perspectives into the varying projects being developed in the department of adult and continuing education at the University of Duisburg-Essen. It examines in particular the career paths of female executives, aspects of work at community colleges, and the question as to how those returning to careers manage the factor of time.

Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries

Science.gov (United States)

Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

2013-01-01

Aims As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. Methods and results National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Conclusions Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement. PMID:23364755

Acute myocardial infarction and diagnosis-related groups: patient classification and hospital reimbursement in 11 European countries.

Science.gov (United States)

Quentin, Wilm; Rätto, Hanna; Peltola, Mikko; Busse, Reinhard; Häkkinen, Unto

2013-07-01

As part of the diagnosis related groups in Europe (EuroDRG) project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their DRG systems deal with patients admitted to hospital for acute myocardial infarction (AMI). The study aims to assist cardiologists and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a primary diagnosis of AMI. Diagnosis-related group classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify AMI patients according to different sets of variables into diverging numbers of DRGs (between 4 DRGs in Estonia and 16 DRGs in France). The most complex DRG is valued 11 times more resource intensive than an index case in Estonia but only 1.38 times more resource intensive than an index case in England. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only €420 in Poland but to €7930 in Ireland. Large variation exists in the classification of AMI patients across Europe. Cardiologists and national DRG authorities should consider how other countries' DRG systems classify AMI patients in order to identify potential scope for improvement and to ensure fair and appropriate reimbursement.

The political economy of diagnosis-related groups.

Science.gov (United States)

Bertoli, Paola; Grembi, Veronica

2017-10-01

A well-established political economic literature has shown as multi-level governance affects the inefficiency of public expenditures. Yet, this expectation has not been empirically tested on health expenditures. We provide a political economy interpretation of the variation in the prices of 6 obstetric DRGs using Italy as a case study. Italy offers a unique institutional setting since its 21 regional governments can decide whether to adopt the national DRG system or to adjust/waive it. We investigate whether the composition and characteristics of regional governments do matter for the average DRG level and, if so, why. To address both questions, we first use a panel fixed effects model exploiting the results of 66 elections between 2000 and 2013 (i.e., 294 obs) to estimate the link between DRGs and the composition and characteristics of regional governments. Second, we investigate these results exploiting the implementation of a budget constraint policy through a difference-in-differences framework. The incidence of physicians in the regional government explains the variation of DRGs with low technological intensity, such as normal newborn, but not of those with high technological intensity, as severely premature newborn. We also observe a decrease in the average levels of DRGs after the budget constraint implementation, but the magnitude of this decrease depends primarily on the presence of physicians among politicians and the political alignment between the regional and the national government. To understand which kind of role the relevance of the political components plays (i.e., waste vs. better defined DRGs), we check whether any of the considered political economy variables have a positive impact on the quality of regional obstetric systems finding no effect. These results are a first evidence that a system of standardized prices, such as the DRGs, is not immune to political pressures. Copyright © 2017 Elsevier Ltd. All rights reserved.

Building a Green Metropolis. Costs and impacts. Plan of the Dutch environmental organization Milieudefensie; Bouwen aan een Groene Metropool. Kosten en effecten. Plan van Milieudefensie

Energy Technology Data Exchange (ETDEWEB)

Doenszelmann, C.E.P.; Schroten, A.

2011-05-15

The plan of the Dutch environmental organization Milieudefensie contains various proposals for a more sustainable realization of accessibility in the Rotterdam region. CE Delft mapped the costs and environmental effects of these proposals. [Dutch] In het plan van Milieudefensie worden verschillende voorstellen gedaan om tot een duurzamere invulling van de bereikbaarheid in de Rotterdamse regio te komen. CE Delft heeft de kosten en de milieueffecten van deze voorstellen in beeld gebracht.

Development of a claim review and payment model utilizing diagnosis related groups under the Korean health insurance.

Science.gov (United States)

Shin, Y S; Yeom, Y K; Hwang, H

1993-02-01

This paper describes the development of a claim review and payment model utilizing the diagnosis related groups (DRGs) for the fee for service-based payment system of the Korean health insurance. The present review process, which examines all claims manually on a case-by-case basis, has been considered to be inefficient, costly, and time-consuming. Differences in case mix among hospitals are controlled in the proposed model using the Korean DRGs. They were developed by modifying the US-DRG system. An empirical test of the model indicated that it can enhance the efficiency as well as the credibility and objectivity of the claim review. Furthermore, it is expected that it can contribute effectively to medical cost containments and to optimal practice pattern of hospitals by establishing a useful mechanism in monitoring the performance of hospitals. However, the performance of this model needs to be upgraded by refining the Korean DRGs which play a key role in the model.

[Innovative culture and diagnosis related groups in a high complexity hospital, Colombia].

Science.gov (United States)

Gorbanev, Iouri; Agudelo-Londoño, Sandra; Cortes, Ariel; Yepes, Francisco J

2016-04-01

Objectives To characterize the perception of Diagnosis-Related Groups (DRGs) as an innovation among physicians, nurses and administrative staff in a hospital in Colombia. Methods A case study of innovative culture in a hospital. Surveys and focus groups were carried out with the medical, nursing and administrative staff. Descriptive statistics were calculated for the perceptions of innovative culture. Comparative analysis was done between professional groups. The results of the focus groups were transcribed and analyzed to deepen the findings of the surveys. Results Significant differences were found in perceptions of the innovative culture. The nursing staff were more enthusiastic than doctors when evaluating the innovative culture and leadership. Physicians felt more autonomy when discussing professional issues. Administrative staff assessed the Hospital's disposition to acquire new medical technologies as higher than that of physicians. The three groups know little about DRG's. Conclusions When implementing a health innovation it is advisable to analyze its effect on the professionals who participate in the implementation. Physicians perceive DRGs as a threat to their professional autonomy, while nurses see it as a pro-innovation force. It is important to involve nursing and administrative staff when implementing this kind of innovation.

3-D multitissue reconstruction of a petrosal durosarcoma for pre-operative planning of craniotomy; 3-D-Multitissue-Rekonstruktion eines Felsenbeinmeningeomas zur praeoperativen Kraniotomieplanung

Energy Technology Data Exchange (ETDEWEB)

Huenerbein, R. [Staedtische Kliniken Kassel (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Keiling, A. [Staedtische Kliniken Kassel (Germany). Klinik fuer Neurochirurgie; Kuhn, F.P. [Staedtische Kliniken Kassel (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie

1996-03-01

The case of a female patient with safe diagnosis of a petrosal durosarcoma is chosen to show that the data obtained by spiral CT can be processed to deliver the full scale of information required by the neurosurgeon, such as the 3-D imaging of the tumor, its situation with reference to the bone, the large arterial vessels, and the venous blood conduits. The spiral CT is shown to be a modality that can compete with arterial angiography in terms of information value and cost-benefit analysis. (orig./MG) [Deutsch] Im vorliegenden Fall einer Patientin mit bekanntem Felsenbeinmeningeom soll gezeigt werden, wie mit einem Spiral-CT-Datensatz die vom Neurochirurgen benoetigten Informationen, wie die plastische Darstellung des Tumors, seine Beziehungen zum Knochen, den grossen arteriellen Gefaessen und den venoesen Blutleitern aussagekraeftig aufbereitet werden kann. Die Spiral-CT konkurriert dabei mit der arteriellen Angiographie sowohl was den Informationsgehalt als auch das Kosten-Nutzen-Verhaeltnis betrifft. (orig./MG)

Job Satisfaction of a selected group of hospital dietitians

Directory of Open Access Journals (Sweden)

Leonie E. Van Heernden

1976-11-01

Full Text Available Research on the job satisfaction of a selected group of hospital dietitians is reported in an attempt to explain the interrelationship of various aspects contributing to such satisfaction. General job satisfaction, satisfaction with specific aspects of the job and personality profiles of a newly developed Job Factor scale. The study is a further contribution to the understanding of job satisfaction of professional women in a specific work environment - in this case professional dietitians in hospitals. Opsomming Die werkstevredenheid van hospitaaldieetkundiges word ondersoek na aanleiding van die interverwantskap van verskillende aspekte wat tot 'n beter verklaring daarvan kan lei. Die algemene werkstevredenheid, werkstevredenheid met spesifieke aspekte van die werk en persoonlikheidstrekke van dieetkundiges word met bestaande skale en ‘n ontwikkelde meetmiddel ondersoek. Die studie is 'n bydrae tot die verdere verklaring en moontlike bevraagtekening van die werkstevredenheid van professionele vroue in 'n bepaalde werksomgewing - in hierdie geval professionele dieetkundiges in hospitale.

The debate over diagnosis related groups.

Science.gov (United States)

Spiegel, A D; Kavaler, F

1985-01-01

With the advent of the Prospective Payment System (PPS) using Diagnosis Related Groups (DRGs) as a classification method, the pros and cons of that mechanism have been sharply debated. Grouping the comments into categories related to administration/management, DRG system and quality of care, a review of relevant literature highlights the pertinent attitudes and views of professionals and organizations. Points constantly argued include data utilization, meaningful medical classifications, resource use, gaming, profit centers, patient homogeneity, severity of illness, length of stay, technology limitations and the erosion of standards.

Joint implementation. Cost benefit analysis of global environmental care; Joint Implementation. Kosten-Nutzen-Ueberlegungen globaler Umweltvorsorge

Energy Technology Data Exchange (ETDEWEB)

Loon, M.A.P.C. van [N.V. Samenwerkende Elektriciteits-Produktiebedrijven (Sep), Arnheim (Netherlands)

1996-01-01

The strategy in SEP, the interconnected electricity supply undertaking of The Netherlands, for the limitation of greenhouse gas emissions is focussed on the implementation of cost-effective `no regret` measures at home and abroad. Here, at present, SEP is concentrating on afforestation measures. Through a daughter organization called the FACE Foundation, SEP finances world-wide afforestation projects. FACE is able to take into account, forco-financing, the CO{sub 2} absorption capacity of these forests. These re-afforestation projects have proved to be a very cost-effective way of levelling out CO{sub 2} emissions in comparison with measures in The Netherlands. (orig.) [Deutsch] Die Strategie der in der Sep zusammengeschlossenen niederlaendischen Elektrizitaetswirtschaft zur Begrenzung von Treibhausgasemissionen konzentriert sich auf die Umsetzung kosteneffektiver `No-regret`-Massnahmen im In- und Ausland. Dort konzentriert sich Sep gegenwaertig auf Aufforstungsmassnahmen. Durch eine Tochterorganisation, die FACE-Stiftung, finanziert Sep weltweit Aufforstungsprojekte mit. Fuer die Mitfinanzierung laesst sich FACE die CO{sub 2}-Bindungskapzitaet dieser Waelder anrechnen. Diese Wiederaufforstungsprojekte haben sich als ein sehr kosteneffektiver Weg zum Ausgleich von CO{sub 2}-Emissionen im Vergleich zu Massnahmen in den Niederlanden herausgestellt. (orig.)

Implementation of new concepts for space HVAC systems in domestic buildings in consideration of cost, consumption and user comfort. Final report; Umsetzung neuer Konzepte der technischen Gebaeudeausruestung im Wohnungsbau unter Beruecksichtigung von Kosten, Verbraeuchen und Nutzerkomfort. Abschlussbericht

Energy Technology Data Exchange (ETDEWEB)

Schmidt, F.; Sucic, D.; Wendler, M.

1998-03-01

wir mit dem Instrumentarium anhand einer prototypischen Implementierung erzielen konnten. Die prototypische Implementierung erlaubt thermische Lastberechnungen fuer 60.000 verschiedene Gebaeude nach der EN 802 (allerdings Ein-Zonen-Modell). Darueber hinaus unterstuetzt sie die Auswahl eines Heizsystems entsprechend vom Nutzer vorgegebenen Kriterien. Diese umfassen die Aspekte Kosten, Umweltvertraeglichkeit und Komfort. (orig./MM)

Simulation of the influence of tar formation in wood gasification processes on the cost of the purified process gas; Simulation des Einflusses der Teerbildung bei der Vergasung von Holz auf die Kosten des gereinigten Produktgases

Energy Technology Data Exchange (ETDEWEB)

Saller, G; Krumm, W [Siegen Univ. (Gesamthochschule) (Germany). Inst. fuer Energietechnik

1998-09-01

The influence of the gasification process and the related tar formation rate on the cost of gas production is investigated with the aid of process models. The processes of gasification, gas purification and adsorptive treatment of waste water were modelled mathematically with a view to process mechanisms and cost. Simulations of the overall process helped to obtain a quantitative assessment of the cost of product gas as a function of process parameters like gasification process and tar formation. (orig./SR) [Deutsch] Mit Hilfe von Prozessmodellen wird untersucht, welchen Einfluss das Vergasungsverfahren und die damit verbundene Teerbildung mit entsprechenden Reinigungsverfahren auf die Produktionskosten des gereinigten Produktgases besitzt. Hierfuer werden die Prozesse der Vergasung, Gasreinigung und adsorptiven Abwasseraufbereitung hinsichtlich verfahrenstechnischer Zusammenhaenge und Kosten mathematisch modelliert. Durch Simulation des Gesamtprozesses werden quantitativ die Kosten des Produktgases in Abhaengigkeit von Prozessparametern wie Vergasungsverfahren und Teerbildung ermittelt. (orig./SR)

Enjoy driving without shifting gears; Spass ohne Schalten

Energy Technology Data Exchange (ETDEWEB)

Obst, M.

1997-07-01

The development criteria which are traditionally demanded at most are reduction of weight, fuel, material and cost. However, other criteria such as comfort, functionality and long lifetime have become the centre of interest during the last few years. This also applies for the development of transmission in the company Zahnradfabrik (ZF), Sarrebruck. The new four-step transmission system is supposed to achieve a very high shift comfort by an electro-hydraulic control system. The contribution provides some data about this transmission. (orig.) [Deutsch] Einsparungen an Gewicht, Kraftstoff, Material und Kosten sind traditionell die meistgeforderten Entwicklungskriterien. Doch draengen sich gerade in den letzten Jahren weitere Aspekte wie Komfort, Funktionalitaet und Langlebigkeit in den Mittelpunkt. So auch in der Getriebeentwicklung bei Zahnradfabrik (ZF). Mit einer elektro-hydraulischen Steuerung soll das neue Vierstufen-Getriebe eine sehr hohe Schaltqualitaet erreichen. Der Beitrag gibt dazu einige Daten. (orig.)

Introducing diagnosis-related groups: is the information system ready?

Science.gov (United States)

Jian, Weiyan; Lu, Ming; Han, Wei; Hu, Mu

2016-01-01

Diagnosis-related group (DRG) system is a classification system widely used in health managements, the foundation of which lies in the medical information system. A large effort had been made to improve the quality of discharge data before the introduction of DRGs in Beijing. We extract discharge data from 108 local hospitals spanning 4 years before and after standardization to evaluate the impact of standardization on DRG grouping performance. The data was grouped on an annual basis in accordance with Beijing's local DRG system. Proportion of ungrouped data, coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of the DRG system. Both the descriptive and regression analysis indicate a significant reduction in terms of ungrouped data and CV for expenditure, increase of RIV for expenditure and length of stay. However, when there was no intervention, that is, between 2005 and 2006 and between 2008 and 2009, changes in these indicators were all insignificant. Therefore, the standardization of discharge data did improve data quality and consequently enhanced the performance of DRGs. Developing countries with a relatively weak information infrastructure should strengthen their medical information system before the introduction of the DRG system. Copyright © 2014 John Wiley & Sons, Ltd.

Efficient use of energy - electric power. Model projects and relevant publications; Energie effizient nutzen - Schwerpunkt Strom. Modellvorhaben und Fachartikel

Energy Technology Data Exchange (ETDEWEB)

Radgen, P.; Jochem, E. [eds.

1999-10-26

The forum intended to provide written information for experts and to develop model projects for selected fields of industry in Baden-Wuerttemberg. However, these two instruments can only be part of an innovation initiative headed by the Land government in cooperation with the Baden-Wuerttemberg industry and science. [German] Der Schwerpunkt des Forums 'Strom effizient nutzen' konzentrierte sich auf die Erarbeitung von schriftlichen Informationen fuer den Fachmann sowie auf die Entwicklung einiger Modellvorhaben fuer einige ausgewaehlte Branchen Baden-Wuerttembergs. Diese beiden Instrumente koennen aber nur Teil einer Innovationsinitiative sein, die Regierung, Wirtschaft und Wissenschaft entwickeln muessten, wollte man einen sichtbaren Erfolg bei der Loesung des o.g. Zielkonfliktes verbuchen. Eine solche Initiative zu konzipieren und zu entfesseln, die der baden-wuerttembergischen Wirtschaft manch positive Impulse braechte, waere machbar; wie die Modellvorhaben dieses Projektes in ueberzeugender Weise belegen, gibt es hinreichend rentable Moeglichkeiten. (orig.)

Coronary artery bypass grafts and diagnosis related groups: patient classification and hospital reimbursement in 10 European countries

Science.gov (United States)

2014-01-01

Background The prospective reimbursement of hospitals through the grouping of patients into a finite number of categories (Diagnosis Related Groups, DRGs), is common to many European countries. However, the specific categories used vary greatly across countries, using different characteristics to define group boundaries and thus those characteristics which result in different payments for treatment. In order to assist in the construction and modification of national DRG systems, this study analyses the DRG systems of 10 European countries. Aims To compare the characteristics used to categorise patients receiving a coronary artery bypass graft (CABG) surgery into DRGs. Further, to compare the structure into which DRGs are placed and the relative price paid for patients across Europe. Method Patients with a procedure of CABG surgery are analysed from Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden. Diagrammatic algorithms of DRG structures are presented for each country. The price in Euros of seven typical case vignettes, each made up of a set of a hypothetical patient’s characteristics, is also analysed for each country. In order to enable comparisons across countries the simplest case (index vignette) is taken as baseline and relative price levels are calculated for the other six vignettes, each representing patients with different combinations of procedures and comorbidities. Results European DRG payment structures for CABG surgery vary in terms of the number of different DRGs used and the types of distinctions which define patient categorisation. Based on the payments given to hospitals in different countries, the most resource intensive patient, relative to the index vignette, ranges in magnitude from 1.37 in Poland to 2.82 in Ireland. There is also considerable variation in how much different systems pay for particular circumstances, such as the occurrence of catheterisation or presence of comorbidity. Conclusion Past

Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries.

Science.gov (United States)

Peltola, Mikko; Quentin, Wilm

2013-01-01

Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and

Generelle aspekter ved mediereception? – Et bud på en multidimensional model for analyse af kvalitative receptionsinterviews

Directory of Open Access Journals (Sweden)

Kim Schrøder

2003-09-01

Full Text Available Findes der generelle aspekter ved receptionen af medieprodukter, som det kan være analytisk frugtbart at orientere sig efter, og som man altid bør belyse, når man analyserer kvalitative receptionsdata – og måske også allerede når man skal planlægge det empiriske feltarbejde i et em- pirisk receptionsprojekt? Denne artikel bygger på, at dette spørgsmål kan besvares bekræftende, og fremlægger et bud på, hvordan en multi- dimensional model for kvalitativ receptionsanalyse kunne se ud.

Do diagnosis-related group-based payments incentivise hospitals to adjust output mix?

Science.gov (United States)

Liang, Li-Lin

2015-04-01

This study investigates whether the diagnosis-related group (DRG)-based payment method motivates hospitals to adjust output mix in order to maximise profits. The hypothesis is that when there is an increase in profitability of a DRG, hospitals will increase the proportion of that DRG (own-price effects) and decrease those of other DRGs (cross-price effects), except in cases where there are scope economies in producing two different DRGs. This conjecture is tested in the context of the case payment scheme (CPS) under Taiwan's National Health Insurance programme over the period of July 1999 to December 2004. To tackle endogeneity of DRG profitability and treatment policy, a fixed-effects three-stage least squares method is applied. The results support the hypothesised own-price and cross-price effects, showing that DRGs which share similar resources appear to be complements rather substitutes. For-profit hospitals do not appear to be more responsive to DRG profitability, possibly because of their institutional characteristics and bonds with local communities. The key conclusion is that DRG-based payments will encourage a type of 'product-range' specialisation, which may improve hospital efficiency in the long run. However, further research is needed on how changes in output mix impact patient access and pay-outs of health insurance. Copyright © 2014 John Wiley & Sons, Ltd.

Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix.

Science.gov (United States)

Ghaffari, S; Doran, C; Wilson, A; Aisbett, C

2010-05-01

This paper examines the quality of routinely collected information in an Iranian hospital in a trial of casemix classification. Australian Refined Diagnosis Related Groups (AR-DRG) were used to classify patient episodes. There were 327 DRGs identified, of which 20% had only 1 case. The grouper program identified invalid records for 4% of total separations. Approximately 4.5% of cases were classified into error DRGs and 3.4% were ungroupable. No complication and comorbidity effects were identified with 93% of total cases. R2 (variance in length of stay explained) was 44% for untrimmed cases, increasing to 63%, 57% and 58% after trimming by L3H3, IQR and 10th-95th percentile methods respectively.

Integral energy concepts for office and residential buildings; Integrale Energiekonzepte fuer Buero- und Wohngebaeude

Energy Technology Data Exchange (ETDEWEB)

Velten, W.

1998-06-01

It has been confirmed by practical project experience that integral energy concepts are an excellent basis for the construction of energy-efficient buildings. In the extreme case buildings can even be self-sufficient in their energy supply. Uniting the responsibility for the overall energy and technology concept in the hands of a single contractor can help reduce frictional losses between those involved in the planning as well costs. A good example of this is the use of a simulation calculation for the prescribed demonstration of proper heat insulation. The presented projects show that it is possible to construct ecologically answerable buildings at attractively low costs. The presented concepts appear particularly convincing from the viewpoint of long-term maintenance of value and user-specific advantages such as agreeable working conditions. [Deutsch] Die konkreten Projekterfahrungen bestaetigen, dass durch integrale Energiekonzepte sowohl im Verwaltungs- als auch im Wohnungsbau hervorragende Voraussetzungen fuer energiesparende Gebaeude geschaffen werden koennen. Im Extremfall kann sogar eine autarke Energieversorgung erreicht werden. Durch Zusammenfassung der Gesamtverantwortung fuer das Energie- und Technikkonzept in einer Hand koennen Reibungsverluste zwischen den Planungsbeteiligten reduziert und Kosten gesenkt werden. Ein Beispiel hierfuer ist die Verbindung des vorgeschriebenen Waermeschutznachweises mit einer fuer alle Beteiligten wesentlich aussagekraeftigeren Simulationsrechnung. Die vorgestellten Projekte zeigen, dass oekologisch sinnvolle Gebaeude auch zu oekonomisch attraktiven Kosten erstellt werden koennen, wobei insbesondere der Aspekt des langfristigen Werterhalts und die nutzerspezifischen Vorteile, z.B. durch angenehmere Arbeitsbedingungen, fuer die vorgestellten Konzepte spricht. (orig.)

Cost-effectiveness of solar energy in energy-efficient buildings; Kosten und Nutzen von Solarenergie in energieeffizienten Bauten

Energy Technology Data Exchange (ETDEWEB)

Kessler, S.; Iten, R.; Vettori, A. [Infras, Zuerich (Switzerland); Haller, A.; Ochs, M. [Ernst Schweizer AG, Hedingen (Switzerland); Keller, L. [Bureau d' Etudes Keller-Burnier, Lavigny (Switzerland)

2005-07-01

This report for the Swiss Federal Office of Energy (SFOE) presents the results of a study that examined the potentials and restraints with respect to the use of solar energy in the new construction and refurbishment of residential buildings in Switzerland. The method used is based on a 'learning-curve' technique. The first part of the report deals with the development of prices for solar-collector installations from 1990 until now. The second part deals with today's costs and future developments up to the year 2030. A reference building is used as the basis for the comparison of eight system variants. A further eight variants combine solar technology with traditional heating installations such as oil, gas and wood boilers and heat-pumps. Scenarios for the market situation for solar energy in 2030 are discussed.

Funding intensive care - approaches in systems using diagnosis-related groups.

OpenAIRE

Ettelt, S; Nolte, E

2010-01-01

This report reviews approaches to funding intensive care in health systems that use activitybased payment mechanisms based on diagnosis-related groups (DRGs) to reimburse hospital care. The report aims to inform the current debate about options for funding intensive care services for adults, children and newborns in England. Funding mechanisms reviewed here include those in Australia (Victoria), Denmark, France, Germany, Italy, Spain, Sweden and the United States (Medicare). Approaches to org...

Energy management through building automation. Fundamentals - Technologies - Applications; Energiemanagement durch Gebaeudeautomation. Grundlagen - Technologien - Anwendungen

Energy Technology Data Exchange (ETDEWEB)

Aschendorf, Bernd [Fachhochschule Dortmund (Germany). Fachbereich Informations- und Elektrotechnik

2014-02-01

The books available in the market consider only the use of individual buildings bus systems, but not to compare with each other with respect to cost-benefit and applicability. In this book, a total of 40 different systems, such as radio bus systems, PEHA-PHC, EIB, LCN, LON, PLC systems, investigated for their possible use in the various categories of buildings. The comparison refers to all levels of the automation pyramid from fieldbus, to automation to the control level and considers in particular the usability for SmartMetering-based energy management. [German] Die am Markt vorhandenen Buecher betrachten lediglich den Einsatz einzelner Gebaeudebussysteme, nicht jedoch den Vergleich untereinander mit Bezug auf Kosten/Nutzen und Anwendbarkeit. In diesem Buch werden insgesamt 40 verschiedene Systeme, wie z.B. Funkbussysteme, PEHA-PHC, EIB-, LCN-, LON-, SPS-Systeme, auf deren Einsatzmoeglichkeit in den verschiedenen Gebaeudekategorien untersucht. Der Vergleich bezieht sich auf alle Ebenen der Automatisierungspyramide vom Feldbus ueber die Automatisierung bis zur Leitebene und betrachtet insbesondere auch die Verwendbarkeit fuer smartMetering-basiertes Energiemanagement.

Bilateral Neuropathy of Primary Sensory Neurons by the Chronic Compression of Multiple Unilateral DRGs

Directory of Open Access Journals (Sweden)

Ya-Bin Xie

2016-01-01

Full Text Available To mimic multilevel nerve root compression and intervertebral foramina stenosis in human, we established a new animal model of the chronic compression of unilateral multiple lumbar DRGs (mCCD in the rat. A higher occurrence of signs of spontaneous pain behaviors, such as wet-dog shaking and spontaneous hind paw shrinking behaviors, was firstly observed from day 1 onward. In the meantime, the unilateral mCCD rat exhibited significant bilateral hind paw mechanical and cold allodynia and hyperalgesia, as well as a thermal preference to 30°C plate between 30 and 35°C. The expression of activating transcription factor 3 (ATF3 was significantly increased in the ipsilateral and contralateral all-sized DRG neurons after the mCCD. And the expression of CGRP was significantly increased in the ipsilateral and contralateral large- and medium-sized DRG neurons. ATF3 and CGRP expressions correlated to evoked pain hypersensitivities such as mechanical and cold allodynia on postoperative day 1. The results suggested that bilateral neuropathy of primary sensory neurons might contribute to bilateral hypersensitivity in the mCCD rat.

The value of magnetic resonance imaging (MRI) in the treatment planning of vertebral metastasis considering economic aspects. A cost benefit-analysis; Die Wertigkeit der Magnetresonanztomographie (MRT) unter oekonomischen Aspekten bei der Bestrahlungsplanung von Wirbelkoerpermetastasen. Eine Kosten-Nutzen-Analyse

Energy Technology Data Exchange (ETDEWEB)

Prott, F.J.; Schlehuber, E.; Scharding, B.J.; Rinast, E. [Strahlentherapie Wiesbaden, St.-Josefs-Hospital (Germany); Micke, O. [Klinik und Poliklinik fuer Strahlentherapie - Radioonkologie, Universitaetsklinikum Muenster (Germany)

2002-05-01

Is magnetic resonance imaging (MRI) based target volume definition for treatment planning of vertebral metastasis effective under economic considerations.From 1994 to 1999, a total of 137 patients with bone metastases affecting the vertebral column underwent MRI of the cercival, thoracic, or lumbar spine for the treatment planning of palliative radiation therapy. The following radiation treatment consisted in a irradiation of the affected vertebral region up to a total dose of 30-40 Gy.The cost calculation for radiotherapy and magnetic resonance tomography was done using the common tariff model (EBM) of the German Health Insurances.In 73% of patients (101 patients), magnetic resonance imaging resulted in marked corrections of the irradiation fields which would have resulted in the necessity of treatment for recurrence in the case of treatment planning without MRI.Consequently, the higher cost of MRI of 345.00 DEM (176,40 EUR) lead to a saving of 497.00 DEM (254,11 EUR) compared to a recurrence treatment of 10 fractions and of 1,428.00 DEM (730,12 EUR) compared to 20 fractions. The transport expenses for the second treatment could be saved as well.Even under economic considerations MRI is effective. (orig.) [German] Ist eine MRT-gestuetzte Zielvolumendefinition bei der Strahlentherapie von Knochenmetastasen ein sinnvolles Vorgehen unter oekonomischen Gesichtspunkten?1994-1999 wurde bei 137 Patienten mit einem ossaer metastasierenden Tumor und Befall der Wirbelsaeule eine Magnetresonanztomographie (MRT) zur Planung einer palliativen Radiatio durchgefuehrt. Die nachfolgende Strahlentherapie bestand aus einer Radiatio des betroffenen Wirbelkoerperabschnitts bis zu einer Gesamtherddosis von 30-40 Gy. Fuer die Berechnung der Kosten wurde der einheitliche Bewertungsmassstab der Deutschen Krankenkassen zugrunde gelegt.Aufgrund der MRT-Untersuchungen wurde bei 73% der Patienten eine Veraenderung des Bestrahlungsfeldes vorgenommen, die im Falle einer nicht MRT

Technically-oriented operation management systems in conjunction with commercial DB systems

Energy Technology Data Exchange (ETDEWEB)

Lex, M.; Heselmann, B. [GiS mbH, Erlangen (Germany); Eschbach, P. [BASF Consult GmbH, Muenchen (Germany)

2001-07-01

Due to the liberalization of the electricity market, the efficiency and competitiveness of a power plant is increasingly measured at the cost per amount of energy generated. Thus, aspects of market-orientation and clearly cheaper electricity generation are in the foreground. Technically-oriented DP systems are necessary to save operating cost. These systems have structures differing from the mere business-oriented systems, because of the different frame conditions and operators' desire to stand out against rivalling competitors by technical and organizational measures. (orig.) [German] Die Effektivitaet und damit Konkurrenzfaehigkeit eines Kraftwerkes wird mit der Liberalisierung des Strommarktes verstaerkt an den Kosten je erzeugter Energieeinheit gemessen. Fuer den Betrieb ruecken damit Aspekte einer marktgerechten und somit deutlich kostenguenstigeren Stromerzeugung verstaerkt in den Vordergrund. Wer Betriebskosten sparen will, braucht technisch orientierte DV-Systeme, die aufgrund der unterschiedlichen Rahmenbedingungen und des Wunsches aller Anlagenbetreiber, sich durch technisch-organisatorische Massnahmen vom Wettbewerb vorteilhaft abzuheben, voellig andere Strukturen aufweisen als die betriebswirtschaftlich orientierten Systeme. (orig.)

Transfusion practice in Helsinki University Central Hospital: an analysis of diagnosis-related groups (DRG).

Science.gov (United States)

Syrjälä, M T; Kytöniemi, I; Mikkolainen, K; Ranimo, J; Lauharanta, J

2001-12-01

Transfusion data combined with data automatically recorded in hospital databases provides an outstanding tool for blood utilization reporting. When the reporting is performed with an online analytical processing (OLAP) tool, real time reporting can be provided to blood subscribers. When this data is combined with a common patient classification system, Diagnosis-Related Groups (DRG), it is possible to produce statistical results, that are similar in different institutions and may provide a means for international transfusion bench-marking and cost comparison. We use a DRG classification to describe the transfusion practice in Helsinki University Central Hospital. The key indicators include the percentage of transfused patients, the number of transfused units and costs in different DRG groups, as well as transfusion rates per DRG weighted treatment episodes. Ninety-three per cent of all transfusions could be classified into different DRGs. The largest blood-using DRG group was acute adult leukaemia (DRG 473), which accounted for 10.4% of all transfusion costs. The 13 largest blood consuming DRGs accounted for half the total costs in 1998. Currently, there is a lack of an internationally accepted standardized way to report institutional or national transfusion practices. DRG-based transfusion reporting might serve as a means for transfusion benchmarking and thus aid studies of variations in transfusion practice.

Cost-effectiveness-analysis: radioiodine or antithyroid drugs as first-line therapy of hyperthyroidism due to Graves` disease; Kosten-Effektivitaets-Analyse: Radioiod oder thyreostatische Medikation bei der Primaerbehandlung der Immunhyperthyreose

Energy Technology Data Exchange (ETDEWEB)

Dietlein, M.; Moka, D.; Dederichs, B.; Schicha, H. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin; Hunsche, E.; Lauterbach, K.W. [Koeln Univ. (Germany). Inst. fuer Gesundheitsoekonomie, Medizin und Gesellschaft

1999-06-01

Aim: As first-line therapy of hyperthyroidism caused by Graves` disease antithyroid drugs are favoured in Europe, while radioiodine therapy is favoured in the USA. Radioiodine therapy has become more economic in Germany since the new recommendations by the Federal German Radiation Protection Committee (SSK) for patient discharge guidelines. Method: Sensitivity analyses took into account the long-term relapse rate of conservative or radioiodine therapy, use of diagnostic tests, level of health insurance, drops in productivity and a discount factor. Costing models included the costs of follow-up care over 30 years. The costs of the hospitalisation for radioiodine therapy were calculated for 300 patients, discharged with 250 MBq I-131 residual activity. Result: Antithyroid drugs were considered cost-effective when they achieved relapse rate of 50% or less, a cut in the number of tests needed and reduced working hours. Failure to meet any one of these conditions makes primary radioiodine therapy more cost-effective in 1593 of 1944 calculated costing models. Repeated conservative therapies will increase clearly the overall costs. Conclusion: Radioiodine is a cost-effective, first-line therapy in patients with a special risk of relapse after primary conservative therapy (goitre, younger patient, persistent elevated TSH-receptor-antibodies or Tc-uptake). (orig.) [Deutsch] Ziel: Die Erstmanifestation einer Immunhyperthyreose wird in Europa ueberwiegend thyreostatisch, in den USA mehrheitlich mit Radioiod definitiv behandelt. Diese beiden Alternativen wurden auf dem Hintergrund neuer nationaler Entlassungsrichtwerte nach einer Radioiodtherapie (RITh) verglichen. Methode: Aus Sicht der Gesellschaft entscheiden einerseits die langfristigen Rezidivraten, andererseits die Menge medizinischer Leistungen, der Versicherungsstatus und der Produktivitaetsausfall des Patienten (Fehlzeiten, Einkommen) sowie die zeitliche Verteilung der Kosten (Diskontierung) ueber die Kosten

Development of a method for classification of hospitals based on results of the diagnosis-related groups and the principle of case-mix index.

Science.gov (United States)

Shelf, Louay

2016-08-18

This research used DRGs and CMI to adjust medical waste production through the calculation of DRGs and CMI scores. These scores were used to assess the performances of teaching hospitals in Damascus. The linear correlations between these scores and the annual amount of waste and DRGs values were studied. The differences between the daily waste generations before and after the adjustment process were determined. Accordingly, the highest values of DRGs and CMI Scores were for the pediatric and Al Assad hospitals respectively. Among the teaching hospitals in Damascus, Al Assad has achieved the highest performance. Based on the results, the accuracy and homogeneity of medical waste generation rates were improved, which in turn leads to continuous improvement in the management of medical wastes.

Kalevipoeg tänapäeval - ühe tulevase Euroopa kultuuri document humain : psühholoogilis-antropoloogilisi aspekte / Peter Petersen ; tõlkinud Krista Räni

Index Scriptorium Estoniae

Petersen, Peter, 1933-

2003-01-01

Lisa 1. William Butler Yeats. Ta igatseb endale taevakangaid / tõlkinud Märt Väljataga, lk. 2587 ; Lisa 2. Novalis. Neue Fragmente. Nr. 393 (Novalis. Werke und Briefe. Stuttgart ; Hamburg : Deutscher Bücherbund, 1962), lk. 2587-2588 ; Lisa 3. Tabel väärtuste kohta, mida Kalevipoja-eeposes esile tuuakse, lk. 2588. Bibl. lk. 2589-2590. Tõlgitud käsikirjast: "Kalevipoeg heute - document humain einer künftigen Kultur Europas: psychologisch-anthropologische Aspekte"

Minimization of costs and fees in municipal sewage disposal. Legal bases, scope for action and reports of experience. PC information system AquaArgument; Kosten- und Abgabenminimierung in der kommunalen Abwasserentsorgung. Rechtliche Grundlagen, Handlungsspielraeume und Erfahrungsberichte. PC-Informationssystem AquaArgument

Energy Technology Data Exchange (ETDEWEB)

Schroeder, R. [Saarberg Hoelter Wassertechnik GmbH, Essen (Germany); Knust, M. [Saarberg Hoelter Wassertechnik GmbH, Essen (Germany); Wittenberg, D. [Kanzlei Zenk Tippenhauer Osmer Schroeter Schmidt-Decker Bergmann, Hamburg (Germany); Rehr-Zimmermann, M. [Kanzlei Zenk Tippenhauer Osmer Schroeter Schmidt-Decker Bergmann, Hamburg (Germany); Hueting, R. [Kanzlei Zenk Tippenhauer Osmer Schroeter Schmidt-Decker Bergmann, Hamburg (Germany); Vogel, H.J. [Bundesministerium fuer Umwelt, Naturschutz und Reaktorsicherheit, Bonn (Germany)

1996-05-01

One of the many tasks of local government is to make provision for sewage disposal. In many towns, necessary investments, the installation of further technical systems, and reconstructions entail a rise in sewage disposal fees. These measures, whose justification can hardly be denied for ecological reasons, and the resulting cost are more and more the object of long-term economic analysis and broad public debate. The brochure points out possibilities for minimizing the costs of, and fees for, municipal sewage disposal. Of course it is up to each municipal administration to decide in favour of or against their implementation (orig.). [Deutsch] Eine von vielen Aufgaben in der Kommune ist die Sicherstellung der Abwasserentsorgung. Die notwendigen Investitionen, technischen Erweiterungen und Rekonstruktionen fuehren vielerorts zu steigenden Abwassergebuehren. Die aus oekologischen Gesichtspunkten kaum in Abrede gestellten Massnahmen und die daraus resultierenden Kosten unterliegen in ihrer Entwicklung immer mehr einer langfristig orientierten wirtschaftlichen Betrachtung und einer damit verbundenen breiten oeffentlichen Diskussion. In dieser Broschuere werden einige Hinweise und Moeglichkeiten zur Kosten- und Abgabenminimierung in der kommunalen Abwasserentsorgung aufgezeigt, deren Umsetzung selbstverstaendlich der Entscheidung der einzelnen Kommune unterliegt. (orig./SR)

Evaluating performance of local case-mix system by international comparison: a case study in Beijing, China.

Science.gov (United States)

Jian, Wei-Yan; Lu, Ming; Cui, Tao; Hu, Mu

2011-01-01

Case-mix is an important tool for health planning and management in many countries. As a major developing country, China is considering the introduction of the case-mix system in the health reform. Beijing, the capital of China, developed a local case-mix version whose performance needs to be evaluated before utilization. The objective of this study was to evaluate the performance of the case-mix system developed in Beijing by comparing it with those used in Australia and the U.S.A. A total of 1.3 million inpatient records from 154 hospitals in Beijing in 2008 were grouped respectively using three case-mix systems: (i) Beijing Diagnosis Related Groups (BJ-DRGs); (ii) US-based All Patient DRGs; and (iii) Australian Refined DRGs. Coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of DRGs system. The BJ-DRGs produced the best CV and RIV results for expenditure. However, at the level of Major Diagnostic Category (MDC), three MDCs of BJ-DRGs gave the poorest RIVs for both expenditure and length of stay. Although the performance of BJ-DRGs was acceptable, further revision and improvement is needed. Comparisons with other mature DRGs versions can assist in identifying the improvement priorities of the local version. Copyright © 2011 John Wiley & Sons, Ltd.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups

Directory of Open Access Journals (Sweden)

Yu-Hua Yan

2017-11-01

Full Text Available Abstract Background This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs on medical resource utilization in inguinal hernia repair (IHR in hospitals with different ownership to provide suitable reference information for hospital administrators. Methods The 2010–2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. Results There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case was more efficient than that in the public hospital (US$902.7/case or nonprofit proprietary hospital (US$817.1/case surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%, while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Conclusions Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

Science.gov (United States)

Yan, Yu-Hua; Kung, Chih-Ming; Chen, Yi

2017-11-09

This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

Gas-fuelled driving and sailing. Cost and environmental effects of natural gas and green gas in transport; Rijden en varen op gas. Kosten en milieueffecten van aardgas en groen gas in transport

Energy Technology Data Exchange (ETDEWEB)

Kampman, B.E.; Croezen, H.J.; Verbraak, G.M.; Brouwer, F.P.E.

2010-06-15

A number of new gaseous fuels for cars and ships is becoming more popular: compressed natural gas (CNG), liquid natural gas (LNG) and biogas. This report presents the results of a study of the costs and environmental effects of these gas applications and compares them to diesel and petrol and the 'common' biofuels biodiesel and bio-ethanol. The green gas applications emit much less CO2 than biodiesel and bio-ethanol from wheat. The air-polluting emissions are much lower in all cases. The basic cost of driving or sailing on these gaseous fuels (excl. levies and taxes) are significantly higher than in case of diesel, but in some cases van be comparable or even lower than in case of liquid biofuels. [Dutch] Een aantal nieuwe gasvormige brandstoffen voor auto's en schepen is in opkomst: aardgas onder druk (CNG), vloeibaar aardgas (LNG) en biogassen. In dit rapport worden de resultaten van een onderzoek naar de kosten en de milieueffecten van deze gastoepassingen gepresenteerd en vergeleken met diesel en benzine en de 'gewone' biobrandstoffen bio-diesel en bio-ethanol. De groen gas-toepassingen stoten aanzienlijk minder CO2 uit dan biodiesel en bio-ethanol uit tarwe. De luchtvervuilende emissies zijn in alle gevallen een stuk lager. De kale kosten van rijden en varen op deze gasvormige brandstoffen (excl. heffingen en belastingen) zijn wel aanzienlijk hoger dan bij diesel, maar kunnen in sommige toepassingen vergelijkbaar of lager uitkomen dan van de vloeibare biobrandstoffen.

All patient refined-diagnostic related group and case mix index in acute care palliative medicine.

Science.gov (United States)

Lagman, Ruth L; Walsh, Declan; Davis, Mellar P; Young, Brett

2007-03-01

The All Patient Refined-Diagnostic Related Group (APR-DRG) is a modification of the traditional DRG that adds four classes of illness severity and four classes of mortality risk. The APR-DRG is a more accurate assessment of the complexity of care. When individuals with advanced illness are admitted to an acute inpatient palliative medicine unit, there may be a perception that they receive less intense acute care. Most of these patients, however, are multisymptomatic, have several comorbidities, and are older. For all patients admitted to the unit, a guide was followed by staff physicians to document clinical information that included the site(s) of malignancy, site(s) of metastases, disease complications, disease-related symptoms, and comorbidities. We then prospectively compared DRGs, APR-DRGs, and case mix index (CMI) from January 1-June 30, 2003, and February 1-July 31,2004, before and after the use of the guide. The overall mean severity of illness (ASOI) increased by 25% (P DRG classifications captured a higher severity of illness and may better reflect resource utilization.

Diagnosis-Related Groups for Stroke in Europe: Patient Classification and Hospital Reimbursement in 11 Countries

OpenAIRE

Peltola, Mikko; Quentin, Wilm

2013-01-01

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG geförderten) Allianz- bzw. Nationallizenz frei zugänglich. This publication is with permission of the rights owner freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively. Background: Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems...

Competitive account management focusing on residential customers; Kundenbindung bei privaten Haushalten

Energy Technology Data Exchange (ETDEWEB)

Schoenheit, I.; Niedergesaess, U. [imug Beratungsgesellschaft mbH, Hannover (Germany)

1999-07-01

The article explains why electric and gas utilities in Germany should not forget the domestic customers when deciding their key account management strategies and marketing policy in the competitive electricity and natural gas markets. Competition in the German energy sector has just begun, and so far the industrial customers have been absorbing most of the utilities` attention. The authors show that this is a short-sighted management strategy and present a number of reasons speaking in favour of bulding up structures or preserving the loyalty of domestic cutomers, as this customer group will finally play an important role in the utilities` efforts to keep their competitive edge. (orig./CB) [Deutsch] Wenn heute unter Marketingaspekt ueber Kundenbindung im Energiemarkt gesprochen wird, dann wird haeufig zuerst oder sogar ausschliesslich ueber die umsatzstarken Geschaeftskunden nachgedacht. Der Wettbewerb, vor allem im Bereich der Grosskunden, kuendigt sich in drastischen Einschnitten in den preispolitischen Spielraeumen der EVU an. Der allgemeine Kosten- und Rationalisierungsdruck auf die Unternehmen der Branche nimmt in deutlichem Umfang zu. Der Beitrag der privaten Haushalte fuer den Unternehmenserfolg wird in diesem Zusammenhang haeufig sehr schnell als gering und vernachlaessigbar eingestuft - insbesondere im Vergleich zu den zu erwartenden potentiellen Umsatzeinbussen durch Grosskundenabwanderungen. Diesem Aspekt kann aber eine Reihe von Argumenten gegenuebergestellt werden, die die Bedeutung von Privatkunden fuer EVU unterstreichen. (orig.)

Redefining diagnosis-related groups (DRGs) for palliative care - a cross-sectional study in two German centres.

Science.gov (United States)

Vogl, Matthias; Schildmann, Eva; Leidl, Reiner; Hodiamont, Farina; Kalies, Helen; Maier, Bernd Oliver; Schlemmer, Marcus; Roller, Susanne; Bausewein, Claudia

2018-04-05

Hospital costs and cost drivers in palliative care are poorly analysed. It remains unknown whether current German Diagnosis-Related Groups, mainly relying on main diagnosis or procedure, reproduce costs adequately. The aim of this study was therefore to analyse costs and reimbursement for inpatient palliative care and to identify relevant cost drivers. Two-center, standardised micro-costing approach with patient-level cost calculations and analysis of the reimbursement situation for patients receiving palliative care at two German hospitals (7/2012-12/2013). Data were analysed for the total group receiving hospital care covering, but not exclusively, palliative care (group A) and the subgroup receiving palliative care only (group B). Patient and care characteristics predictive of inpatient costs of palliative care were derived by generalised linear models and investigated by classification and regression tree analysis. Between 7/2012 and 12/2013, 2151 patients received care in the two hospitals including, but not exclusively, on the PCUs (group A). In 2013, 784 patients received care on the two PCUs only (group B). Mean total costs per case were € 7392 (SD 7897) (group A) and € 5763 (SD 3664) (group B), mean total reimbursement per case € 5155 (SD 6347) (group A) and € 4278 (SD 2194) (group B). For group A/B on the ward, 58%/67% of the overall costs and 48%/53%, 65%/82% and 64%/72% of costs for nursing, physicians and infrastructure were reimbursed, respectively. Main diagnosis did not significantly influence costs. However, duration of palliative care and total length of stay were (related to the cost calculation method) identified as significant cost drivers. Related to the cost calculation method, total length of stay and duration of palliative care were identified as significant cost drivers. In contrast, main diagnosis did not reflect costs. In addition, results show that reimbursement within the German Diagnosis-Related Groups system does not

Radon as a remedy - radiobiological and medical aspects, risk; Radon als Heilmittel - strahlenbiologische und medizinische Aspekte, Risiko

Energy Technology Data Exchange (ETDEWEB)

Schwarz, E.R.; Nuernberger, E.; Martignoni, K. [Inst. fuer Strahlenhygiene des Bundesamtes fuer Strahlenschutz, Oberschleissheim/Neuherberg (Germany)

1995-09-01

For years there have been controversial discussions about the benefit and risk of radon-balneo-therapy. This is particularly true where the inhalation of radon and its daughter products in curative galleries is concerned. Animal experiments and studies on uranium miners have clearly shown that the exposure with radon and its daughter products is connected with an additional risk for lung cancer. Findings on balneo-therapeutic mechanisms are, at best, incomplete and the topic of controversial discussions in radiobiology. This applies specifically to `hormesis` or `adaptive response`, as indicated in this context. Given the numerous reports of therapeutic results, there appear to be curative effects from radon-balneotherapy for special indications. (orig.) [Deutsch] Nutzen und Risiko der Radon-Balneotherapie werden seit Jahren widerspruechlich diskutiert. Dies gilt insbesondere fuer die Inhalation des Radons und seiner Folgeprodukte in Heilstollen. Tierversuche und Untersuchungen bei Uranbergleuten haben eindeutig gezeigt, dass mit der Exposition durch Radon und seinen Folgeprodukten ein zusaetzliches Lungenkrebsrisiko verbunden ist. Erkenntnisse zum Wirkungsmechanismus der Radon-Balneotherapie liegen allenfalls in Ansaetzen vor und werden in der Strahlenbiologie kontrovers diskutiert. Dies gilt insbesondere fuer die in diesem Zusammenhang angefuehrte `Hormesis` bzw. `Adaptive Response`. Geht man von den zahlreich berichteten therapeutischen Erfahrungen aus, so scheint es Hinweise auf Heileffekte der Radon-Balneotherapie fuer spezielle Indikationen zu geben. (orig.)

Air quality in the Netherlands. Health effects and societal cost. A brief overview for the year 2005; Luchtkwaliteit in Nederland. Gezondheidseffecten en hun maatschappelijke kosten. Een beknopt overzicht van de stand van zaken in 2005

Energy Technology Data Exchange (ETDEWEB)

Singels, M.; Klooster, J.P.G.N. [CE, Delft (Netherlands); Hoek, G. [Environmental and Occupational Health Division, Institute for Risk Assessment Sciences IRAS, Utrecht (Netherlands)

2005-09-15

An overview is given of the socio-economic effects of air pollution in the Netherlands in the year 2004. The most important conclusion is that air pollution causes between 4 and 40 billion euro damage. The damage concerns mainly respiratory diseases and mortality as a result of continued exposure to particulates and ozone. [Dutch] Een actueel overzicht wordt gegeven van de stand van de wetenschap rond de gezondheidseffecten van luchtvervuiling en de maatschappelijke die deze met zich meebrengen. De belangrijkste conclusie is dat de effecten van luchtvervuiling de maatschappij per jaar minimaal 4 miljard euro (en maximaal 40 miljard) kosten. Het grootste deel daarvan is het gevolg van vroegtijdige sterfte door langdurende blootstelling aan fijn stof. Ongeveer een kwart van dit bedrag wordt bepaald door het ontstaan of de toename van ziekten en klachten als COPD (met name chronische bronchitis), ontstekingsreacties in de luchtwegen, vermindering van longfunctie en verergering van bestaande longklachten (waaronder astma-aanvallen). Ook kortdurende blootstelling kan tot vroegtijdige sterfte en ziekte leiden. In het rapport wordt een overzicht gegeven van de meest recente onderzoeken over de gezondheidseffecten van met name fijn stof en ozon, en wordt in beeld gebracht welke stoffen en emissiebronnen van betekenis zijn voor voor de luchtkwaliteit. Met name verbrandingsprocessen (o.a. in wegverkeer en scheepvaart) zijn schadelijk voor de gezondheid. Tenslotte wordt toegelicht hoe de maatschappelijke kosten van de gezondheidseffecten berekend zijn. Essentie hierin is het uitdrukken van een verloren levensjaar (ofwel de vermindering van een gezonde levensduurverwachting) in termen van geld.

Comparative investigation of conventional and R744 auxiliary heating systems in motor cars with low fuel consumption on the basis of a 1.9 l TDI engine; Vergleich konventioneller Zuheizsysteme mit R744-Zuheizsystemen in Automobilen mit geringem Kraftstoffverbrauch auf Basis eines 1,9 l TDI Motors

Energy Technology Data Exchange (ETDEWEB)

Schaefer, B.; Feuerecker, G.; Heinle, D.; Strauss, T. [Behr GmbH und Co. KG, Stuttgart (Germany). Entwicklungszentrum

2003-07-01

1,9 I-TDI Motors durchgefuehrt. Als Simulationsinstrument wurde die bei BEHR entwickelte Software BISS (Behr Integrierte System Simulation) verwendet. Die Leistungen der Waermepumpen sind in allen Temperaturbereichen deutlich hoeher als die Leistungen konventioneller Zuheizsysteme. Der auf die Leistung bezogene Kraftstoffmehrverbrauch ist um 15% niedriger als der Kraftstoffmehrverbrauch konventioneller Zuheizsysteme. In einer Bewertung der verschiedenen Zuheizsysteme zeigt der PTC-Zuheizer das vorteilhafteste Kosten/Nutzen-Verhaeltnis. (orig.)

Graves' disease and toxic nodular goiter - radioiodine therapy; Morbus Basedow und Autonomie - Radioiodtherapie

Energy Technology Data Exchange (ETDEWEB)

Schicha, H.; Dietlein, M. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

2002-04-01

konservativ-medikamentoeser Therapieversuch ueber 1-1,5 Jahre empfohlen. Diese Arbeit zeigt Patientengruppen mit Morbus Basedow auf, fuer die bei konservativer Therapie ein erhoehtes Rezidivrisiko besteht. Unter Beruecksichtigung von Nutzen, Risiken, Kosten und Patientenkomfort ist die Radioiodtherapie die primaere Therapie der Wahl bei etwa 60-70% der Patienten mit Hyperthyreose infolge Morbus Basedow. (orig.)

Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm

Science.gov (United States)

Luo, Ai-Jing; Chang, Wei-Fu; Xin, Zi-Rui; Ling, Hao; Li, Jun-Jie; Dai, Ping-Ping; Deng, Xuan-Tong; Zhang, Lei; Li, Shao-Gang

2018-01-01

AIM To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. METHODS The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. RESULTS The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. CONCLUSION The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund. PMID:29487824

Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm.

Science.gov (United States)

Luo, Ai-Jing; Chang, Wei-Fu; Xin, Zi-Rui; Ling, Hao; Li, Jun-Jie; Dai, Ping-Ping; Deng, Xuan-Tong; Zhang, Lei; Li, Shao-Gang

2018-01-01

To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP) and build up an area-specified senile cataract diagnosis related group (DRG) of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID) model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

Diagnosis related group grouping study of senile cataract patients based on E-CHAID algorithm

Directory of Open Access Journals (Sweden)

Ai-Jing Luo

2018-02-01

Full Text Available AIM: To figure out the contributed factors of the hospitalization expenses of senile cataract patients (HECP and build up an area-specified senile cataract diagnosis related group (DRG of Shanghai thereby formulating the reference range of HECP and providing scientific basis for the fair use and supervision of the health care insurance fund. METHODS: The data was collected from the first page of the medical records of 22 097 hospitalized patients from tertiary hospitals in Shanghai from 2010 to 2012 whose major diagnosis were senile cataract. Firstly, we analyzed the influence factors of HECP using univariate and multivariate analysis. DRG grouping was conducted according to the exhaustive Chi-squared automatic interaction detector (E-CHAID model, using HECP as target variable. Finally we evaluated the grouping results using non-parametric test such as Kruskal-Wallis H test, RIV, CV, etc. RESULTS: The 6 DRGs were established as well as criterion of HECP, using age, sex, type of surgery and whether complications/comorbidities occurred as the key variables of classification node of senile cataract cases. CONCLUSION: The grouping of senile cataract cases based on E-CHAID algorithm is reasonable. And the criterion of HECP based on DRG can provide a feasible way of management in the fair use and supervision of medical insurance fund.

DRGs and Military Medicine: A Look at DRGs and Length of Stay.

Science.gov (United States)

1985-01-01

Medicine I Casemix 3 Diagnosis Related Groups 4 Utilization Review 7 Financial Analysis 7 Productivity 8 Sampling Frame for Quality Studies 9 AUTOGRP 9...posture is enhanced. CASEMIX Casemix is a term used to describe the degree of case complexity (level of care required) of specific diagnoses and the mix of...different diagnoses treated by an institution. The concept of casemix and its effect on resource consumption has been addressed at length

The use potential of aquifer thermal energy storage systems in Canada; Das Anwendungspotential fuer Aquiferwaermespeichersysteme in Kanada

Energy Technology Data Exchange (ETDEWEB)

Cruickshanks, F. [Environment Canada, Dartmouth, ON (Canada); Morofski, E. [Government Services Canada, Ottawa, ON (Canada). Technology RD and D

1994-12-31

This paper offers a brief overview of the historical and technical aspects of aquifer thermal energy storage and its use potential in commercial buildings in Canada. Aquifer thermal energy storage systems are now attractive both for new commercial buildings in Canada and for some already existing ones. This holds true especially of the Atlantic region, where fuel costs are rising and electric power rates vary according to the time of day. The simple pay-back period for ATES systems is between zero and five years. The economic aspects of the use of ATES systems in buildings are pointed out. (orig./BWI) [Deutsch] Dieser Beitrag gibt eine kurze Uebersicht der historischen und technischen Aspekte der Waermespeicherung in Aquiferen und deren Verwendungspotential in kommerziellen Gebaeuden in Kanada. Aquiferwaermespeicherungssysteme sind nunmehr attraktiv sowohl fuer neue als auch fuer manche bereits bestehenden kommerziellen Gebaeude in Kanada. Dies gilt insbesondere fuer die atlantische Region wegen der dort steigenden Kosten fuer Brennstoffe und tageszeitabhaengigen fuer elektrischen Strom. Die einfache Amortisationszeit fuer ATES-Systeme liegt zwischen null und fuenf Jahren. Die wirtschaftlichen Gesichtspunkte des Einsatzes von ATES-Systemen in kommerziellen Gebaeuden werden angefuehrt. (orig./BWI)

Casemix classification systems.

Science.gov (United States)

Fetter, R B

1999-01-01

The idea of using casemix classification to manage hospital services is not new, but has been limited by available technology. It was not until after the introduction of Medicare in the United States in 1965 that serious attempts were made to measure hospital production in order to contain spiralling costs. This resulted in a system of casemix classification known as diagnosis related groups (DRGs). This paper traces the development of DRGs and their evolution from the initial version to the All Patient Refined DRGs developed in 1991.

Speaking the same language: underestimating financial impact when using diagnosis-related group versus ICD-9-based definitions for trauma inclusion criteria.

Science.gov (United States)

Deppe, Sharon; Truax, Christopher B; Opalek, Judy M; Santanello, Steven A

2009-04-01

Hospital accounting methods use diagnosis-related group (DRG) data to identify patients and derive financial analyses and reports. The National Trauma Data Bank and trauma programs identify patients with trauma by International Classification of Diseases, Ninth Edition (ICD-9)-based definitions for inclusion criteria. These differing methods of identifying patients result in economic reports that vary significantly and fail to accurately identify the financial impact of trauma services. Routine financial data were collected for patients admitted to our Trauma Service from July 1, 2005 to June 30, 2006 using two methods of identifying the cases; by trauma DRGs and by trauma registry database inclusion criteria. The resulting data were compared and stratified to define the financial impact on hospital charges, reimbursement, costs, contribution to margin, downstream revenue, and estimated profit or loss. The results also defined the impact on supporting services, market share and total revenue from trauma admissions, return visits, discharged trauma alerts, and consultations. A total of 3,070 patients were identified by the trauma registry as meeting ICD-9 inclusion criteria. Trauma-associated DRGs accounted for 871 of the 3,070 admissions. The DRG-driven data set demonstrated an estimated profit of $800,000 dollars; the ICD-9 data set revealed an estimated 4.8 million dollar profit, increased our market share, and showed substantial revenue generated for other hospital service lines. Trauma DRGs fail to account for most trauma admissions. Financial data derived from DRG definitions significantly underestimate the trauma service line's financial contribution to hospital economics. Accurately identifying patients with trauma based on trauma database inclusion criteria better defines the business of trauma.

Economic aspects of adaptation to the climate change. Bibliographic study on the cost and benefits of adaptation measures to cope with global climate change; Oekonomische Aspekte der Anpassung an den Klimawandel. Literaturauswertung zu Kosten und Nutzen von Anpassungsmassnahmen an den Klimawandel

Energy Technology Data Exchange (ETDEWEB)

Troeltzsch, Jenny; Goerlach, Benjamin [Ecologic gGmbH Institut fuer Internationale und Europaeische Umweltpolitik, Berlin (Germany); Lueckge, Helen; Peter, Martin [INFRAS - Forschung und Beratung, Zuerich (Switzerland); Sartorius, Christian [Fraunhofer-Institut fuer System- und Innovationsforschung (ISI), Karlsruhe (Germany)

2011-09-15

Measures for adaptation to the global climate change are a comparatively recent but highly complex field of economic investigation. Adaptation measures differ in many respects from measures to prevent emissions of greenhouse gases, and these differences are reflected in the methodology of economic analyses. For example, the evaluation of adaptation measures tends to depend more strongly on a concrete regional and time context. On the other hand, there is no single variable by which the effects of adaptation measures can be measured, and therefore there is no adaptation goal that is quantified (in time and volume). The contribution outlines certain aspects that have been identified as critical in the course of the process of literature compilation. This compilation does not intend to provide a final discussion of the problems inherent in an economic evaluation of adaptation measures; rather, it points out certain aspects that are relevant for understanding the available fields of action. (orig./RHM)

Focus groups in organizational research

Directory of Open Access Journals (Sweden)

L. Kamfer

1989-05-01

Full Text Available Focus groups are commonly used in marketing research. In this article an application of the focus group technique within an organizational context is described. Nine focus groups were conducted during the planning stage of a survey intended to establish employee perceptions of advancement policies and practices in a major South African manufacturing company. Fourteen themes emerged from a content analysis of the discussions. Two of these reflected aspects requiring commitment decisions from management toward the survey. The others indicated areas of concern which should be included in the survey. In this way, the focus groups contributed useful information for the subsequent sample survey. Opsomming Fokusgroepe word algemeen in bemarkingsnavorsing aangewend. In hierdie studie word 'n toepassingvan die fokusgroeptegniek in die konteks van 'n opname binne 'n organisasie beskryf. Nege fokusgroepbesprekings is gevoer tydens die beplanningstadium van 'n opname wat binne 'n Suid-Afrikaanse vervaardigingsonderneming gedoen is. Die doel van die opname was om die persepsies van werknemers teenoor die bestaande personeel- en bestuursontwikkelingsbeleid en -praktyke van die maatskappy te bepaal. Veertien temas is deur middel van 'n inhoudontleding gei'dentifiseer. Twee hiervan het aspekte aangedui waaroor bestuur beginselbesluite t.o.v. die opname sou moes neem. Die ander het probleemareas aangedui wat by die ondersoek selfingesluit behoort te word. Sodoende het die fokusgroepe inligting verskafwat vir die latere vraelysopname belangrik was.

[Costs of appendicitis treatment by diagnosis-related groups in a third-level pediatric hospital].

Science.gov (United States)

Tlacuilo-Parra, Alberto; Hernández-Hernández, Araceli; Venegas-Dávalos, Martha; Gutiérrez-Hermosillo, Violeta; Guevara-Gutiérrez, Elizabeth; Ambriz-González, Gabriela

2014-01-01

Diagnosis-related groups (DRGs) are widely used in Europe. They allow performing comparisons in hospitals and incurrent hospital payment systems, defining the payment categories. We undertook this study to classify children who underwent appendectomy according to DRGs. Cross-sectional study. Comorbidities, length of hospitalization, histopathologic classification, and DRG classifications were analyzed. We included 313 patients, 62% males, with an average age of 8 ± 3 years; 91% were referred by another hospital and 67% were treated at night. Average length of hospitalization was 4 ± 3 days. There were comorbidities in 8% and surgical complications in 11%. According to histopathology, appendicitis was edematous (11%), suppurative (36%), gangrenous (22%), perforated (29%), and abscessed (2%). At discharge, 97% of the patients were healthy. Total cost for DRG 343 was $10,470,173.00 (Mexican pesos), DRG 342 was $1,227,592.00 and DRG 340 was $511,521.00. The global amount was $12,209,286.00 (Mexican pesos). The unitary cost for treatment of appendectomy for DRG 343 was $37,935.00, for DRG 342 was $49,103.00 and for DRG 340 was $42,626.00 (Mexican pesos). Because 88% of the cases of appendicitis were uncomplicated, this amount of money could be spent to treat these patients in a second-level hospital, using reimbursement 343 without generating additional expenses.

What is sauce for the goose is sauce for the gander. Plea of Transport and Logistics Netherlands for a practical and transparent system to calculate societal cost in the transportation sector in order to realize governmental targets for equal treatment of means of transportation; Gelijke monniken, gelijke kappen. Pleidooi van Transport en Logistiek Nederland voor een praktisch en transparant systeem van doorberekening van maatschappelijke kosten in de transportsector om overheidsdoelstellingen te halen bij gelijke behandeling van vervoerswijzen

Energy Technology Data Exchange (ETDEWEB)

Ohm, R.; Poppink, P. (eds.)

2002-07-01

; Application requires a set of measures. [Dutch] Dit rapport verdiept zich in de maatschappelijke kosten van het goederentransport voor de Nederlandse samenleving in 2002. TLN borduurt daarbij voort op het rapport 'Efficiente prijzen voor het verkeer' (1999), dat CE in opdracht van het Ministerie van Verkeer en Waterstaat heeft geschreven. Met dit rapport wil TLN een constructieve bijdrage leveren aan de uitwerking van de Witboeken 'Fair payment for infrastructure use' (1998) en 'European transport policy for 2010, Time to decide' (2001) van de Europese Commissie, en de Nederlandse discussies op het punt van de internalisering van de maatschappelijke kosten. Met 'Gelijke monniken, gelijke kappen' is zoveel mogelijk gezocht naar de achterkant van het gelijk en niet naar de uitvergroting van de verschillen tussen de diverse vervoerswijzen. Uiteindelijk gaat het er om dat de transportsector als geheel zijn belangrijke rol voor de samenleving duurzaam kan vervullen, tegen zo laag mogelijke maatschappelijke kosten. Om dat doel te bereiken dienen alle vervoerswijzen gelijk behandeld te worden en de overheid de transportsector via het systeem van heffingen prikkels te geven de marginale maatschappelijke kosten te internaliseren. Daar waar dat niet lukt, zal de overheid de opbrengsten van heffingen ten goede moeten laten komen aan het doel waarvoor ze worden geheven, t.w. bereikbaarheid, leefbaarheid en veiligheid. De volgende punten komen aan de orde:Marginale kosten per definitie kosten van duurste maatregel om doel te bereiken; Geen enkele vervoerswijze betaalt alle marginale kosten; Transportkosten stijgen minste bij wegvervoer en meeste bij binnenvaart; Markt verandert qua modal split, werkgelegenheid en havenoverslag; Marktmodel of overheidsmodel?; Overheidsmodel zorgt voor zwaardere lasten voor spoor en binnenvaart; Onbetaalde rekening valt in praktijk lager uit dan in theorie; Wensen van bedrijfsleven en samenleving zijn door politiek te

Cholecystectomy and Diagnosis-Related Groups (DRGs): Patient Classification and Hospital Reimbursement in 11 European Countries

OpenAIRE

Gerli Paat-Ahi; Ain Aaviksoo; Maria Świderek

2014-01-01

Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectom...

Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries

OpenAIRE

Quentin, Wilm; Scheller-Kreinsen, David; Geissler, Alexander; Busse, Reinhard

2012-01-01

Background As part of the EuroDRG project, researchers from 11 countries (i.e., Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their diagnosis-related groups (DRG) systems deal with appendectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a diagnosis of appendicitis treated with a procedure ...

Diagnosis-Related Groups (DRG and Hospital Business Performance Management

Directory of Open Access Journals (Sweden)

Szynkiewicz Piotr

2014-12-01

Full Text Available The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.

Lower cost, more comfort. Simulation software for interactive building sessions; Lagere kosten, meer comfort. Simulatiesoftware maakt weg vrij voor interactieve bouwsessies Steeds meer opdrachtgevers en projectontwikkelaars realiseren zich dat de levensduurkosten van een gebouw een veelvoud van de investering kunnen zijn. Om beslissingen te kunnen nemen die deze kosten kunnen bemvloeden is het belangrijk om al in de ontwerpfase met het complete (bouw)team verschillende alternatieven door te rekenen. Een gebouwsi- mulatiesysteem kan hierbij uitkomst bieden.

Energy Technology Data Exchange (ETDEWEB)

Lankhoorn, B. [Schouten Techniek, Zwaag (Netherlands)

2012-12-15

More and more clients and project developers realize that the life cycle cost of a building can be a multiple of the investment. To be able to make the right decision to lower the cost it is important to calculate different alternatives already in the design phase with the complete (construction) team. A building simulation system can be the solution [Dutch] Steeds meer opdrachtgevers en projectontwikkelaars realiseren zich dat de levensduurkosten van een gebouw een veelvoud van de investering kunnen zijn. Om beslissingen te kunnen nemen die deze kosten kunnen bemvloeden is het belangrijk om al in de ontwerpfase met het complete (bouw)team verschillende alternatieven door te rekenen. Een gebouwsi- mulatiesysteem kan hierbij uitkomst bieden.

Health Professionals Information for Diagnostics Related Groups (DRGs) with the Use of a Website.

Science.gov (United States)

Mpizopoulou, Katerina; Mpizopoulou, Zoe; Magita, Andrianna; Mechili, Aggelos E; Diomidous, Marianna; Mantas, John

2015-01-01

In recent years the costs of hospital care in developed countries absorbed a high proportion of total health resources. In Greece, after the establishment of the National Health System (NHS), funding for hospitals comes mainly from the state budget, and social insurance, therefore auditing of hospital cost is imperative to ensure their viability, especially at this time when the country is tested by economic crisis. Overtime many factors for the increase of hospital cost have been mentioned, such as the rapid development of medical technology, the low level of organization of the hospital system and the low productivity of human resources. The problem of rising health expenditure over the past decades is a worldwide phenomenon and it has brought about many changes in traditional retrospective methods for financing in the hospital sector, with prospective financial forms that combine patient composition and needs, and the productive activity of hospital need to the rationalization and contain expenditures. The system of Diagnosis Related Groups was a revolutionary success over the past decades and has now achieved worldwide recognition.

Determining the effects of patient casemix on length of hospital stay: a proportional hazards frailty model approach.

Science.gov (United States)

Lee, A H; Yau, K K

2001-01-01

To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs). A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs. Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients. The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.

The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

Science.gov (United States)

Antioch, Kathryn M; Walsh, Michael K

2004-06-01

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

Cost benefit analysis of energy conservation measures on the motor car traffic sector. Nutzen-Kosten-Analyse fuer Energiesparmassnahmen auf dem Sektor Kraftwagenverkehr

Energy Technology Data Exchange (ETDEWEB)

Bruner-Newton, I.; Lenz, H.P.; Vecernik, P.; Biberschick, D.; Wailzer, F.

1981-01-01

The book consists of 6 chapters and an introduction. The following subjects are discussed: Chapter 2: Search for relevant publications. Chapter 3: Austria's energy situation and its influence on individual motor car traffic. Chapter 4: Ways to reduce fuel consumption. Chapter 5: Cost benefit analyses. Chapter 6: Evaluation of the possible energy conservation measures.

DEGAM-Leitlinien als App für Mobiltelefone – Einsatz, Anregungen und Nutzen für den Lernprozess von Studierenden im Fach Allgemeinmedizin [Smartphone Application of Primary Care Guidelines used in Education of Medical Students

Directory of Open Access Journals (Sweden)

Waldmann, Uta-Maria

2013-02-01

Full Text Available [english] Background and Objective: The guidelines of the German College of General Practitioners and Family Physicians (DEGAM on frequent and important reasons for encounter in Primary Care play a central role in the teaching of Family Medicine. They were edited by the authors into an app for mobile phones, making them available at all times to General Practitioners and medical students. This study examines the issue: how useful do students consider this application within their learning process in Family Medicine? Method: The short versions of the 15 DEGAM guidelines were processed as a web app (for all smartphone software systems including offline utilisation, and offered to students in the Family Medicine course, during clinical attachments in General Practice, on elective compulsory courses or for their final year rotation in General Practice. The evaluation was made with a structured survey using the feedback function of the Moodle learning management system [] with Likert scales and free-text comments. Results: Feedback for evaluation came from 14 (25% of the student testers from the Family Medicine course (9, the clinical attachment in General Practice (1, the final year rotation in General Practice (1 and elective compulsory courses (4. Students rated the app as an additional benefit to the printed/pdf-form. They use it frequently and successfully during waiting periods and before, during, or after lectures. In addition to general interest and a desire to become acquainted with the guidelines and to learn, the app is consulted with regard to general (theoretical questions, rather than in connection with contact with patients. Interest in and knowledge of the guidelines is stimulated by the app, and on the whole the application can be said to be well suited to the needs of this user group. Discussion: The students evaluated the guidelines app positively: as a modern way of familiarising them with the guidelines and expanding their

Cost-benefit analysis of stricter emission ceilings for air pollutants. National evaluation for the revision of the Gothenburg Protocol; Kosten en baten van strengere emissieplafonds voor luchtverontreinigende stoffen. Nationale evaluatie voor de herziening van het Gothenburg Protocol

Energy Technology Data Exchange (ETDEWEB)

Smeets, W.

2012-06-15

The Netherlands experiences high benefits of strict European emission targets for air pollutants. The Dutch live longer and are healthier because of extra emission reductions. In addition, damage to nature decreases. This emerges from a cost-benefit analysis of a number of possible variants for tightening emission targets by 2020 in the context of the revision of the Gothenburg Protocol [Dutch] Nederland ondervindt hoge baten van strenge Europese emissiedoelen voor luchtverontreinigende stoffen. Nederlanders leven langer en gezonder door extra emissiereducties. Daarnaast neemt de schade aan de natuur af. Dit blijkt uit een kosten-batenanalyse van een aantal mogelijke varianten voor aanscherping van emissiedoelen per 2020 in het kader van de herziening van het Gothenburg protocol.

Evaluation eines neuen Mentoring-Programms für Medizinstudierende in der hausärztlichen Grundversorgung: Erfahrungen von Studierenden und Lehrärzten [Evaluation of a new undergraduate mentoring program in general practitioners' offices: experiences of students and mentors

Directory of Open Access Journals (Sweden)

Feller, Sabine

2010-05-01

Full Text Available [english] Purpose: In this study we conducted a formative evaluation of a new mentoring program in ambulatory primary care for undergraduate medical students. The objectives were Methods: In the first year of the implementation, 1 and 3 year students completed eight half days in a GP's office; 4 year students completed a three-week block. Students were supervised in a one-to-one mentoring format. Students and their mentors completed a questionnaire one year after implementation of the program. Quantitative and qualitative data were analyzed. Results: Ninety percent of the students and 98% of the GPs were highly satisfied with the new program. The positive aspects that contributed to a high acceptance of the program were the opportunity to arrange flexible mentoring dates over the year, a good integration of students with the practical work of the GPs, the real context of care, high motivation on the part of the participants, the one-to-one teaching format, the definition of clear learning objectives, and the rewarding of teaching by the faculty. Both groups were of the opinion that the benefit for 3 and 4 year students was higher than that for 1 year students. Weak points of the clerkships were the limited teaching time of the mentors and to some extent a lack of regular and timely feedback to the students. Conclusions: In this study we identified factors that contributed to high satisfaction among the participants with the new clerkships. These factors may help curriculum planners in the development of educational programs in the field of ambulatory primary care. Important aspects for the continuing education of teachers and measures to enhance the program are proposed. The benefits for students of early patient contact are discussed. [german] Zielsetzung: In dieser Studie haben wir die Einführungsphase eines neuen Mentoring-Programms für Medizinstudierende in der hausärztlichen Grundversorgung evaluiert. Es sollten folgende Aspekte

Explaining resource consumption among non-normal neonates

Science.gov (United States)

Schwartz, Rachel M.; Michelman, Thomas; Pezzullo, John; Phibbs, Ciaran S.

1991-01-01

The adoption by Medicare in 1983 of prospective payment using diagnosis-related groups (DRGs) has stimulated research to develop case-mix grouping schemes that more accurately predict resource consumption by patients. In this article, the authors explore a new method designed to improve case-mix classification for newborns through the use of birth weight in combination with DRGs to adjust the unexplained case-mix severity. Although the findings are developmental in nature, they reveal that the model significantly improves our ability to explain resource use. PMID:10122360

ISSLS PRIZE IN BASIC SCIENCE 2018: Growth differentiation factor-6 attenuated pro-inflammatory molecular changes in the rabbit anular-puncture model and degenerated disc-induced pain generation in the rat xenograft radiculopathy model.

Science.gov (United States)

Miyazaki, Shingo; Diwan, Ashish D; Kato, Kenji; Cheng, Kevin; Bae, Won C; Sun, Yang; Yamada, Junichi; Muehleman, Carol; Lenz, Mary E; Inoue, Nozomu; Sah, Robert L; Kawakami, Mamoru; Masuda, Koichi

2018-04-01

To elucidate the effects of growth differentiation factor-6 (GDF6) on: (i) gene expression of inflammatory/pain-related molecules and structural integrity in the rabbit intervertebral disc (IVD) degeneration model, and (ii) sensory dysfunction and changes in pain-marker expression in dorsal nerve ganglia (DRGs) in the rat xenograft radiculopathy model. Forty-six adolescent rabbits received anular-puncture in two non-consecutive lumbar IVDs. Four weeks later, phosphate-buffered saline (PBS) or GDF6 (1, 10 or 100 µg) was injected into the nucleus pulposus (NP) of punctured discs and followed for 4 weeks for gene expression analysis and 12 weeks for structural analyses. For pain assessment, eight rabbits were sacrificed at 4 weeks post-injection and NP tissues of injected discs were transplanted onto L5 DRGs of 16 nude rats to examine mechanical allodynia. The rat DRGs were analyzed immunohistochemically. In GDF6-treated rabbit NPs, gene expressions of interleukin-6, tumor necrosis factor-α, vascular endothelial growth factor, prostaglandin-endoperoxide synthase 2, and nerve growth factor were significantly lower than those in the PBS group. GDF6 injections resulted in partial restoration of disc height and improvement of MRI disc degeneration grades with statistical significance in rabbit structural analyses. Allodynia induced by xenograft transplantation of rabbit degenerated NPs onto rat DRGs was significantly reduced by GDF6 injection. Staining intensities for ionized calcium-binding adaptor molecule-1 and calcitonin gene-related peptide in rat DRGs of the GDF6 group were significantly lower than those of the PBS group. GDF6 injection may change the pathological status of degenerative discs and attenuate degenerated IVD-induced pain.

Utility of coronal oblique slices in cervical spine MRI. Improved detection of the neuroforamina; Nutzen der halbkoronaren Schichtung im MRT der Halswirbelsaeule. Verbesserte Erkennbarkeit von Neuroforamina

Energy Technology Data Exchange (ETDEWEB)

Freund, W.; Hoepner, G. [Universitaetskliniken Ulm, Klinik fuer Diagnostische und Interventionelle Radiologie, Ulm (Germany); Klessinger, S. [Nova Clinic Biberach, Neurochirurgie, Biberach (Germany); Universitaetskliniken Ulm, Neurochirurgie, Ulm (Germany); Mueller, M. [Universitaetskliniken Ulm, Klinik fuer Diagnostische und Interventionelle Radiologie, Ulm (Germany); Universitaetskliniken Aachen, Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Halatsch, M.E. [Universitaetskliniken Ulm, Neurochirurgie, Ulm (Germany); Weber, F. [Bundeswehrkrankenhaus Ulm, Neurologie, Ulm (Germany); Schmitz, B. [Universitaetskliniken Ulm, Neuroradiologie, Ulm (Germany)

2015-11-15

Angulated projections are standard in conventional radiography of the cervical spine, but rarely used in magnetic resonance imaging (MRI). As neuroforaminal pathology plays an important role in the etiology of radicular syndromes and may influence an operative approach, the utility of coronal oblique slices in MRI is explored. In a retrospective setting, 25 consecutive patients with neurologically diagnosed cervical monoradiculopathy were identified. T2-weighted sagittal, coronal oblique, and transversal slice orientations were anonymized. Two radiologists and two neurosurgeons independently assessed the cases. Criteria were site, cause, and grading of the neuroforaminal stenosis and the level of confidence on a 100-point visual analog scale (VAS). We computed interrater agreement, sensitivity, and t tests. Using only one slice orientation, the sensitivity in detecting the relevant neuroforamen was 0.40 for transversal, 0.68 for sagittal, and 0.64 for coronal oblique scans. A combination of the different angulations increased sensitivity and in 4 cases only the coronal oblique scans proved diagnostic. The readers felt significantly more confident in attributing the cause of the pathology on coronal oblique planes (a mean of 72 VAS points, p = 0.0003 vs 58 (sagittal) vs 64 (transversal)). Interrater agreement was significantly better for experienced (kappa 0. 48) than for inexperienced readers (0.32, p = 0.02). Adding coronal oblique planes in cervical spine MRI increases sensitivity and confidence in attributing the cause of neuroforaminal pathology. They are regarded as useful by all the readers. (orig.) [German] Im Gegensatz zur Magnetresonanztomographie (MRT) sind in der konventionellen Roentgendiagnostik der Halswirbelsaeule (HWS) Schraegaufnahmen Standard. Da neuroforaminale Pathologien wichtige Ursachen von radikulaeren Syndromen sind und die Operationstechnik moeglicherweise beeinflussen, wird der Nutzen halbkoronarer Schichten in der MRT untersucht. In

An evaluation of a model for the systematic documentation of hospital based health promotion activities: results from a multicentre study

DEFF Research Database (Denmark)

Tønnesen, Hanne; Christensen, Mette E; Groene, Oliver

2007-01-01

The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records and in pat......The first step of handling health promotion (HP) in Diagnosis Related Groups (DRGs) is a systematic documentation and registration of the activities in the medical records. So far the possibility and tradition for systematic registration of clinical HP activities in the medical records...

Kostenproblem Harninkontinenz

Directory of Open Access Journals (Sweden)

Füsgen I

1998-01-01

Full Text Available Harninkontinenz ist verbunden mit körperlichen Beeinträchtigungen, psychosozialen Problemen und ökonomischen Kosten. Diese Belastungen für den Betroffenen, aber auch für die Gesellschaft beinhalten erhebliche "Kosten", die bisher viel zu wenig untersucht und dargestellt wurden. Die Dimension des Kostenproblems übersteigt bereits bei Teilerfassungen alle Vorstellungen. Dabei stellen aufgrund der hohen Tabuisierung der Inkontinenz diese Teilerfassungen wiederum nur Teilkosten dar. Von Bedeutung für die Beeinflussung der Kosten sind ohne Zweifel erfolgreiche Diagnostik und Therapie. Die Qualität der eingesetzten Hilfsmittel beinhaltet ebenfalls eine mögliche Beeinflussung der Kosten. Studien zur Kostenerfassung der Inkontinenzproblematik sind bei der vermuteten bzw. angedeuteten Größenordnung dringlich notwendig.

An intelligent utilization of the facettes of IT outsourcing - About costs and use of outsourcing in the branch of energy economy; Facetten des IT-Outsourcings intelligent nutzen - Ueber Kosten und Nutzen des Outsourcings in der Engergiewirtschaftsbranche

Energy Technology Data Exchange (ETDEWEB)

Koehler-Schute, Christiana (ed.)

2008-07-01

The restructuring of the German energy economy is connected with an enormous expenditure of know-how and substantial financial investments. Under this aspect, the book under consideration wants to suggest decision-makers in companies to include options to the outsourcing into their strategic considerations. Additionally, information for their decision preparation is to give to the decision-makers. The book contains the following contributions: (a) Information technology (IT) as business drivers in public utilities of the future (Holger Bonk, Wolfgang Herbers); (b) Smart outsourcing as creation of value factor (Ulrich Czubayko, Anke Schaefer); (c) From the web service to the full outsourcing in the energy market - an overview for decision making Make-or-Buy (Alexander-Ivo Franz); (d) Outsourcing in the energy industry from view of Siemens IT Solutions and services (Josef Kapp); (e) Consumption accounting, energy data management, customer data administration and data exchange from one hand: A standardised ASP solution offers data management from one hand (Mario Strauss, Kristina Seifert); (f) Smart of Metering systems, AMM and reading of the meter successfully outsourcen (Ralf Hoffmann, Simon Loeffler); (g) Contract design with the outsourcing with special consideration of the BPO and IT-outsourcing (Thomas Soebbing).

Toxicological and industrial-medical aspects of exposure to dichloromethane and other aliphatic halocarbons; Toxikologische und arbeitsmedizinische Aspekte der Exposition gegenueber Dichlormethan und anderen aliphatischen Halogenkohlenwasserstoffen

Energy Technology Data Exchange (ETDEWEB)

Pankow, D. [ed.] [Halle-Wittenberg Univ., Halle (Germany). Inst. fuer Pharmakologie und Toxikologie; Verkoyen, C. [ed.] [Deutsche Forschungsanstalt fuer Luft- und Raumfahrt e.V. (DLR), Bonn (Germany). Projekttraegerschaften fuer Arbeit, Umwelt und Gesundheit; Wolna, P. [ed.] [Halle-Wittenberg Univ., Halle (Germany). Inst. fuer Pharmakologie und Toxikologie; Wuenscher, U. [ed.] [Halle-Wittenberg Univ., Halle (Germany). Inst. fuer Pharmakologie und Toxikologie

1993-12-31

The present volume is based on contributions to the workshop on ``Toxicological and industrial-medical aspects of exposure to dichloromethane and other aliphatic halocarbons`` which took place in Halle (Saale) on 25 November 1993. The purpose of the master project was to examine by animal experiment the effects of certain noxions factors on moderate CO hypoxia and the cardiovascular system as a whole following DCM intoxication, in particular the additional uptake of solvents and drings. Another part of the project consisted in specific examinations of gene toxicity. (orig./MG) [Deutsch] Der vorliegende Berichtsband entstand aus Beitraegen eines am 25. November 1993 in Halle (Saale) stattgefundenen Workshops ``Toxikologische und arbeitsmedizinische Aspekte der Exposition gegenueber Dichlormethan und anderen aliphatischen Halogenkohlenwasserstoffen``. Das Ziel des Vorhabens bestand darin, tierexperimentell die Beeinflussung der moderaten CO-Hypoxie nach DCM-Aufnahme durch verschiedene Faktoren, insbesondere durch zusaetzliche Aufnahme von Loesungs- und Arzneimitteln zu untersuchen sowie Wirkungen auf das Herz-Kreislauf-System zu erfassen. Weiterhin erfolgten gezielte Untersuchungen zur Gentoxizitaet. (orig./MG)

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center.

Science.gov (United States)

Wu, Suo-Wei; Pan, Qi; Chen, Tong; Wei, Liang-Yu; Xuan, Yong; Wang, Qin; Li, Chao; Song, Jing-Chen

2017-07-05

With the rising incidence as well as the medical expenditure among patients with unstable angina pectoris, the research aimed to investigate the inpatient medical expenditure through the combination of diagnosis-related groups (DRGs) among patients with unstable angina pectoris in a Grade A tertiary hospital to conduct the referential standards of medical costs for the diagnosis. Single-factor analysis and multiple linear stepwise regression method were used to investigate 3933 cases between 2014 and 2016 in Beijing Hospital (China) whose main diagnosis was defined as unstable angina pectoris to determine the main factors influencing the inpatient medical expenditure, and decision tree method was adopted to establish the model of DRGs grouping combinations. The major influential factors of inpatient medical expenditure included age, operative method, therapeutic effects as well as comorbidity and complications (CCs) of the disease, and the 3933 cases were divided into ten DRGs by four factors: age, CCs, therapeutic effects, and the type of surgery with corresponding inpatient medical expenditure standards setup. Data of nonparametric test on medical costs among different groups were all significant (P angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

The clustering evolution of distant red galaxies in the GOODS-MUSIC sample

Science.gov (United States)

Grazian, A.; Fontana, A.; Moscardini, L.; Salimbeni, S.; Menci, N.; Giallongo, E.; de Santis, C.; Gallozzi, S.; Nonino, M.; Cristiani, S.; Vanzella, E.

2006-07-01

Aims.We study the clustering properties of Distant Red Galaxies (DRGs) to test whether they are the progenitors of local massive galaxies. Methods.We use the GOODS-MUSIC sample, a catalog of ~3000 Ks-selected galaxies based on VLT and HST observation of the GOODS-South field with extended multi-wavelength coverage (from 0.3 to 8~μm) and accurate estimates of the photometric redshifts to select 179 DRGs with J-Ks≥ 1.3 in an area of 135 sq. arcmin.Results.We first show that the J-Ks≥ 1.3 criterion selects a rather heterogeneous sample of galaxies, going from the targeted high-redshift luminous evolved systems, to a significant fraction of lower redshift (1mass, like groups or small galaxy clusters. Low-z DRGs, on the other hand, will likely evolve into slightly less massive field galaxies.

Physical properties of distant red galaxies in the COSMOS/UltraVISTA field

Science.gov (United States)

Ma, Zhongyang; Fang, Guanwen; Kong, Xu; Fan, Lulu

2015-10-01

We present a study on physical properties for a large distant red galaxy (DRG) sample, using the K-selected multi-band photometry catalog of the COSMOS/UltraVISTA field and the CANDELS near-infrared data. Our sample includes 4485 DRGs with (J - K)AB > 1.16 and KAB DRG morphology are consistent with our rest-frame UVJ color classification; quiescent DRGs are generally compact while star-forming DRGs tend to have extended structures. We find the star formation rate (SFR) and the stellar mass of star-forming DRGs present tight "main sequence" relations in all redshift bins. Moreover, the specific SFR (sSFR) of DRGs increases with redshift in all stellar mass bins and DRGs with higher stellar masses generally have lower sSFRs, which indicates that galaxies were much more active on average in the past, and star formation contributes more to the mass growth of low-mass galaxies than to high-mass galaxies. The infrared-derived SFR dominates the total SFR of DRGs which occupy the high-mass range, implying that the J - K color criterion effectively selects massive and dusty galaxies. DRGs with higher M* generally have redder (U - V)rest colors, and the (U - V)rest colors of DRGs become bluer at higher redshifts, suggesting high-mass galaxies have higher internal dust extinctions or older stellar ages and they evolve with time. Finally, we find that DRGs have different overlap among extremely red objects, BzK galaxies, IRAC-selected extremely red objects, and high-z ultraluminous infrared galaxies, indicating that DRGs are not a special population and they can also be selected by other color criteria.

Single or multi-repository concept? A personal contribution to the discussion of pros and cons; Ein- oder Mehr-Endlager-Konzept? Ein persoenlicher Beitrag zur Diskussion der Vor- und Nachteile

Energy Technology Data Exchange (ETDEWEB)

Closs, K.-D. [Projektraeger fuer Wassertechnologie und Entsorgung, Forschungszentrum Karlsruhe GmbH (Germany); Duphorn, K. [Christian-Albrechts-Universitaet zu Kiel (Germany); Kuehn, K. [Institut fuer Bergbau, TU Clausthal-Zellerfeld (Germany)

2002-05-01

Gruenen nach der Bundestagswahl von 1998 wurde zur Entsorgung der deutschen Kernkraftwerke ein von der bis dahin angestrebten Praxis abweichender Weg vereinbart. Unter anderem soll nur ein einziges Endlager in tiefen geologischen Formationen etwa ab dem Jahr 2030 zur Verfuegung stehen. Die Erkundung des Salzstockes Gorleben soll aufgrund bestehender Zweifel unterbrochen werden bei paralleler grundsaetzlicher Diskussion zu potenziell geeigneten Wirtsgesteinen und Standorten. Der von der Bundesregierung einberufene 'Arbeitskreis Auswahlverfahren Endlagerstandorte (AkEnd)' soll mit diesen Vorgaben wissenschaftliche Standortkriterien erarbeiten. Die Autoren, Mitglieder des AkEnd, kommen aufgrund von fachlichen Erkenntnissen sowie der historisch gewachsenen Entsorgungs- und Standortsituation in Deutschland zu dem Schluss, dass ein Mehr-Endlager-Konzept substanzielle Vorteile aufweist. Folgende Aspekte werden dafuer genannt: - Entsorgungskonzeption: Das Mehr-Endlager-Konzept bietet mit dem weit fortgeschrittenen Endlagerprojekt Konrad eindeutige Vorteile. Dies auch vor dem Hintergrund der von der oeffentlichen Hand zu bewaeltigenden Menge an Abfaellen mit vernachlaessigbarer Waermeentwicklung. - Langzeitsicherheit: Vorteile, u.a. im Hinblick auf sicherheitstechnische Aspekte bezueglich der moeglichen Kompromisse bei einem Ein-Endlager-Konzept und der moeglichen Einschraenkung der Anzahl potenzieller Standorte, liegen vor. - Nachweisverfahren: Es liegen nachweistechnische Vorteile bei Aufteilung der Abfaelle auf zwei oder mehr Endlager vor. - Kosten: Eine differenzierte Betrachtung der Kosten fuer alle endzulagernden Abfaelle deutet auf Vorteile - insbesondere fuer die oeffentliche Hand - bei einem Mehr-Endlager-Konzept hin. (orig.)

Magnetic resonance imaging of the hand in rheumatoid arthritis. New scientific insights and practical application; Magnetresonanztomographie der Hand bei rheumatoider Arthritis. Wissenschaftliche Ergebnisse und praktische Anwendung

Energy Technology Data Exchange (ETDEWEB)

Hermann, K.G.A. [Charite - Universitaetsmedizin Berlin, Institut fuer Radiologie am Campus Mitte, Berlin (Germany)

2006-05-15

Magnetic resonance imaging (MRI) is a sensitive diagnostic modality for the detection of inflammatory changes in peripheral joints. Nevertheless, the widespread clinical use of MRI in assessing patients with early rheumatoid arthritis is still hampered by the technical complexity and higher cost of MRI compared with conventional radiography. This overview summarizes the results of recent research and gives practical tips on how to perform MRI of the hands. The authors present an MR protocol for hand imaging, discuss the pros and cons of low-field MR scanners, and outline pitfalls and artifacts. The MRI changes associated with rheumatoid arthritis such as synovitis, tenosynovitis, erosions, and bone marrow edema are described including their prognostic significance. The proven facts on the validation and grading of MR changes in rheumatoid arthritis are summarized. Finally, the role of MRI in the differential diagnosis of arthritis is critically discussed. (orig.) [German] Die Magnetresonanztomographie (MRT) ist ein sensitives Verfahren zur Detektion entzuendlicher Veraenderungen der peripheren Gelenke. Den breiten Einsatz der MRT im Fruehstadium der rheumatoiden Arthritis behindern derzeit jedoch der im Vergleich zur konventionellen Roentgendiagnostik hoehere technische Aufwand und vermehrte Kosten. Diese Uebersichtsarbeit fasst wichtige Studienergebnisse zusammen und gibt praktische Hinweise fuer Hand-MRTs. Ein geeignetes Sequenzprotokoll wird vorgestellt, Vor- und Nachteile von Niederfeld-MRTs werden beruecksichtigt, moegliche Fehlerquellen und Artefakte diskutiert. Magnetresonanztomographische Befunde bei rheumatoider Arthritis wie Synovitis, Tenosynovitis, Erosionen und Knochenmarkoedeme werden beschrieben und deren prognostische Bedeutung dargestellt. Gesicherte Fakten zur Validierung und Moeglichkeiten der Graduierung MR-tomographischer Veraenderungen bei rheumatoider Arthritis werden zusammengefasst. Der Nutzen der MRT zur differenzialdiagnostischen

Ammonia regulations near nature areas in Denmark and the Netherlands compared

NARCIS (Netherlands)

Luesink, Harry; Michels, Rolf

2018-01-01

Bedrijven die binnen 400 m van Natura 2000-gebieden willen uitbreiden, maken extra kosten vergeleken met bedrijven die geen negatieve invloed hebben op natuurgebieden. Voor bedrijven in Denemarken zijn die kosten hoger dan in Nederland. Voor bedrijven die wat verder weg liggen van Natura

Smart Metering. Technological, economic and legal aspects. 2. ed.; Smart Metering. Technologische, wirtschaftliche und juristische Aspekte des Smart Metering

Energy Technology Data Exchange (ETDEWEB)

Koehler-Schute, Christiana (ed.)

2010-07-01

Smart metering comprises more than just meter technology, and the use of information and communication technologies is indispensable. Processes, roles and business models must be reconsidered as further challenges arise in the context of smart metering. For one, there is the operator of the metering points. Secondly, there is the end user who is in the role of an active market partner. Further, there is smart metering as a basic technology, e.g. for smart grids and smart homes. In spite of the need for action, many utilities are reluctant to introduce smart metering. Reasons for this are the cost, a lack of defined standards, and an unclear legal situation. On the other hand, smart metering offers potential for grids and distribution that should be made use of. The authors discuss all aspects of the subject. The point out the chances and limitations of smart metering and present their own experience. [German] Smart Metering geht weit ueber die Zaehlertechnologie hinaus und der Einsatz von Informations- und Kommunikationstechnologien ist unabdingbar. Damit einhergehend muessen Prozesse, Rollen und auch Geschaeftsmodelle neu durchdacht werden. Denn weitere Herausforderungen stehen im direkten Zusammenhang mit Smart Metering. Das ist zum einen die Rolle des Messstellenbetreibers / Messdienstleisters. Das ist zum anderen der Endnutzer, dem die Rolle des aktiven Marktpartners zugedacht wird. Das ist des Weiteren das Smart Metering als Basistechnologie beispielsweise fuer Smart Grid und Smart Home. Trotz des Handlungsdrucks stehen viele Unternehmen der Energiewirtschaft dem Smart Metering zurueckhaltend gegenueber. Drei gewichtige Gruende werden ins Feld gefuehrt: die Kostenfrage, nicht definierte Standards und die in vielen Bereichen ungeklaerte Gesetzeslage. Demgegenueber bietet das Smart Metering Potenziale fuer Netz und Vertrieb, die es zu nutzen gilt. Die Autoren setzen sich in ihren Beitraegen mit diesen Themen auseinander, zeigen Chancen, aber auch Grenzen des

Mundtørhed og fødeindtagelse

DEFF Research Database (Denmark)

Pedersen, Anne Marie Lynge; Dynesen, Anja Weirsøe

2017-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende viden om kostens betydning for diabetes mellitus (DM) og parodontal inflammation. Der er i vekslende grad dokumentation for sammenhænge mellem kost, DM og marginal parodontitis (MP). Med baggrund i forøget viden om kostens betydning...

Kost, diabetes mellitus og parodontal inflammation

DEFF Research Database (Denmark)

Damgaard, Christian; Holmstrup, Palle

2016-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende viden om kostens betydning for diabetes mellitus (DM) og parodontal inflammation. Der er i vekslende grad dokumentation for sammenhænge mellem kost, DM og marginal parodontitis (MP). Med baggrund i forøget viden om kostens betydning...

Kost, diabetes mellitus og parodontal inflammation

DEFF Research Database (Denmark)

Damgaard, Christian; Holmstrup, Palle

2017-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende viden om kostens betydning for diabetes mellitus (DM) og parodontal inflammation. Der er i vekslende grad dokumentation for sammenhænge mellem kost, DM og marginal parodontitis (MP). Med baggrund i forøget viden om kostens betydning...

Probiotika og caries

DEFF Research Database (Denmark)

Keller, Mette Kirstine

2017-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende viden om kostens betydning for diabetes mellitus (DM) og parodontal inflammation. Der er i vekslende grad dokumentation for sammenhænge mellem kost, DM og marginal parodontitis (MP). Med baggrund i forøget viden om kostens betydning...

Sukker og caries

DEFF Research Database (Denmark)

Twetman, Svante

2017-01-01

Nærværende artikel præsenterer en oversigt over den foreliggende viden om kostens betydning for diabetes mellitus (DM) og parodontal inflammation. Der er i vekslende grad dokumentation for sammenhænge mellem kost, DM og marginal parodontitis (MP). Med baggrund i forøget viden om kostens betydning...

Planning for subacute care: predicting demand using acute activity data.

Science.gov (United States)

Green, Janette P; McNamee, Jennifer P; Kobel, Conrad; Seraji, Md Habibur R; Lawrence, Suanne J

2016-01-01

Objective The aim of the present study was to develop a robust model that uses the concept of 'rehabilitation-sensitive' Diagnosis Related Groups (DRGs) in predicting demand for rehabilitation and geriatric evaluation and management (GEM) care following acute in-patient episodes provided in Australian hospitals. Methods The model was developed using statistical analyses of national datasets, informed by a panel of expert clinicians and jurisdictional advice. Logistic regression analysis was undertaken using acute in-patient data, published national hospital statistics and data from the Australasian Rehabilitation Outcomes Centre. Results The predictive model comprises tables of probabilities that patients will require rehabilitation or GEM care after an acute episode, with columns defined by age group and rows defined by grouped Australian Refined (AR)-DRGs. Conclusions The existing concept of rehabilitation-sensitive DRGs was revised and extended. When applied to national data, the model provided a conservative estimate of 83% of the activity actually provided. An example demonstrates the application of the model for service planning. What is known about the topic? Health service planning is core business for jurisdictions and local areas. With populations ageing and an acknowledgement of the underservicing of subacute care, it is timely to find improved methods of estimating demand for this type of care. Traditionally, age-sex standardised utilisation rates for individual DRGs have been applied to Australian Bureau of Statistics (ABS) population projections to predict the future need for subacute services. Improved predictions became possible when some AR-DRGs were designated 'rehabilitation-sensitive'. This improved methodology has been used in several Australian jurisdictions. What does this paper add? This paper presents a new tool, or model, to predict demand for rehabilitation and GEM services based on in-patient acute activity. In this model, the

De economische betekenis van de jacht in Nederland.

OpenAIRE

Kruyt, C.; Li, A.D.; Oskam, A.J.; Slangen, L.H.G.

1987-01-01

De economische betekenis van de 3 functies van jacht (produktie, beheer en recreatie) worden belicht. De totale kosten die de jagers ten behoeve van de jacht maken worden geschat, waarbij ook de financiele bestemming wordt aangegeven. Men schat het aantal aan jacht verbonden arbeidsplaatsen op 700. Een kosten-batenanalyse van de jacht is tevens uitgevoerd

32 CFR 199.10 - Appeal and hearing procedures.

Science.gov (United States)

2010-07-01

... diagnosis-related groups (DRGs), or the methodology for the classification of inpatient discharges within... discharges within each DRG, since each of these is established by this part. (iv) Certain other issues on the...

Die DDC auf neuen Wegen - verbale Sucheinstiege für klassifikatorisch erschlossene Titel

OpenAIRE

Christiane Maibach

2014-01-01

Die Dewey-Dezimalklassifikation (DDC) ist ein mächtiges Instrument der klassifikatorischen Inhaltserschließung. Immer mehr Bibliotheken im In- und Ausland erkennen den Nutzen der international am weitesten verbreiteten Universalklassifikation. Die Deutsche Nationalbibliothek (DNB) setzt die DDC seit 2006 für die inhaltliche Erschließung der Bibliografiereihen A, B und H ein. Seitdem wurden rund 800.000 Publikationen mit DDC-Notationen versehen. Der Nutzen von Klassifikationen ist unter Biblio...

[Seasonal distribution of clinical case codes (DOC study)].

Science.gov (United States)

von Dercks, N; Melz, R; Hepp, P; Theopold, J; Marquass, B; Josten, C

2017-02-01

The German diagnosis-related groups remuneration system (G-DRG) was implemented in 2004 and patient-related diagnoses and procedures lead to allocation to specific DRGs. This system includes several codes, such as case mix (CM), case mix index (CMI) and number of cases. Seasonal distribution of these codes as well as distribution of diagnoses and DRGs may lead to logistical consequences for clinical management. From 2004 to 2013 all the main diagnoses and DRGs for inpatients were recorded. Monthly and seasonal distributions were analyzed using ANOVA. The average monthly number of cases was 265 ± 25 cases, the average CM was 388.50 ± 51.75 and the average CMI was 1.46 ± 0.15 with no significant seasonal differences (p > 0.1). Concussion was the most frequently occurring main diagnosis (3739 cases) followed by fractures of the humeral head (699). Significant distribution differences could be shown for humeral head fractures in monthly (p = 0.018) and seasonal comparisons (p = 0.006) with a maximum in winter. Radius (p = 0.01) and ankle fractures (p ≤ 0.001) also occurred most frequently in winter. Non-bony lesions of the shoulder were significantly less in spring (p = 0.04). The DRGs showed no evidence of a monthly or seasonal clustering (p > 0.1). The significant clustering of injuries in specific months and seasons should lead to logistic consequences (e.g. operating room slots, availability of nursing and anesthesia staff). For a needs assessment the analysis of main diagnoses is more appropriate than DRGs.

What can we learn from international comparisons of costs by DRG?

Science.gov (United States)

Pirson, M; Schenker, L; Martins, D; Dung, Duong; Chalé, J J; Leclercq, P

2013-02-01

The objective of this study was to compare costs data by diagnosis related group (DRG) between Belgium and Switzerland. Our hypotheses were that differences between countries can probably be explained by methodological differences in cost calculations, by differences in medical practices and by differences in cost structures within the two countries. Classifications of DRG used in the two countries differ (AP-DRGs version 1.7 in Switzerland and APR-DRGs version 15.0 in Belgium). The first step of this study was to transform Belgian summaries into Swiss AP-DRGs. Belgian and Swiss data were calculated with a clinical costing methodology (full costing). Belgian and Swiss costs were converted into US$ PPP (purchasing power parity) in order to neutralize differences in purchasing power between countries. The results of this study showed higher costs in Switzerland despite standardization of cost data according to PPP. The difference is not explained by the case-mix index because this was similar for inliers between the two countries. The length of stay (LOS) was also quite similar for inliers between the two countries. The case-mix index was, however, higher for high outliers in Belgium, as reflected in a higher LOS for these patients. Higher costs in Switzerland are thus probably explained mainly by the higher number of agency staff by service in this country or because of differences in medical practices. It is possible to make international comparisons but only if there is standardization of the case-mix between countries and only if comparable accountancy methodologies are used. Harmonization of DRGs groups, nomenclature and accountancy is thus required.

Aspects of vulnerable patients and informed consent in clinical trials [Aspekte schutzbedürftiger Patienten sowie der Einwilligung nach Aufklärung in klinischen Prüfungen

Directory of Open Access Journals (Sweden)

Hundt, Ferdinand

2013-01-01

Full Text Available [english] Scope: To discuss the rationale behind informed consent in clinical trials focusing on vulnerable patients from a European and German viewpoint. Methods: Scientific literature search via PubMed, Medline, Google.Results: Voluntary informed consent is the cornerstone of policies regulating clinical trials. To enroll a patient into a clinical trial without having obtained written and signed consent is to be considered as a serious issue in the conduct of a clinical trial. Development of ethical guidance for physicians started before Christ Era with the Hippocratic Oath. Main function of consent, as articulated in all guidelines developed for clinical research, is to facilitate an individual’s freedom of choice, respect autonomy, and thus to ensure welfare of the participants in clinical trials. Minors are unable to provide legally binding informed consent, this issue is addressed through a combination of parental permission and minor’s assent. Illiteracy is a critical problem that affects all corners of our earth; it has no boundaries and exists among every race and ethnicity, age group, and economic class. New strategies to improve communication with patients including the use of videotapes or animated cartoon illustrations could be taught. Finally the time with the potential participant seems to be the best way to improve understanding. Conclusion: Discovery of life saving and life enhancing new treatments requires partnership that is based on good communication and trust between patients and researchers, sponsors, ethics committees, authorities, lawyers and politicians so that vulnerable patients can benefit from the results of well controlled clinical trials. [german] Ziel: Diskussion der Aspekte der Einwilligung schutzbedürftiger Patienten nach Aufklärung zur Teilnahme an klinischen Prüfungen aus europäischem und deutschem Blick.Methoden: Wissenschaftliche Literaturrecherche via PubMed, Medline und Google. Ergebnis: Das

Future of the gas industry. Energy carriers instead of power source?; Zukunft der Gaswirtschaft. Energietraeger statt Energiequelle?

Energy Technology Data Exchange (ETDEWEB)

Bothe, David; Janssen, Matthias; Riechmann, Christoph [Frontier Economics, Koeln (Germany)

2017-03-15

For a long time, natural gas was considered as an ideal bridge technology for the energy transition because of the relatively low CO{sub 2} content. With increasing decarbonisation of electricity generation by renewable energies and the associated political vision of a far-reaching electrification of energy applications, in particular in the heat sector, the gas sector is, however, threatened to be overtaken by the renewables. This creates increasing uncertainty for business models and investments in the natural gas sector itself, but also potentially high macroeconomic costs of the energy transition. It can be shown that such a development is not unavoidable if the gas sector succeeds in using the existing possibilities cleverly. Thereby the continued use of existing gas infrastructure plays a central role. For use of the opportunities, however, a paradigm shift in politics, regulation and natural gas sector is necessary, whose key points are developed in this article. [German] Lange wurde Gas aufgrund des relativ geringen C0{sub 2}-Gehalts als ideale Brueckentechnologie fuer die Energiewende gehandelt. Mit zunehmender Dekarbonisierung der Stromerzeugung durch erneuerbare Energien und der damit verbundenen politischen Vision einer weitreichenden Elektrifizierung von Energieanwendungen insbesondere im Waermesektor droht die Gaswirtschaft allerdings von den Erneuerbaren ueberholt zu werden. Das schafft zunehmende Unsicherheit fuer Geschaeftsmodelle und Investitionen im Gassektor selbst, aber auch potenziell hohe gesamtwirtschaftliche Kosten der Energiewende. Es laesst sich zeigen, dass eine solche Entwicklung nicht unabwendbar ist, wenn es der Gaswirtschaft gelingt, die vorhandenen Moeglichkeiten clever zu nutzen. Dabei spielt der fortgesetzte Gebrauch der bereits vorhandenen Gasinfrastruktur die zentrale Rolle. Zur Nutzung der Chancen ist aber ein Paradigmenwechsel in Politik, Regulierung und Gaswirtschaft notwendig, dessen Eckpunkte in diesem Artikel entwickelt

Ethik in der Medizinischen Ausbildungsforschung [Ethics in medical education research

Directory of Open Access Journals (Sweden)

Marienhagen, Jörg

2009-02-01

Anspruch auf eine ethisch orientierte Herangehensweise an Studien in der Ausbildungsforschung. Des Weiteren führt dies zu einem hohen methodischen Standard. Die Untersuchung von wissenschaftlichen Fragestellungen im Kontext der Medizinischen Ausbildung erfordert daher einen verantwortungsbewussten Umgang der Untersucher mit den Probanden und Sicherheit auf dem Gebiet der angestrebten Methodik. Dabei sollten, wie in biomedizinischen Studien verbindlich vorgeschrieben, Nutzen-Risiko-Abwägungen und Kosten-Nutzen-Analysen bereits in der Planungsphase bedacht werden, um potenziellen Schaden von den Probanden abzuwenden. Bei der Publikation der Ergebnisse sollte darauf geachtet werden, dass die Publikation Angaben zur Methode und zur Reliabilität enthält und der eingebrachte Anteil der beteiligten Autoren sichtbar wird. Die Autoren empfehlen zur Unterstützung der Forscherinnen und Forscher und zur Sicherung der Interessen aller beteiligten Gruppen eine fachgesellschaftseigene Ethikkommission einzurichten. Dies wird auch notwendig, da die führenden Publikationsmedien (Journals in der Medizinischen Ausbildungsforschung dies zunehmend voraussetzen. Die Gesellschaft für Medizinische Ausbildung ist als Fachgesellschaft aufgerufen eine entsprechende Kommission einzurichten und so die Sicherzustellung der Basisstandards sach- und fachgerecht zu begleiten.

ALIAS an innovative intranet-system for the remaining life analysis of systems and components; ALIAS - ein innovatives Intranet-System zur Restlebensdaueranalyse von Systemen und Bauteilen

Energy Technology Data Exchange (ETDEWEB)

Jovanovic, A S; Schweikhard, T [Stuttgart Univ. (Germany). Staatliche Materialpruefungsanstalt; Balos, D [Stuttgart Univ. (Germany). Staatliche Materialpruefungsanstalt; [Grosskraftwerk Mannheim AG (Germany)

1998-11-01

The paper describes an innovative and advanced system for remaining life assessment of industrial high-temperature components developed at MPA Stuttgart, Germany and being currently introduced into the power plants in Germany and in several other countries. The system is a corporate memory system, essentially meaning that all the information/knowledge of a corporation (company, institute, etc.) should be maximally exploited in future activities of the company, with minimum changes in the existing structure of the data/information/knowledge already available. The system has two main aspects of practical implementation: (a) the organizational one, represented by MPA LifeTech, and (b) the software system one represented by the ``parent systems`` WISDOM and (WISDOM - WWW-based Intelligent System for Data and Documentation Management, ALIAS - The Advanced modular intelligent Life Assessment Software System). (orig.) [Deutsch] Das Papier beschreibt ein innovatives und fortschrittliches Softwaresystem, das an der MPA Stuttgart entwickelt wurde und bei mehreren europaeischen und deutschen Kraftwerksbetreibern eingefuehrt wird. Das Konzept beruht auf der Idee von s.g. corporate memory systems mit der Zielsetzung, die gesamte Bandbreite an Informationen und Wissen eines Unternehmens (Firma, Institution usw.) fuer dessen zukuenftige Aktivitaeten optimal zu nutzen. Die bestehende Struktur der bereits vorhandenen Daten sollte dabei nur geringfuegig geaendert werden muessen. Zur praktischen Durchfuehrung des Konzepts sind zwei Aspekte von Bedeutung: die Organisation (MPA LifeTech) und das Softwaresystem bzw. Systeme WISDOM und ALIAS (WISDOM - WWW-based Intelligent System for Data and Documentation Management, ALIAS - The Advanced modular Intelligent Life Assessment Software System). (orig.)

[Cardiovascular medicine in the German diagnosis-related group--(G-DRG) system 2005].

Science.gov (United States)

Fürstenberg, T; Bunzemeier, H; Roeder, N; Reinecke, H

2005-05-01

The German diagnosis-related Group (G-DRG) System has recently been published in its third version. From 2005 on, this system will be the definite measure for the budgets of nearly all german hospitals. The preliminary phase with no budget reduction or redistribution being made and in which an inappropriate classification system had no negative impact on reimbursement has, thus, come to an end. At present, many hospitals are struggling in an economic competition about the independence or maintenance of the hospital or several sub-departments. The changes in the classification system with regard to a marked increase in the number of G DRGs, a modified grouping-logic, more properly determined reductions and extra charges for low and high outlier as well as the introduction of further additional charges contribute thereby to a better covering of services and treatments of cardiovascular patients. However, while many of the known problems have been eliminated, there are still weaknesses in the G-DRG System even concerning cardiovascular medicine. The G-DRG System has to be adapted continuously with consultation of the clinical expertise of the respective medical societies. The most important new aspects and changes in the G-DRG System 2005 and the accompanied execution regulations are explained with special view on cardiology.

Utilization of potentials - regular reduction of costs. An intelligent regulation and control of cooling furniture; Potenziale nutzen - Kosten geregelt senken. Intelligente Regelung und Steuerung von Kuehlmoebeln

Energy Technology Data Exchange (ETDEWEB)

Di Lieto, Gianluca [Wurm GmbH und Co. KG Elektronische Systeme, Remscheid (Germany). Bereich Vertrieb und Marketing

2011-02-15

The trade installs new, energy-efficient refrigerant plants and equips its salesrooms with energy-saving cooling furniture. In order to work in such a way that all potentials are exhausted an intelligent regulation and control is necessary. At the same time these systems help to fulfil legal requirements to a large extent automatically as for example with the security of food by means of a correct storage temperature (HACCP). But in the sense of a positive environmental balance, not all options are used by the users so far. They renounce savings with the energy in the two digit percent area due to an individual adjustment of the plant operation.

New trends in processing and disposal of municipal and industrial sewage sludges. 8. Joint seminar `waste water technology` with exhibitor`s forum; Neue Trends bei der Behandlung und Entsorgung kommunaler und industrieller Klaerschlaemme. Achtes gemeinsames Seminar `Abwassertechnik` mit Ausstellerforum

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-12-31

The present conference proceedings handle all aspects of sewage sludge disposal: agricultural use of sewage sludge, processing in anaerobic reactors, composting, drain, drying, gasification, combustion, economical aspects, ecological aspects, building, design and operation of modern sludge treatment plants. (SR) [Deutsch] Der vorliegende Tagungsband behandelt alle Aspekte der Klaerschlammentsorgung: landwirtschaftliche Nutzung von Klaerschlamm, Behandlung in Anaerobreaktoren, Kompostierung, Entwaesserung, Trocknung, Vergasung, Verbrennung, wirtschaftliche Aspekte, oekologische Aspekte, Bau, Ausruestung und Betrieb von modernen Schlammbehandlungsanlagen. (SR)

Morphological evaluation of lumbar dorsal root ganglion on three-dimensional magnetic resonance imaging

International Nuclear Information System (INIS)

Shen Jun; Chen Jianyu; Zhou Cuiping; Liang Biling; Xu Xiaomao

2007-01-01

Objective: To investigate the morphological features of normal lumbar dorsal root ganglia using a three-dimensional (3D) coronal MR imaging. Methods: One hundred and fifteen volunteers were included. Ages ranged from 15 to 75 years, with a mean of 40 years. Coronal 3D fast field echo (FFE) with water selective excitation (Proset) MR examination of 1150 dorsal root ganglia were underwent at nerve root levels from L1 to L5. The source coronal images were further reconstructed into a series of rotational alignment coronal images with an interval angel of 12 degree using maximum intensity projection (MIP) technique. All DRGs of bilateral spinal nerve from L1 to L5 were morphologically analyzed on the original and MIP images including qualitative evaluation of the location, signal intensity, architecture and quantitative dimensional measurement. Results: There were 225, 225, 219, 210 and 160 foraminal ganglia from L1 to L5 level, respectively. The incidence of intraspinal ganglia from L3 to L5 gradually increased with a maximum at L5 level of 29.1% (X 2 =188.371, P<0.01). One thousand one hundred and thirteen (96.8%) DRGs were intermediate intensity on MIP images. The width and length of L1 DRGs were from 2. 00 to 5.50 mm (3.38±0.77) mm, 2.00 to 7.00 mm (4.35±0.89) mm, respectively. The width and length of L5 DRGs were from 3.50 to 9.00 mm (6.40±0.91) mm, 6.00 to 19.00 mm [(11.58± 2.25) mm], respectively. There was statistically significant difference in the dimension of DRGs from L5 to L1 (F=41.527-205.998, P<0.01). In 1150 DRGs, three types of architecture of DRGs including 822 singular, 317 bi- and 11 tri-ganglion DRGs could be found with a high prevalence of the bi-ganglia in L4 and L3 DRGs and a higher incidence of the singular ganglia in the L5 and L2 and L1 DRGs. Conclusions: The normal anatomy and variant of the lumbar dorsal root ganglia could be clearly demonstrated by 3D FFE MR imaging with Proset. As the level of the nerve root traveled down caudally

[Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

Science.gov (United States)

Schütz, U; Reichel, H; Dreinhöfer, K

2007-01-01

We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

Partnervalg på film

DEFF Research Database (Denmark)

Kramer, Mette

2006-01-01

Nye kognitions- og evolutionspsykologiske aspekter på kvinders filmpræferencer for romantiske film og melodramer......Nye kognitions- og evolutionspsykologiske aspekter på kvinders filmpræferencer for romantiske film og melodramer...

[Financing of inpatient orthopedics and trauma surgery in the G-DRG system 2010].

Science.gov (United States)

Franz, D; Schemmann, F; Roeder, N; Mahlke, L

2010-08-01

The German DRG (diagnosis-related groups) system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also additional and innovation payments. This paper analyzes and evaluates the relevant developments of the G-DRG System 2010 for orthopedics and traumatology from the medical and classification perspectives. Analyses of relevant diagnoses, medical procedures and G-DRGs in the versions 2009 and 2010 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI) were carried out. The DRG catalog is has grown from 8 to 1,200 G-DRGs. A number of codes for surgical measures have been newly established or modified. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopedics and traumatology has been changed, especially in the areas of spinal surgery and surgery of the upper and lower extremities. The actual impact of the changes may vary depending on the individual hospital services. For the first time since the introduction of the G-DRG system, the pure numerical changes at the level of DRGs themselves are so marginal that only part of the DRG users in the hospitals will register them. The changes implemented not only a high selectivity between complex and less complex scenarios, but partly also unintended and unjustified revaluation of less complex measures. The G-DRG system has gained complexity again. Especially the G-DRG allocation of spinal surgery and multiple surgical interventions of the upper and/or lower extremities have reached such a complexity that only a few DRG users can follow them.

"Bending the cost curve" in gastroenterology.

Science.gov (United States)

Slattery, E; Harewood, G C; Murray, F; Patchett, S

2013-12-01

Increasing attention is being focused on reigning in escalating costs of healthcare, i.e. trying to 'bend the cost curve'. In gastroenterology (GI), inpatient hospital care represents a major component of overall costs. This study aimed to characterize the trend in cost of care for GI-related hospitalizations in recent years and to identify the most costly diagnostic groups. All hospital inpatients admitted between January 2008 and December 2009 with a primary diagnosis of one of the six most common GI-related Diagnosis Related Groups (DRGs) in this hospital system were identified; all DRGs contained at least 40 patients during the study period. Patient Level Costing (PLC) was used to express the total cost of hospital care for each patient; PLC comprised a weighted daily bed cost plus cost of all medical services provided (e.g., radiology, pathology tests) calculated according to an activity-based costing approach; cost of medications were excluded. All costs were discounted to 2009 values. Mean length of stay (LOS) was also calculated for each DRG. Over 2 years, 470 patients were admitted with one of the six most common GI DRGs. Mean cost of care increased from 2008 to 2009 for all six DRGs with the steepest increases seen in 'GI hemorrhage (non-complex)' (31 % increase) and 'Cirrhosis/Alcoholic hepatitis (non-complex)' (45 % increase). No differences in readmission rates were observed over time. There was a strong correlation between year-to-year change in costs and change in mean LOS, r = 0.93. The cost of GI-related inpatient care appears to be increasing in recent years with the steepest increases observed in non-complex GI hemorrhage and non-complex Cirrhosis/Alcoholic hepatitis. Efforts to control the increasing costs should focus on these diagnostic categories.

A Study to Develop a Model for the Allocation of Medical Supply Funds to the Various Clinical Services at Keller Army Community Hospital Based Upon Inpatient Weighted Units and Ambulatory Weighted Units

Science.gov (United States)

1989-05-11

zDiagnosis Related Groups (DRGs), as developed by ther Mz researchers at Yale University in the late 1960s, were a m mmeans of classifying patients by...the group’s recalibration of the Rickard 19 ambulatory portion of the HCU was most important. This was because it resulted in, "an ambulatory

75 FR 60417 - Proposed Collection; Comment Request

Science.gov (United States)

2010-09-30

...-related groups (DRGs). The CHAMPUS DRG-based payment system, except for children's hospitals (whose.../CHAMPUS DRG-based payment system is modeled on the Medicare Prospective Payment System (PPS) and was... instructions for submitting comments. Mail: Federal Docket Management System Office, 1160 Defense Pentagon...

Influence of waste managemental and technical planning parameters on plant costs; Einfluss abfallwirtschaftlicher und technischer Plannungsgroessen auf die Anlagenkosten

Energy Technology Data Exchange (ETDEWEB)

Beckmann, R. [Inst. fuer Umwelt, Sicherheits- und Energietechnik e.V., Oberhausen (Germany)

1998-09-01

The probable future costs of thermal waste treatment depend on a great number of influencing factors. One of the essential aims of the present contribution is to elaborate and present the sensitivity of costs to various parameters. [Deutsch] Die zukuenftig zu erwartenden Kosten der thermischen Abfallbehandlung haengen von einer Vielzahl von Einflussgroessen ab. Im Rahmen des Beitrags besteht daher ein wesentliches Ziel darin, die Sensitivitaet der Kosten hinsichtlich verschiedenster Parameter herauszuarbeiten und darzustellen. (orig./SR)

Sport og medierettigheder

DEFF Research Database (Denmark)

Jakobsen, Søren Sandfeld

2014-01-01

Kapitlet behandler en række medie-, immaterial- og konkurrenceretlige aspekter ved overdragelse af tv-rettigheder til store sportsbegivenheder.......Kapitlet behandler en række medie-, immaterial- og konkurrenceretlige aspekter ved overdragelse af tv-rettigheder til store sportsbegivenheder....

Pravni aspekti gradnje i isporuke broda

Directory of Open Access Journals (Sweden)

Zoran Tasić

2014-12-01

Full Text Available Autor iznosi neke pravne aspekte gradnje i isporuke broda, osvrćući se pri tome ne samo na neke aspekte hrvatskoga prava, već i na prisustvo engleskoga prava u ugovorima o gradnji broda kako hrvatskih, tako i svjetskih brodogradilišta. Mada se radi o izuzetno složenoj pravnoj problematici, autor nastoji približiti neke od bitnih odredaba ugovora o gradnji broda, temeljna prava i obveze ugovornih strana, posljedice neispunjenja ugovornih obveza, pravne aspekte isporuke broda, ulogu klasifikacijskih društava.

[Evaluation of the appropriateness of hospital admissions using the iso-gravity classification systems APR-DRG and Disease Staging and the Italian version of Appropriateness Evaluation Protocol (AEP)].

Science.gov (United States)

D'Andrea, G; Capalbo, G; Volpe, M; Marchetti, M; Vicentini, F; Capelli, G; Cambieri, A; Cicchetti, A; Ricciardi, G; Catananti, C

2006-01-01

Our main purpose was to evaluate the organizational appropriateness of admissions made in a university hospital, by comparing two iso-gravity classification systems, APR-DRG and Disease Staging, with the Italian version of AEP (PRUO). Our analysis focused on admissions made in 2001, related to specific Diagnosis Related Groups (DRGs), which, according an Italian Law, would be considered at high risk of inappropriateness, if treated as ordinary admissions. The results obtained by using the 2 classification systems did not show statistically significant differences with respect to the total number of admissions. On the other hand, some DRGs showed statistically significant differences due to different algorithms of attribution of the severity levels used by the two systems. For almost all of the DRGs studied, the AEP-based analysis of a sample of medical records showed an higher number of inappropriate admissions in comparison with the number expected by iso-gravity classification methods. The difference is possibly due to the percentage limits of tolerability fixed by the Law for each DRG. Therefore, the authors suggest an integrated use of the two methods to evaluate organizational appropriateness of hospital admissions.

Specialty-specific admission: a cost-effective intervention?

LENUS (Irish Health Repository)

Slattery, E

2012-02-01

INTRODUCTION: Cost effectiveness of healthcare has become an important component in its delivery. Current practices need to be assessed and measured for variations that may lead to financial savings. Speciality specific admission is known not only to lead improved clinical outcomes but also to lead important cost reductions. METHODS: All patients admitted to an Irish teaching hospital via the emergency department over a 2-year period with a gastroenterology (GI) related illness were included in this analysis.GI illness was classified using the Disease related grouping (DRG) system. Mean length of stay (LOS) and patient level costing (PLC) were calculated. Differences between DRGs with respect to speciality (i.e. specialist vs. non-specialist) were calculated for the five commonest DRGs. RESULTS: Significant variations in LOS and PLC were demonstrated in the DRGs. Mean LOS varied with increasing complexity, from 3.2 days for non-complex GI haemorrhage to 14.4 days for complex alcohol related cirrhosis as expected. A substantial difference in LOS within DRG groups was demonstrated by large standard deviations in the mean (up to 8.1 days in some groups) and was independent of complexity of cases. PLC also varied widely in both complex and non-complex cases with standard deviations of up to 17,342 noted. Specialty-specific admission was associated with shorter LOS for most GI admissions. CONCLUSION: Significant disparity exists for both LOS and PLC for most GI diagnoses. Specialty-specific admissions are associated with reduced LOS. Specialty-specific admission would appear to be cost-effective which may also lead to improved clinical outcomes.

Modelle in die onderrig van fisika

Directory of Open Access Journals (Sweden)

J. J. A. Smit

1998-07-01

Full Text Available Die rol van modelle in die onderrig van fisika is sedert die vroeë tagtigerjare erken. In die onderrig word die absent op die kwantitaiewe aspekte van die vak geplaas, terwyl die kwatitatiewe aspekte min aandag kry.

Primärer Hyperaldosteronismus - die häufigste monokausale Ursache der "essenziellen Hypertonie"

Directory of Open Access Journals (Sweden)

Tomaschitz A

2009-01-01

Full Text Available Der primäre Hyperaldosteronismus (PHA ist durch eine vom Renin-Angiotensin-System entkoppelte, inadäquat gesteigerte Aldosteronproduktion charakterisiert, die durch Kochsalzbelastung nicht ausreichend supprimierbar ist. Die Prävalenz des PHA wird in hypertensiven Patienten auf 5–13 %, sowie bei therapierefraktären hypertensiven Patienten auf 23 % geschätzt. Damit ist der PHA die häufigste Ursache einer sekundären Hypertonie. Zusätzlich ist eine erhöhte Aldosteronkonzentration unabhängig vom Blutdruck mit einem gesteigerten Risiko für die Entstehung einer kardiovaskulären Erkrankung, den plötzlichen Herztod, die linksventrikuläre Hypertrophie, eines Schlaganfalls, einer intrazerebralen Blutung, einer Niereninsuffizienz, einer Atherosklerose, eines gesteigerten Gefäßremodellings und des metabolischen Syndroms assoziiert. Die Ursache eines PHA ist in mehr als 95 % eine bilaterale Nebennierenrindenhyperplasie (idiopathischer Hyperaldosteronismus [IHA] oder ein Aldosteron-produzierendes Adenom (APA der Nebenniere. Der diagnostische Ablauf des PHA gliedert sich in drei Teile: (1 Screening, (2 Bestätigungstest und (3 Subtypenevaluierung (CT-Untersuchung und Nebennierenvenensampling. Die Aldosteron-Renin-Ratio- (ARR- Bestimmung ist der derzeit empfohlene Screeningtest bei Verdacht auf einen PHA. Durch unterschiedliche Vortestbedingungen und Medikamente können jedoch falsch positive und falsch negative Untersuchungsergebnisse resultieren. Entsprechend einer Kosten-Nutzen-Analyse wird derzeit nur in bestimmten Gruppen hypertensiver Patienten ein PHA-Screening empfohlen. Aufgrund der zahlreichen organschädigenden Aldosteron- induzierten Effekte wäre jedoch ein Screening aller hypertensiven Patienten zu überlegen. Nach einer unilateralen laparoskopischen Adrenalektomie (bei APA oder einer seltenen unilateralen Hyperplasie kann bei 30–60 % der Patienten eine Verbesserung der Blutdrucksituation erzielt werden. Bei Patienten mit einem

Benign thyroid disorders, radioiodine therapy and diagnosis related groups (DRGs): aspects of cost/benefit

International Nuclear Information System (INIS)

Dietlein, M.; Schicha, H.

2005-01-01

The increasing prevalence of goiter and thyroid nodules in older patients is accompanied by an increasing frequency of treatment and cost. Cost-effectiveness is given for programs of prophylaxis (primary prevention, e.g. alimentary iodine supplementation), for programs of screening (secondary prevention. e.g. TSH-screening), and for therapeutic strategies to avoid complications of thyroid dysfunction (atrial fibrillation, myocardial infarction, death for cardiac reasons) and to minimize iatrogenic complications (tertiary prevention). Examples of tertiary prevention are radioiodine-therapy of Graves' disease in patients who have an increased risk of relapse after antithyroid drugs (ATD), radioiodine therapy of ouvert or subclinical hyperthyroidism, and radioiodine therapy of large goiters in older patients or in patients suffering from a relevant co-morbidity. A cost-effectiveness-analysis for different therapeutic strategies of Graves' disease has been published using a lifelong time-horizon. The ablative radioiodine dose-regime is cost-effective as a first line therapy if the risk of relapse after ATD exceeds 60%. Cost-minimization-analysis, comparing resection of goiter and radioiodine, has shown lower cost of radioiodine therapy for toxic multinodular goiter up to 100 ml and for Graves' disease up to 60 ml goiter volume. Medical aspects (volume of goiter, uptake of nodules, regressive goiter, suspicion on malignancy, patients' age, co-morbidity, patients' decision) remain decisive for the choice of treatment. (orig.)

Wollen wirklich alle den "mündingen Verbraucher"?

DEFF Research Database (Denmark)

Strünck, Christoph; Becker, Tilman; Jungermann, Helmut

Die Verbraucherpolitik beruft sich auf das Leitbild des „mündigen Verbrauchers“. Allerdings gibt es unterschiedliche Interpretationen, was unter Mündigkeit zu verstehen ist. Außerdem ist die Wirklichkeit häufig weit entfernt vom Ideal des „mündigen Verbrauchers“. Diese Unschärfe nutzen Verbände u...... Leitbild des mündigen Verbrauchers für sich nutzen, wird im vorliegenden Diskussionspapier erörtert. Dazu werden zunächst einige konkrete Thesen und daraus abgeleitete Empfehlungen präsentiert. Im Hauptteil des Papiers wird die Instrumentalisierung des Leitbilds grundsätzlich erörtert....

Effect of electroacupuncture on thermal pain threshold and expression of calcitonin-gene related peptide, substance P and γ-aminobutyric acid in the cervical dorsal root ganglion of rats with incisional neck pain.

Science.gov (United States)

Qiao, Li-Na; Liu, Jun-Ling; Tan, Lian-Hong; Yang, Hai-Long; Zhai, Xu; Yang, Yong-Sheng

2017-08-01

Acupuncture therapy effectively reduces post-surgical pain, but its mechanism of action remains unclear. The aim of this study was to investigate whether expression of γ-aminobutyric acid (GABA) and the neuropeptides substance P (SP) and calcitonin gene-related peptide (CGRP) in the primary sensory neurons of cervical dorsal root ganglia (DRG) are involved in electroacupuncture (EA)-induced analgesia in a rat model of incisional neck pain. The pain model was established by making a longitudinal midline neck incision in 60 rats. Another 15 rats underwent sham surgery (normal group). Post-incision, 15 rats remained untreated (model group) and 45 rats underwent EA (frequency 2/100 Hz, intensity 1 mA) at bilateral LI18, LI4-PC6 or ST36-GB34 (n=15 each) for 30 min at 4 hours, 24 hours, and 48 hours post-surgery, followed by thermal pain threshold (PT) measurement. 30 min later, the rats were euthanased and cervical (C3-6) DRGs removed for measurement of immunoreactivity and mRNA expression of SP/CGRP and the GABAergic neuronal marker glutamic acid decarboxylase 67 (GAD67). Thermal PT was significantly lower in the model group versus the normal group and increased in the LI18 and LI4-PC6 groups but not the ST36-GB34 group compared with the model group. Additionally, EA at LI18 and LI4-PC6 markedly suppressed neck incision-induced upregulation of mRNA/protein expression of SP/CGRP, and upregulated mRNA/protein expression of GAD67 in the DRGs of C3-6 segments. EA at LI18/LI4-PC6 increases PT in rats with incisional neck pain, which is likely related to downregulation of pronociceptive mediators SP/CGRP and upregulation of the inhibitory transmitter GABA in the primary sensory neurons of cervical DRGs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Sådan bliver whistleblowing moralsk tilladeligt

DEFF Research Database (Denmark)

Rønn, Kira Vrist

2017-01-01

Der er brug for en mere nuanceret debat om det moralske aspekt af whistleblowing. Derfor er her tre kriterier, der kan bruges som rettesnore......Der er brug for en mere nuanceret debat om det moralske aspekt af whistleblowing. Derfor er her tre kriterier, der kan bruges som rettesnore...

Function-based payment model for inpatient medical rehabilitation: an evaluation.

Science.gov (United States)

Sutton, J P; DeJong, G; Wilkerson, D

1996-07-01

To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

Degas og New Orleans

DEFF Research Database (Denmark)

Indhold: Jean Sutherland Boggs: Edgar Degas og New Orleans. Marilyn R. Brown: Fransk-amerikanske aspekter af Degas' "Portrætter i et kontor, New Orleans". Katalog.......Indhold: Jean Sutherland Boggs: Edgar Degas og New Orleans. Marilyn R. Brown: Fransk-amerikanske aspekter af Degas' "Portrætter i et kontor, New Orleans". Katalog....

Bænken på kanten. Social kapital, lokalsamfund og lokalt forankrede kulturbærende institutioner

DEFF Research Database (Denmark)

Lolle, Anna Kristine E. L.

dens operationalisering diskuteres i afhandlingen, og diskussionen leder op til et forslag om at inddrage et nyt aspekt, når man undersøger social kapital i lokalsamfund. Et aspekt som mine data viste var et vigtigt element i dannelsen af de sociale netværk, tilliden og reciprociteten, nemlig et...

Blockage of High-Affinity Choline Transporter Increases Visceral Hypersensitivity in Rats with Chronic Stress

Science.gov (United States)

2018-01-01

Background Visceral hypersensitivity is a common feature of irritable bowel syndrome. Cholinergic system involves in the development of visceral hypersensitivity, and high-affinity choline transporter (CHT1) is of crucial importance in choline uptake system. However, involvement of CHT1 in visceral hypersensitivity remains unknown. The research aimed to study the CHT1 expression in dorsal root ganglions (DRGs) and the role of CHT1 in visceral hypersensitivity. Methods Repetitive water avoidance stress (WAS) was used to induce visceral hypersensitivity in rats. Colorectal distension (CRD) was determined, and the abdominal withdrawal reflex (AWR) and threshold intensity data were recorded to measure the visceral sensitivity. After intraperitoneal injection of hemicholinium-3 (HC-3), the specific inhibitor of CHT1, CRD data were also recorded. The CHT1 expression of DRGs was investigated by Western blotting, immunohistochemistry, and quantitative RT-PCR. Acetylcholine levels in the DRGs were detected by the assay kit. Results Repetitive WAS increased the AWR score of CRD at high distension pressure and decreased the mean threshold of rats. The CHT1 expression and acetylcholine concentration of DRG were significantly increased in WAS rats. After the administration of HC-3, the AWR score in WAS group was significantly increased at higher distension pressure while the threshold intensity was significantly reduced compared to the normal saline group. Acetylcholine concentration was significantly lower than the normal saline rats. Conclusion Our research firstly reports that CHT1 is overexpressed in noninflammatory visceral hypersensitivity, and blockage of CHT1 can enhance the visceral hypersensitivity. CHT1 may play an inhibitory role in visceral hypersensitivity. PMID:29849603

The Nexus of Armed Conflict

DEFF Research Database (Denmark)

Buhl, Kenneth Øhlenschlæger

2010-01-01

Denne afhandling omhandler anvendelse af den humanitære folkeret, også kendt som krigens love, fra to relaterede aspekter. Det første aspekt vedrører tærskel-problematikken (issue of demarcation), dvs. sondringen mellem fred og væbnet konflikt. Det er her påstanden at dualismen væbnet konflikt – ...

Investigating sustainability through vernacular architecture

DEFF Research Database (Denmark)

Eybye, Birgitte Tanderup

2015-01-01

Teksten drøfter, hvordan bæredygtighed kan komme til udtryk i førindustriel vernacular architecture, og om fortidens bæredygtige aspekter kan anvendes fremadrettet.......Teksten drøfter, hvordan bæredygtighed kan komme til udtryk i førindustriel vernacular architecture, og om fortidens bæredygtige aspekter kan anvendes fremadrettet....

The costs of acute readmissions to a different hospital –

DEFF Research Database (Denmark)

Dahl, Christian M.; Kongstad, Line Planck

2017-01-01

Treatment costs are found to vary substantially and systematically within DRGs. Several factors have been shown to contribute to the variation in costs within DRGs. We argue that readmissions might also explain part of the observed variation in costs. A substantial number of all readmissions occu....... If teaching hospitals are not compensated for the additional costs of treating different-hospital readmission patients, they might be unfairly funded under a DRG-based payment scheme.......Treatment costs are found to vary substantially and systematically within DRGs. Several factors have been shown to contribute to the variation in costs within DRGs. We argue that readmissions might also explain part of the observed variation in costs. A substantial number of all readmissions occur...... to a different hospital. The change in hospital indicates that a progression of the illness has occurred since the initial hospitalisation. As a result, different-hospital readmissions might be more costly compared to same-hospital admissions. The aim of this paper is twofold. Firstly, to analyse differences...

Etiske aspekter

DEFF Research Database (Denmark)

Andersen, Svend

2007-01-01

Indførelse af vaccination mod HPV-virus til forebyggelse af livmoderhalskræft vurderes på grundlag af de fire etiske principper Autonomi, Godgørenhed, Ikke-skade, Retfærdighed. Konklusionen er at det alt taget i bertragtning er etisk tilrådeligt at indføre vaccinen.......Indførelse af vaccination mod HPV-virus til forebyggelse af livmoderhalskræft vurderes på grundlag af de fire etiske principper Autonomi, Godgørenhed, Ikke-skade, Retfærdighed. Konklusionen er at det alt taget i bertragtning er etisk tilrådeligt at indføre vaccinen....

Evaluation of the performance of diagnosis-related groups and similar casemix systems: methodological issues.

Science.gov (United States)

Palmer, G; Reid, B

2001-05-01

With the increasing recognition and application of casemix for managing and financing healthcare resources, the evaluation of alternative versions of systems such as diagnosis-related groups (DRGs) has been afforded high priority by governments and researchers in many countries. Outside the United States, an important issue has been the perceived need to produce local versions, and to establish whether or not these perform more effectively than the US-based classifications. A discussion of casemix evaluation criteria highlights the large number of measures that may be used, the rationale and assumptions underlying each measure, and the problems in interpreting the results. A review of recent evaluation studies from a number of countries indicates that considerable emphasis has been placed on the predictive validity criterion, as measured by the R2 statistic. However, the interpretation of the findings has been affected greatly by the methods used, especially the treatment and definition of outlier cases. Furthermore, the extent to which other evaluation criteria have been addressed has varied widely. In the absence of minimum evaluation standards, it is not possible to draw clear-cut conclusions about the superiority of one version of a casemix system over another, the need for a local adaptation, or the further development of an existing version. Without the evidence provided by properly designed studies, policy-makers and managers may place undue reliance on subjective judgments and the views of the most influential, but not necessarily best informed, healthcare interest groups.

Estimation of hospital efficiency--do different definitions and casemix measures for hospital output affect the results?

Science.gov (United States)

Vitikainen, Kirsi; Street, Andrew; Linna, Miika

2009-02-01

Hospital efficiency has been the subject of numerous health economics studies, but there is little evidence on how the chosen output and casemix measures affect the efficiency results. The aim of this study is to examine the robustness of efficiency results due to these factors. Comparison is made between activities and episode output measures, and two different output grouping systems (Classic and FullDRG). Non-parametric data envelopment analysis is used as an analysis technique. The data consist of all public acute care hospitals in Finland in 2005 (n=40). Efficiency estimates were not found to be highly sensitive to the choice between episode and activity descriptions of output, but more so to the choice of DRG grouping system. Estimates are most sensitive to scale assumptions, with evidence of decreasing returns to scale in larger hospitals. Episode measures are generally to be preferred to activity measures because these better capture the patient pathway, while FullDRGs are preferred to Classic DRGs particularly because of the better description of outpatient output in the former grouping system. Attention should be paid to reducing the extent of scale inefficiency in Finland.

42 CFR 412.503 - Definitions.

Science.gov (United States)

2010-10-01

... through September 30. LTC-DRG stands for the diagnosis-related group used to classify patient discharges... on or after October 1, 2007, are classified by a severity-adjusted patient classification system, the MS-LTC-DRGs. Any reference to the term “LTC-DRG” shall be considered a reference to the term “MS-LTC...

Sustainability and social benefits of the planning of green areas and landscape planning versus their curteilment. Lifestyles as a challenge to, and an opportunity for, economy; Wirtschaft, Wissenschaft und Umwelt. Bd. 7. Nachhaltigkeit und gesellschaftlicher Nutzen von Gruenordnungsplanung und Landschaftsplanung kontra Reduktion. - Lebensstile als Herausforderung und Chance fuer die Wirtschaft

Energy Technology Data Exchange (ETDEWEB)

NONE

1998-11-01

The book contains the lecture series given within the framework of the 7th Economy Forum ``Economy, science and environment``, organized jointly by the Zentralstelle fuer Forschungs- und Entwicklungstransfer und Wissenschaftliche Weiterbildung (FET and WW) of Essen University and the chamber of industry and trade for Essen, Muelheim/Ruhr and Oberhausen in Essen. The lectures were delivered at the following events at the Essen University: `Sustainability and social benefits of the planning of green areas and landscapes versus their curtailment` (5 June 1997); and `Lifestyles as a challenge to and an opportunity for economy` (13 November 1997). (orig.) [Deutsch] Der Bericht gibt die Vortraege der Veranstaltungsreihe Wirtschaftsforum VII `Wirtschaft, Wissenschaft und Umwelt` wieder, veranstaltet von der FET and WW Zentralstelle fuer Forschungs- und Entwicklungstransfer und Wissenschaftliche Weiterbildung der Universitaet-GH Essen in Zusammenarbeit mit der Industrie- und Handelskammer fuer Essen, Muelheim an der Ruhr, Oberhausen zu Essen. Die Vortraege sind auf folgenden Veranstaltungen an der Universitaet-GH Essen gehalten worden:`Nachhaltigkeit und gesellschaftlicher Nutzen von Gruenordnungsplanung und Landschaftsplanung kontra Reduktion` am 5. Juni 1997 und `Lebensstile als Herausforderung und Chance fuer die Wirtschaft` am 13. November 1997. (orig.)

Genome-Wide Identification and Analysis of Drought-Responsive Genes and MicroRNAs in Tobacco

Directory of Open Access Journals (Sweden)

Fuqiang Yin

2015-03-01

Full Text Available Drought stress response is a complex trait regulated at transcriptional and post-transcriptional levels in tobacco. Since the 1990s, many studies have shown that miRNAs act in many ways to regulate target expression in plant growth, development and stress response. The recent draft genome sequence of Nicotiana benthamiana has provided a framework for Digital Gene Expression (DGE and small RNA sequencing to understand patterns of transcription in the context of plant response to environmental stress. We sequenced and analyzed three Digital Gene Expression (DGE libraries from roots of normal and drought-stressed tobacco plants, and four small RNA populations from roots, stems and leaves of control or drought-treated tobacco plants, respectively. We identified 276 candidate drought responsive genes (DRGs with sequence similarities to 64 known DRGs from other model plant crops, 82 were transcription factors (TFs including WRKY, NAC, ERF and bZIP families. Of these tobacco DRGs, 54 differentially expressed DRGs included 21 TFs, which belonged to 4 TF families such as NAC (6, MYB (4, ERF (10, and bZIP (1. Additionally, we confirmed expression of 39 known miRNA families (122 members and five conserved miRNA families, which showed differential regulation under drought stress. Targets of miRNAs were further surveyed based on a recently published study, of which ten targets were DRGs. An integrated gene regulatory network is proposed for the molecular mechanisms of tobacco root response to drought stress using differentially expressed DRGs, the changed expression profiles of miRNAs and their target transcripts. This network analysis serves as a reference for future studies on tobacco response stresses such as drought, cold and heavy metals.

Axisymmetric wave propagation in gas shear flow confined by a rigid-walled pipeline

International Nuclear Information System (INIS)

Chen Yong; Huang Yi-Yong; Chen Xiao-Qian; Bai Yu-Zhu; Tan Xiao-Dong

2015-01-01

The axisymmetric acoustic wave propagating in a perfect gas with a shear pipeline flow confined by a circular rigid wall is investigated. The governing equations of non-isentropic and isentropic acoustic assumptions are mathematically deduced while the constraint of Zwikker and Kosten is relaxed. An iterative method based on the Fourier–Bessel theory is proposed to semi-analytically solve the proposed models. A comparison of numerical results with literature contributions validates the present contribution. Meanwhile, the features of some high-order transverse modes, which cannot be analyzed based on the Zwikker and Kosten theory, are analyzed (paper)

[Financing of inpatient orthopaedics and trauma surgery in the 2011 G-DRG System].

Science.gov (United States)

Franz, D; Schemmann, F; Roeder, N; Siebert, H; Mahlke, L

2011-09-01

The German DRG system forms the basis for billing inpatient hospital services. It includes not only the case groups (G-DRGs), but also copayments. This paper analyses and evaluates the relevant developments of the 2011 G-DRG system for orthopaedics and traumatology from the medical and classificatory perspective. An analysis was performed of relevant diagnoses, medical procedures and G-DRGs in the 2010 and 2011 versions based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). A number of codes for surgical measures have been newly established or modified - above all in foot surgery, arthroscopic surgery and wound surgery. Here, the identification and the correct and performance-based mapping of complex and elaborate scenarios was again the focus of the restructuring of the G-DRG system. The G-DRG structure in orthopaedics and traumatology is changed, especially for polytraumata. The allocation of common cases with a standardized treatment pattern appears to be appropriate and the reimbursement adequate. For the less common and more complex cases the 2011 G-DRG system still shows need for further modification (e.g. polytraumata, joint replacement, spine surgery). The proper integration of the modified OPS classification for foot surgery to the appropriate G-DRGs will be essential to maintain the high quality of the reimbursement structure for the future.

Ein digitales Textformat für die Literaturwissenschaft: Die Richtlinien der Text Encoding Initiative und ihr Einsatz bei Textkonstitution und Textanalyse

Directory of Open Access Journals (Sweden)

Christof Schöch

2016-06-01

Full Text Available Die stetig voranschreitende Digitalisierung literarischer Texte verschiedenster Sprachen, Epochen und Gattungen stellt die Literaturwissenschaften immer wieder vor die Frage, wie sie diese Entwicklung mitgestalten und zu ihrem Vorteil nutzen können. Dabei ist digital nicht gleich digital, sondern es existiert eine Vielzahl sehr unterschiedlicher, digitaler Repräsentationsformen von Text. Nur wenige dieser Repräsentationsformen werden literaturwissenschaftlichen Anforderungen tatsächlich gerecht, darunter diejenige, die den Richtlinien der Text Encoding Initiative folgt. Der vorliegende Beitrag vergleicht zunächst einige derzeit gängige digitale Repräsentationsformen von Text. Für literaturwissenschaftliche Forschung besonders geeignet erweist sich hierbei eine Repräsentationsform, die den Richtlinien der Text Encoding Initiative folgt. Daher informiert der Beitrag anschließend über deren Nutzen für die literaturwissenschaftliche Arbeit, sowohl im Bereich der wissenschaftlichen Textedition als auch im Bereich der Analyse und Interpretation von Texten. Nur wenn die Literaturwissenschaften in ihrer Breite den Nutzen von offenen, expressiven, flexiblen und standardisierten, langfristig nutzbaren Formaten für die Forschung erkennen, können sie sich mit dem erforderlichen Nachdruck für deren Verbreitung einsetzen und durch die zunehmende Verfügbarkeit von Texten in solchen Formaten für die eigene Forschung und Lehre davon profitieren.

Patient-Centred Multidisciplinary Inpatient Care-Have Diagnosis-Related Groups an Effect on the Doctor-Patient Relationship and Patients' Motivation for Behavioural Change?

Science.gov (United States)

Romeyke, Tobias; Noehammer, Elisabeth; Ch Scheuer, Hans; Stummer, Harald

2016-10-01

The aim of this, the largest survey of patients performed to date, is to analyse the effects of diagnosis related groups (DRGs) on the doctor-patient relationship in the context of interdisciplinary patient-centered care. In addition, it is intended to investigate the possibility of motivating patients to change their behavioural patterns and lifestyle in the context of holistic therapy. Over a period of five years, a continuous survey was performed of hospitalised patients who were exercising their entitlement to interdisciplinary therapy in an acute, inpatient setting. The therapy was evaluated as good to very good both with and without the conditions of the case tariff fee system. Effects of the diagnosis related groups on the quality of the doctor-patient relationship could not be demonstrated (Mann-Whitney U test, p>0,05). A clear trend was evident in the influence on motivation to change behavioural patterns and lifestyle (Fisher's exact test, p=0,000). Studies of the effects of reimbursement systems in the context of interdisciplinary care are still in their infancy, despite the widespread use of diagnosis related groups. The mandatory character implicit in the case tariff fee system, which requires minimum qualitative standards for structural and procedural parameters in the context of providing interdisciplinary patient-centered care, can influence patients' behavioural patterns and lifestyle.

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol

Science.gov (United States)

Spirig, Rebecca; Spichiger, Elisabeth; Martin, Jacqueline S.; Frei, Irena Anna; Müller, Marianne; Kleinknecht, Michael

2014-01-01

Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. Background: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. Methods/Design: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting

Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol.

Science.gov (United States)

Spirig, Rebecca; Spichiger, Elisabeth; Martin, Jacqueline S; Frei, Irena Anna; Müller, Marianne; Kleinknecht, Michael

2014-01-01

With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings

Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer. Literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Panje, Cedric; Andratschke, Nikolaus; Guckenberger, Matthias [Zurich University Hospital, Department of Radiation Oncology, Zurich (Switzerland); Brunner, Thomas B. [Freiburg University Hospital, Department of Radiation Oncology, Freiburg (Germany); Niyazi, Maximilian [University of Munich, Department of Radiation Oncology, Munich (Germany)

2016-12-15

This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer. A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation. Data on renal and pancreatic SBRT are limited, but show promising rates of local control for both treatment sites. For pancreatic cancer, fractionated SBRT should be preferred to single-dose treatment to reduce the risk of gastrointestinal toxicity. Motion-compensation strategies and image guidance are paramount for safe SBRT delivery in both tumor entities. SBRT for renal cancer and pancreatic cancer have been successfully evaluated in phase I and phase II trials. Pancreatic SBRT should be practiced carefully and only within prospective protocols due to the risk of severe gastrointestinal toxicity. SBRT for primary renal cell cancer appears a viable option for medically inoperable patients but future research needs to better define patient selection criteria and the detailed practice of SBRT. (orig.) [German] Die Arbeitsgruppe ''Stereotaktische Radiotherapie'' der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) legt eine Zusammenfassung der aktuellen Literatur und daraus resultierende Empfehlungen zur Durchfuehrung der stereotaktischen Strahlentherapie (SBRT) beim Nierenzellkarzinom und beim Pankreaskarzinom vor. Es erfolgte eine Literaturrecherche zur Evidenz der SBRT beim Nierenzell- und Pankreaskarzinom, wobei der Schwerpunkt auf prospektive Studien und technische Aspekte fuer die klinische Umsetzung gelegt wurde. Fuer die SBRT beim Pankreaskarzinom und Nierenzellkarzinom sind bisher nur wenige Studien veroeffentlicht worden, die jedoch konsistent eine hohe Rate an lokaler Tumorkontrolle

Blockage of High-Affinity Choline Transporter Increases Visceral Hypersensitivity in Rats with Chronic Stress

Directory of Open Access Journals (Sweden)

Chen Zhao

2018-01-01

Full Text Available Background. Visceral hypersensitivity is a common feature of irritable bowel syndrome. Cholinergic system involves in the development of visceral hypersensitivity, and high-affinity choline transporter (CHT1 is of crucial importance in choline uptake system. However, involvement of CHT1 in visceral hypersensitivity remains unknown. The research aimed to study the CHT1 expression in dorsal root ganglions (DRGs and the role of CHT1 in visceral hypersensitivity. Methods. Repetitive water avoidance stress (WAS was used to induce visceral hypersensitivity in rats. Colorectal distension (CRD was determined, and the abdominal withdrawal reflex (AWR and threshold intensity data were recorded to measure the visceral sensitivity. After intraperitoneal injection of hemicholinium-3 (HC-3, the specific inhibitor of CHT1, CRD data were also recorded. The CHT1 expression of DRGs was investigated by Western blotting, immunohistochemistry, and quantitative RT-PCR. Acetylcholine levels in the DRGs were detected by the assay kit. Results. Repetitive WAS increased the AWR score of CRD at high distension pressure and decreased the mean threshold of rats. The CHT1 expression and acetylcholine concentration of DRG were significantly increased in WAS rats. After the administration of HC-3, the AWR score in WAS group was significantly increased at higher distension pressure while the threshold intensity was significantly reduced compared to the normal saline group. Acetylcholine concentration was significantly lower than the normal saline rats. Conclusion. Our research firstly reports that CHT1 is overexpressed in noninflammatory visceral hypersensitivity, and blockage of CHT1 can enhance the visceral hypersensitivity. CHT1 may play an inhibitory role in visceral hypersensitivity.

Kosten van allogene stamceltransplantaties

NARCIS (Netherlands)

M. van Agthoven (Michel); M.T. Groot (Martijn); C.A. Uyl-de Groot (Carin)

2001-01-01

textabstractAllogene stamceltransplantatie is een topspecialistische procedure die met succes kan worden ingezet in de behandeling van (hematologische) maligniteiten, met name bij leukemie. Van oudsher worden transplantaten van verwante donoren gebruikt, maar met de mogelijkheden om transplantaten

New approaches for the reliability-oriented structural optimization considering time-variant aspects; Neue Ansaetze fuer die zuverlaessigkeitsorientierte Strukturoptimierung unter Beachtung zeitvarianter Aspekte

Energy Technology Data Exchange (ETDEWEB)

Kuschel, N.

2000-07-01

The optimization of structures with respect to cost, weight or performance is a well-known application of the nonlinear optimization. However reliability-based structural optimization has been subject of only very few studies. The approaches suggested up to now have been unsatisfactory regarding general possibility of application or easy handling by user. The objective of this thesis is the development of general approaches to solve both optimization problems, the minimization of cost with respect to constraint reliabilty and the maximization of reliability under cost constraint. The extented approach of an one-level-method will be introduced in detail for the time-invariant problems. Here, the reliability of the sturcture will be analysed in the framework of the First-Order-Reliability-Method (FORM). The use of time-variant reliability analysis is necessary for a realistic modelling of many practical problems. Therefore several generalizations of the new approaches will be derived for the time-variant reliability-based structural optimization. Some important properties of the optimization problems are proved. In addition some interesting extensions of the one-level-method, for example the cost optimization of structural series systems and the cost optimization in the frame of the Second-Order-Reliabiity-Method (SORM), are presented in the thesis. (orig.) [German] Die Optimierung von Tragwerken im Hinblick auf die Kosten, das Gewicht oder die Gestalt ist eine sehr bekannte Anwendung der nichtlinearen Optimierung. Die zuverlaessigkeitsorientierte Strukturoptimierung wurde dagegen weit seltener untersucht. Die bisher vorgeschlagenen Ansaetze koennen bezueglich ihrer allgemeinen Verwendbarkeit oder ihrer nutzerfreundlichen Handhabung nicht befriedigen. Das Ziel der vorliegenden Arbeit ist nun die Entwicklung allgemeiner Ansaetze zur Loesung der beiden Optimierungsprobleme, einer Kostenminimierung unter Zuverlaessigkeitsrestriktionen und einer

Sea-anemone toxin ATX-II elicits A-fiber-dependent pain and enhances resurgent and persistent sodium currents in large sensory neurons

Directory of Open Access Journals (Sweden)

Klinger Alexandra B

2012-09-01

Full Text Available Abstract Background Gain-of-function mutations of the nociceptive voltage-gated sodium channel Nav1.7 lead to inherited pain syndromes, such as paroxysmal extreme pain disorder (PEPD. One characteristic of these mutations is slowed fast-inactivation kinetics, which may give rise to resurgent sodium currents. It is long known that toxins from Anemonia sulcata, such as ATX-II, slow fast inactivation and skin contact for example during diving leads to various symptoms such as pain and itch. Here, we investigated if ATX-II induces resurgent currents in sensory neurons of the dorsal root ganglion (DRGs and how this may translate into human sensations. Results In large A-fiber related DRGs ATX-II (5 nM enhances persistent and resurgent sodium currents, but failed to do so in small C-fiber linked DRGs when investigated using the whole-cell patch-clamp technique. Resurgent currents are thought to depend on the presence of the sodium channel β4-subunit. Using RT-qPCR experiments, we show that small DRGs express significantly less β4 mRNA than large sensory neurons. With the β4-C-terminus peptide in the pipette solution, it was possible to evoke resurgent currents in small DRGs and in Nav1.7 or Nav1.6 expressing HEK293/N1E115 cells, which were enhanced by the presence of extracellular ATX-II. When injected into the skin of healthy volunteers, ATX-II induces painful and itch-like sensations which were abolished by mechanical nerve block. Increase in superficial blood flow of the skin, measured by Laser doppler imaging is limited to the injection site, so no axon reflex erythema as a correlate for C-fiber activation was detected. Conclusion ATX-II enhances persistent and resurgent sodium currents in large diameter DRGs, whereas small DRGs depend on the addition of β4-peptide to the pipette recording solution for ATX-II to affect resurgent currents. Mechanical A-fiber blockade abolishes all ATX-II effects in human skin (e.g. painful and itch

Der praktische Nutzen des Konsensusstatements "praktische Fertigkeiten im Medizinstudium" – eine Validierungsstudie [The practial use of the consensus statement on practical skills in medical school – a validation study

Directory of Open Access Journals (Sweden)

Blaum, Wolf E.

2012-08-01

Full Text Available [english] Objective: The importance of the acquisition of practical medical skills during medical school is increasing. With the consensus statement “Practical Skills,” developed by the GMA as part of the National Competency-Based Learning Objective Catalogue for Medicine (NKLM, a reference frame was created for the procurement of such skills. This frame consists of 290 learning objectives divided by “organ system,” type (core or elective learning objective, current stage of medical education and level of instruction. By comparing a large and well evaluated range of student tutorials with the consensus statement, one can analyze the practical benefit of the statement, as well as evaluate the tutorial program for completeness. Methods: In the first stage, four evaluators in two groups independently classified all consensus statement’s learning objectives by each of the 48 tutorials currently offered. The inter-rater reliability among the evaluators of each group was calculated both collectively, and according to each organ system. In the second stage, disagreements in the classification were resolved through discussion and consensus decision-making. The coverage of the learning objectives by the tutorials, in the required level of instruction, was then analyzed separately by learning objective type and organ system. Reasons for any initial dissent were recorded and grouped thematically. Results: The correlation between the classifications of the two evaluators was moderately significant. The strength of this correlation, and thus the precision of individual learning goals wording, varied according to organ system. After a consensus was reached, the results show that the offered tutorials covered 66% of all learning objectives, as well as 74% of the core objectives. The degree of coverage differed according to organ system and stage of medical education. Conclusion: The consensus statement is suitable to systematically analyze and

Health care information systems and formula-based reimbursement: an empirical study.

Science.gov (United States)

Palley, M A; Conger, S

1995-01-01

Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

Integration einer Volltextsuchmaschine in Meta-Akad

OpenAIRE

Tuchbreiter, Jochen

2003-01-01

Das Projekt Meta-Akad hat das Ziel, Lernenden und Lehrenden den möglichst einfachen, umfassenden und schnellen Zugriff auf Lehrmaterial zu ermöglichen. Dabei werden verschiedene, über die Aspekte einer reinen Internet- Suchmaschine hinausgehende Aspekte berücksichtigt: Neben dem Aufbau einer umfangreichen und repräsentativen Sammlung von Lerndokumenten sollen diese mittels bibliothekarischer Methoden erschlossen und mit umfangreichen Metadaten, wie beispielsweise einer inhaltlichen Einordnung...

Sustainable electricity supply of the future. Costs and benefits of a transformation to 100% renewable energies; Nachhaltige Stromversorgung der Zukunft. Kosten und Nutzen einer Transformation hin zu 100% erneuerbaren Energien

Energy Technology Data Exchange (ETDEWEB)

Burger, Andreas; Luenenbuerger, Benjamin; Osiek, Dirk

2012-08-15

In the brochure under conideration, the Federal Environment Agency (Dessau-Rosslau, Federal Republic of Germany) reports on a sustainable electricity supply in the future. The costs and benefits of the transformation to 100% renewable energy sources are considered. The Federal Environment Agency concludes: A sustainable power supply requires the transition to a fully renewable energy supply. A full supply of electricity from renewable sources by 2050 is feasible technically. Thereby electricity from wind power and solar energy may play a central role in any ambitious expansion scenarios. The cost of power generation from renewable energy already are sunk. This trend will continue. Since the conventional power generation is more expensive in the future, renewable energy pays off more and more. Environmentally harmful subsidies and the lack of consideration of the social costs caused by the fossil and nuclear power generation massively distort the competition at the expense of renewable energy. The transformation of the energy system is worthwhile macroeconomically. The promotion of renewable energies avoids social follow-up costs caused by environmental damages and health related harms. Jobs are created. The regional value added is increased. It also improves the competitiveness of the fast-growing world markets for renewable energy technologies.

Diagnosis-related group (DRG)-based case-mix funding system, a promising alternative for fee for service payment in China.

Science.gov (United States)

Zhao, Cuirong; Wang, Chao; Shen, Chengwu; Wang, Qian

2018-05-13

Fee for services (FFS) is the prevailing method of payment in most Chinese public hospitals. Under this retrospective payment system, medical care providers are paid based on medical services and tend to over-treat to maximize their income, thereby contributing to rising medical costs and uncontrollable health expenditures to a large extent. Payment reform needs to be promptly implemented to move to a prospective payment plan. The diagnosis-related group (DRG)-based case-mix payment system, with its superior efficiency and containment of costs, has garnered increased attention and it represents a promising alternative. This article briefly describes the DRG-based case-mix payment system, it comparatively analyzes differences between FFS and case-mix funding systems, and it describes the implementation of DRGs in China. China's social and economic conditions differ across regions, so establishment of a national payment standard will take time and involve difficulties. No single method of provider payment is perfect. Measures to monitor and minimize the negative ethical implications and unintended effects of a DRG-based case-mix payment system are essential to ensuring the lasting social benefits of payment reform in Chinese public hospitals.

[Comparison of pedicle and free tissue transfers in the German DRG system].

Science.gov (United States)

Lotter, O; Stahl, S; Hohenstein, C; Schaller, H-E; Jaminet, P

2011-12-01

Diagnosis-Related Groups (DRGs) are a patient classification system grouping related types of patients to the resources they have consumed. In this analysis, we compared pedicle and free flaps in plastic and reconstructive surgery in the actual German DRG system. After grouping common flaps while systematically modifying the diagnosis, the operative procedure(s), and the receptor site, reimbursement and thresholds of length of stay were identified. The mean value of the average length of stay was higher in free flaps as compared to pedicle flaps (15 vs. 9 days) and the mean reimbursement in free flaps was almost twice as high as in pedicle flaps (8 936 € vs. 4 582 €). Regarding the diagnosis, third-grade open fractures in pedicle flaps and full-thickness burns in free flaps are in the vanguard of reimbursement. Higher DRG conformity is generally found with free flaps. Different possibilities in coding the procedures and the strong dependence on the underlying diagnosis lead to variations of remuneration and length of stay, which are not explainable and sometimes even seem paradoxical. Furthermore, mixed calculation creates DRGs that lose the ability to describe the real effort. © Georg Thieme Verlag KG Stuttgart · New York.

Preah Vihear Reloaded – The Thai-Cambodian Border Dispute Preah Vihear Reloaded – Der Grenzkonflikt zwischen Thailand und Kambodscha

Directory of Open Access Journals (Sweden)

Sonja Meyer

2009-04-01

Full Text Available This article investigates the recent Thai-Cambodian border clash over the Preah Vihear temple. The temple was registered as a World Heritage Site in July 2008. Cambodia made its application in 2007, causing nationalist resentments in Thailand. The paper highlights underlying and proximate causes of the military escalation in October 2008 and argues that both sides are likely to dig in their heels as the temple is an important symbol of national identity, territorial integrity, and sovereignty. As such, any concession would involve high political costs that neither side can afford given their current domestic political situation, especially Thailand. Further, both sides are using the conflict for their own benefit in that it creates social cohesion, strengthens national identity, and generates a sense of community. After decades of civil war, this is particularly important in Cambodia. Dieser Beitrag untersucht den kürzlich eskalierten thailändisch-kambodschanischen Grenzkonflikt um den Tempel Preah Vihear. Der Tempel wurde im Juli 2008 in die Liste des UNESCO-Weltkulturerbes aufgenommen. Kambodscha hatte seinen Antrag im Jahr 2007 gestellt, was in Thailand nationalistische Gefühle hervorrief. Der Artikel wird die tiefer liegenden Ursachen und direkten Auslöser der Eskalation im Oktober 2008 betrachten. Es ist wahrscheinlich, dass beide Seiten auf ihren Standpunkten beharren werden, da der Tempel ein wichtiges Symbol der nationalen Identität, der territorialen Integrität und Souveränität für beide Parteien darstellt. Jegliche Zugeständnisse wären mit hohen innenpolitischen Kosten verbunden, die sich keine der beiden Konfliktparteien leisten kann. Nach den politischen Unruhen des letzten Jahres gilt dies besonders für Thailand. Ferner nutzen die Akteure den Konflikt zu ihrem eigenen Vorteil. Die Abgrenzung zu anderen schafft soziale Kohäsion, stärkt die nationale Identität und trägt zu einem Zusammengehörigkeitsgefühl bei, das

Ambulante geriatrische Remobilisation

Directory of Open Access Journals (Sweden)

Janig H

2014-01-01

Full Text Available Die steigende Zahl älterer, multimorbider Menschen, die eine geriatrisch remobilisierende Behandlung benötigen, macht die Schaffung neuer oder alternativer geriatrischer Behandlungsmöglichkeiten neben den bereits bestehenden Strukturen im stationären Bereich erforderlich. Ein Projekt des Elisabethinen-Krankenhauses in Klagenfurt erprobt die Wirksamkeit einer ambulanten geriatrischen Remobilisation, über die vorläufigen Ergebnisse wird berichtet. Die therapeutischen Leistungen der ambulanten geriatrischen Remobilisation unterscheiden sich nicht von jenen, die bisher üblicherweise stationär angeboten werden, sie nutzen jedoch zusätzlich infrastrukturelle und soziale Ressourcen des gewohnten Wohnumfeldes. Die Ergebnisse der Evaluation der im Zeitraum Jänner bis Dezember 2013 130 ambulant und stationär betreuten Patienten zeigen, dass nach Einschätzung der behandelnden Ärzte 92 % der Patienten die vorgegebenen Therapieziele vollständig erreichen, unabhängig von Alter, Geschlecht und Therapiedauer. Das Ausmaß der Selbstständigkeit steigt um 19 % an und das Sturzrisiko der ambulant betreuten Patienten sinkt um 67 %, jenes der stationär betreuten Patienten immerhin um 28 %. Während zu Beginn der Therapie noch geschulte Laienhilfe (ambulante Patienten oder professionelle Hilfe (stationäre Patienten erforderlich ist, reicht für die Mehrzahl der Patienten zu Ende der Remobilisation eine ungeschulte Laienhilfe. Die Zahl der täglich eingenommenen Medikamente verringert sich bei den ambulanten Patienten von 8,7 auf 6,6 und bei den stationären von 9,5 auf 8,6 Wirkstoffe pro Tag. Für die stationäre Remobilisationsbehandlung entstehen pro Patient Kosten von 5835,– €, für die ambulante Remobilisation solche von rund 2585,– €, was eine Ersparnis zugunsten der ambulanten Therapie von rund 56 % ausmacht. Aus ihrer subjektiven Sicht berichten ambulante Patienten über bessere körperliche Fähigkeiten, einen geringeren

THESEUS - achieving maximum possible road transport tanker safety by means of experimental accident simulation; THESEUS - Tankfahrzeuge mit hoechsterreichbarer Sicherheit durch experimentelle Unfallsimulation

Energy Technology Data Exchange (ETDEWEB)

Rompe, K.; Heuser, G.

1996-03-01

wurden durch Untersuchungen an Tankfahrzeugkomponenten und begleitende komplexe Berechnungen der Versagensmechanismen ergaenzt. Parallel dazu wurde die statische Kippstabilitaet von Tankfahrzeugen auf einer Kippbruecke ermittelt. In dynamischen Fahrversuchen, ergaenzt durch rechnerische Simulation, wurden Ursachen und konstruktive Moeglichkeiten zur Vermeidung des Umkippens als haeufigste Unfallursache mit Gefahrgutaustritt analysiert. Als Ergebnis wurden Massnahmen zur Erhoehung der Sicherheit der Tankfahrzeuge ermittelt und zum Teil einer Nutzen/Kosten-Betrachtung unterzogen. (orig.)

Development of MY-DRG casemix pharmacy service weights in UKM Medical Centre in Malaysia.

Science.gov (United States)

Ali Jadoo, Saad Ahmed; Aljunid, Syed Mohamed; Nur, Amrizal Muhammad; Ahmed, Zafar; Van Dort, Dexter

2015-02-10

The service weight is among several issues and challenges in the implementation of case-mix in developing countries, including Malaysia. The aim of this study is to develop the Malaysian Diagnosis Related Group (MY-DRG) case-mix pharmacy service weight in University Kebangsaan Malaysia-Medical Center (UKMMC) by identifying the actual cost of pharmacy services by MY-DRG groups in the hospital. All patients admitted to UKMMC in 2011 were recruited in this study. Combination of Step-down and Bottom-up costing methodology has been used in this study. The drug and supplies cost; the cost of staff; the overhead cost; and the equipment cost make up the four components of pharmacy. Direct costing approach has been employed to calculate Drugs and supplies cost from electronic-prescription system; and the inpatient pharmacy staff cost, while the overhead cost and the pharmacy equipments cost have been calculated indirectly from MY-DRG data base. The total pharmacy cost was obtained by summing the four pharmacy components' cost per each MY-DRG. The Pharmacy service weight of a MY-DRG was estimated by dividing the average pharmacy cost of the investigated MY-DRG on the average of a specified MY-DRG (which usually the average pharmacy cost of all MY-DRGs). Drugs and supplies were the main component (86.0%) of pharmacy cost compared o overhead cost centers (7.3%), staff cost (6.5%) and pharmacy equipments (0.2%) respectively. Out of 789 inpatient MY-DRGs case-mix groups, 450 (57.0%) groups were utilized by the UKMMC. Pharmacy service weight has been calculated for each of these 450 MY-DRGs groups. MY-DRG case-mix group of Lymphoma & Chronic Leukemia group with severity level three (C-4-11-III) has the highest pharmacy service weight of 11.8 equivalents to average pharmacy cost of RM 5383.90. While the MY-DRG case-mix group for Circumcision with severity level one (V-1-15-I) has the lowest pharmacy service weight of 0.04 equivalents to average pharmacy cost of RM 17.83. A mixed

Investigating DRG cost weights for hospitals in middle income countries.

Science.gov (United States)

Ghaffari, Shahram; Doran, Christopher; Wilson, Andrew; Aisbett, Chris; Jackson, Terri

2009-01-01

Identifying the cost of hospital outputs, particularly acute inpatients measured by Diagnosis Related Groups (DRGs), is an important component of casemix implementation. Measuring the relative costliness of specific DRGs is useful for a wide range of policy and planning applications. Estimating the relative use of resources per DRG can be done through different costing approaches depending on availability of information and time and budget. This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of stay (LOS).We concluded that calculation of DRG cost weights (CWs) using Australian service weights provides a sensible starting place for DRG-based hospital management; but restructuring hospital accounting systems, designing computerized feeder systems, using appropriate software, and development of national service weights that reflect local practice patterns will enhance the accuracy of DRG CWs.

What explains DRG upcoding in neonatology? The roles of financial incentives and infant health.

Science.gov (United States)

Jürges, Hendrik; Köberlein, Juliane

2015-09-01

We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and German hospital data from 2006 to 2011, we show that (1) since the introduction of DRGs, hospitals have upcoded at least 12,000 preterm infants and gained additional reimbursement in excess of 100 million Euro; (2) upcoding rates are systematically higher at thresholds with larger reimbursement hikes and in hospitals that subsequently treat preterm infants, i.e. where the gains accrue; (3) upcoding is systematically linked with newborn health conditional on birth weight. Doctors and midwives respond to financial incentives by not upcoding newborns with low survival probabilities, and by upcoding infants with higher expected treatment costs. Copyright © 2015 Elsevier B.V. All rights reserved.

Casemix reimbursement: a Singapore Children's Hospital perspective.

Science.gov (United States)

Yoong, S L

2001-07-01

Casemix reimbursement was introduced to Singapore in October 1999 using the Australian National Diagnosis Related Groups Version 3.1 (AN-DRGs 3.1). The possible impact of this classification system on a Singapore Children's Hospital is discussed. Data on paediatric patients in KK Women's and Children's Hospital (KKH) were drawn from the inhouse Datamart warehouse system, and reviewed with regards to volume of patients, length of stay and charges. Several high cost categories were selected for a more in-depth review and discussed. The classification system and reimbursement method did not take into account the higher cost of treating children, thus penalising the Children's Hospital. The wide variety of cases treated also gave rise to difficulty in obtaining appropriate reimbursement. The lack of severity of illness measures was a drawback in the Diagnosis Related Group (DRG) for ventilated patients. The lack of outcome measures gave rise to potentially inequitable reimbursement in some high cost neonatal DRGs. While Casemix is an improvement over previous methods of providing Government funding in Singapore, particular aspects need to be reviewed, and reimbursement criteria refined to ensure equitable funding to Children's Hospital.

[Quality of case allocation of orthopedics and trauma surgery in the 2004 and 2014 versions of the German DRG system. An interim assessment of the development process].

Science.gov (United States)

Franz, D; Schemmann, F; Selter, D D; Auhuber, T; Gehweiler, D; Roeder, N; Siebert, H; Mahlke, L

2014-10-01

Since 2004 the German diagnosis-related groups (DRG) system has been applied nationwide in all German somatic hospitals. The G-DRG system is updated annually in order to increase the quality of case allocation. What developments have occurred since 2004 from the perspective of orthopedics and trauma surgery? This article takes stock of the developments between 2004 and 2014. Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2004 and 2014 based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). The number of G-DRGs in the whole system increased by 45.1 % between 2004 and 2014. The number of G-DRGs in the major diagnostic category (MDC) 08 that contains the majority of orthopedic and trauma surgery categories increased in the same period by 61.6 %. The reduction of variance of inlier costs in the MDC 08 category, a statistical measure of the performance of the G-DRG system, was below the corresponding value of the total system in 2004 as well in 2014. However, the reduction of variance of inlier costs in MDC 08 (+ 30.0 %) rose more from 2004 to 2014 than the corresponding value of the overall system (+ 21.5 %). Many modifications of the classification systems of diagnoses (ICD-10-GM) and medical procedures (OPS) and the structures of the G-DRG system could significantly improve the quality of case allocation from the perspective of orthopedics and trauma surgery between 2004 and 2014. Th assignment of cases could be differentiated so that complex cases with more utilization of resources were allocated to higher rated G-DRGs and vice versa. However, further improvements of the G-DRG system are necessary. Only correct and complete documentation and coding can provide a high quality of calculation of costs as a basis for a correct case allocation in future G-DRG systems.

Financial impact of accurate discharge coding in a liaison psychiatry service.

LENUS (Irish Health Repository)

Jordan, Iain

2012-12-01

Previous research has shown that patients seen by liaison psychiatry services are a complex and expensive patient group and that the psychiatric co-morbidities of hospital inpatients are poorly attested at discharge for assignment to diagnosis-related groups (DRGs). The aim of this study was to investigate the accuracy of discharge coding in a neuropsychiatry liaison population. We also aimed to establish whether or not, had the correct diagnosis been assigned, additional funding would have been allocated to the hospital.

Superiority of the practical method to theory: Diagnose of service life of ropes in overhead transmission grids; Praktische Methode der Theorie ueberlegen: Diagnose der Lebensdauer von Freileitungsseilen

Energy Technology Data Exchange (ETDEWEB)

Brueckner, W.F.

2005-02-07

In designing overhead transmission lines, cable tension is of prior importance. High tension means shorter life unless vibration dampers are installed. On the other hand, higher tension will reduce the overall cost to an optimum level. The author presents experience and measured vibration sensitivities. (orig.) [German] Beim Entwurf von Freileitungen ist die Zugspannung der Seile von besonderer Bedeutung. Erhoehte Seilzugspannungen verringern die Lebensdauer der Seile, soweit die Schwingungsgefahr nicht durch geeignete Schwingungsdaempfer vermieden wird. Mit erhoehter Seilzugspannung verringern sich auch die Kosten der gesamten Freileitung bis zur optimalen Grenze, die von den Kosten je km fuer verschiedene Spannweiten zu bestimmen ist. Der Verfasser beschreibt Erfahrungen ueber die gemessene Schwingungsgefaehrdung der Seile. (orig.)

Veganism: Ett hållbart alternativ för framtiden : Konsumentundersökning

OpenAIRE

Wessman, Christian

2016-01-01

Internationella mattrender som veganismen har ökat under de senaste åren med hjälp av en ökande efterfrågan. Trots att vegan kosten nått internationell publicitet och ett växande utbud i livsmedelsaffärer och restauranger, är veganerna fortfarande en minoritet i Finland. För många handlar vegan kosten om djurens väl, men för andra också om att nå en hälsosammare livsstil eller för att bli mer klimatsmart, eftersom mat står för största andelen av vår påverkan på miljön. Enligt en under...

[Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005-2006)].

Science.gov (United States)

Gómez, Joaquín; García-Vázquez, Elisa; Antonio Puertas, José; Ródenas, Julio; Herrero, José Antonio; Albaladejo, Carmen; Baños, Víctor; Canteras, Manuel; Alcaraz, Manolo

2009-02-01

Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (peconomic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.

Do diagnosis-related groups appropriately explain variations in costs and length of stay of hip replacement? A comparative assessment of DRG systems across 10 European countries.

Science.gov (United States)

Geissler, Alexander; Scheller-Kreinsen, David; Quentin, Wilm

2012-08-01

This paper assesses the variations in costs and length of stay for hip replacement cases in Austria, England, Estonia, Finland, France, Germany, Ireland, Poland, Spain and Sweden and examines the ability of national diagnosis-related group (DRG) systems to explain the variation in resource use against a set of patient characteristic and treatment specific variables. In total, 195,810 cases clustered in 712 hospitals were analyzed using OLS fixed effects models for cost data (n=125,698) and negative binominal models for length-of-stay data (n=70,112). The number of DRGs differs widely across the 10 European countries (range: 2-14). Underlying this wide range is a different use of classification variables, especially secondary diagnoses and treatment options are considered to a different extent. In six countries, a standard set of patient characteristics and treatment variables explain the variation in costs or length of stay better than the DRG variables. This raises questions about the adequacy of the countries' DRG system or the lack of specific criteria, which could be used as classification variables. Copyright © 2012 John Wiley & Sons, Ltd.

Sudden death and cervical spine: A new contribution to pathogenesis for sudden death in critical care unit from subarachnoid hemorrhage; first report - An experimental study.

Science.gov (United States)

Kazdal, Hizir; Kanat, Ayhan; Aydin, Mehmet Dumlu; Yazar, Ugur; Guvercin, Ali Riza; Calik, Muhammet; Gundogdu, Betul

2017-01-01

Sudden death from subarachnoid hemorrhage (SAH) is not uncommon. The goal of this study is to elucidate the effect of the cervical spinal roots and the related dorsal root ganglions (DRGs) on cardiorespiratory arrest following SAH. This was an experimental study conducted on rabbits. This study was conducted on 22 rabbits which were randomly divided into three groups: control ( n = 5), physiologic serum saline (SS; n = 6), SAH groups ( n = 11). Experimental SAH was performed. Seven of 11 rabbits with SAH died within the first 2 weeks. After 20 days, other animals were sacrificed. The anterior spinal arteries, arteriae nervorum of cervical nerve roots (C6-C8), DRGs, and lungs were histopathologically examined and estimated stereologically. Statistical analysis was performed using the PASW Statistics 18.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Intergroup differences were assessed using a one-way ANOVA. The statistical significance was set at P < 0.05. In the SAH group, histopathologically, severe anterior spinal artery (ASA) and arteriae nervorum vasospasm, axonal and neuronal degeneration, and neuronal apoptosis were observed. Vasospasm of ASA did not occur in the SS and control groups. There was a statistically significant increase in the degenerated neuron density in the SAH group as compared to the control and SS groups ( P < 0.05). Cardiorespiratory disturbances, arrest, and lung edema more commonly developed in animals in the SAH group. We noticed interestingly that C6-C8 DRG degenerations were secondary to the vasospasm of ASA, following SAH. Cardiorespiratory disturbances or arrest can be explained with these mechanisms.

Accuracy of the all patient refined diagnosis related groups classification system in congenital heart surgery.

Science.gov (United States)

Parnell, Aimee S; Shults, Justine; Gaynor, J William; Leonard, Mary B; Dai, Dingwei; Feudtner, Chris

2014-02-01

Administrative data are increasingly used to evaluate clinical outcomes and quality of care in pediatric congenital heart surgery (CHS) programs. Several published analyses of large pediatric administrative data sets have relied on the All Patient Refined Diagnosis Related Groups (APR-DRG, version 24) diagnostic classification system. The accuracy of this classification system for patients undergoing CHS is unclear. We performed a retrospective cohort study of all 14,098 patients 0 to 5 years of age undergoing any of six selected congenital heart operations, ranging in complexity from isolated closure of a ventricular septal defect to single-ventricle palliation, at 40 tertiary-care pediatric centers in the Pediatric Health Information Systems database between 2007 and 2010. Assigned APR-DRGs (cardiac versus noncardiac) were compared using χ2 or Fisher's exact tests between those patients admitted during the first day of life versus later and between those receiving extracorporeal membrane oxygenation support versus those not. Recursive partitioning was used to assess the greatest determinants of APR-DRG type in the model. Every patient admitted on day 1 of life was assigned to a noncardiac APR-DRG (pDRG (pDRG experienced a significantly increased mortality (pDRG coding has systematic misclassifications, which may result in inaccurate reporting of CHS case volumes and mortality. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

MORALNI ASPEKT DOPINGA

Directory of Open Access Journals (Sweden)

Višeslav Krsmanović

2005-04-01

Full Text Available Expansion of top, competitive sports in last few decades has reached the global proportions and significance. Political, economic and cultural aspects of sports make it a very influental social phenomenon and value but on the other hand the limits of human capabilities and strong sport competition presents the basic limitations on the road that leads to the top of world class sport achievements, recognitions, awards, fame and personal fortune. Records, victories and achievements, prestige and benefits (on the national level, wear out fisical, psihological and moral aspect of every athlete putting them in temptetion of consuming unlegal medications during treaning or compiting acctivities. Legal (sport standards and morality of athletes presents the foundation of defencive anti-doping strategy as a proactive method of fight against the usage of ileagal medicines in achieving better sport results. The basic moral principles of sport are justice and equiaty. They are an assumption of competition, but not the sport life outside of its bounderies. The research have shown that the usege of doping medicines is leaned on three motives: 1. toughness of treaning and lonelyness of athletes, 2. weak personal responsibilities, 3. moral predispositions and personal charakteristics od athletes. The concluion is that moral causes of doping usage are weaker than psihological (individual and general social reasons. They are the part of decision of individuals and in the case of social moral crisis they could be an alibi for moral judgement. That doesn`t mean that value of morality is underestimated and neglected and that in social acctivities moral concenese and principles don`t have significant meaning. Predstavnici Ju

Dokumentation, Kalkulation und Prozessanalyse im DRG-Zeitalter

OpenAIRE

Ingenerf, J; Gerdsen, F; Seik, B; Pöppl, SJ; Schreiber, R; Heinemeier, AK; Köppe, K; Bruch, HP

2005-01-01

The introduction of the G-DRGs (German Diagnosis Related Groups) in the year 2002 and the gradual use as a reimbursement system beginning from 2005 forces hospitals to meet enormous challenges with respect to organizational and IT-issues. The quality of the basic data set in terms of case and data completeness, accuracy and timeliness has to be ensured because with that the DRG case group and hence, the associated revenue is determined. From the economic point of view the costs of providing t...

Livskroppe in silico

DEFF Research Database (Denmark)

Michelsen, Anders Ib

2008-01-01

Med udgangspunkt i kunstprojektet Black Shoals diskuteres forholdet mellem kunstigt liv i computere – ”Alife” program-former - og den menneskelige krop. Alife analyseres som kroppe ”in silico”. Det vil sige kroppe, som fremstilles artificielt gennem computermodeller, hvor aspekter af menneskekrop......Med udgangspunkt i kunstprojektet Black Shoals diskuteres forholdet mellem kunstigt liv i computere – ”Alife” program-former - og den menneskelige krop. Alife analyseres som kroppe ”in silico”. Det vil sige kroppe, som fremstilles artificielt gennem computermodeller, hvor aspekter af...

Alterations in the Anandamide Metabolism in the Development of Neuropathic Pain

Directory of Open Access Journals (Sweden)

Natalia Malek

2014-01-01

Full Text Available Endocannabinoids (EC, particularly anandamide (AEA, released constitutively in pain pathways might be accountable for the inhibitory effect on nociceptors. Pathogenesis of neuropathic pain may reflect complex remodeling of the dorsal root ganglia (DRGs and spinal cord EC system. Multiple pathways involved both in the biosynthesis and degradation of AEA have been suggested. We investigated the local synthesis and degradation features of AEA in DRGs and spinal cord during the development and maintenance of pain in a model of chronic constriction injury (CCI. All AEA synthesis and degradation enzymes are present on the mRNA level in DRGs and lumbar spinal cord of intact as well as CCI-treated animals. Deregulation of EC system components was consistent with development of pain phenotype at days 3, 7, and 14 after CCI. The expression levels of enzymes involved in AEA degradation was significantly upregulated ipsilateral in DRGs and spinal cord at different time points. Expression of enzymes of the alternative, sPLA2-dependent and PLC-dependent, AEA synthesis pathways was elevated in both of the analyzed structures at all time points. Our data have shown an alteration of alternative AEA synthesis and degradation pathways, which might contribute to the variation of AEA levels and neuropathic pain development.

Measuring case-mix complexity of tertiary care hospitals using DRGs.

Science.gov (United States)

Park, Hayoung; Shin, Youngsoo

2004-02-01

The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective.

Science.gov (United States)

Busato, André; von Below, Georg

2010-10-16

Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

Electronic patient journey boards a vital piece of the puzzle in patient flow.

Science.gov (United States)

Clark, Kevin W; Moller, Susan; O'Brien, Lauri

2014-06-01

Internationally, there is growing interest in the applicability of visual management in healthcare, although little is known about the extent of its effectiveness. In the past 5 years technical advances have permitted the integration of all relevant data into a singular display that can improve staff efficiency, accelerate decisions, streamline workflow processes and reduce oversights and errors in clinical practice. The aim of the case study is to describe the features and application of electronic patient journey boards (EPJBs) as an enabler to accelerate patient flow that has been demonstrated and evaluated in Queensland Health hospitals. In 2012 and 2013 we collected ward-specific data that was sourced from the Queensland Hospital Admitted Patient Data Collection, determining the top 10 overnight diagnostic-related groups (DRGs) for each ward participating in the pilots. The Statistical Output Unit within Queensland Health then provided data and analysis on the ALOS for each of these DRGs for the period following an EPJB installation, along with the ALOS for the same DRGs for the corresponding period in the previous year. Patient length of stay reduced and display of estimated discharge dates improved with the introduction of EPJBs along with improved communication and information management resulting in time savings from 20 min per staff member per shift to 2.5h per ward a day. Queensland and South Australian Health systems have succeeded in 'making the hospital patient journey visible' through an innovative combination of information management and prominent display of key information related to patient care portrayed on large liquid crystal display (LCD) screens in hospital wards.

Up-regulation of p55 TNF alpha-receptor in dorsal root ganglia neurons following lumbar facet joint injury in rats.

Science.gov (United States)

Sakuma, Yoshihiro; Ohtori, Seiji; Miyagi, Masayuki; Ishikawa, Tetsu; Inoue, Gen; Doya, Hideo; Koshi, Takana; Ito, Toshinori; Yamashita, Masaomi; Yamauchi, Kazuyo; Suzuki, Munetaka; Moriya, Hideshige; Takahashi, Kazuhisa

2007-08-01

The rat L5/6 facet joint is multisegmentally innervated from the L1 to L6 dorsal root ganglia (DRG). Tumor necrosis factor (TNF) is a known mediator of inflammation. It has been reported that satellite cells are activated, produce TNF and surround DRG neurons innervating L5/6 facet joints after facet injury. In the current study, changes in TNF receptor (p55) expression in DRG neurons innervating the L5/6 facet joint following facet joint injury were investigated in rats using a retrograde neurotransport method followed by immunohistochemistry. Twenty rats were used for this study. Two crystals of Fluorogold (FG; neurotracer) were applied into the L5/6 facet joint. Seven days after surgery, the dorsal portion of the capsule was cut in the injured group (injured group n = 10). No injury was performed in the non-injured group (n = 10). Fourteen days after the first application of FG, bilateral DRGs from T13 to L6 levels were resected and sectioned. They were subsequently processed for p55 immunohistochemistry. The number of FG labeled neurons and number of FG labeled p55-immunoreactive (IR) neurons were counted. FG labeled DRG neurons innervating the L5/6 facet joint were distributed from ipsilateral L1 to L6 levels. Of FG labeled neurons, the ratio of DRG neurons immunoreactive for p55 in the injured group (50%) was significantly higher than that in the non-injured group (13%). The ratio of p55-IR neurons of FG labeled DRG neurons was significantly higher in total L1 and L2 DRGs than that in total L3, 4, 5 and 6 DRGs in the injured group (L1 and 2 DRG, 67%; L3, 4, 5 and 6 DRG, 37%, percentages of the total number of p55-IR neurons at L1 and L2 level or L3-6 level/the total number of FG-labeled neurons at L1 and L2 level or L3-6 level). These data suggest that up-regulation of p55 in DRG neurons may be involved in the sensory transmission from facet joint injury. Regulation of p55 in DRG neurons innervating the facet joint was different between upper DRG innervated

Effects of diagnosis-related group payment system on appendectomy outcomes.

Science.gov (United States)

Kim, Tae Hyun; Park, Eun-Cheol; Jang, Sung-In; Jang, Suk-Yong; Lee, Sang Ah; Choi, Jae Woo

2016-12-01

The voluntary diagnosis-related group (DRG) payment system was introduced in 2002. Since July 2013, the Korean government has mandated DRG participation for all hospitals. The main purpose of this study was to examine the effects of mandatory DRG participation on various outcome metrics for appendectomy patients. We collected inpatient DRG data for 280,062 appendectomy patients between 2007 and 2014 using the Health Insurance Review and Assessment database. We examined patient outcome metrics such as length of stay (LOS), total medical cost, spillover, and readmission rate, according to hospital size. As a result of DRG participation, the average LOS for patients decreased (adjusted ratio: 0.83 [large hospitals], 0.83 [small hospitals]; 95% confidence interval [CI]: 0.82-0.84, 0.82-0.84), the total medical costs of patients increased (adjusted ratio: 1.23 [large hospitals], 1.35 [small hospitals]; 95% CI: 1.22-1.24, 1.34-1.36), the spillover of patients increased (adjusted ratio: 2.10 [large hospitals], 2.30 [small hospitals]; 95% CI: 2.03-2.18, 2.16-2.45), and the readmission rates of appendectomy patients decreased (adjusted ratio: 0.85 [large hospitals], 0.49 [small hospitals]; 95% CI: 0.77-0.94, 0.42-0.57). The mandatory implementation of the DRG payment system in South Korea has led to significant reductions in LOS and readmission rates for appendectomy patients. However, any resulting expansion of outpatient services may result in unnecessary resource usage rather than improving medical quality. Policy makers should consider the various implications reflected by these results when considering DRGs for other diseases. Copyright © 2016 Elsevier Inc. All rights reserved.

[Diagnostic control. Psychiatric comorbidity in patients of technical orthopedic units].

Science.gov (United States)

Lange, C; Heuft, G; Wetz, H H

2001-04-01

Because of the new hospital finance law a DRG (Diagnosis Related Groups) controlled discount liquidation under consideration of the medical impairment becomes necessary. In this paper the importance of a correct and complete description of the psychic comorbidity for the development of German-Refined-DRGs (GR-DRGs) in the orthopedic field is described. Therefore we analysed data of orthopedic in-patients, who are diagnosed by consultation of the clinic for psychosomatics and psychotherapy. A psychic comorbidity (ICD-10 Chapter F (V)) was diagnosed by 95% of the consulted patient. 30% of the patients showed difficulties in coping with their disease. 40% suffered from chronical psychoneurotic patterns and conflicts, which can be explained (a) as consequence of a difficult psychosocial adaptation by chronic disease or after an amputation (b) as basic mental disorders (c) as cause of the orthopaedic complications. Therefore the number of indications for a psychotherapeutic or psychiatric treatment is very high. The knowledge about a psychic comorbidity can--beside financial aspects--help the team on the orthopaedic station in the treatment of difficult patient.

Using simulation to educate hospital staff about casemix.

Science.gov (United States)

Cromwell, D A; Priddis, D; Hindle, D

1998-10-01

When the Australian government funded a casemix development program, few hospital clinicians or staff knew much about casemix classifications like Diagnosis Related Groups (DRGs). Although the concepts behind casemix are essentially simple, it is not a trivial task to explain the logic used to assign patients to classes, or the use of casemix data for management or funding. Therefore, as part of a project to create educational material, a computer-based management game, built around a simulation model of a hospital, was developed. The game was designed for use in a workshop setting, to allow participants to test their understanding of the casemix information presented to them. The simulation mimicked the operation of a hospital, with a player taking the role of a hospital manager. It aimed to demonstrate how AN-DRGs might be used for funding; how patient costs are influenced by hospital activity; and how casemix data can assist in monitoring the use of resources. The game, called Dragon, proved to be very successful, and is now distributed as part of the National Casemix Education series.

[Diagnosis-related groups as an instrument to develop suitable case-based lump sums in hematology and oncology].

Science.gov (United States)

Thalheimer, Markus

2011-01-01

In 2003 a new reimbursement system was established for German hospitals. The approximately 17 million inpatient cases per year are now reimbursed based on a per-case payment regarding diagnoses and procedures, which was developed from an internationally approved system. The aim was a better conformity of costs and efforts in in-patient cases. In the first 2 years after implementation, the German diagnosis-related group (DRG) system was not able to adequately represent the complex structures of treatment in hematological and oncological in-patients. By creating new diagnoses and procedures (International Classification of Diseases 10 (ICD-10) and Surgical Operations and Procedures Classification System (OPS) catalogues), generating new DRGs and better splitting of existing ones, the hematology and oncology field could be much better described in the following years. The implementation of about 70 'co-payment structures' for new and expensive drugs and procedures in oncology was also crucial. To reimburse innovations, an additional system of co-payments for innovations was established to bridge the time until innovations are represented within the DRG system itself. In summary, hematological and oncological in-patients, including cases with extraordinary costs, are meanwhile well mapped in the German reimbursement system. Any tendencies to rationing could thereby be avoided, as most of the established procedures and costly drugs are adequately represented in the DRG system. Copyright © 2011 S. Karger AG, Basel.

Sudden death and cervical spine: A new contribution to pathogenesis for sudden death in critical care unit from subarachnoid hemorrhage; first report – An experimental study

Science.gov (United States)

Kazdal, Hizir; Kanat, Ayhan; Aydin, Mehmet Dumlu; Yazar, Ugur; Guvercin, Ali Riza; Calik, Muhammet; Gundogdu, Betul

2017-01-01

Context: Sudden death from subarachnoid hemorrhage (SAH) is not uncommon. Aims: The goal of this study is to elucidate the effect of the cervical spinal roots and the related dorsal root ganglions (DRGs) on cardiorespiratory arrest following SAH. Settings and Design: This was an experimental study conducted on rabbits. Materials and Methods: This study was conducted on 22 rabbits which were randomly divided into three groups: control (n = 5), physiologic serum saline (SS; n = 6), SAH groups (n = 11). Experimental SAH was performed. Seven of 11 rabbits with SAH died within the first 2 weeks. After 20 days, other animals were sacrificed. The anterior spinal arteries, arteriae nervorum of cervical nerve roots (C6–C8), DRGs, and lungs were histopathologically examined and estimated stereologically. Statistical Analysis Used: Statistical analysis was performed using the PASW Statistics 18.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Intergroup differences were assessed using a one-way ANOVA. The statistical significance was set at P < 0.05. Results: In the SAH group, histopathologically, severe anterior spinal artery (ASA) and arteriae nervorum vasospasm, axonal and neuronal degeneration, and neuronal apoptosis were observed. Vasospasm of ASA did not occur in the SS and control groups. There was a statistically significant increase in the degenerated neuron density in the SAH group as compared to the control and SS groups (P < 0.05). Cardiorespiratory disturbances, arrest, and lung edema more commonly developed in animals in the SAH group. Conclusion: We noticed interestingly that C6–C8 DRG degenerations were secondary to the vasospasm of ASA, following SAH. Cardiorespiratory disturbances or arrest can be explained with these mechanisms. PMID:28250634

Green4sure. The Green Energy Plan. Background report; Green4sure. Het Groene Energieplan. Achtergrondrapport

Energy Technology Data Exchange (ETDEWEB)

Rooijers, F.J. (ed.) (and others)

2007-05-15

The Green Energy Plan indicates how the ambitious climate targets of the cabinet can be achieved at the lowest cost. Main issue is that all energy consumers individually (industry, electricity production, aviation) or collectively (built environment, transport) are placed in an emission credits system with climate budget. The effort and costs are differentiated in order to ensure a largest possible acceptance. Moreover, new standards will be introduced for vehicles, buildings (existing and new) and appliances. The effects of the plan have been calculated and will lead to the desired halving of greenhouse gas emissions, an annual efficiency improvement of 2.1%. In 2030 the annual cost will amount to over 4 billion euro, but there are also substantial social benefits. This background report focuses on households, utilities and SME, greenhouse farming, traffic, industry, electricity, renewable energy, biomass and biodiversity, CO2 storage, external costs and benefits of Green4Sure, employment and socio-economic effects as well as the climate act. [mk]. [Dutch] Het Groene Energieplan geeft aan hoe de ambitieuze klimaatdoelen van het kabinet gehaald kunnen worden tegen de laagste kosten. Belangrijkste punten zijn dat alle energiegebruikers individueel (industrie, elektriciteitsproductie, luchtvaart) of collectief (gebouwde omgeving, transport) onder een emissierechtensysteem met klimaatbudget komen te vallen. De inspanningen, en daarmee de kosten zijn gedifferentieerd om de acceptatie zo groot mogelijk te laten zijn. Daarnaast komen er normen voor voertuigen, gebouwen (nieuw en bestaand) en apparaten. De effecten van het plan zijn doorgerekend en leiden tot de gewenste halvering van de broeikasgassen, een jaarlijkse efficiencyverbetering van 2,1%. De kosten bedragen in 2030 jaarlijks ruim 4 miljard euro, maar er zijn ook forse maatschappelijke baten. In dit achtergrondrapport wordt aandacht besteed aan huishoudens, utiliteiten en MKB, glastuinbouw, verkeer, industrie

Open access: Financiering van de APC

NARCIS (Netherlands)

Bonder, K.A.

2014-01-01

Hoe worden de kosten van BioMedCentral’s Article Processing Charges gedekt, hoe worden verantwoordelijkheden omtrent de betaling daarvan gedeeld, en wat zijn de opvattingen van deze auteurs over Open Access? Enquête.

Priority setting of foodborne pathogens: disease burden and costs of selected enteric pathogens

NARCIS (Netherlands)

Kemmeren JM; Mangen MJJ; van Duynhoven YTHP; Havelaar AH; MGB

2006-01-01

Toxoplasmose veroorzaakt van zeven onderzochte voedseloverdraagbare micro-organismen de hoogste ziektelast. Dit is een voorlopige conclusie in een groot onderzoek naar ziektelast van door voedseloverdraagbare micro-organismen en de daaraan gerelateerde kosten. De andere onderzochte

Neuronal calcium-binding proteins 1/2 localize to dorsal root ganglia and excitatory spinal neurons and are regulated by nerve injury

DEFF Research Database (Denmark)

Zhang, Ming Dong; Tortoriello, Giuseppe; Hsueh, Brian

2014-01-01

, and nerve injury-induced regulation of NECAB1/NECAB2 in mouse dorsal root ganglia (DRGs) and spinal cord. In DRGs, NECAB1/2 are expressed in around 70% of mainly small- and medium-sized neurons. Many colocalize with calcitonin gene-related peptide and isolectin B4, and thus represent nociceptors. NECAB1....../2 neurons are much more abundant in DRGs than the Ca2+-binding proteins (parvalbumin, calbindin, calretinin, and secretagogin) studied to date. In the spinal cord, the NECAB1/2 distribution is mainly complementary. NECAB1 labels interneurons and a plexus of processes in superficial layers of the dorsal horn....... In the dorsal horn, most NECAB1/2 neurons are glutamatergic. Both NECAB1/2 are transported into dorsal roots and peripheral nerves. Peripheral nerve injury reduces NECAB2, but not NECAB1, expression in DRG neurons. Our study identifies NECAB1/2 as abundant Ca2+-binding proteins in pain-related DRG neurons...

Impact of self-financed rotavirus vaccines on hospital stays and costs in Spain after a 3-year introductory period.

Science.gov (United States)

Redondo-González, O; Tenías-Burillo, J M; Ruiz-Gonzalo, J

2017-07-01

Vaccination has reduced rotavirus hospitalizations by 25% in European regions with low-moderate vaccine availability. We aimed to quantify the reduction in hospital costs after the longest period in which Rotarix® and Rotateq® were simultaneously commercially available in Spain. Cases, length of stay (LOS), and diagnosis-related groups (DRGs) were retrieved from the Minimum Basic Data Set. Healthcare expenditure was estimated through the cost accounting system Gescot®. DRGs were clustered: I, non-bacterial gastroenteritis with complications; II, without complications; III, requiring surgical/other procedures or neonatal cases (highest DRG weights). Comparisons between pre (2003-2005)- and post-vaccine (2007-2009) hospital stays and costs by DRG group were made. Rotaviruses were the most common agents of specific-coded gastroenteritis (N = 1657/5012). LOS and extended LOS of rotaviruses fell significantly in 2007-2009 (β-coefficient = -0·43, 95% confidence intervals (95% CI) -0·68 to -0·17; and odds ratio 0·62, 95% CI 0·50-0·76, respectively). Overall, costs attributable to rotavirus hospitalizations fell approximately €244 per patient (95% CI -365 to -123); the decrease in DRG group III was €2269 per patient (95% CI -4098 to -380). We concluded modest savings in hospital costs, largely attributable to cases with higher DRG weights, and a faster recovery. A universal rotavirus vaccination program deserves being re-evaluated, regarding its potential high impact on both at-risk children and societal costs.

Paying the Piper, Calling the Tune: Implications of Changes in Reimbursement

OpenAIRE

Victor R. Fuchs

1985-01-01

The United States is in the midst of a revolution in health care finance, the third since the end of World War II. Medicare's prospective payment system (PPS) based on diagnosis-related groups (DRGs), the State of California's hospital-specific contracts for Medi-Cal patients, deductibles and coinsurance, health maintenance organizations (HMOs), and preferred provider organizations (PPOs) are among the best known symbols of the new era in health care finance. This paper analyzes the economic ...

[Changes to diagnosis-related groups in urology in 2007. Urology in the G-DRG-System 2007].

Science.gov (United States)

Wenke, A; Franz, D; Pühse, G; Hertle, L; Roeder, N

2008-02-01

The German DRG (dose-related groups) system is updated each year by the institution dealing with the remuneration in hospitals (InEK). Once again, the German Spcoety for Urology has supported the adjustment process in a constructive manner. Analysis of the changes and their implications is highly significant for urology. This article describes and discusses the main changes in the system for the specialty of urology insofar as they concern the structure of the DRG system and the catalogues of diagnoses (ICD) and of procedures (OPS). The 2007 edition of the DRG system leads to numerous changes for urology. There are new OPS codes for partial resection of the kidney, treatment of urinary incontinence and radical resection in the pelvis minor. Additional payment for implantation of a prosthetic penis is divided with reference to the type of prosthesis. At DRG level, new DRG splits are found depending on the PCCL and patient age. Combination operations on the bladder and bowel and on the male genitalia are assigned to newly established DRGs. The changes described enhance the professional accuracy of the representations of urological care provision. New strategies designed to solve problems in representation have been established (e.g. multi-step interventions). Various problems persist, e.g. those of operations on the penis (DRG M03Z) and the need for more finely defined representation of laser treatment in urology. In the short term practicable solutions to the problem of improving the quality of representation are needed.

0,5 x global + 0,5 x lokal = glokal

DEFF Research Database (Denmark)

Hollensen, Svend; Schimmelpfennig, Christian

2014-01-01

Bei der Markteinführung neuer Produkte stehen viele CMOs vor der Entscheidung, eine globale vs. lokale Marketingstrategie zu fahren. Während erstere Verbundeffekte – sogenannte Economies of Scope – nutzen und damit das Marketingbudget schonen, verspricht letztere größere Markterfolge durch die be...

Leven als piranha

NARCIS (Netherlands)

drs. Frans van den Reep

2014-01-01

Internet verlaagt maatschappelijke transactiekosten en de kosten verbonden met het regelen van samenwerking dramatisch. Het dwingt ondernemingen dan ook de interne transactiekosten te verlagen, zegt lector Frans van der Reep van Inholland. Is dit een 'piranha economie'?

Hbo's: 1000 euro extra per allochtone leerling

NARCIS (Netherlands)

De Volkskrant

2006-01-01

De vier grote hogescholen in de Randstad willen 1000 euro extra voor elke student van laag opgeleide ouders. Bestuursvoorzitter Pim Breebaart van de Haag-se Hogeschool verwacht dat dit de schatkist bijna 20 miljoen euro zal kosten.

Alles is betrekkelijk: over de relatie tussen normschending en sanctie in het aansprakelijkheidsrecht

NARCIS (Netherlands)

S.D. Lindenbergh (Siewert)

2006-01-01

textabstractIs de Nederlandse Bank als toezichthouder aansprakelijk voor de schade van houders van levensverzekeringspolissen van de door wanbeheer faillietverklaarde verzekeringsmaatschappij Vie d’Or? Is de producent van het ondeugdelijke voorbehoedmiddel Implanix aansprakelijk voor de kosten van

Posttraumatski stresni poremećaj

OpenAIRE

Glavaš, Vlatko

2017-01-01

Ritam života današnjeg čovjeka ubrzan je i mnogi ne obraćaju pažnju na vlastito psihološko stanje. Posljedica toga je nakupljanje traumatskih ili stresnih događaja u ljudima. Stres ili trauma tumači se kao događaj izvan uobičajenog ljudskog iskustva. Jedan oblik bolesti koji se u vezi s time javlja je posttraumatski stresni poremećaj (PTSP). PTSP zahvaća oboljelu osobu u cjelini djelujući na sve aspekte razvoja osobe, odnosno biološke, psihološke i socijalne aspekte. Na biološkom p...

Constraint driven operation assignment for retargetable VLIW compilers

NARCIS (Netherlands)

Bekooij, M.J.G.

2004-01-01

In veel consumenten elektronica producten worden processoren toegepast voor het bewerken van gedigitaliseerde signalen. Deze processoren zijn gewoonlijk ingebed in een systeem en moeten wat rekenkracht, vermogensverbruik en fabricage kosten aan stringente eisen voldoen. Door het optimaliseren van

Why and how did Israel adopt activity-based hospital payment? The Procedure-Related Group incremental reform.

Science.gov (United States)

Brammli-Greenberg, Shuli; Waitzberg, Ruth; Perman, Vadim; Gamzu, Ronni

2016-10-01

Historically, Israel paid its non-profit hospitals on a perdiem (PD) basis. Recently, like other OECD countries, Israel has moved to activity-based payments. While most countries have adopted a diagnostic related group (DRG) payment system, Israel has chosen a Procedure-Related Group (PRG) system. This differs from the DRG system because it classifies patients by procedure rather than diagnosis. In Israel, the PRG system was found to be more feasible given the lack of data and information needed in the DRG classification system. The Ministry of Health (MoH) chose a payment scheme that depends only on inhouse creation of PRG codes and costing, thus avoiding dependence on hospital data. The PRG tariffs are priced by a joint Health and Finance Ministry commission and updated periodically. Moreover, PRGs are believed to achieve the same main efficiency objectives as DRGs: increasing the volume of activity, shortening unnecessary hospitalization days, and reducing the gaps between the costs and prices of activities. The PRG system is being adopted through an incremental reform that started in 2002 and was accelerated in 2010. The Israeli MoH involved the main players in the hospital market in the consolidation of this potentially controversial reform in order to avoid opposition. The reform was implemented incrementally in order to preserve the balance of resource allocation and overall expenditures of the system, thus becoming budget neutral. Yet, as long as gaps remain between marginal costs and prices of procedures, PRGs will not attain all their objectives. Moreover, it is still crucial to refine PRG rates to reflect the severity of cases, in order to tackle incentives for selection of patients within each procedure. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

Kwaliteit van geo-informatie in kabels en leidingen

NARCIS (Netherlands)

Oort, van P.A.J.

2004-01-01

Gebrekkige informatie over de ligging van kabels en leidingen leidt tot een verhoogde kans op beschadigingen. Een kosten-baten-analyse zou kunnen bijdragen aan het gerichter aanpakken van de oorzaken van schade. Een analyse vanuit Wageningen Universiteit (aio onderzoek)

GPS'en en andere nieuwe vormen van recreatie in de natuur

NARCIS (Netherlands)

Boer, de T.A.; Raffe, van J.K.

2003-01-01

Alterra verrichtte een verkennend onderzoek naar een aantal nieuwere recreatievormen: GPS-wandelen, struinen, mountainbiken, paalkamperen, laarzenpaden en speelbossen. Welke voorzieningen zijn nodig, kosten en baten, effecten op de natuur en het draagvlak voor de natuur, etc. De consequenties van

Moeilijk te sturen met groeilicht: drie belichtingssystemen onderzocht bij paprika

NARCIS (Netherlands)

Stijger, H.; Hogendonk, L.

2005-01-01

De stuurbaarheid van paprika is moeilijk zonder buitenlicht, maar ook mét groeilicht. De productieverschillen tussen de drie verschillende belichtingssystemen zijn minimaal. Bij het systeem dat de meeste kilo's geeft, de vaste belichting, zijn de kosten het laagst.

Evaluatie pilot toepassing van technieken op gebied van electronic monitoring binnen een penitentiaire inrichting

NARCIS (Netherlands)

Bekkers, R.N.A.; te Velde, R.; Segers, J.; Bilderbeek, R.

2008-01-01

Publicatienummer 2006.051-0713; Een evaluatie van een pilot inzake de toepassing van technieken op gebied van electronic monitoring binnen een penitentiaire inrichting. Wat zijn de gevolgen voor de veiligheid (incidenten, ontvluchtingen) en welk inzicht biedt een kosten-batenanalyse?

Bedrijfseconomisch perspectief de maat genomen

NARCIS (Netherlands)

Burg, van den S.W.K.; Rood, G.A.; Lienen, van Frederiek; Veldhuis-van Essen, C.

2016-01-01

Het concept natuurlijk kapitaal maakt de maatschappelijke waarde van de goederen en diensten waarin de natuur voorziet zichtbaar. Maar is dit concept ook bruikbaar bij de ontwikkeling van sluitende verdienmodellen? Bij een bedrijfseconomische toepassing staan drie aandachtspunten centraal: de kosten

ADHD-problematikkens sociale aspekter

DEFF Research Database (Denmark)

Høgsbro, Kjeld; Eskelinen, Leena; Andersen, Maja Lundemark

Denne forskningsrapport sammenfatter resultaterne fra en undersøgelse af den sociale indsats overfor mennesker med en ADHD-problematik. Den bidrager til en øget forståelse for, hvordan ADHD-problematikken påvirker familiers og individers relationer til arbejdsmarkedet og samfundet, samtidig med...

Psykologiske aspekter ved overvaegt

DEFF Research Database (Denmark)

Madsen, Svend Aage; Grønbaek, Helle; Olsen, Hanne

2006-01-01

Although knowledge of the biological aspects of obesity is increasing very rapidly, psychological approaches are increasingly in demand. Psychological theory and research concerning the emotional and cognitive impacts of being obese, the psychological causes involved in obesity, and the psycholog......Although knowledge of the biological aspects of obesity is increasing very rapidly, psychological approaches are increasingly in demand. Psychological theory and research concerning the emotional and cognitive impacts of being obese, the psychological causes involved in obesity......, and the psychological elements of treatment and motivations for treatment are requested. There is no clear separation between the psychological factors that function as causes of obesity and the psychological effects of obesity. Rather, they appear to be related in a circle of interconnectedness. This is important...... to keep in mind when seeking ways to motivate and support obese patients....

Genetische Aspekte der Osteoporose

Directory of Open Access Journals (Sweden)

Obermayer-Pietsch B

1998-01-01

Full Text Available Eine genetische Grundlage der Osteoporose wird neben Umwelteinflüssen seit langem vermutet. Bei Familien- und Zwillingsuntersuchungen wurden erbliche Einflüsse von etwa 46-75 % auf die Knochendichte - abhängig von den Meßorten - festgestellt. Neben einer genetischen Belastung durch eine betroffene Mutter wurde auch ein väterlicher Einfluß auf die Ausprägung der individuellen Knochendichte nachgewiesen. Verschiedenste Kandidatengene wurden bisher untersucht. Bedeutende Beiträge dazu sind in den genetischen Polymorphismen von Östrogen- und anderen Hormonrezeptoren und anderen wichtigen Genorten zu sehen. Eine Durchleuchtung des genetischen Hintergrundes der Osteoporose kann in Zukunft verbesserte Möglichkeiten der Früherkennung und Differenzierung der Diagnostik eröffnen und damit zu neuen Strategien für Prophylaxe und Therapie der Osteoporose führen.

Neurologiske aspekter ved stammen

DEFF Research Database (Denmark)

Mertz, Line Bie; Østergaard, John R

2006-01-01

Stuttering is characterised by repetitions, prolongations and pausing while speaking. Researchers have looked for many explanations. However, the cause of stuttering remains unknown. In recent years, structural abnormalities in the speech-related structures of the central nervous system have been...... brought into focus as a cause of stuttering. Research has shown signs of a lateral hemisphere asymmetry, abnormalities in the basal ganglia, dysfunction in the supplementary motor area and/or a dysfunction in the coordination of the cerebellum. This article is a review of this part of the literature...

Aspekte van effektiewe skoolbestuur

OpenAIRE

2014-01-01

M.Ed. (Education Management) In this study aspects relevant to effective school management are considered from a didactic-pedagogic perspective. The future development of the community is to a large extent determined by education. The requirements of and demands that are made on education require that schools be regarded more and more as undertakings. Aspects which determine and influence the effectiveness of a school are thus important. The quality of leadership of the school principal an...

Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

Science.gov (United States)

Wittenbecher, Friedrich

2013-01-01

Abstract Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. PMID:24115798

Reductions in Average Lengths of Stays for Surgical Procedures Between the 2008 and 2014 United States National Inpatient Samples Were Not Associated With Greater Incidences of Use of Postacute Care Facilities.

Science.gov (United States)

Dexter, Franklin; Epstein, Richard H

2018-03-01

Diagnosis-related group (DRG) based reimbursement creates incentives for reduction in hospital length of stay (LOS). Such reductions might be accomplished by lesser incidences of discharges to home. However, we previously reported that, while controlling for DRG, each 1-day decrease in hospital median LOS was associated with lesser odds of transfer to a postacute care facility (P = .0008). The result, though, was limited to elective admissions, 15 common surgical DRGs, and the 2013 US National Readmission Database. We studied the same potential relationship between decreased LOS and postacute care using different methodology and over 2 different years. The observational study was performed using summary measures from the 2008 and 2014 US National Inpatient Sample, with 3 types of categories (strata): (1) Clinical Classifications Software's classes of procedures (CCS), (2) DRGs including a major operating room procedure during hospitalization, or (3) CCS limiting patients to those with US Medicare as the primary payer. Greater reductions in the mean LOS were associated with smaller percentages of patients with disposition to postacute care. Analyzed using 72 different CCSs, 174 DRGs, or 70 CCSs limited to Medicare patients, each pairwise reduction in the mean LOS by 1 day was associated with an estimated 2.6% ± 0.4%, 2.3% ± 0.3%, or 2.4% ± 0.3% (absolute) pairwise reduction in the mean incidence of use of postacute care, respectively. These 3 results obtained using bivariate weighted least squares linear regression were all P < .0001, as were the corresponding results obtained using unweighted linear regression or the Spearman rank correlation. In the United States, reductions in hospital LOS, averaged over many surgical procedures, are not accomplished through a greater incidence of use of postacute care.

Analysis of photovoltaic systems. Leadership/cooperation in Task II of the IEA Implementing Agreements Photovoltaic Power Systems, database operation; Analyse des Betriebsverhaltens von Photovoltaiksystemen. Leitung/Mitarbeit im Task II des IEA Implementing Agreements Photovoltaic Power Systems, Betrieb der Datenbank. Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

Schreitmueller, K.; Niemann, M.; Decker, B.; Jahn, U.; Meyer, H.

2000-02-01

the analysis of PV systems of the different types addressed in the database are presented and discussed. (orig.) [German] Im Rahmen des Vorhabens wurde an den laufenden Arbeiten im Task II des 'Photovoltaic Power System Programme' (PVPS) der Internationalen Energieagentur (IEA) wesentlich mitgewirkt. Es ist eine zentrale Aufgabe des Task II, das Wissen ueber die Auslegung und das Betriebsverhalten von Photovoltaik(PV)-Systemen zu verbreiten und durch Ansprache geeigneter Zielgruppen die Markteinfuehrung der PV-Technologie voranzutreiben. Dabei stuetzt sich das Vorhaben auf die Erstellung und Aktualisierung einer dezentralen Datenbank, in der sowohl detaillierte Anlagedaten von realisierten PV-Anlagen als auch monatsaufgeloeste Betriebsergebnisse der vermessenen PV-Systeme gesammelt und aufbereitet werden. Ziel der Arbeiten ist es, Informationen ueber Energieertraege, Zuverlaessigkeit und Kosten von verschiedenen PV-Systemen aus der ganzen Welt bereitzustellen und Richtlinien fuer optimale PV-Anlagen in Bezug auf ihr Betriebsverhalten und ihre Auslegung zu entwickeln. Die dezentrale Datenbank auf PC-Basis wurde im ISFH erstellt und konfiguriert. Das Datenbankprogramm besteht aus dem Programm 'PVbase' und dem Programm 'PVreport'. Umfangreiche Softwarewerkzeuge erlauben die Selektion von PV-Anlagen, die graphische und statistische Aufarbeitung der relevanten Daten von PV-Anlagen und den Export von berechneten Jahresmittelwerten. Die Datenbank enthaelt derzeit mehr als 260 PV-Anlagen mit monatlichen Datensaetzen von ueber 600 Betriebsjahren. Neben den allgemeinen Informationen sind Angaben ueber die Art der PV-Anlage (Netzverbund, Insel- oder Hybridanlage), ihre Montageart, ihre verwendeten Komponenten und oekonomische Daten enthalten. Die Datenbank umfasst einen grossen Anteil weltweit realisierter PV-Anlagen mit installierter Messdatenerfassung. Der Nutzen der kontinuierlich verbesserten Datenbank liegt in der Verbreitung von Informationen

Prognozowanie i ujmowanie przychodóww przedsiębiorstwie postawionymw stan upadłości likwidacyjnej

OpenAIRE

Janusz Czerny

2010-01-01

W upadłości likwidacyjnej przedsiębiorstw mamy do czynienia z dwoma stru-mieniami przychodów, a mianowicie z przychodami dotyczącymi zbycia przedsię-biorstwa lub jego składników majątku oraz z przychodami związanymi z ewentual-nym kontynuowaniem działalności: Przychody ze sprzedaży przedsiębiorstwa powinny być prognozowane głównie na podstawie informacji płynących z systemu rachunkowości, co stanowi tzw. sta-tyczny aspekt upadłości, natomiast jej aspekt dynamiczny jest związany z zakre-sem...

Determination of the agricultural and process-related boundary conditions for the use of rapeseed oil and its refinery products as motor fuel. Final report; Ermittlung der landwirtschaftlichen, prozesstechnischen und verfahrenstechnischen Rahmenbedingungen fuer die Verwendung von Rapsoel und seiner Umwandlungsprodukte als Kraftstoff. Schlussbericht

Energy Technology Data Exchange (ETDEWEB)

Schliephake, D; Hacker, C M

1994-11-01

The use of rapeseed oil as a motor fuel is viewed from various angles: Production aspects; environmental aspects; marketing aspects in agriculture; business management aspects in the Federal Republic of Germany; production and refining of rapeseed oil; use of rapeseed oil methyl ester as diesel fuel and in mineral oil processing plants; engine performance. (orig./SR) [Deutsch] In dem vorliegenden Bericht wird der Einsatz von Rapsoel als Kraftstoff aus verschiedenen Blickwinkeln betrachtet: Produktionsaspekte, Umweltaspekte, marktwirtschaftliche Aspekte in der Landwirtschaft; betriebswirtschaftliche Aspekte in der Bundesrepublik Deutschland; Herstellung und Raffination von Rapsoel; Einsatz von Rapsoelmethylester als Dieselkraftstoff und in Anlagen der Mineraloelverarbeitung; Motortechnische Untersuchungsergebnisse. (orig./SR)

Tekster til organisationsanalyse

DEFF Research Database (Denmark)

Bogen samler klassiske og nyere tekster om organisationer. Forfattere som Weber, Taylor, March, Schein, Mintzberg og Weick indgår mange steder som fast pensum på organisationsfag, og her er de samlet i een bog. Tilsammen tilbyder teksterne afsæt for analyser af en lang række aspekter af organisat......Bogen samler klassiske og nyere tekster om organisationer. Forfattere som Weber, Taylor, March, Schein, Mintzberg og Weick indgår mange steder som fast pensum på organisationsfag, og her er de samlet i een bog. Tilsammen tilbyder teksterne afsæt for analyser af en lang række aspekter af...

Towards a broader weighing and regulating framework for investments in interconnectors. The societal cost benefit analysis; Naar een breder afwegings- en reguleringskader voor investeringen in interconnectoren. De Maatschappelijke Kosten-Baten Analyse (MKBA)

Energy Technology Data Exchange (ETDEWEB)

Sijm, J.P.M.; Welle, A.J. van der [ECN Policy Studies, Petten (Netherlands); Tieben, B.; Hof, B.; Kocsis, V. [SEO Economisch Onderzoek, Amsterdam (Netherlands)

2013-04-15

Interconnectors that link national grids are important for further integration of the European electricity grid. Against this background, the main question of this study is as follows: What does a broadened assessment and regulatory framework for investments in interconnectors look like which secures optimal contribution of these investments to the social welfare of the involved countries? To answer this question, the broadened assessment framework is developed first, i.e. the Social Cost-Benefit Analysis (SCBA). Next, the implications for the regulatory framework are analysed with regard to the following three aspects: (1) cost allocation, (2) network planning, and (3) efficiency versus investment incentives. Finally, a case study is conducted of a 'fictitious but realistic' investment project in interconnection to illustrate how certain social effects from the developed SCBA framework can be practically and concretely established [Dutch] Interconnectoren voor de verbinding tussen nationale netwerken zijn belangrijk voor de verdere integratie van het Europese elektriciteitsnetwerk. In het huidige afwegingskader worden investeringsbeslissingen ten aanzien van interconnectoren in Nederland genomen door de nationale netwerkbeheerder, TenneT, na goedkeuring door het Ministerie van Economische Zaken (EZ), gebaseerd op een advies van de Nederlandse Mededingingsautoriteit (NMa). Binnen dit kader baseert TenneT zijn investeringsbeslissingen in het bijzonder op de kosten en handelseffecten van de interconnector. Een belangrijke beperking van dit kader is dat er relatief weinig aandacht wordt besteed aan andere overwegingen en (externe) effecten, zowel positief als negatief, zoals de effecten op meer marktintegratie en concurrentie, de voorzienings- en leveringszekerheid van elektriciteit, de inpassing van duurzame elektriciteit in het net, milieueffecten, de effecten op netwerkcongestie en op investeringen in nieuwe productiecapaciteit. De vraag is nu hoe zowel

Vergleich der Trinkwasserpreise im europäischen Rahmen

DEFF Research Database (Denmark)

Kraemer, R. Andreas; Piotrowski, R.; Kipfer, A.

1998-01-01

Zusammenfassung: In diesem Vorhaben wurden die Kosten der Trinkwasserversorgung und die Wasserpreise in ausgewählten Mitgliedstaaten der Europäischen Union untersucht. Eine Analyse vorliegender Studien und Statistiken wurde ergänzt durch gesonderte Befragungen, die durch Experten in den jeweilige...

Plussen en minnen : MKBA’s op ICT-gebied in kaart gebracht

NARCIS (Netherlands)

Koopmans, C.; van Benthem, M.

De Studiegroep Informatiesamenleving en Overheid werkt aan een advies over digitale voorzieningen en diensten van de overheid. Voor deze studiegroep heeft het ministerie van BZK behoefte aan meer inzicht in de belangrijkste maatschappelijke kosten-batenanalyses (MKBA’s) die op dit terrein zijn

Fytoremediëring in Nederland: mogelijkheden en beperkingen

NARCIS (Netherlands)

Japenga, J.; Römkens, P.F.A.M.

2001-01-01

Mogelijkheden en problemen van de verschillende vormen van het toepassen van planten bij sanering en beheer van verontreinigde bodems in termen van milieurendement en kosten. Ook wordt verslag gedaan van onderzoek gericht op het vaststellen van mogelijke negatieve milieueffecten van fytoremediëring

Enterprise resource planning: Evaluatie van recente implementaties

NARCIS (Netherlands)

Voordijk, Johannes T.; van Leuven, Arjen; Laan, Albertus

2004-01-01

De dominante bedrijfsstategie van laagste kosten blijkt binnen bouwbedrijven een 'fit' te bemoelijken tussen bedrijfs- en IT-stratiegieen gericht op productdifferentiatie, zo blijkt uit een casestudy. Vanwege de nadruk op back-officeprocessen staan ERP-implementaties niet hoog op de agenda van het

De farmaceutische industrie in het maatschappelijk debat: Een feitelijke beschrijving van de markt voor innovatieve geneesmiddelen in Nederland

NARCIS (Netherlands)

Kok, L.; van der Voort, J.

2014-01-01

Er is in de media kritiek op de innovatieve farmaceutische industrie. Dit zijn de farmaceutische fabrikanten die nieuwe geneesmiddelen ontwikkelen. De kritiek gaat over geringe meerwaarde van nieuwe medicijnen, hoge prijzen, hoge winsten en hoge kosten van marketing. Ook de wijze waarop de

Shp-1 dephosphorylates TRPV1 in dorsal root ganglion neurons and alleviates CFA-induced inflammatory pain in rats.

Science.gov (United States)

Xiao, Xing; Zhao, Xiao-Tao; Xu, Ling-Chi; Yue, Lu-Peng; Liu, Feng-Yu; Cai, Jie; Liao, Fei-Fei; Kong, Jin-Ge; Xing, Guo-Gang; Yi, Ming; Wan, You

2015-04-01

Transient receptor potential vanilloid 1 (TRPV1) receptors are expressed in nociceptive neurons of rat dorsal root ganglions (DRGs) and mediate inflammatory pain. Nonspecific inhibition of protein-tyrosine phosphatases (PTPs) increases the tyrosine phosphorylation of TRPV1 and sensitizes TRPV1. However, less is known about tyrosine phosphorylation's implication in inflammatory pain, compared with that of serine/threonine phosphorylation. Src homology 2 domain-containing tyrosine phosphatase 1 (Shp-1) is a key phosphatase dephosphorylating TRPV1. In this study, we reported that Shp-1 colocalized with and bound to TRPV1 in nociceptive DRG neurons. Shp-1 inhibitors, including sodium stibogluconate and PTP inhibitor III, sensitized TRPV1 in cultured DRG neurons. In naive rats, intrathecal injection of Shp-1 inhibitors increased both TRPV1 and tyrosine-phosphorylated TRPV1 in DRGs and induced thermal hyperalgesia, which was abolished by pretreatment with TRPV1 antagonists capsazepine, BCTC, or AMG9810. Complete Freund's adjuvant (CFA)-induced inflammatory pain in rats significantly increased the expression of Shp-1, TRPV1, and tyrosine-phosphorylated TRPV1, as well as the colocalization of Shp-1 and TRPV1 in DRGs. Intrathecal injection of sodium stibogluconate aggravated CFA-induced inflammatory pain, whereas Shp-1 overexpression in DRG neurons alleviated it. These results suggested that Shp-1 dephosphorylated and inhibited TRPV1 in DRG neurons, contributing to maintain thermal nociceptive thresholds in normal rats, and as a compensatory mechanism, Shp-1 increased in DRGs of rats with CFA-induced inflammatory pain, which was involved in protecting against excessive thermal hyperalgesia.

Impacts of the abolition of NOx emission trade; Effecten van de afschaffing van NOx- emissiehandel

Energy Technology Data Exchange (ETDEWEB)

Kroon, P [ECN Beleidsstudies, Petten (Netherlands)

2012-09-15

The consequences of abolishing the NOx emission trade have been analyzed for the installations that are covered by BEMS legislation (Dutch decree on emission limits for medium-sized combustion plants). The following aspects have been analyzed: What are the enforcement costs if these installations need to comply with BEMS requirements as of 2014?; How are these costs distributed across the various sectors and in particular for the sectors of onshore/offshore gas and oil extraction, greenhouse horticulture and hospitals?; To what extent can costs be lowered by allowing a 2-,3- or 5-year delay of the implementation date for existing installations in BEMS? To answer the above questions, data were used from the NEA (Netherlands Emission Authority) at sector level. Model calculations were conducted to determine the costs and effects [Dutch] De gevolgen van de afschaffing van NOx-emissiehandel zijn geanalyseerd voor het installatiepark dat terugvalt op BEMS-wetgeving (Besluit emissie-eisen middelgrote stookinstallaties). De volgende zaken zijn geanalyseerd: Wat zijn de nalevingskosten indien vanaf 2014 deze installaties aan de BEMS-eisen moeten voldoen?; Hoe zijn deze kosten verdeeld over de verschillende sectoren en in het bijzonder voor de sectoren offshore/onshore gas- en oliewinning, de glastuinbouw en ziekenhuizen?; In hoeverre zijn de kosten te verlagen door 2, 3 of 5 jaar uitstel te geven ten opzichte van de implementatiedatum voor bestaande installaties in BEMS? Voor het beantwoorden van de bovenstaande vragen is gebruik gemaakt van gegevens van de NEa (Nederlandse Emissie autoriteit) op sectorniveau. Met modelberekeningen zijn hiermee kosten en effecten bepaald.

Keuzeaspecten bouwmethoden en processen bij het bouwen

NARCIS (Netherlands)

Vissers, M.M.J.; Vlaar, G.J.; Hofkes, xx; Brinksma, xx; Zimmermann, xx; Van Tol, xx; Flapper, xx; Bonebakker, xx

2006-01-01

De bouwsector is fors in beweging. Sterker dan vroeger staat klant-gericht denken en werken centraal. Innovatie en automatisering moeten ertoe leiden dat de kosten flink omlaag gaan. De vele keuzemogeuijkheden en de diverse belanghebbenden maken een keuze voor een bouwmethode niet eenvoudig. Een

Regenwater opvangen voor het vee loont op Lagekostenbedrijf

NARCIS (Netherlands)

Blanken, K.

2005-01-01

Het Lagekostenbedrijf in Lelystad heeft ongeveer een jaar een proefopstelling gebruikt om regenwater op te vangen en als drinkwater voor het vee te gebruiken. De kosten voor het aanleggen van de watervoorziening zijn berekend en in een tabel weergegeven, evenals de besparing op de hoeveelheid

Productiviteitstrends in het gevangeniswezen

NARCIS (Netherlands)

Niaounakis, T.K.; Urlings, T.H.; Van Heezik, A.A.S.

2014-01-01

Dit rapport schetst een beeld van de belangrijkste ontwikkelingen in beleid en produc-tiviteit in het gevangeniswezen gedurende de periode 1970-2012. Om het verloop van de productiviteit bloot te leggen, worden ontwikkelingen in de kosten aan de hand van statistische methoden gerelateerd aan

Meer of minder licht

NARCIS (Netherlands)

Graaf, A. van der; Steentjes, A.

2000-01-01

Interview Wout van Bommel, informatie over DYNO onderzoek van Alferdinck en Hogema bij TNO Technische Menskunde De natuur heeft 'recht op duisternis', zegt de milieubeweging, en daarom moet de verlichting op wegen worden teruggedrongen. De overheid wil dat ook, want de kosten moeten omlaag.

Per maand of per kWh?: beoordeling van de effecten van een ander tariefsysteem voor kleinverbruikers electriciteit

NARCIS (Netherlands)

Aalbers, R.F.A.; de Nooij, M.

2006-01-01

Dit rapport bepaalt de effecten van de invoering van een capaciteitstarief voor de kosten van het transport van elektriciteit voor kleinverbruikers. Centraal kenmerk van een capaciteitstarief is dat kleinverbruikers niet langer per afgenomen kWh, maar een vast bedrag per aansluiting betalen. In het

Deltaplan Erwinia C : praktijkgericht (C-) onderzoek aan Erwinia-problemen in bloembolgewassen 2009-2013

NARCIS (Netherlands)

Doorn, van J.; Vreeburg, P.J.M.; Leeuwen, van P.J.; Martin, W.S.; Dees, R.H.L.

2013-01-01

Erwinia vormt een groot probleem in bloembolgewassen als hyacint, iris, Dahlia en Zantedeschia. Geschat wordt (precieze cijfers ontbreken) dat de economische schade door o.a. uitval van aangetaste bollen en kosten als gevolg van extra uitzoeken ongeveer 5- 8 miljoen euro op jaarbasis bedraagt. Daar

Motorisch leren in de praktijk : implicaties voor preventie en revalidatie voorste-kruisbandletsel

NARCIS (Netherlands)

Benjaminse, Anne; Gokeler, Alli

Een reconstructie van de voorste kruisband (VKB) brengt hoge me- dische en maatschappelijke kosten met zich mee. De auteurs van dit artikel vatten de resultaten van wetenschappelijk onderzoek naar preventieprogramma’s voor VKB- blessures samen. Zij vullen deze aan met nieuwe inzichten over mo-

Bestrijding van duist in wintertarwe

NARCIS (Netherlands)

Timmer, R.D.

2006-01-01

Duist, en speciaal resistente duist, is één van de grootste problemen in het graantelend gebied het Oldambt. De wintertarwegewassen ondervinden sterke concurrentie van de groeiende duistpopulatie, hetgeen ten koste gaat van de opbrengst. De inzet en kosten van de toegepaste herbiciden nemen toe

Thermal processing of conditioned waste and fuel substitutes; Thermische Behandlung vorbehandelter Abfaelle und Ersatzbrennstoffe

Energy Technology Data Exchange (ETDEWEB)

Velden, F. van der; Engweiler, J. [Von Roll Umwelttechnik AG, Zurich (Switzerland)

1998-12-31

Different technologies for the thermal processing of mechanical-biologically conditioned waste are described and compared in terms of cost and flexibility. (orig.) [Deutsch] Es werden verschiedene Technologien der thermischen Behandlung mechanisch-biologisch vorbehandelter Abfaelle vorgestellt und im Hinblick auf Kosten und Flexibilitaet verglichen. (orig.)

TNT gaat op klantreis om tevredenheid te meten

NARCIS (Netherlands)

Jorritsma, A.

2010-01-01

Als we weten wat klanten ervaren en voelen, weten we ook wat we goed doen en waar de verbeterpunten zitten, hoe we de omzet kunnen laten groeien en kosten kunnen besparen. TNT Post omarmde de door TNO ontwikkelde 'Customer Journey' methode en ging op klantreis.

Miks astume tarastamise teed? / Herbert Vainu

Index Scriptorium Estoniae

Vainu, Herbert, 1929-2011

2004-01-01

Kapitalismi ja sotsialismi positiivseid jooni ühitava konvergentsiteooria asendumisest sotsiaalseid aspekte mittearvestava algkapitalismiga Eestis ja teistes Euroopa Liidu riikides. Inglise tarastamissüsteemist kui eeskujust

Digitale Antidiskriminierungsarbeit

Directory of Open Access Journals (Sweden)

Simone Rafael

2017-12-01

Full Text Available Rechtsextreme und andere Menschenfeind_innen nutzen das Internet intensiv, um Abwertung von Gruppen zu normalisieren und Bedrohung und Hass zu verbreiten. Wie tritt die digitale demokratische Zivilgesellschaft dem entgegen? – Mit Fakten und Argumentationsstrategien, der Stärkung von Gegenrede durch NGOs und Privatpersonen und digitaler Streetwork mit gefährdeten Jugendlichen.

Emotional Branding in der Automobilindustrie: ein Schlüssel zu langfristigem Markenerfolg?

OpenAIRE

Nadler, Sabrina; Rennhak, Carsten

2011-01-01

In der Automobilindustrie vollzieht sich aktuell ein Wandel von der Technik- zur Kundenorientierung. Die Konsumenten sollen Produkte und Dienstleistungen nicht nur einfach nutzen, sondern eine emotionale Bindung zu ihnen aufbauen und sie im Idealfall sogar lieben. Seit Gobé (2001) werden entsprechende Markenführungsansätze mit dem Schlagwort „Emotional Branding“ bezeichnet.

Lean Six Sigma in het ziekenhuis: De beschikbaarheid van infuuspompen

NARCIS (Netherlands)

Does, R.J.M.M.; Kemper, B.P.H.; Koopmans, M.

2011-01-01

In het topklinisch ziekenhuis Medisch Spectrum Twente werd in 2008 een Lean Six Sigma-project gestart. Het doel was vermindering van operationele kosten van infuuspompen. Het is een interessant voorbeeld van Lean Six Sigma in de gezondheidszorg, omdat het laat zien dat kostenbesparing niet hoeft te

Minimale temperatuurgrenzen bij courgette : onderzoek 2002

NARCIS (Netherlands)

Janse, J.; Raaphorst, M.G.M.

2003-01-01

In verband met liberalisering van de energiemarkt wordt er een nieuwe gaswet ingevoerd. Om de kosten te drukken is het zeer belangrijk om de contractcapaciteit te verkleinen. Maar onder extreme winterse omstandigheden is er dan een grote kans op een te lage kastemperatuur. Door het Praktijkonderzoek

Het geheim van Alibaba

NARCIS (Netherlands)

den Butter, F.A.G.; Wu, X.

2016-01-01

Alibaba is in korte tijd uitgegroeid tot het grootste internet handelsplatform in de wereld. Volgens de Amsterdamse hoogleraar Frank den Butter en de Chinese studente Xiaoyi Wu weet Alibaba uitstekend in te spelen op de Chinese cultuur en instituties bij het omlaag brengen van de kosten van

De economische betekenis van de jacht in Nederland.

NARCIS (Netherlands)

Kruyt, C.; Li, A.D.; Oskam, A.J.; Slangen, L.H.G.

1987-01-01

De economische betekenis van de 3 functies van jacht (produktie, beheer en recreatie) worden belicht. De totale kosten die de jagers ten behoeve van de jacht maken worden geschat, waarbij ook de financiele bestemming wordt aangegeven. Men schat het aantal aan jacht verbonden arbeidsplaatsen op 700.

Energy-oriented modernisation of prefabricated residential buildings in East Germany, illustrated by the example of large-panel buildings at Weimar, Ludwig-Feuerbach-Str. 10-18; Energetische Sanierung des industriell errichteten Wohnungsbaus in den neuen Bundeslaendern am Beispiel der Grossblockbauweise in Weimar, Ludwig-Feuerbach-Str. 10 bis 18

Energy Technology Data Exchange (ETDEWEB)

Reiss, J.; Erhorn, H. [Fraunhofer-Institut fuer Bauphysik, Stuttgart (Germany); Augner, R.; Warnstedt, K. [Weimarer Wohnstaette GmbH, Weimar (Germany); Nitschke, S.; Wenzel, P. [Architektengemeinschaft Nitschke-Donath, Weimar (Germany)

1997-12-31

The demonstration object with 40 residential units is described in the condition prior to its redevelopment. The parts of the redevelopment concept dealing with energy conservation and design are discussed in detail. Further, the execution of the construction work and the measurements necessary to make a thermal and energetic analysis of the building are described. In tabulated form, heat energy consumption quantities are listed as a function of space air temperature. Similarly, the cost of redevelopment and area-specific costs of the thermal insulation systems installed at the building are indicated. (MSK) [Deutsch] Das Demonstrationsobjekt mit 40 Wohnungen wird in seinem Zustand vor der Sanierung beschrieben. Die energetischen Massnahmen des Sanierungskonzepts sowie gestalterische Massnahmen werden naeher erlaeutert. Weiter werden die Bauausfuehrung und die fuer die thermische und energetische Gebaeudeanalyse notwendigen Messungen beschrieben. Tabellarische werden die Heizwaermeverbraeuche in Abhaengigkeit von der Raumlufttemperatur aufgezeigt. Ebenso sind die Kosten fuer die Sanierung sowie die flaechenspezifischen Kosten fuer die am Gebaeude ausgefuehrten Daemmsysteme aufgefuehrt.

Analysis of the electrical energy requirements of the GSI facility

CERN Document Server

Ripp, Christopher

2013-01-01

Die Veränderung auf dem deutschen Energiemarkt durch die Energiewende bringt eine Viel-zahl von Problemen mit sich. Der stetig ansteigende Ausbau von erneuerbaren Energien und die daraus resultierende starke Schwankung der eingespeisten Energiemengen zwingen die Netzbetreiber zum Ausbau der Stromnetze [1]. Die dadurch verursachten Kosten lassen die Netznutzungsgebühren steigen, welche an die Endkunden weitergegeben werden. Ebenfalls stieg die EEG-Umlage (Erneuerbare-Energie-Gesetz) von 3,6ct/kWh im Jahr 2012 über 5,3ct/kWh im Jahr 2013 auf 6,3ct/kWh für das Jahr 2014 [2], [3], [4]. Die extrem schnell steigenden Energiekosten zwingen die Verbraucher zur Erhöhung ihrer Energieeffizienz, um die laufenden Kosten so niedrig wie möglich zu halten [3]. Dies verlangt nach innovativen Ansätzen und Lösungen im unternehmenseigenen Energiemanagement. Besonders For-schungseinrichtungen mit großem Energiebedarf müssen eine höhere Energieeffizienz reali-sieren, um bei knappen Budgets ihrem Forschungsauftrag gerec...

Parameters for viable process combinations; Randbedingungen fuer sinnvolle Verfahrenskombinationen

Energy Technology Data Exchange (ETDEWEB)

Lahl, U.; Zeschmar-Lahl, B. [BZL Kommunikation und Projektsteuerung GmbH, Oyten (Germany)

1998-09-01

The following parameters merit examination in determining the viability of process combinations: conceptual and technical soundness, environmental acceptability, energy balance, flexibility, costs, economic risk potential. The present contribution on this subject is not intended to take the place of or cover the scope of single-case studies. In practice, viability studies on process combinations have to deal with concrete plans involving precisely defined material flow balances, emissions, costs etc. The present paper therefore only presents the basic principles of this type of study. [Deutsch] Folgende Randbedingungen fuer sinnvolle Verfahrenskombinationen sind zu untersuchen: - konzeptionelle und technische Stimmigkeit, - Umweltvertraeglichkeit, - energetische Bilanz, - Flexibilitaet, - Kosten, - oekonomisches Risikopotential. Nun kann dieser Beitrag zum Thema keine Einzelfallbetrachtung ersetzen bzw. abdecken. Im Rahmen einer echten Pruefung auf `Sinnhaftigkeit` einer Kombinationsloesung stehen sich ganz konkrete Planungen gegenueber, die wiederum mit definierten Stoffflussbilanzen, Emissionen, Kosten usw. verbunden sind. Im Rahmen dieser Betrachtung koennen nur die Grundzuege einer derartigen Pruefung dargestellt werden. (orig.)

Heating power stations - influencing costs by organisational measures; Heizkraftwerke - Kostenbeeinflussung durch organisatorische Massnahmen

Energy Technology Data Exchange (ETDEWEB)

Riedlinger, R.A.

1993-12-31

The products of district heating and, in the foreseeable future also electrical power, must compete in the market with low prices. Low prices, which still provide a profit, are only possible based on low costs. Low costs are achieved by cost control. The basis for cost control is transparency of costs. Mainly organisational measures were proposed and described. From the individual stages of the organisation, the organisational build-up is obtained, the important feature of which is the allocation of competence to make decisions. (orig./KO) [Deutsch] Die Produkte Fernwaerme und in absehbarer Zeit auch elektrische Energie, muessen sich im Markt mit niedrigen Preisen behaupten. Niedrige Preise, die trotzdem einen Gewinn erbringen sollen, sind nur auf der Basis niedriger Kosten moeglich. Niedrige Kosten erreicht man durch Kostensteuerung, Controlling. Grundlage der Kostensteuerung ist Kostentransparenz. Es wurden im wesentlichen ablauforganisatorische Massnahmen vorgeschlagen und beschrieben. Aus den einzelnen Stationen der Ablauforganisation ergibt sich letztendlich die Aufbauorganisation, deren wesentliches Merkmal die Zuordnung von Entscheidungskompetenz ist. (orig./KO)

Gefährlicher Trend : Smartphone im Strassenverkehr : auch zu Fuss ist das Ablenkungspotenzial sehr gross.

NARCIS (Netherlands)

2016-01-01

Viele Menschen, die sich zu Fuß im Straßenverkehr bewegen, nutzen dabei das Smartphone. Dies ist das Ergebnis einer Erhebung von DEKRA in sechs europäischen Hauptstädten. Von den rund 14.000 erfassten Personen nutzten fast 17 Prozent ihr Handy — für Textnachrichten, zum Telefonieren oder Musikhören.

Media Memories in Focus Group Discussions - Methodological Reflections Instancing the Global Media Generations Project

Directory of Open Access Journals (Sweden)

Theo Hug

2010-06-01

Full Text Available Medienereignisse wie auch die Einführung und Verbreitung neuer Medientechnologien und Formate bringen mannigfaltige Wege des „Eintretens von Medien ins Leben“ mit sich. Im Projekt Globale Mediengenerationen (GMG wurden Medienerinnerungen aus der Kindheit im Kontext von Gruppendiskussionen am Beispiel dreier Generationen aus verschiedenen Ländern aller Kontinente untersucht. Dabei wurden medienbezogene Wissensbestände von drei Alterskohorten globaler Generationen analysiert. Der Artikel diskutiert methodologische Aspekte des Projekts und komplexe und selektive Prozesse des Erinnerns vergangener Ereignisse. Er untersucht Gemeinsamkeiten und Unterschiede des GMG-Ansatzes mit dem dokumentarischen Ansatz von Ralf Bohnsack, die beide in der Wissenssoziologie von Karl Mannheim verwurzelt sind. Darüber hinaus wird Medialität als basale methodologische Kategorie in Erwägung gezogen, nicht nur im Hinblick auf die Klärung begrifflicher Grundlagen, sondern auch als inhärente Dimension von Forschungsprozessen. Media events in general and the introduction and divulgence of new media technologies and formats in particular implicate various (new ways of “media entering life.” In the Global Media Generations (GMG research project, articulation of individuals’ memories of childhood experiences with the media was afforded by context of focus groups of three generations in different countries of six continents. In this project media related knowledge segments of different age cohorts have been analyzed and interpreted. The article deals with methodological questions of the project and complex processes of ‘remembering’ past events. It explores commonalities and differences of the GMG approach with Ralf Bohnsack’s documentary approach, both rooted in the sociology of knowledge of Karl Mannheim. Furthermore, mediality is taken into consideration as a basic methodological category, which means that it is perceived not only as subject matter to

Medicaid prospective payment: Case-mix increase

Science.gov (United States)

Baker, Samuel L.; Kronenfeld, Jennie J.

1990-01-01

South Carolina Medicaid implemented prospective payment by diagnosis-related group (DRG) for inpatient care. The rate of complications among newborns and deliveries doubled immediately. The case-mix index for newborns increased 66.6 percent, which increased the total Medicaid hospital expenditure 5.5 percent. Outlier payments increased total expenditure further. DRG distribution change among newborns has a large impact on spending because newborn complication DRGs have high weights. States adopting a DRG-based payment system for Medicaid should anticipate a greater increase in case mix than Medicare experienced. PMID:10113463

The Implications of Culture for Dictionaries of the African Languages*

Directory of Open Access Journals (Sweden)

A.C. Nkabinde

2011-10-01

Full Text Available

Abstract: This article attempts to show how culture or aspects thereof can be used to comple-ment linguistic and other information in the compilation of dictionaries of African languages. Some obstacles in the way of achieving this goal are identified and proposals made on how to deal with them. Although only some cultural aspects of a single language are examined, the conclusions are valid for cultural aspects of all African languages.

Keywords: CONTEXT, CULTURE, CORPUS, EUPHEMISM, FIGURATIVE LANGUAGE, HLONIPHA, KINSHIP TERMS, LEXICAL BORROWING, MULTILINGUALISM, SPEECH COM-MUNITY, STANDARD ZULU, TABOO

Opsomming: Die implikasies van kultuur vir woordeboeke van die Afri-katale. Hierdie artikel probeer om aan te toon hoe kultuur of aspekte daarvan gebruik kan word om taalkundige en ander inligting aan te vul by die samestelling van woordeboeke van die Afrika-tale. 'n Aantal struikelblokke op die weg om hierdie doel te bereik, word geïdentifiseer en voor-stelle gemaak oor hoe om hulle te hanteer. Alhoewel slegs sommige kulturele aspekte van 'n enkele taal ondersoek word, is die gevolgtrekkings geldig vir kulturele aspekte van alle Afrikatale.

Sleutelwoorde: EUFEMISME, FIGUURLIKE TAAL, HLONIPHA, KONTEKS, KORPUS, KULTUUR, LEKSIKALE ONTLENING, TAALGEMEENSKAP, TABOE, STANDAARDZOELOE, VEELTALIGHEID, VERWANTSKAPSTERME

Expression profile of vesicular nucleotide transporter (VNUT, SLC17A9) in subpopulations of rat dorsal root ganglion neurons.

Science.gov (United States)

Nishida, Kentaro; Nomura, Yuka; Kawamori, Kanako; Moriyama, Yoshinori; Nagasawa, Kazuki

2014-09-05

ATP plays an important role in the signal transduction between sensory neurons and satellite cells in dorsal root ganglia (DRGs). In primary cultured DRG neurons, ATP is known to be stored in lysosomes via a vesicular nucleotide transporter (VNUT), and to be released into the intercellular space through exocytosis. DRGs consist of large-, medium- and small-sized neurons, which play different roles in sensory transmission, but there is no information on the expression profiles of VNUT in DRG subpopulations. Here, we obtained detailed expression profiles of VNUT in isolated rat DRG tissues. On immunohistochemical analysis, VNUT was found in DRG neurons, and was predominantly expressed by the small- and medium-sized DRG ones, as judged upon visual inspection, and this was compatible with the finding that the number of VNUT-positive DRG neurons in IB4-positive cells was greater than that in NF200-positive ones. These results suggest that VNUT play a role in ATP accumulation in DRG neurons, especially in small- and medium-sized ones, and might be involved in ATP-mediated nociceptive signaling in DRGs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Sotsiaalkapitali mõõtmine / Anneli Kaasa

Index Scriptorium Estoniae

Kaasa, Anneli, 1975-

2006-01-01

Ülevaade sotsiaalkapitali eri aspekte kirjeldavatest näitajatest, võimalikest meetoditest andmete kogumiseks, töötlemiseks ja üldistamiseks, sotsiaalkapitali mõõtmisega seotud probleemidest. Tabel

Does HIPE data capture the complexity of stroke patients in an acute hospital setting?

LENUS (Irish Health Repository)

Clarke, B

2010-01-01

The Hospital Inpatient Enquiry (HIPE) system is currently used as a principle source of national data on discharges from acute hospitals. The Casemix Programme is used to calculate funding for patient care (HIPE activity and Specialty Costs Returns). Th coding is usually undertaken by clerical personnel. We were concerned that the medical complexity of our stroke patients was not captured by the process. The aims of this study were to compare activity coded by HIPE coding staff and medical staff in consecutive stroke patients discharged from the hospital. One hundred consecutive discharged patients with stroke as primary diagnosis were coded by clerical staff [usual practice] and by medical staff. We compared the coding and any differences. We calculated the financial comparison of subsequent differences in Diagnostic Related Groups (DRGs) and Relative Values (RVs). Clinician coded DRGs resulted in a higher assigned RV in 45 cases. The total RV value for HIPE using clerical coding was 595,268.94 euros and using medical coding was 725,252.16 euros. We conclude that medical input is useful in detailing the complications arising in stroke patients. We suggest that physicians should assist in the HIPE coding process in order to capture clinical complexity, so that funding can be appropriately assigned to manage these complex patients.

Danskernes kostvaner

DEFF Research Database (Denmark)

Trolle, Ellen; Gondolf, Ulla Holmboe; Ege, Majken

. Indholdet af mikronæringsstoffer i gennemsnitskosten var rigelig for følgende mikronæringsstoffer: Vitamin A, thiamin, folat, vitamin B12, vitamin C, calcium, magnesium samt jod. For følgende mikronæringsstoffer var kostens indhold acceptabel: riboflavin, niacin, vitamin B6, magnesium, fosfor, zink, selen...

Wind energy. From the garage workshop to a global market. 25 years scientific accompaniment; Windenergie - von der Garagen-Werkstatt zum Weltmarkt. 25 Jahre wissenschaftliche Begleitung

Energy Technology Data Exchange (ETDEWEB)

Hahn, Berthold; Stuebig, Cornelia [Fraunhofer Institut fuer Windenergie und Energiesystemtechnik (IWES), Kassel (Germany); Ponick, Bernd [Fraunhofer Institut fuer Windenergie und Energiesystemtechnik (IWES), Kassel (Germany); Hannover Univ. (Germany); Keller, Sarina [DLR Deutsches Zentrum fuer Luft- und Raumfahrt e.V., Koeln (Germany); Felder, Martin; Jachmann, Henning [Zentrum fuer Sonnenenergie- und Wasserstoff-Forschung Baden-Wuerttemberg (ZSW), Stuttgart (Germany)

2015-04-15

The plant technology for the use of wind energy on land is so sophisticated that the WEA can be operated as ''normal'' power plants to the grid. Of course, there are still potential for development, for example, in terms of improved reliability, or concerning the fledgling offshore use, always with an emphasis on the simultaneous reduction in costs. Although from the former garages workshops is little remaining, the production techniques are another major issue in terms of quality and costs. The cost of electricity from wind energy is taking account of external costs are already competitive with conventional power generation. To limit the costs of the energy transition one to expect from the wind energy as of the other technologies cost reduction. Various studies show that the wind energy supply in the balance is sufficient several times to provide the expected contribution to supply. [German] Die Anlagentechnologie fuer die Windenergienutzung an Land ist so ausgereift, dass die WEA als ''normale'' Kraftwerke am Netz betrieben werden koennen. Selbstverstaendlich bestehen weiterhin Entwicklungspotenziale, z. B. hinsichtlich verbesserter Zuverlaessigkeit oder bezueglich der noch jungen Offshore Nutzung, immer mit einem Augenmerk auf die gleichzeitige Kostenreduktion. Auch wenn von den ehemaligen Garagen Werkstaetten wenig uebrig geblieben ist, sind die Produktionstechniken ein weiteres wesentliches Thema bezueglich Qualitaet und Kosten. Die Kosteneffizienz der Stromerzeugung aus Windenergie ist unter Beruecksichtigung externer Kosten heute schon konkurrenzfaehig zur konventionellen Stromerzeugung. Zur Begrenzung der Kosten der Energiewende wird aber von der Windenergie wie von den anderen Technologien weiterhin eine Kostenreduktion erwartet. Diverse Studien zeigen, dass das Windenergieangebot in der Bilanz mehrfach ausreicht, um den erwarteten Beitrag zur Versorgung leisten zu koennen.

Meditsiinidoktor Marje Oona / Heidi-Ingrid Maaroos

Index Scriptorium Estoniae

Maaroos, Heidi-Ingrid, 1942-

2005-01-01

Tartu Ülikooli polikliiniku ja perearstiteaduse õppetooli assistendi ja teaduri Marje Oona doktoritöö "Helicobacter pylori infektsioon lastel : epidemioloogilisi ja ravi aspekte" kaitsmisest Tartu Ülikoolis 12. jaanuaril 2005

Studia Generalia "Mõisteloomest ja tähistamisest"

Index Scriptorium Estoniae

2007-01-01

Studia Generalia loengus vaadeldakse erinevaid tähistamisteooriaid ning esitatakse neil põhinev mudel, mille abiga saab kultuurinähtuste analüüsis seostada nende kogemuslikke ja keelelisi aspekte

Hereditaer motorisk sensorisk neuropati (Charcot-Marie-Tooths sygdom). Molekyloergenetiske aspekter

DEFF Research Database (Denmark)

Hertz, M J; Børglum, Anders; Brandt, C A

1995-01-01

Hereditary motor and sensory neuropathy (HMSN) comprises a heterogenous group of peripheral neuropathies which are classified on the basis of symptoms, mode of inheritance and electrophysiological and neuropathological investigations. HMSN type I, or Charcot-Marie-Tooth disease (CMT) type 1...... be detected by DNA-analysis. The genes for HMSN type Ia, Ib and an X-linked dominant form have been identified as PMP22, MPZ and GJB1 respectively. Analysis for these molecular defects will become important in the differential diagnosis of peripheral neuropathies and will surely prove invaluable......, is a hypertrophic and demyelinating neuropathy with reduced nerve conduction velocity, and most often with dominant inheritance. HMSN type II (CMT type 2), the neuronal or axonal form, is dominantly inherited with normal or only moderately reduced nerve conduction velocity. HMSN type III, also called Déjérine...

Robots niet langer Science Fiction: scenario's voor de samenwerking met robots

NARCIS (Netherlands)

Popma, J.

2015-01-01

Hoewel industriële robots al jaren bestaan, lijkt hun opmars nu toch echt begonnen. Diverse scenario's buitelen over elkaar: hoeveel banen gaat dit kosten? Maar zeker zo interessant is wat de robotisering betekent voor de werknemers die wél hun baan houden. Hoe gaan die samenwerken met robots? En

Case-mix classificatie als basis voor bekostiging van wijkverpleging : Een verkennend onderzoek in opdracht van MeanderGroep Zuid-Limburg

NARCIS (Netherlands)

Elissen, Arianne; Metzelthin, Silke; van den Bulck, Anne; Verbeek, Hilde; Ruwaard, Dirk

2017-01-01

n opdracht van MeanderGroep Zuid‐Limburg is tussen mei 2016 en april 2017 door de Universiteit Maastricht een verkennend onderzoek uitgevoerd naar de relatie tussen cliëntkenmerken en het gebruik en de kosten van wijkverpleging. Doel is om een bijdrage te leveren aan de ontwikkeling van een nieuwe

The power of supply chain finance : how companies can apply collaborative finance models in their supply chain to mitigate risks and reduce costs

NARCIS (Netherlands)

Michiel Steeman

2014-01-01

Supply chain finance krijgt steeds meer aandacht bij bedrijven als een middel om hun supply chain strategie te ondersteunen. Het gaat hierbij niet alleen om het reduceren van kosten maar ook om het mitigeren van de risico’s in de keten. Wij verwachten dan ook dat vooral bij grote bedrijven de

Concepts to increase the seasonal coefficient of performance of an air-water heat pump: Comparison according to costs and benefits; Konzepte zur Erhoehung der saisonalen Leistungszahl einer Luft-Wasser-Waermepumpe. Vergleich hinsichtlich Kosten und Nutzen

Energy Technology Data Exchange (ETDEWEB)

Mader, Gunda [Danfoss A/S, Nordborg (Denmark); Tiedemann, Thomas [Danfoss GmbH, Offenbach (Germany); Palm, Bjoern [KTH, Stockholm (Sweden)

2012-07-01

The regulation EN 14825 defines three climate profiles for the calculation of the seasonal coefficient of performance (SCOP) of an air-water heat pump. Nine key figures for the evaluation of a system result together with three possible profiles of the water intake temperature. In particular, the combination of cold climate profile and enhanced intake temperatures is particularly critical with respect to the achievable SCOP. With the classic system design with two heat exchangers, a compressor and an expansion valve, sufficiently high SCOP values can often no longer be achieved, or the heat pump cannot be operated no longer due to an enhanced outlet temperatures of the refrigerant at the compressor and at low ambient temperatures. Different concepts concerning the system design, component selection and control are known in order to extend the operational area of a heat pump to large differences between the temperature of the heat source and the temperature of the heat sink as well as to achieve simultaneously enhanced SCOP values. The numerical screening method is used in order to compare several concepts of this type by means of the different SCOP values as well as the costs attributable to the plant. For this, the Pareto curves of the optimal combination of the heat transfer surfaces are determined taking into account the condition of a limited refrigerant temperature at the compressor outlet. Different refrigerants also are included in the analysis. The impact of different control parameters and control strategies as well as the different choice of components are investigated by means of a sensitivity analysis.

S2k-Leitlinie zum Gebrauch von Präparationen zur lokalen Anwendung auf der Haut (Topika).

Science.gov (United States)

Wohlrab, Johannes; Staubach, Petra; Augustin, Matthias; Eisert, Lisa; Hünerbein, Andreas; Nast, Alexander; Reimann, Holger; Strömer, Klaus; Mahler, Vera

2018-03-01

Diese Leitlinie richtet sich an Assistenz- und Fachärzte der Dermatologie sowie an Kostenträger und politische Entscheidungsgremien. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen unter Einbindung von Apothekern erstellt. Die Leitlinie stellt allgemeine Aspekte der Pharmakokinetik sowie der regulatorischen Begrifflichkeiten dar. Es werden Empfehlungen zur Indikation von Magistralrezepturen sowie deren Qualitätssicherung gegeben. Die Bedeutung der galenischen Grundlagen und die Problematik bei einer Substitution gegeneinander verschiedener Grundlagen werden dargestellt. Die Leitlinie umfasst Kriterien zur Auswahl einer adäquaten Grundlage sowie spezifische Aspekte zur Therapieplanung. Die Leitlinie gibt Empfehlungen zum Management bei Unverträglichkeiten gegenüber Bestandteilen der Grundlagen oder Hilfsstoffe. © 2018 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.

LibGuide som social platform

DEFF Research Database (Denmark)

Nielsen, Susanne; Volder Kjær, Berit; Andersen, Bente Thorup

2011-01-01

undervisningsforløb. Det er formålet herved at højne både kvaliteten af undervisningen og udviklingen af elevernes informationskompetence. LibGuide er planlagt til at skulle understøtte en kommunikativ forståelse og samarbejdet mellem eleverne og bibliotekar/lærer, dvs. der er fokus på det sociale aspekt. Artiklen...... viser at de nævnte mål indebærer et eksplorativt udviklingsforløb. Udviklingen af et værktøj, der skal indfri de nævnte samarbejdsmæssige aspekter, forudsætter en evalueringsproces, hvor der gives tid til erhvervelsen af mange erfaringer og refleksioner. Artiklen gør rede for de ideer, der ligger bag...

The Significance of Tallinn and Livonia to Helsinki in 1550-1600 / Seppo Aalto

Index Scriptorium Estoniae

Aalto, Seppo

2013-01-01

Helsingi oli oma asutamisest peale Tallinnaga tihedalt seotud. Kui Rootsi sai 1560. aastatel Tallinna ja Põhja-Eesti enda valdusesse, siis need sidemed tihenesid ning mõjutasid Helsingi eluolu kõiki aspekte

Alteration of the cell adhesion molecule L1 expression in a specific subset of primary afferent neurons contributes to neuropathic pain.

Science.gov (United States)

Yamanaka, Hiroki; Obata, Koichi; Kobayashi, Kimiko; Dai, Yi; Fukuoka, Tetsuo; Noguchi, Koichi

2007-02-01

The cell adhesion molecule L1 (L1-CAM) plays important functional roles in the developing and adult nervous systems. Here we show that peripheral nerve injury induced dynamic post-transcriptional alteration of L1-CAM in the rat dorsal root ganglia (DRGs) and spinal cord. Sciatic nerve transection (SCNT) changed the expression of L1-CAM protein but not L1-CAM mRNA. In DRGs, SCNT induced accumulation of the L1-CAM into the surface of somata, which resulted in the formation of immunoreactive ring structures in a number of unmyelinated C-fiber neurons. These neurons with L1-CAM-immunoreactive ring structures were heavily colocalized with phosphorylated p38 MAPK. Western blot analysis revealed the increase of full-length L1-CAM and decrease of fragments of L1-CAM after SCNT in DRGs. Following SCNT, L1-CAM-immunoreactive profiles in the dorsal horn showed an increase mainly in pre-synaptic areas of laminae I-II with a delayed onset and colocalized with growth-associated protein 43. In contrast to DRGs, SCNT increased the proteolytic 80-kDa fragment of L1-CAM and decreased full-length L1-CAM in the spinal cord. The intrathecal injection of L1-CAM antibody for the extracellular domain of L1-CAM inhibited activation of p38 MAPK and emergence of ring structures of L1-CAM immunoreactivity in injured DRG neurons. Moreover, inhibition of extracellular L1-CAM binding by intrathecal administration of antibody suppressed the mechanical allodynia and thermal hyperalgesia induced by partial SCNT. Collectively, these data suggest that the modification of L1-CAM in nociceptive pathways might be an important pathomechanism of neuropathic pain.

Acute morphine activates satellite glial cells and up-regulates IL-1β in dorsal root ganglia in mice via matrix metalloprotease-9

Directory of Open Access Journals (Sweden)

Berta Temugin

2012-03-01

Full Text Available Abstract Background Activation of spinal cord glial cells such as microglia and astrocytes has been shown to regulate chronic opioid-induced antinociceptive tolerance and hyperalgesia, due to spinal up-regulation of the proinflammatory cytokines such as interleukin-1 beta (IL-1β. Matrix metalloprotease-9 (MMP-9 has been implicated in IL-1β activation in neuropathic pain. However, it is unclear whether acute opioid treatment can activate glial cells in the peripheral nervous system. We examined acute morphine-induced activation of satellite glial cells (SGCs and up-regulation of IL-1β in dorsal root ganglia (DRGs, and further investigated the involvement of MMP-9 in these opioid-induced peripheral changes. Results Subcutaneous morphine injection (10 mg/kg induced robust peripheral glial responses, as evidenced by increased GFAP expression in DRGs but not in spinal cords. The acute morphine-induced GFAP expression is transient, peaking at 2 h and declining after 3 h. Acute morphine treatment also increased IL-1β immunoreactivity in SGCs and IL-1β activation in DRGs. MMP-9 and GFAP are expressed in DRG neurons and SGCs, respectively. Confocal analysis revealed a close proximity of MMP-9 and GFAP immunostaining. Importantly, morphine-induced DRG up-regulation of GFAP expression and IL-1β activation was abolished after Mmp9 deletion or naloxone pre-treatment. Finally, intrathecal injections of IL-1β-selective siRNA not only reduced DRG IL-1β expression but also prolonged acute morphine-induced analgesia. Conclusions Acute morphine induces opioid receptors- and MMP-9-dependent up-regulation of GFAP expression and IL-1β activation in SGCs of DRGs. MMP-9 could mask and shorten morphine analgesia via peripheral neuron-glial interactions. Targeting peripheral glial activation might prolong acute opioid analgesia.

RiceMetaSys for salt and drought stress responsive genes in rice: a web interface for crop improvement.

Science.gov (United States)

Sandhu, Maninder; Sureshkumar, V; Prakash, Chandra; Dixit, Rekha; Solanke, Amolkumar U; Sharma, Tilak Raj; Mohapatra, Trilochan; S V, Amitha Mithra

2017-09-30

Genome-wide microarray has enabled development of robust databases for functional genomics studies in rice. However, such databases do not directly cater to the needs of breeders. Here, we have attempted to develop a web interface which combines the information from functional genomic studies across different genetic backgrounds with DNA markers so that they can be readily deployed in crop improvement. In the current version of the database, we have included drought and salinity stress studies since these two are the major abiotic stresses in rice. RiceMetaSys, a user-friendly and freely available web interface provides comprehensive information on salt responsive genes (SRGs) and drought responsive genes (DRGs) across genotypes, crop development stages and tissues, identified from multiple microarray datasets. 'Physical position search' is an attractive tool for those using QTL based approach for dissecting tolerance to salt and drought stress since it can provide the list of SRGs and DRGs in any physical interval. To identify robust candidate genes for use in crop improvement, the 'common genes across varieties' search tool is useful. Graphical visualization of expression profiles across genes and rice genotypes has been enabled to facilitate the user and to make the comparisons more impactful. Simple Sequence Repeat (SSR) search in the SRGs and DRGs is a valuable tool for fine mapping and marker assisted selection since it provides primers for survey of polymorphism. An external link to intron specific markers is also provided for this purpose. Bulk retrieval of data without any limit has been enabled in case of locus and SSR search. The aim of this database is to facilitate users with a simple and straight-forward search options for identification of robust candidate genes from among thousands of SRGs and DRGs so as to facilitate linking variation in expression profiles to variation in phenotype. Database URL: http://14.139.229.201.

Effects of electroacupuncture at 2 and 100 Hz on rat type 2 diabetic neuropathic pain and hyperalgesia-related protein expression in the dorsal root ganglion.

Science.gov (United States)

He, Xiao-Fen; Wei, Jun-Jun; Shou, Sheng-Yun; Fang, Jian-Qiao; Jiang, Yong-Liang

To investigate the analgesic effects of electroacupuncture (EA) at 2 and 100 Hz on type 2 diabetic neuropathic pain (DNP) and on the expressions of the P2X3 receptor and calcitonin gene-related peptide (CGRP) in the dorsal root ganglion (DRG). Rat type 2 DNP was induced by a high calorie and high sugar diet fed for 7 weeks, plus a single intraperitoneal injection of streptozotocin (STZ) after 5 weeks. EA at 2 and 100 Hz was carried out once every day after 7 weeks for 7 consecutive days. Body weight, serum fasting insulin (FINS), fasting blood glucose (FBG), insulin sensitivity index (ISI), and paw withdrawal latency (PWL) were measured. The expressions of L4-L6 DRG P2X3 receptors and CGRP were assessed by immunofluorescence. Type 2 DNP was successfully induced as shown by the increased body weight, FINS, and FBG, as well as the reduced ISI and PWL. Expressions of P2X3 receptors and CGRP in L4-L6 DRGs increased. EA at both 2 and 100 Hz relieved type 2 DNP, but the analgesic effect of EA was stronger at 2 Hz. P2X3 receptor expression decreased in L4-L6 DRGs following EA at 2 Hz and in L5 and L6 DRGs following EA at 100 Hz. EA at both 2 and 100 Hz down-regulated CGRP overexpression in L4-L6 DRGs. These findings indicate that EA at 2 Hz is a good option for the management of type 2 DNP. The EA effect may be related to its down-regulation of the overexpressions of the DRG P2X3 receptors and CGRP in this condition.

Chronic stress and peripheral pain: Evidence for distinct, region-specific changes in visceral and somatosensory pain regulatory pathways.

Science.gov (United States)

Zheng, Gen; Hong, Shuangsong; Hayes, John M; Wiley, John W

2015-11-01

Chronic stress alters the hypothalamic-pituitary-adrenal (HPA) axis and enhances visceral and somatosensory pain perception. It is unresolved whether chronic stress has distinct effects on visceral and somatosensory pain regulatory pathways. Previous studies reported that stress-induced visceral hyperalgesia is associated with reciprocal alterations of endovanilloid and endocannabinoid pain pathways in DRG neurons innervating the pelvic viscera. In this study, we compared somatosensory and visceral hyperalgesia with respect to differential responses of peripheral pain regulatory pathways in a rat model of chronic, intermittent stress. We found that chronic stress induced reciprocal changes in the endocannabinoid 2-AG (increased) and endocannabinoid degradation enzymes COX-2 and FAAH (decreased), associated with down-regulation of CB1 and up-regulation of TRPV1 receptors in L6-S2 DRG but not L4-L5 DRG neurons. In contrast, sodium channels Nav1.7 and Nav1.8 were up-regulated in L4-L5 but not L6-S2 DRGs in stressed rats, which was reproduced in control DRGs treated with corticosterone in vitro. The reciprocal changes of CB1, TRPV1 and sodium channels were cell-specific and observed in the sub-population of nociceptive neurons. Behavioral assessment showed that visceral hyperalgesia persisted, whereas somatosensory hyperalgesia and enhanced expression of Nav1.7 and Nav1.8 sodium channels in L4-L5 DRGs normalized 3 days after completion of the stress phase. These data indicate that chronic stress induces visceral and somatosensory hyperalgesia that involves differential changes in endovanilloid and endocannabinoid pathways, and sodium channels in DRGs innervating the pelvic viscera and lower extremities. These results suggest that chronic stress-induced visceral and lower extremity somatosensory hyperalgesia can be treated selectively at different levels of the spinal cord. Copyright © 2015 Elsevier Inc. All rights reserved.

Potenciais usos dos AP-DRG para discriminar o perfil da assistência de unidades hospitalares Potential uses of AP-DRG to describe the health care profile in hospital units

Directory of Open Access Journals (Sweden)

Marina Ferreira de Noronha

2004-01-01

Full Text Available Os All Patient Diagnosis Related Groups (AP-DRG constituem-se em um sistema de classificação de pacientes internados em hospitais gerais, que reúne pacientes em grupos, considerando diversas características com impacto no consumo de recursos hospitalares e critérios clínicos. O AP-DRG tem suas diversas versões utilizadas para a gerência e como unidade de pagamento a hospitais. O objetivo deste artigo foi descrever a classificação, explorando suas potencialidades para gerar informações para a gestão de hospitais. Foi utilizada a base de dados da região de Ribeirão Preto, São Paulo Brasil, de 1997, que inclui unidades hospitalares públicas, privadas e filantrópicas. Foram realizadas comparações entre Ribeirão Preto e Estados Unidos quanto ao tempo médio de permanência hospitalar de AP-DRGs selecionados. Utilizando-se os pesos relacionados ao custo relativo dos DRGs, construídos para o Estado de Nova York, Estados Unidos, foi possível verificar o perfil da atenção prestada por trinta hospitais da região de Ribeirão Preto e também o perfil dos pacientes pagos pelo SUS procedentes de outras localidades. Avalia-se que a classificação fornece informações acerca do perfil de complexidade da atenção hospitalar, tanto no que diz respeito à regionalização e sua organização em níveis de complexidade, como para subsidiar as decisões de composição dessa rede de assistência, auxiliar no seu monitoramento e contribuir para o aprimoramento do pagamento aos hospitais.The All Patient Diagnosis Related Groups (AP-DRG provide a classification system for general hospital inpatients, aggregating hospitalizations based on resource use and clinical criteria. The different versions of the AP-DRG have been applied to inpatient care management and reimbursement. This paper aimed to describe the classification and explore the potential for generating information on inpatient care management based on data from the Ribeirão Preto

Lepitusmenetlusest. Kuidas toimub lepitamine? / Kirsty Laidvee

Index Scriptorium Estoniae

Laidvee, Kirsty, 1978-

2013-01-01

Lepitusseaduse jõustumisega 1. jaan. 2010. a. võeti Eesti õiguskorda üle Euroopa Parlamendi ja nõukogu direktiiv nr 2008/52/EÜ. Lepitusseadus reguleerib keskseid mediatsiooni ja tsiviilkohtumenetluse vahelise seose aspekte

Hamm q.q./ABN AMRO: inning van stil verpande vorderingen tijdens faillissement

NARCIS (Netherlands)

M.L. Tuil (Mark)

2010-01-01

textabstractIn deze bijdrage wordt het arrest HR 30 oktober 2009, LJN BJ0861, RvdW 2009, 1271 (Hamm q.q./ABN AMRO) besproken. Aan de orde komen de wachtperiode die voor de curator geldt op grond van het arrest ING/Verdonk, de informatieverschaffing door de curator aan de pandhouder en de kosten

Zachtrot in iris. Onderzoek naar de oorzaak van zachtrot (Erwinia) en zoeken naar teeltmaatregelen om aantasting te verminderen of te voorkomen. Onderzoeksjaren 2003-2005

NARCIS (Netherlands)

Vlaming, E.A.C.

2005-01-01

De laatste jaren treden er steeds meer problemen op met zachtrot bij irissen in de bewaring bij 30°C. Tijdens deze warme bewaring kan soms meer dan 50% van de bollen worden aangetast. De bollen worden zacht en drogen later in. Het probleem neemt jaarlijks toe. De afnemers hebben grote kosten door

Charting a path forward: policy analysis of China's evolved DRG-based hospital payment system.

Science.gov (United States)

Liu, Rui; Shi, Jianwei; Yang, Beilei; Jin, Chunlin; Sun, Pengfei; Wu, Lingfang; Yu, Dehua; Xiong, Linping; Wang, Zhaoxin

2017-09-01

At present, the diagnosis-related groups-based prospective payment system (DRG-PPS) that has been implemented in China is merely a prototype called the simplified DRG-PPS, which is known as the 'ceiling price for a single disease'. Given that studies on the effects of a simplified DRG-PPS in China have usually been controversial, we aim to synthesize evidence examining whether DRGs can reduce medical costs and length of stay (LOS) in China. Data were searched from both Chinese [Wan Fang and China National Knowledge Infrastructure Database (CNKI)] and international databases (Web of Science and PubMed), as well as the official websites of Chinese health departments in the 2004-2016 period. Only studies with a design that included both experimental (with DRG-PPS implementation) and control groups (without DRG-PPS implementation) were included in the review. The studies were based on inpatient samples from public hospitals distributed in 12 provinces of mainland China. Among them, 80.95% (17/21) revealed that hospitalization costs could be reduced significantly, and 50.00% (8/16) indicated that length of stay could be decreased significantly. In addition, the government reports showed the enormous differences in pricing standards and LOS in various provinces, even for the same disease. We conclude that the simplified DRGs are useful in controlling hospitalization costs, but they fail to reduce LOS. Much work remains to be done in China to improve the simplified DRG-PPS. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Enkele etiese aspekte van natuurbewaring

Directory of Open Access Journals (Sweden)

B. J. Engelbrecht

1992-01-01

Full Text Available Certain ethical aspects of nature conservation The present worldwide ecocrisis is of such a magnitude and seriousness that man’s life, living standards, future and very existence on earth are at stake. The main components of this man-made ecocrisis are the existing increasing overpopulation of earth, the exorbitant demands on the natural resources of our planet, the pace at which the non-renewable energy and other resources are being depleted and the pollution of the whole earth. In this paper we shall treat the population explosion problem as perhaps the most basic of the four components of the ecocrisis; we shall also give special attention to the associated ethical issues.

Kliniske aspekter af Marfans syndrom

DEFF Research Database (Denmark)

Belsing, Tina Zimmermann; Lund, Allan Meldgaard; Søndergaard, Lars

2011-01-01

Marfan syndrome (MFS) and MFS-related diseases are inherited connective tissue disorders involving several organ systems. The diagnosis of MFS is difficult as the many symptoms overlap with those of other systemic connective tissue diseases. The phenotype is progressive. Effective surgical therapy...

Ökonomische Aspekte wissenschaftlicher Fachzeitschriften

OpenAIRE

Fessler, Georg

1999-01-01

In this thesis economical aspects of scientific journals (print and e-journals) are reflected. At first, the history, the definition and the functions of scientific journals in the academic context are examined. The development of e-journals is traced and advantages and disadvantages are presented. Next, some considerations to economical characteristics of information goods are presented and the interactions of the authors, publishers, readers and libraries are set out. The supply side and th...

Maatskaplike aspekte van geriatriese sorg

Directory of Open Access Journals (Sweden)

D. Louw

1979-09-01

Full Text Available Dit is maar enkele dekades gelede dat Westerse gemeenskappe bewus geword het van die besondere behoeftes van die relatief groot en nog steeds groeiende persentasie bejaardes in hulle midde. Nie alleen het die liggaamlike behoeftes van liggaamlike afgetakelde bejaardes die aandag getrek nie maar die gemeenskappe het ook bewus geword van die maatskaplike behoeftes van ouerwordendes in ’n tydperk wat gekenmerk is deur die dramatiese veranderings in die lewenswyses van ons mense — veranderinge wat in baie opsigte ’n negatiewe invloed gehad het op die lewensomstandighede van ’n groot groep bejaardes. Welsynsbeplanners het besef dat hulle in hulle beplanning spesiale voorsiening moes maak vir die lewensbehoeftes van hierdie groep in die gemeenskap en dat hulle in die verband ’n groot agterstand het om in te haal. Geneeshere wat belang begin stel het in die gesondheidsbehoeftes van bejaardes het ook besef dat gevestigde geneeskundige praktyke geensins voldoen aan die spesifieke behoeftes van ’n groot groep bejaardes nie en dat groot aanpassings gemaak moes word met betrekking tot hulle benaderings en metodes van behandeling van hierdie pasiente.

Aspekte der Phytoremediation organischer Schadstoffe

DEFF Research Database (Denmark)

Trapp, Stefan

2000-01-01

Phytoremediation is the quite novel technique of cleaning polluted sites through the use of plants. Phytoremediation methods are comparatively cheap, are accepted by the public and are ecologically advantageous, compared to common technological approaches. Until today, there have been only a few...... examples for successful applications. One reason is that the processes occurring are complex, and a full clean up may require many years. Plants have an influence on the water balance of a site, they change redox potential and pH, and stimulate microbial activity of the soil. These indirect influences may...... accelerate degradation in the root zone or reduce the leaching of compounds into the groundwater. Compounds taken up into plants may be metabolised, accumulate, or volatilise into air. Based on these processes, several phytoremediation methods have been developed: Phytoextraction, rhizofiltration...

Psykosociale aspekter ved dissemineret sklerose

DEFF Research Database (Denmark)

Stenager, E; Stenager, E N; Knudsen, Lone

1995-01-01

Using multiple sclerosis as a model, it is demonstrated how a chronic neurological disorder has psychosocial consequences during the period between onset and diagnosis, at the time of diagnosis, and in the post-diagnostic period. The impact of the disorder on self-esteem, civil status, habitation...

Enkele etiese aspekte van natuurbewaring

OpenAIRE

B. J. Engelbrecht

1992-01-01

Certain ethical aspects of nature conservation The present worldwide ecocrisis is of such a magnitude and seriousness that man’s life, living standards, future and very existence on earth are at stake. The main components of this man-made ecocrisis are the existing increasing overpopulation of earth, the exorbitant demands on the natural resources of our planet, the pace at which the non-renewable energy and other resources are being depleted and the pollution of the whole earth. In this ...

Pioniere Und Aspekte der Nachrichtendienste

Directory of Open Access Journals (Sweden)

Flaviu Călin RUS

2003-01-01

Full Text Available This article is telling us about the most important forms of writing news in a press agency. We explain the history of creating press agency.s in Europe. A very important idea in this article is to explain the role of the power and state in controlling the .free. press in time. We also try to explain the developing of the relations between the financial world and the press agency in time.

Update Cimicifuga racemosa – neue Erkenntnisse aus Wissenschaft und Forschung: Differenzierte Evidenz für Wirksamkeit und Sicherheit von Traubensilberkerzen-Arzneimitteln zur Behandlung klimakterischer Beschwerden

Directory of Open Access Journals (Sweden)

Beer AM

2014-01-01

Full Text Available Unter den bei Wechseljahresbeschwerden eingesetzten Phytotherapeutika ist die Traubensilberkerze (Cimicifuga racemosa, Actaea racemosa am besten dokumentiert. Die Monographie des Herbal Medicinal Product Committee der Europäischen Arzneimittelbehörde bestätigt das positive Nutzen-Risiko-Profil von Cimicifugaracemosa-(CR- Arzneimitteln. Voraussetzung ist deren Herstellung unter GMP-Bedingungen mit nachweislicher pharmazeutischer Qualität. In einer aktualisierten Metaanalyse unter Berücksichtigung aller geeigneten randomisierten kontrollierten Studien (RCTs zeigt CR eine signifikant bessere Wirksamkeit bei der Besserung klimakterischer Beschwerden im Vergleich zu Placebo. Ein aktueller Review zur Wirksamkeit und Sicherheit von CR bei Wechseljahresbeschwerden differenziert erstmalig zwischen Extrakten, deren Qualität (nachgewiesen durch den Arzneimittelstatus und Indikation – und wird somit den Besonderheiten der Phytotherapie gerecht. Hierbei erwiesen sich alle in klinischen Studien untersuchten CR-Extrakte als sicher und gut verträglich. Jedoch konnten nur qualitativ hochwertige, offiziell geprüfte, zugelassene CR-Arzneimittel ihre Wirksamkeit und somit ein positives Nutzen-Risiko-Profil nachweisen. Konsistent konfirmatorische Evidenz mit Oxford-Evidenzlevel 1 und höchstem Empfehlungsgrad A erbringt hierbei nur der isopropanolische Cimicifuga-racemosa-Spezialextrakt (iCR, der in vielen Studien an 11.000 Patientinnen untersucht wurde.

Autori moraalsed õigused : [bakalaureusetöö] / Laur Hiob ; Tartu Ülikool, õigusteaduskond ; juhendaja: Heiki Pisuke

Index Scriptorium Estoniae

Hiob, Laur, 1977-

2000-01-01

Autori moraalsete õiguste kujunemise ajalooline ülevaade, rahvusvahelised õigusallikad (WIPO konventsioonid, WTO ja EL dokumendid, inimõiguste aktid), filosoofiline ja juriidiline aspekt, moraalsete õiguste liigid, äleminek ja kehtivustähtajad, õiguste kaitse

Deontiline modaalsus poliitikute arvamusartiklites / Karin Mandra

Index Scriptorium Estoniae

Mandra, Karin

2008-01-01

Lähtudes funktsionaalse grammatika põhimõtetest analüüsitakse, missuguste tegevuste ja protsesside vajalikkust poliitikud oma arvamusartiklites rõhutavad ning kuivõrd on esindatud deontiline aspekt (ehk kellele on direktiivsus suunatud)

[25 years of the DRG-based health-financing system in Hungary].

Science.gov (United States)

Babarczy, Balázs; Gyenes, Péter; Imre, László

2015-07-19

After a thourough development phase, a new system of health financing was introduced in Hungary in 1993. One of the cornerstones of the system was the financing of acute hospital care through Diagnosis-Related Groups (DRGs). This method was part of a comprehensive healthcare model, elaborated and published around 1990 by experts of Gyógyinfok, a public institute. The health financing system that was finally introduced reflcted in large part this theoretical model, while the current Hungarian system differs from it in some important respects. The objective of this article is to identify these points of divergence.

A new generation of medium-voltage switchboards and circuit-breakers; Eine neue Generation von Mittelspannungsschaltanlagen und -leistungsschaltern

Energy Technology Data Exchange (ETDEWEB)

Saemann, D.; Weichert, R.; Werner, S. [Siemens AG, Erlangen (Germany). Bereich Energieuebertragung und -verteilung

1998-04-06

Todays market and the trend towards globalization of business both call for new products. The authors describe the new generation of medium-voltage switchgears and circuit-breakers, along with the benefit they bring for customers. (orig./RHM) [Deutsch] Der Markt und die Globalisierung des Geschaeftes fordern neue Produkte. Die Verfasser beschreiben die neue Generation von Mittelspannungsschaltanlagen und -schaltern sowie deren Nutzen fuer die Anwender. (orig./RHM)

Panel-basierte Mixed-Methods-Studien

OpenAIRE

Legewie, Nicolas; Tucci, Ingrid

2016-01-01

Mixed-Methods-Studien erfreuen sich wachsender Beliebtheit. Immer mehr Studien nutzen dabei auch Panel-basierte Mixed-Methods-Designs, in denen bestehende Längsschnittstudien durch qualitative Befragungsformen ergänzt werden. Innerhalb der reichhaltigen Veröffentlichungen zum Thema Mixed-Methods-Forschung finden sich bisher aber kaum Diskussionen solcher Mixed-Methods-Designs. Im vorliegenden Artikel diskutieren wir Design, Durchführung, sowie Potenzialeund Herausforderungen von Panel-basiert...

Informationsdesign von Bildungsportalen : Struktur und Aufbau netzbasierter Bildungsressourcen

OpenAIRE

Panke, Stefanie

2009-01-01

Sowohl Unternehmen als auch Bildungseinrichtungen, Verlage, politische Organisationen, Verbände, Interessengruppen und Privatpersonen nutzen das Internet, um Informationen zu verbreiten. Die Varianz an Akteuren, Adressaten und Botschaften spiegelt sich wider in einem wachsenden Spektrum an Web-Genres: Suchmaschine, E-Commerce-Auftritt und Online-Zeitung teilen sich die Aufmerksamkeit der Leser unter anderem mit privaten Weblogs und kollaborativen Wissenssammlungen wie der Enzyklopädie Wikiped...

The Analysis of Heterogeneous Text Documents with the Help of the Computer Program NUD*IST

OpenAIRE

Plaß, Christine; Schetsche, Michael

2000-01-01

Anhand eines aktuellen Forschungsprojekts wird der Nutzen des Computerprogramms NUD*IST für die qualitative Dokumentenanalyse erörtert. Unser Projekt untersucht die gesellschaftliche Bewertung von spektakulären Straftaten. Dazu wurden Dokumente aus dem gesamten 20. Jahrhundert erhoben, digitalisiert und unter Einsatz von NUD*IST ausgewertet. Da öffentliche und fachliche Diskurse untersucht werden, ist das Datenmaterial des Projekts außerordentlich heterogen: fachwissenschaftliche Publikatione...

Die Auswertung heterogener Textdokumente mit Hilfe des Computerprogramms NUD*IST

OpenAIRE

Plaß, Christine; Schetsche, Michael

2000-01-01

Anhand eines aktuellen Forschungsprojekts wird der Nutzen des Computerprogramms NUD*IST für die qualitative Dokumentenanalyse erörtert. Unser Projekt untersucht die gesellschaftliche Bewertung von spektakulären Straftaten. Dazu wurden Dokumente aus dem gesamten 20. Jahrhundert erhoben, digitalisiert und unter Einsatz von NUD*IST ausgewertet. Da öffentliche und fachliche Diskurse untersucht werden, ist das Datenmaterial des Projekts außerordentlich heterogen: fachwissenschaftliche Publikatione...

Pflege und Beruf: ungleiche Chancen der Vereinbarkeit

OpenAIRE

Keck, Wolfgang

2011-01-01

Die Vereinbarkeit von Beruf und Pflege wird in der Öffentlichkeit zu wenig thematisiert. Pflegende in einkommensschwachen Familien können sich keine zusätzlichen Pflegedienste leisten und müssen häufiger Einschnitte im Beruf in Kauf nehmen. Beschäftigte in unteren Hierarchieebenen können Beruf und Pflege nur schwer vereinbaren, da sie flexible Arbeitszeitregelungen seltener nutzen können.

Pornographie als Metapher

Directory of Open Access Journals (Sweden)

Caroline Schubarth

2010-02-01

Full Text Available In diesem Artikel werden unterschiedliche metaphorische Verwendungen des Pornografiebegriffs und deren Implikationen untersucht. Während die Existenz von Pornografie der feministischen Anti-Porno-Bewegung als Erklärung für die anhaltende Diskriminierung von Frauen in westlichen Gesellschaften dient, nutzen rechtskonservative Kräfte den Pornografievorwurf als Rechtfertigung für die Zensur von als deviant empfundenen Identitäten und sexuellen Praktiken.

Kengetallen kosten-batenanalyse van het WK voetbal

NARCIS (Netherlands)

van den Berg, M.; de Nooij, M.; Koopmans, C.

2010-01-01

In Nederland bestaan ambities om in 2018 of 2022 het WK voetbal te organiseren, samen met België. Hiervan worden positieve impulsen verwacht voor het imago van Nederland, het toerisme en de economische groei. Ook krijgt het organiserend comité een vooraf vastgestelde bijdrage van de FIFA. De

Imaging of nasopharyngeal diseases; Bildgebung bei Erkrankungen des Nasopharynx

Energy Technology Data Exchange (ETDEWEB)

Koesling, S.; Hofmockel, T. [Martin-Luther-Universitaet Halle-Wittenberg, Klinik und Poliklinik fuer Diagnostische Radiologie, Halle (Germany); Knipping, S. [Martin-Luther-Universitaet Halle-Wittenberg, Klinik und Poliklinik fuer Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Halle (Germany)

2009-01-15

This article gives an overview about the main nasopharyngeal pathologies and incidental findings, which a radiologist could be confronted with in daily practice. These include nasopharyngeal cysts, lymphoid hyperplasia, juvenile angiofibroma, carcinomas and non-Hodgkin lymphoma. Typical radiological findings, possibilities for making a specific diagnosis, differential diagnosis and description of the spread of a neoplasm are the central points. Investigation techniques and clinical signs are briefly summarized. (orig.) [German] Dieser Beitrag gibt einen Ueberblick ueber nasopharyngeale Erkrankungen und Zufallsbefunde, mit denen der Radiologe haeufig und weniger haeufig konfrontiert werden kann. Dazu zaehlen zystische Raumforderungen, die hyperplastische Rachenmandel, das juvenile Nasenrachenfibrom, Nasopharynxkarzinom und Non-Hodgkin-Lymphom. Im Vordergrund stehen dabei das radiologische Erscheinungsbild, Moeglichkeiten einer artdiagnostischen Zuordnung, differenzialdiagnostische Aspekte und bei Neoplasien Aussagen zur Ausbreitungsdiagnostik. Untersuchungstechnische und klinische Aspekte sowie die Diagnosesicherung werden kurz erwaehnt. (orig.)

Performance evaluation of inpatient service in Beijing: a horizontal comparison with risk adjustment based on Diagnosis Related Groups.

Science.gov (United States)

Jian, Weiyan; Huang, Yinmin; Hu, Mu; Zhang, Xiumei

2009-04-30

The medical performance evaluation, which provides a basis for rational decision-making, is an important part of medical service research. Current progress with health services reform in China is far from satisfactory, without sufficient regulation. To achieve better progress, an effective tool for evaluating medical performance needs to be established. In view of this, this study attempted to develop such a tool appropriate for the Chinese context. Data was collected from the front pages of medical records (FPMR) of all large general public hospitals (21 hospitals) in the third and fourth quarter of 2007. Locally developed Diagnosis Related Groups (DRGs) were introduced as a tool for risk adjustment and performance evaluation indicators were established: Charge Efficiency Index (CEI), Time Efficiency Index (TEI) and inpatient mortality of low-risk group cases (IMLRG), to reflect respectively work efficiency and medical service quality. Using these indicators, the inpatient services' performance was horizontally compared among hospitals. Case-mix Index (CMI) was used to adjust efficiency indices and then produce adjusted CEI (aCEI) and adjusted TEI (aTEI). Poisson distribution analysis was used to test the statistical significance of the IMLRG differences between different hospitals. Using the aCEI, aTEI and IMLRG scores for the 21 hospitals, Hospital A and C had relatively good overall performance because their medical charges were lower, LOS shorter and IMLRG smaller. The performance of Hospital P and Q was the worst due to their relatively high charge level, long LOS and high IMLRG. Various performance problems also existed in the other hospitals. It is possible to develop an accurate and easy to run performance evaluation system using Case-Mix as the tool for risk adjustment, choosing indicators close to consumers and managers, and utilizing routine report forms as the basic information source. To keep such a system running effectively, it is necessary to

pastorale begeleiding van die emosioneel verwonde tiener

African Journals Online (AJOL)

1 Met emosionele verwonding word verwys na die gevolge van aspekte soos verwerping ..... gevind dat getraumatiseerde kinders geneig is om hul onverwerkte trauma ..... The changing face of the South African family: single moms now the.

Bases of a fuel saving program for the passenger car traffic in Austria and benefit-cost-analysis of individual fuel economics. Grundlagen eines Energiesparkonzeptes fuer den PKW-Verkehr in Oesterreich und Nutzen-Kosten-Untersuchung einzelner Energiesparmassnahmen

Energy Technology Data Exchange (ETDEWEB)

Bruner-Newton, I.

1979-01-01

The influences on the fuel consumption of the individual automobile are investigated and their importance is appraised. From these data measures are derived to obtain a sensible fuel consumption. After a survey of conventional benefit-cost-analyses, guide lines for a benefit-cost-analyses of fuel economies in passenger car traffic are given. A target system is established which includes the most important criteria, which determine the total fuel consumption of passenger cars in Austria. Hereby it is possible to calculate the fuel saving potential of a certain measure. The economy of a measure is characterized by a benefit-cost-ratio. The developed methods of appraisal are applied to 14 measures and prove to be a suitable instrument for a systematic and comparable analyses of the individual measures. The measures are listed according to their economy when examining three different periods. It is shown which average annual fuel saving potential can be achieved by means of which annual costs.

Healthcare reforms in Cyprus 2013-2017: Does the crisis mark the end of the healthcare sector as we know it?

Science.gov (United States)

Petrou, Panagiotis; Vandoros, Sotiris

2018-02-01

As part of a bailout agreement with the International Monetary Fund, the European Commission and the European Central Bank (known as the Troika), Cyprus had to achieve a fiscal surplus through budget constraints and efficiency enhancement. As a result, a number of policy changes were implemented, including a reform of the healthcare sector, and major healthcare reforms are planned for the upcoming years, mainly via the introduction of a National Health System. This paper presents the healthcare sector, provides an overview of recent reforms, assesses the recently implemented policies and proposes further interventions. Recent reforms targeting the demand and supply side included the introduction of clinical guidelines, user charges, introduction of coding for Diagnosis Related Groups (DRGs) and the revision of public healthcare coverage criteria. The latter led to a reduction in the number of people with public healthcare coverage in a time of financial crises, when this is needed the most, while co-payments must be reassessed to avoid creating barriers to access. However, DRGs and clinical guidelines can help improve performance and efficiency. The changes so far are yet to mark the end of the healthcare sector as we know it. A universal public healthcare system must remain a priority and must be introduced swiftly to address important existing coverage gaps. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

Science.gov (United States)

Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

2015-10-01

In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. Project HOPE—The People-to-People Health Foundation, Inc.

Use of stereographic projection for worldwide numerical weather prediction with a regional nested model

Energy Technology Data Exchange (ETDEWEB)

Prenosil, T. [Amt fuer Wehrgeophysik, Traben-Trarbach (Germany)

1998-01-01

Mittels einer fiktiven Polrotation ist das Deutsche Amt fuer Wehrgeophysik in der Lage, auf der Basis eines regelmaessigen Netzmodells fuer eine stereographische Ebene fuer jeden beliebigen Punkt der Erde hochaufloesende Wettervorhersagen zu erstellen. Die horizontale Koordinatentransformation garantiert numerische Stabilitaet fuer grosse Zeitschritte zu vertretbaren Kosten. Die Modellergebnisse werden mit Hilfe des Visualisierungsprogramms Vis5D vorgestellt. (orig.)

Europeanization of the Hospital Markets - Opportunities and Risks for German Hospitals (Europaeisierung des Krankenhausmarkets - Chancen und Risiken fuer deutsche Krankenhaeuser)

Science.gov (United States)

2004-07-06

Information Services Institut (3M HIS Institut) hat u.a. mit der Entwicklung eines Werkzeugs zur Pflege und Weiterentwicklung des deutschen DRG-Systems ftir... Pflege (Krankenhauspflege) a. die Kosten wachsen schneller als allgerneine Inflation b. praktisch stabile Krankenversicherungsentnahme c. es existieren 9...Krankenkassen d. die Pflege ist von der Krankenversicherung voll (theoretisch) vergUltet e. Missverhlitnis zwischen Versicherungsentnuhrne und

Full sun ahead. 8000 miles on the sea; Volle Sonne voraus. 8.000 Meilen auf dem Meer

Energy Technology Data Exchange (ETDEWEB)

Fred, Winter

2013-10-01

Passionate sailors from Austria have built a boat fully fed by solar panels. The diesel generator is obsolete. Cost and convenience of solar technology even beats the traditional sailing. [German] Passionierte Segler aus Oesterreich haben ein Boot gebaut, das sich vollstaendig aus Solarmodulen speist. Der Dieselgenerator hat ausgedient. Bei Kosten und Komfort schlaegt die Solartechnik sogar die traditionellen Segel.

Eesti panusest projektis "Education 2030" / Eve Kikas

Index Scriptorium Estoniae

Kikas, Eve, 1955-

2016-01-01

OECD projektist "Education 2030", mille eesmärgiks on võtmekompetentside täpsustamine. Käsitlus hõlmab lisaks kognitiivsetele ka sotsiaalseid ja emotsionaalseid aspekte. Eesti võimalustest projekti panustada, projekti "Education 2030" tegevustest ja suundumustest

Transgenerationale Wertevermittlung in der Familie

DEFF Research Database (Denmark)

Demuth, Carolin

2013-01-01

Der vorliegende Beitrag geht der Frage nach, inwiefern sich in den biografisch-narrativen Konstruktionen junger Erwachsener transgenerationale Aspekte der Identifizierung bzw. Abgrenzung zu den Wertevorstellungen der Ursprungsfamilie finden lassen. Besonderes Augenmerk liegt hierbei auf den Dimen...

An Evaluation of the Lower Rio Grande Valley Contracts with Non-VA Providers

National Research Council Canada - National Science Library

Piihl, Janet

1999-01-01

... (DRGs with a HCFA average length of stay of three days or less). Surprisingly, four months after the contracts were implemented actual utilization of the contracts was significantly lower than projected...

Standorte der Hoch- und Berufsschulen in Estland - Faktor zur Förderung der Regionalpolitik / Matti Raudjärv

Index Scriptorium Estoniae

Raudjärv, Matti

2004-01-01

Kuigi erineva potentsiaaliga, on kõrgharidus esindatud enamikes Eesti maakondades (puudub vaid Hiiu, Jõgeva ja Põlva maakonnas, Valga teeb koostööd Läti Valka linnaga), kuid kutsehariduse regionaalne aspekt on autori arvates kavandatud tasakaalustamatult. Tabel

Ökonomische Effekte der Vereinigten Bühnen Wien: Endbericht ; Studie im Auftrag der Vereinigten Bühnen Wien

OpenAIRE

Schnabl, Alexander; Dippenaar, Sarah; Müllbacher, Sandra; Skrivanek, Isabella; Weberberger, Irene

2011-01-01

aus dem Inhaltsverzeichnis: Einleitung; Kultur und Tourismus - ökonomische Aspekte; Untersuchungsmethode; Ökonomische Effekte der Ausgaben der Vereinigten Bühnen Wien; Ökonomische Effekte der Ausgaben der BesucherInnen der Vereinigten Bühnen Wien; Executive Summary; Literaturverzeichnis;

Impact of case type, length of stay, institution type, and comorbidities on Medicare diagnosis-related group reimbursement for adult spinal deformity surgery.

Science.gov (United States)

Nunley, Pierce D; Mundis, Gregory M; Fessler, Richard G; Park, Paul; Zavatsky, Joseph M; Uribe, Juan S; Eastlack, Robert K; Chou, Dean; Wang, Michael Y; Anand, Neel; Frank, Kelly A; Stone, Marcus B; Kanter, Adam S; Shaffrey, Christopher I; Mummaneni, Praveen V

2017-12-01

OBJECTIVE The aim of this study was to educate medical professionals about potential financial impacts of improper diagnosis-related group (DRG) coding in adult spinal deformity (ASD) surgery. METHODS Medicare's Inpatient Prospective Payment System PC Pricer database was used to collect 2015 reimbursement data for ASD procedures from 12 hospitals. Case type, hospital type/location, number of operative levels, proper coding, length of stay, and complications/comorbidities (CCs) were analyzed for effects on reimbursement. DRGs were used to categorize cases into 3 types: 1) anterior or posterior only fusion, 2) anterior fusion with posterior percutaneous fixation with no dorsal fusion, and 3) combined anterior and posterior fixation and fusion. RESULTS Pooling institutions, cases were reimbursed the same for single-level and multilevel ASD surgery. Longer stay, from 3 to 8 days, resulted in an additional $1400 per stay. Posterior fusion was an additional $6588, while CCs increased reimbursement by approximately $13,000. Academic institutions received higher reimbursement than private institutions, i.e., approximately $14,000 (Case Types 1 and 2) and approximately $16,000 (Case Type 3). Urban institutions received higher reimbursement than suburban institutions, i.e., approximately $3000 (Case Types 1 and 2) and approximately $3500 (Case Type 3). Longer stay, from 3 to 8 days, increased reimbursement between $208 and $494 for private institutions and between $1397 and $1879 for academic institutions per stay. CONCLUSIONS Reimbursement is based on many factors not controlled by surgeons or hospitals, but proper DRG coding can significantly impact the financial health of hospitals and availability of quality patient care.

Entrprise Risk Management : Das COSO-ERM-Framework

OpenAIRE

Ruud, Flemming; Sommer, Katerina

2006-01-01

Das Enterprise Risk Management (ERM) ist ein wichtiges Element der Corporate Governance. Es kann Unternehmen bei der Zielerreichung unterstützen, indem es hilft, Chancen und Risiken zu erkennen und geeignete Massnahmen zu ergreifen. Die Weiterentwicklung des Internal-Control-Framework zu einem Enterprise-Risk-Management-Framework, dessen Grund sätze, Ziele und Komponenten, dessen Nutzen und Grenzen sowie die Unterschiede zum ursprünglichen COSO-ICFramework ist Gegenstand dieses Artikels.

Wohnquartiersbeschreibung: ein Instrument zur Regionalisierung von Nachbarschaften

OpenAIRE

Hoffmeyer-Zlotnik, Jürgen H. P.

2001-01-01

'Ausgehend von der Annahme, daß soziale Differenzierung sich in räumlicher Differenzierung niederschlägt, bietet eine Beschreibung der Struktur des näheren Wohnumfeldes die Möglichkeit, das Wohnquartier als Handlungsraum und Sozialisationsinstanz zur Interpretation von Umfragedaten zu nutzen. Das vorliegende Instrumentarium erlaubt es, das Wohnquartier unabhängig von Zensusdaten über Merkmale, die in der eigenen Umfrage erhoben werden, zu charakterisieren.' (Autorenreferat) 'The general hy...

Sozialkapital - ein neues OECD-Programm : Bericht über die Tagung 'Measuring Social Capital' Budapest 21.-23. Mai 2003

OpenAIRE

Gehmacher, Ernst

2003-01-01

'Der Begriff 'Sozialkapital' bezieht sich auf Formen gesellschaftlichen Zusammenhalts, die politischen, sozialen und wirtschaftlichen Nutzen bringen. Unter dem Eindruck, dass sich traditionelle Normen, Vertrauensverhältnisse und Bindungen auflösen und in Zukunft neue soziale Bindungen Bedeutung gewinnen werden, hat die OECD das Programm 'Measuring Social Capital' organisiert: bis 2004 sollen statistische Indikatoren und Survey-Fragen für vergleichende Studien entwickelt werden. Nach einem Übe...

Professionelle Literaturrecherche und -verwaltung im Web [Praxisbericht

OpenAIRE

Schaffert, Sandra

2007-01-01

In diesem Beitrag werden Hinweise für eine professionelle Literaturrecherche und -verwaltung im World Wide Web gegeben. Dazu werden für die pädagogische Ausbildung und Forschung einschlägige Literaturdatenbanken genannt, insbesondere solche, die kostenlos zu nutzen sind. Außerdem werden Tipps für clevere Recherchen sowie eine kurze Übersicht über Web-Werkzeuge zur Verwaltung von bibliografischen Angaben gegeben. (DIPF/Orig.)

Qualitätssicherung an Hochschulen durch Zulassungsverfahren

OpenAIRE

Hell, Benedikt

2007-01-01

Dieser Beitrag zeigt auf, dass Zulassungsverfahren einen wichtigen Beitrag zur Qualitätssicherung im tertiären Bildungsbereich leisten können. In Form eines Gedankenspiels wird das Portersehe Value Chain Framework herangezogen, um die besondere Stellung von Auswahlverfahren als Qualitätssicherungselement aufzuzeigen. Einen weiteren Schwerpunkt bildet die Analyse der prognostischen Aussagekraft und der Betrachtung des Nutzens von Auswahlverfahren. Hierzu werden Kennzahlen präsentiert, die durc...

Anwendung der isothermalen Mikrokalorimetrie zur physikochemischen Charakterisierung molekularer Interaktionen in pharmazeutischen Formulierungen

OpenAIRE

Schicke, Burkhard Christoph

2010-01-01

Die isothermalen Mikrokalorimetrie (IMC) ermöglicht die Erfassung von Wärmeflüssen im Mikrowattbereich. Der Nutzen und die Aussagekraft dieser Methode wurden bei folgenden physikochemischen Prozessen untersucht: Hydratation von Diclofenac-Natrium (DfNa) zum Tetrahydrat bei verschiedenen Temperaturen und relativen Feuchten, Kompatibilitäts¬untersuchungen von DfNa und amphiphiler Stärke bei 100% rH und Temperaturen bis zu 313 K, Kristallisationsverhalten von unterschiedlichen Triglycerid-Phosph...

Mathematical modelling and simulation of solar-assisted drying of bulk farm products; Mathematische Modellierung und Simulation der solar unterstuetzten Trocknung landwirtschaftlicher Schuettgueter

Energy Technology Data Exchange (ETDEWEB)

Maltry, W.; Ziegler, T.; Richter, I.

1997-04-01

The report deals with problems associated with the harnessing of solar energy for drying bulk farm products: technical fundamentals, enthalpy diagrams, models for grain drying, experimental investigations, analysis of drying processes, benefits and applications of drying processes, advances. (HW) [Deutsch] Der Bericht behandelt die Probleme der Solarenergienutzung zur Trockung landwirtschaftlicher Massengueter: - Trocknungstechnische Grundlagen - Enthalpie-Diagramme - Modelle zur Koernertrocknung - experimentelle Untersuchungen - Analyse von Trocknungsprozesse - Nutzen und Verwertbarkeit der Trocknungsprozesse - Fortschritte. (HW)

Der Effekt von Akupunktur in der Prävention von Prüfungsangst

OpenAIRE

Krüger, Peter

2017-01-01

Prüfungsangst ist ein weit verbreitetes gesellschaftliches Phänomen, das bisher in nur wenigen wissenschaftlichen Ansätzen untersucht wurde. Die Zahl der Studenten, die Gehirn - Doping zur Leistungssteigerung und zur Minimierung von Prüfungsangst nutzen, steigt stetig an. In bisherigen Studien wurde Akupunktur an Herz 7 als vielversprechende Behandlungsalternative dargestellt. Basierend auf diesen Ergebnissen, wurde in dieser Arbeit untersucht, ob eine Einzelpunktakupunktur an Herz 7 die ...

Historical Science and the "Estonian War of Independence" : looking for a new research agenda / Karsten Brüggemann

Index Scriptorium Estoniae

Brüggemann, Karsten, 1965-

2010-01-01

Vabadussõjad kipuvad aja möödudes muutuma legendaarseks. Tänapäevase lähenemise seisukohalt jääb Eesti Vabadussõja puhul palju küsimusi siiski lahtiseks. Eesti vaatenurk kipub rahvusvahelisi aspekte ignoreerima

Almen og praksisnær kompetenceudvikling for voksne

DEFF Research Database (Denmark)

Hviid, Marianne Kemeny; Keller, Hanne Dauer; Rasmussen, Annette

Rapporten sammenfatter og diskuterer erfaringer og resultater fra forskningsdelen i projektet KOM-UD (Kompetenceudvikling i udkantsområder). Rapportens kapiteler behandler forskellige aspekter af arbejdet med praksisnær (og oftest virksomhedsrettet) almen voksenundervisning med brug af resultater...

Monetary and Fiscal Policy Interactions in the Euro Area

Science.gov (United States)

2004-03-01

Balassa - Samuelson -Effekt, Nr. 3/2002, erschienen in: Stefan Reitz (Hg.): Theoretische und wirtschaftspolitische Aspekte der internatio- nalen Integration...156, 2000, S. 646-660. Friihere Diskussionsbeitriige zur Finanzwissenschaft Josten, Stefan, Crime, Inequality, and Economic Growth. A Classical Argument

Qualitative research in nursing - Advancing the humanistic imperative

Directory of Open Access Journals (Sweden)

A Botes

1996-12-01

Full Text Available Die boek spreek nie net die filosofiese dimentsies van kwalitatiewe navorsing aan nie, maar ook die metodologiese aspekte. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.

Characterizing Rat PNS Electrophysiological Response to Electrical Stimulation Using in vitro Chip-Based Human Investigational Platform (iCHIP)

Energy Technology Data Exchange (ETDEWEB)

Khani, Joshua [Georgetown Univ., Washington, DC (United States); Prescod, Lindsay [Georgetown Univ., Washington, DC (United States); Enright, Heather [Georgetown Univ., Washington, DC (United States); Felix, Sarah [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Osburn, Joanne [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Wheeler, Elizabeth [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Kulp, Kris [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

2015-08-18

Ex vivo systems and organ-on-a-chip technology offer an unprecedented approach to modeling the inner workings of the human body. The ultimate goal of LLNL’s in vitro Chip-based Human Investigational Platform (iCHIP) is to integrate multiple organ tissue cultures using microfluidic channels, multi-electrode arrays (MEA), and other biosensors in order to effectively simulate and study the responses and interactions of the major organs to chemical and physical stimulation. In this study, we focused on the peripheral nervous system (PNS) component of the iCHIP system. Specifically we sought to expound on prior research investigating the electrophysiological response of rat dorsal root ganglion cells (rDRGs) to chemical exposures, such as capsaicin. Our aim was to establish a protocol for electrical stimulation using the iCHIP device that would reliably elicit a characteristic response in rDRGs. By varying the parameters for both the stimulation properties – amplitude, phase width, phase shape, and stimulation/ return configuration – and the culture conditions – day in vitro and neural cell types - we were able to make several key observations and uncover a potential convention with a minimal number of devices tested. Future work will seek to establish a standard protocol for human DRGs in the iCHIP which will afford a portable, rapid method for determining the effects of toxins and novel therapeutics on the PNS.

Smarte Städte. Digitalisierte urbane Infrastrukturen und ihre Subjekte als Themenfeld kritischer Stadtforschung

Directory of Open Access Journals (Sweden)

Sybille Bauriedl

2017-06-01

Full Text Available Welche Bedeutung hat eine zunehmend digitale Vernetzung für (europäische Städte und ihre Bewohner_innen? Die aktuelle kritische „Smart City“-Forschung versucht diese Frage für unterschiedliche Aspekte der Stadtpolitik zu beantworten. Sie betrachtet Smart City als Marketingetikett wettbewerbsorientierter Stadtregierungen, als Dienstleistungsprodukt von IT-Konzernen und als Eingangstor zur deregulierten Vernetzung digitaler Daten. Dieser Beitrag setzt sich systematisch mit der Verwobenheit dieser Aspekte auseinander, mit einem Fokus auf erstens digital vernetzte Infrastrukturen kommunaler Daseinsvorsorge und zweitens auf vernetzte Interaktions- und Kommunikationstechnologien in der Alltagspraxis. Dabei wird die diskursive, die strukturelle und die subjektive Ebene von Optimierungsversprechen, Selbststeuerung und Ermächtigung diskutiert. Diese Betrachtung zeigt Städte als Orte spontaner, ungeplanter und widerständiger Interaktionen, die gleichzeitig an Effizienz-, Kontroll-, Optimierungs- und Wettbewerbsidealen ausgerichtet sind.

Prognozowanie i ujmowanie przychodóww przedsiębiorstwie postawionymw stan upadłości likwidacyjnej

Directory of Open Access Journals (Sweden)

Janusz Czerny

2010-03-01

Full Text Available W upadłości likwidacyjnej przedsiębiorstw mamy do czynienia z dwoma stru-mieniami przychodów, a mianowicie z przychodami dotyczącymi zbycia przedsię-biorstwa lub jego składników majątku oraz z przychodami związanymi z ewentual-nym kontynuowaniem działalności: Przychody ze sprzedaży przedsiębiorstwa powinny być prognozowane głównie na podstawie informacji płynących z systemu rachunkowości, co stanowi tzw. sta-tyczny aspekt upadłości, natomiast jej aspekt dynamiczny jest związany z zakre-sem i czasem kontynuowanej działalności, o czym decyduje syndyk, mając na uwa-dze naczelny cel upadłości, jakim jest optymalne zaspokojenie roszczeń wierzycieli.

Mihaila Bulgakova Volands un Marijas Korelli Lučija (salīdzinošā analīze)

OpenAIRE

Suhackis, Aleksandrs

2009-01-01

Darbs ir veltīts sātana tēlu romānos «Sātana Sēras» Marijas Korelli un «Meistars un Margarita» Mihaila Bulgakova salidzinošās analīzei. Pētīšanas mērķis ir salīdzināt Lučio Rimanca un Volanda tēlus simvolisma un demonoloģijas tradīcijas aspektā. Īpaša uzmanība ir veltīta arī uz simvolisma tradicijas, dekadanca un romantīsma abskatiem, ar mērķi analīzēt, literārus darbus „Satana Sēras” un „Meistars un Margarita” šaja aspektā. Darbs ir dalīts uz divam daļām. Pirmā ir aprakstīti teoretiskie ...

Organizational values and organizational practice: what makes them diverge? / Krista Jaakson, Anne Reino, Maaja Vadi

Index Scriptorium Estoniae

Jaakson, Krista, 1974-

2008-01-01

Artikkel analüüsib väärtuspõhist juhtimist mõjutavaid aspekte Eesti organisatsioonide põhjal; väärtuspõhise juhtimise ja organisatsiooni väärtuste teoreetilistest alustest ning protsessi mõjutavatest aspektidest. Tabelid. Skeemid

Billedkunstdidaktik

DEFF Research Database (Denmark)

Mathiesen, Frants; Arvedsen, Karsten

Fagdidaktik på grundlag af socialkonstruktivistisk tilgang til visuel kultur og fagets mangfoldige aspekter. Billedskunstdidaktik beskæftiger sig med sansning, oplevelse, forståelse og fremstilling af og deltagelse i visuelle fænomener og begivenheder i billedkunstundervisning....

"Vi kan jo ikke gå hen og voldtage en mand, vel?"

DEFF Research Database (Denmark)

Pedersen, Bodil Maria

2008-01-01

Seksualiserede overgrebs betydninger generaliseres, kønsneutraliseres og patologiseres ofte. I modsætning hertil viser kvinders personlige perspektiver, hvordan de seksualiserede overgrebs betydninger bliver forskelligt reflekterede og kønnede, ligesom de bliver begrundede i aspekter ved kvindern...

MLU and IPSyn measuring absolute complexity / Lea Nieminen

Index Scriptorium Estoniae

Nieminen, Lea

2009-01-01

Mõõdetakse soome laste spontaanseid lauseid struktuurilise keerukuse mõõtmiseks kasutatavate vahenditega, nagu VKP (väljendite keskmine pikkus) ja produktiivse süntaksi indeks IPSyn, et kindlaks teha, milliseid aspekte kumbki mõõdik näitab

Äärelinn, anarhism ja võõrandumine = Suburbs, Anarchism and Detachment / Rasmus Kask

Index Scriptorium Estoniae

Kask, Rasmus

2008-01-01

Artikkel uurib äärelinnade mõningaid aspekte nende elanike perspektiivist. Näiteks toodud autori enda Raudalu elamurajoonis tehtavad uuringud. Autori sõnul on praeguseks anarhismil sama palju tegemist äärelinnaga kui linnaplaneerimisel kodanike heaolutundega. Bibliograafia lk. 45

Reimbursement of care for severe trauma under SwissDRG.

Science.gov (United States)

Moos, Rudolf M; Sprengel, Kai; Jensen, Kai Oliver; Jentzsch, Thorsten; Simmen, Hans-Peter; Seifert, Burkhardt; Ciritsis, Bernhard; Neuhaus, Valentin; Volbracht, Jörk; Mehra, Tarun

2016-01-01

Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014). The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002. The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001). The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.

Energy revolution for Africa; Energierevolution fuer Afrika

Energy Technology Data Exchange (ETDEWEB)

Gies, Erica

2017-07-01

Decreasing energy costs from renewable sources could enable many African countries to make the leap into a clean future. This would save the continent the detour via the classic dirty sources. [German] Sinkende Kosten fuer Energie aus erneuerbaren Quellen koennten vielen afrikanischen Laendern den Sprung in eine saubere Zukunft ermoeglichen. Damit wuerde sich der Kontinent den Umweg ueber die klassischen schmutzigen Quellen sparen.

Domotics. Comfortable and energy efficient?; Domotica. Comfortabel en energiezuinig?

Energy Technology Data Exchange (ETDEWEB)

Van Wolferen, H.; Hendriksen, L.; Traversari, R. [TNO Milieu, Energie en Procesinnovatie TNO-MEP, Apeldoorn (Netherlands)

2003-02-01

Insight is given into the added value of domotics (home automation) in the handling and control of comfort installations, focusing on comfort and energy consumption. Costs are indicated. [Dutch] Een overzicht wordt gegeven van de toegevoegde waarde van domotica bij de bediening en regeling van comfortinstallaties. Hierbij wordt de meeste aandacht gegeven aan comfort en energiegebruik. De kosten worden alleen indicatief besproken.

Das erweiterte X-in-the-Loop-Framework zur durchgängigen Integration von Optimierungsverfahren in den Produktentwicklungsprozess am Beispiel der Entwicklung energieeffizienter Fahrzeuge = The advanced X-in-the-Loop-Framework for continuous integration of optimization procedures into the product development process using examples of the development of fuel efficient vehicles

OpenAIRE

Schröter, Jens

2013-01-01

Die Anforderungen an die Individualmobilität steigen weiter an: So erwartet der Konsument innovative Fahrzeuge - bei gleichbleibenden Kosten. Gleichzeitig muss gesetzesinduziert die Abgasemission weiter reduziert und im Hinblick auf die schwindenden Ressourcen der Kraftstoffverbrauch gesenkt werden. Deshalb wird in der vorliegenden Arbeit das erweiterte X-in-the-Loop-Framework zur durchgängigen Integration von Optimierungsverfahren in den Produktentwicklungsprozess entwickelt und validiert.

Andrographolide Inhibits Mechanical and Thermal Hyperalgesia in a Rat Model of HIV-Induced Neuropathic Pain

Directory of Open Access Journals (Sweden)

Zhihua Yi

2018-06-01

Full Text Available Aim: In this study, we investigated whether andrographolide (Andro can alleviate neuropathic pain induced by HIV gp120 plus ddC treatment and the mechanism of its action.Methods: The paw withdrawal threshold and the paw withdrawal latency were observed to assess pain behaviors in all groups of the rats, including control group, control combined with Andro treatment group, sham group, gp120 combined with ddC treatment group, gp120 plus ddC combined with A438079 treatment group, and gp120 plus ddC combined with Andro treatment by intrathecally injecting at a dose of 25 μg/20 μl group. The protein expression levels of the P2X7 receptor, tumor necrosis factor-α-receptor (TNFα-R, interleukin-1β (IL-1β, IL-10, phospho-extracellular regulated protein kinases (ERK (p-ERK in the L4–L6 dorsal root ganglia (DRG were measured by western blotting. Real-time quantitative polymerase chain reaction was used to test the mRNA expression level of the P2X7 receptor. Double-labeling immunofluorescence was used to identify the co-localization of the P2X7 receptor with glial fibrillary acidic protein (GFAP in DRG. Molecular docking was performed to identify whether the Andro interacted perfectly with the rat P2X7 (rP2X7 receptor.Results: Andro attenuated the mechanical and thermal hyperalgesia in gp120+ddC-treated rats and down-regulated the P2X7 receptor mRNA and protein expression in the L4–L6 DRGs of gp120+ddC-treated rats. Additionally, Andro simultaneously decreased the expression of TNFα-R and IL-1β protein, increased the expression of IL-10 protein in L4–L6 DRGs, and inhibited the activation of ERK signaling pathways. Moreover, Andro decreased the co-expression of GFAP and the P2X7 receptor in the SGCs of L4–L6 DRG on 14th day after surgery.Conclusion: Andro decreased the hyperalgesia induced by gp120 plus ddC.

Reflections on Contemporary Construction Practice

DEFF Research Database (Denmark)

Beim, Anne

2011-01-01

Indledningskapitlet til bogen, Tectonic Visions in Architecture, som behandler det for arkitketuren centrale tektonikbegreb. Gennem analyse af et antal moderne bygningsværker berøres arkitekturens teknologiske aspekter og produktonsformer og ikke mindst industrielle processer og miljøtilpasset...

Eco-friendly alternatives for control and use of invasive plants in agroforestry systems

DEFF Research Database (Denmark)

Nielsen, Mette Olaf; Pérez, M. Reinoso; Sørensen, Marten

2013-01-01

Artiklen er en del af transdiciplinært projekt om anvendelse af øko-venlige metoder til bekæmpelse af den invasive marabu-plante i Cuba. Ud over de naturvidenskabelige aspekter inddrager paperet human- og socialvindenskabelige dimensioner af problemstillingen....

What is Welfare?

DEFF Research Database (Denmark)

Greve, Bent

2008-01-01

Hvad er velfærd? Skal ikke økonomiske aspekter inddrages ved opgørelsen og vurdering af velfærd, herunder lykke. Individ og samfundsniveau inddrages ved vurderingen. En komparativ analyse af 10 lande præsenteres. Udgivelsesdato: August...

Enterprise Risk Management : Das COSO-ERM-Framework

OpenAIRE

Ruud, Flemming; Sommer, Katerina

2006-01-01

Das Enterprise Risk Management (ERM) ist ein wichtiges Element der Corporate Governance. Es kann Unternehmen bei der Zielerreichung unterstützen, indem es hilft, Chancen und Risiken zu erkennen und geeignete Massnahmen zu ergreifen. Die Weiterentwicklung des Internal-Control-Framework zu einem Enterprise-Risk-Management-Framework, dessen Grund sätze, Ziele und Komponenten, dessen Nutzen und Grenzen sowie die Unterschiede zum ursprünglichen COSO-ICFramework ist Gegenstand dieser Ausführunge...

Update of the external cost for environmental damage (for Flanders) with regard to air pollution and climatic change; Actualisering van de externe milieuschadekosten (algemeen voor Vlaanderen) met betrekking tot luchtverontreiniging en klimaatverandering

Energy Technology Data Exchange (ETDEWEB)

De Nocker, L.; Michiels, H.; Deutsch, F.; Lefebvre, W.; Buekers, J.; Torfs, R. [Unit Ruimtelijke Milieuaspecten, VITO, Mol (Belgium)

2010-12-15

This report contains a set of indicators for calculating external costs of air-polluting substances and greenhouse gases. The external costs of environmental damage relate to the damage to human health, eco systems, buildings and economy as a result of an activity. This leads to loss of welfare for inhabitants in Flanders and abroad for the current and future generations. The magnitude and evolution of the external or environmental damage cost resulting from air pollution is one of the indicators for the MIRA report that translates the state of the environment into consequences for man and economy. [Dutch] Dit rapport bevat een set van kengetallen voor de berekening van de externe kosten van luchtverontreinigende stoffen en broeikasgassen. De externe kosten of milieuschadekosten hebben betrekking op de schade aan menselijke gezondheid, ecosystemen, gebouwen en economie als gevolg van een activiteit. Dit leidt tot een verlies aan welvaart voor inwoners in Vlaanderen en het buitenland, voor deze en toekomstige generaties. De omvang en evolutie van de externe of milieuschadekosten ten gevolge van luchtverontreiniging ia 1 van de indicatoren voor het MIRA rapport die de toestand van het milieu vertaalt naar gevolgen voor mens en economie.

Mobile Vending - Nutzen und Grenzen des Telemetrieeinsatzes bei Warenautomaten

OpenAIRE

Heinkele, Christian; Pousttchi, Key; Legler, Steffen

2004-01-01

The use of telemetry via wireless communication technique is able to support the process of operating vending machines. The advantages on appropriate kinds of vending machines can be achieved by using a demand-driven instead of a trigger-driven provisioning as well as a trouble-shooting in real time. The availability of reliable telemetrically collected real time data enhance the analysis and optimization of the supply in vending machines and the profitability of vending machine places, too. ...

Võimendusefekti ja võimendusriski mõõtmise alternatiivsed meetodid / Vambola Raudsepp, Alo Raudik

Index Scriptorium Estoniae

Raudsepp, Vambola

2003-01-01

Autorid käsitlevad võimendusefektiga seonduvaid aspekte, vaatlevad alternatiivseid võimalusi võimendusest tuleneva riski kindlaksmääramises. Samas tutvustavad nad võimendusriski faktori LRF (leveraging risk factor) kontseptsiooni, mis võimaldab erinevate ettevõtete riskitaset hinnata ja võrrelda

Professor Nukem - et eksperiment med oplevelsesbaseret forskningsformidling

DEFF Research Database (Denmark)

Sandvik, Kjetil; Thorhauge, Anne Mette

2007-01-01

Professor Nukem er resultatet af et forskningsprojekt om oplevelsesbaseret forskningsformidling der har form som et computerspil med tilhørende website, hvor brugeren interaktivt kan engagere sig i forskning omkring sociale og kulturelle aspekter ved computerspil. Professor Nukem kan spilles på...

Corporate taxes and internal borrowing within multinational firms / Peter Egger, Christian Keuschnigg, Valeria Merlo, Georg Wamser

Index Scriptorium Estoniae

2014-01-01

Artiklis esitatakse sisemise kapitalituruga rahvusvaheliste ettevõtete teoreetilist mudeli, käsitledes selliseid aspekte nagu kohalik vs. välismaised karakteristikud (kasumi maksumäärad, puudused institutsionaalses kvaliteedis, finantssektori nõrkus jt.), aluseks Saksamaa rahvusvahelised ettevõtted eri riikides (sh. Eesti).

Building Models and Building Modelling

DEFF Research Database (Denmark)

Jørgensen, Kaj; Skauge, Jørn

2008-01-01

I rapportens indledende kapitel beskrives de primære begreber vedrørende bygningsmodeller og nogle fundamentale forhold vedrørende computerbaseret modulering bliver opstillet. Desuden bliver forskellen mellem tegneprogrammer og bygnings­model­lerings­programmer beskrevet. Vigtige aspekter om comp...

En problematisering af samspillet mellem centrale pædagogiske principper på arkitektuddannelsen

DEFF Research Database (Denmark)

Grønbæk, Niels; Hedegaard Møller, Camilla

2013-01-01

Ud fra John Deweys erfaringspædagogik, bygget op om begreberne erfaring, situation og samspil, undersøges aspekter af en strukturel adskillelse af målstyrede og projektbaserede undervisningspraksisser med arkitektuddannelsen på Kunstakademiets Skoler for Arkitektur Design og Konservering som...

Syntaksens rolle i sprogtilegnelsen hos autistiske børn

DEFF Research Database (Denmark)

Nyvad, Anne Mette

2017-01-01

I litteraturen om de sproglige karakteristika i autisme-spektrum-forstyrrelser (ASF) har man traditionelt fokuseret på afvigelser i forbindelse med pragmatiske aspekter af kommunikation. Den nyeste forskning tyder dog på, at selv højfunktionelle voksne autister uden konstateret sprogforsinkelse har...

Body consciousness and somaesthetics in music education

DEFF Research Database (Denmark)

Holgersen, Sven-Erik

2010-01-01

Artiklen diskuterer aspekter af Richard Shusterman (2008) Body Consciousness: A Philosophy of Mindfulness and Somaesthetics herunder bogens relevans for musikpædagogik og specielt Shustermans læsning af Merleau-Pontys fænomenologi. Shustermans definitioner af fire former for intentionalitet samme...

Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand.

Science.gov (United States)

Annear, Peter Leslie; Kwon, Soonman; Lorenzoni, Luca; Duckett, Stephen; Huntington, Dale; Langenbrunner, John C; Murakami, Yuki; Shon, Changwoo; Xu, Ke

2018-05-07

Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand. We reviewed the design of case-based payment systems, their experience with implementation, evidence about impact on service delivery, and lessons drawn for the Asian region. We found that countries must first establish adequate infrastructure, human resource capacity and information management systems. Capping of volumes and prices is sometimes essential along with a high degree of hospital autonomy. Rather than introduce a complete classification system in one stroke, these countries have phased in DRGs, in some cases with hospitals volunteering to participate as a first step (Korea), and in others using a blend of different units for hospital payment, including length of stay, and fee-for-service (Japan). Case-based payment systems are not a panacea. Their value is dependent on their design and implementation and the capacity of the health system. Copyright © 2018 Elsevier B.V. All rights reserved.

Bildgebendes Multispektralsystem zur Serienfarbmessung an goniochromatischen Oberflächenbeschichtungen in der Automobil- und Zulieferindustrie

OpenAIRE

Jäger, Stefan

2006-01-01

In dieser Arbeit wird ein multispektrales bildgebendes System zur Farbmessung von Metall- und Perleffektlacken in einem industriellen Umfeld vorgestellt. Der Zweck des vorgeschlagenen Systems ist die Serienüberwachung und daraus folgend, die Steuerung von Lackierprozessen in der Automobil- und Zulieferindustrie, um das Qualitätsniveau anzuheben und Kosten zu reduzieren. Ausgehend von der Analyse der messtechnischen Anforderungen und den durch die Prozesstechnik gegebenen Randbedingungen wurde...

Untersuchungen zum Einfluss der Betriebsbedingungen auf die Schädigung und Instandhaltung von Turboluftstrahltriebwerken

OpenAIRE

Müller, Matthias H.

2013-01-01

Langfristige Instandhaltungsverträge und der anhaltende Kostendruck haben die Notwendigkeit einer zuverlässigen Vorhersage und einer Reduzierung der Kosten für die Instandhaltung von Turboluftstrahltriebwerken zur Folge. Die Instandhaltungsbedürftigkeit und Zuverlässigkeit von Turboluftstrahltriebwerken wird wesentlich durch die betreibertypischen Betriebsbedingungen und die auftretenden Schädigungsmechanismen beeinflusst. Der Verlauf der Bauteilschädigung wird neben den Betriebsbedingungen d...

Characterization of spinal afferent neurons projecting to different chambers of the rat heart.

Science.gov (United States)

Guić, Maja Marinović; Kosta, Vana; Aljinović, Jure; Sapunar, Damir; Grković, Ivica

2010-01-29

The pattern of distribution of spinal afferent neurons (among dorsal root ganglia-DRGs) that project to anatomically and functionally different chambers of the rat heart, as well as their morphological and neurochemical characteristics were investigated. Retrograde tracing using a patch loaded with Fast blue (FB) was applied to all four chambers of the rat heart and labeled cardiac spinal afferents were characterized by using three neurochemical markers. The majority of cardiac projecting neurons were found from T1 to T4 DRGs, whereas the peak was at T2 DRG. There was no difference in the total number of FB-labeled neurons located in ipsilateral and contralateral DRGs regardless of the chambers marked with the patch. However, significantly more FB-labeled neurons projected to the ventricles compared to the atria (859 vs. 715). The proportion of isolectin B(4) binding in FB-labeled neurons was equal among all neurons projecting to different heart chambers (2.4%). Neurofilament 200 positivity was found in greater proportions in DRG neurons projecting to the left side of the heart, whereas calretinin-immunoreactivity was mostly represented in neurons projecting to the left atrium. Spinal afferent neurons projecting to different chambers of the rat heart exhibit a variety of neurochemical phenotypes depending on binding capacity for isolectin B(4) and immunoreactivity for neurofilament 200 and calretinin, and thus represent important baseline data for future studies. (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Low Frequency Electroacupuncture Alleviated Spinal Nerve Ligation Induced Mechanical Allodynia by Inhibiting TRPV1 Upregulation in Ipsilateral Undamaged Dorsal Root Ganglia in Rats

Directory of Open Access Journals (Sweden)

Yong-Liang Jiang

2013-01-01

Full Text Available Neuropathic pain is an intractable problem in clinical practice. Accumulating evidence shows that electroacupuncture (EA with low frequency can effectively relieve neuropathic pain. Transient receptor potential vanilloid type 1 (TRPV1 plays a key role in neuropathic pain. The study aimed to investigate whether neuropathic pain relieved by EA administration correlates with TRPV1 inhibition. Neuropathic pain was induced by right L5 spinal nerve ligation (SNL in rats. 2 Hz EA stimulation was administered. SNL induced mechanical allodynia in ipsilateral hind paw. SNL caused a significant reduction of TRPV1 expression in ipsilateral L5 dorsal root ganglia (DRG, but a significant up-regulation in ipsilateral L4 and L6 DRGs. Calcitonin gene-related peptide (CGRP change was consistent with that of TRPV1. EA alleviated mechanical allodynia, and inhibited TRPV1 and CGRP overexpressions in ipsilateral L4 and L6 DRGs. SNL did not decrease pain threshold of contralateral hind paw, and TRPV1 expression was not changed in contralateral L5 DRG. 0.001, 0.01 mg/kg TRPV1 agonist 6′-IRTX fully blocked EA analgesia in ipsilateral hind paw. 0.01 mg/kg 6′-IRTX also significantly decreased pain threshold of contralateral paw. These results indicated that inhibition of TRPV1 up-regulation in ipsilateral adjacent undamaged DRGs contributed to low frequency EA analgesia for mechanical allodynia induced by spinal nerve ligation.

Molekylærbiologiske aspekter af Marfansyndromer

DEFF Research Database (Denmark)

Belsing, Tina Zimmermann; Lund, Allan Meldgaard; Abildstrøm, Steen Zabell

2011-01-01

Marfan syndrome (MFS) is a hereditary connective tissue disorder. Studies of MFS have established the critical contribution of fibrillin-1 deficiency to disease progression through altered cell-matrix interactions and dysregulated TGF-β signalling. It is now known that the disease is caused...

Molekylærbiologiske aspekter af Marfansyndromer

DEFF Research Database (Denmark)

Belsing, Tina Zimmermann; Lund, Allan Meldgaard; Abildstrøm, Steen Zabell

2011-01-01

Marfan syndrome (MFS) is a hereditary connective tissue disorder. Studies of MFS have established the critical contribution of fibrillin-1 deficiency to disease progression through altered cell-matrix interactions and dysregulated TGF-ß signalling. It is now known that the disease is caused...

Aspekter af integrationsindsatsen i 6 kommuner

DEFF Research Database (Denmark)

Rosdahl, Anders

Dette arbejdspapir præsenterer resultaterne af en mindre kvalitativ undersøgelse af kommuners indsats for at bringe nyankomne flygtninge og indvandrere i beskæftigelse. Undersøgelsen er en opfølgning på en kvantitativ benchmarkanalyse, som er gennemført af Amternes og Kommunernes Forskningsinstit...

Rechtliche Aspekte der Provenienzforschung in Bibliotheken

Directory of Open Access Journals (Sweden)

Bernd Juraschko

2017-12-01

Full Text Available Die Verfügungsbefugnis über die in einer Bibliothek befindlichen Medien gehört zu den grundlegenden Voraussetzungen, damit bibliothekarische Dienstleistungen angeboten werden können. Gleichzeitig stehen Bibliotheken im Lichte der Öffentlichkeit, was einen klaren und sicheren Umgang mit der Herkunft der Medien erfordert. Ist die Herkunft oder die Zuordnung der Medien nicht sicher oder erfolgte ein vorhergehender Erwerb durch eine Unrechtshandlung, so sollte über das Instrument der Provenienzforschung und nachgelagerter Handlungen ein sachgerechter Umgang erfolgen. Ein zentraler Wegbereiter für die Entwicklung der Provenienzforschung war und ist die Diskussion um die NS-Raubkunst. Ein weiterer Anlass ist die Entziehung von Kulturgütern in der SBZ bzw. DDR. Auch weniger spektakuläre Umstände – wie fehlende Unterlagen – lassen einen Nachforschungsbedarf entstehen. Der Beitrag beschäftigt sich aus juristischer Sicht mit der Provenienzforschung. The power of disposal over the library media is a basic requirement for libraries to offer their services. At the same time, libraries are in the public eye and need to treat the provenience of their media openly and reliably. If the history of a media item is unknown or the former acquisition was illegal, the issue should be properly handled by provenience research and subsequent actions. Provenience research has been pioneered by the discussion of the Nazi-looted art. Another catalyst for provenience research was the looted art in the Soviet Zone and German Democratic Republic. But also less spectacular circumstances like missing documentaries can make provenience research necessary. The present article covers provenience research from the legal point of view

Hjertestopbehandling. Nyere aspekter af kardiopulmonal genoplivning

DEFF Research Database (Denmark)

Herlevsen, Per Ove; Andersen, H H; Jepsen, S

1989-01-01

compression and increase survival. Cardiac arrest results in anaerobic metabolism and combined metabolic and respiratory acidosis. On account of relatively low minute volume during external cardiac compression decrease in end-tidal carbon dioxide concentration is observed together with arterial alkalosis...

Aspekte van mikrostrukturele verskeidenheid en inkonsekwentheid

African Journals Online (AJOL)

Information Technology

splintering in die tekssamehang van 'n semantiese subkommentaar a.g.v. die afstandsadressering tussen koteksinskrywing en betekenisparafrase of vertaal- ekwivalent. Alhoewel die gebrek aan onmiddellike adressering die samehang versteur, word 'n mate van kohesie steeds behou deur 'n duidelike markering van die ...

Cute and Cool in Contemporary Japanese Visual Arts

DEFF Research Database (Denmark)

Borggreen, Gunhild Ravn

2011-01-01

Med udgangspunkt i officiel japansk promovering af tre unge kvinder inden for modebranchen som kulturambassadører inden for "Japan Cool" diskuterer artiklen forskellige kulturelle aspekter af det japanske begreb kawaii (nuttet) som både brand for japansk kultureksport og som et kritisk subversivt...

Kolm päeva Lulea ülikoolis / Sirje Virkus

Index Scriptorium Estoniae

Virkus, Sirje, 1956-

1999-01-01

23.-25. aprillini toimus Luleas projekti "Information Technology and Gender- Comparative and Cross-disciplinary Perspectives" esimene tööseminar, kus käsitleti infotehnoloogia aspekte naisuuringuis ning anti ülevaade vastavasisulisest uurimistööst kogu maailmas. Eestit esindasid Sirje Virkus ja Vello Randla

Konspirationsteorier og alternative forklaringer i historieundervisningen

DEFF Research Database (Denmark)

Peters, Rikke Louise Alberg

2017-01-01

, nemlig historiebrug og kildearbejde. Til slut illustreres ud fra en konkret case, nemlig konspirationsteorien om ’Eurabia’, som vi bl.a. kender fra Anders Breiviks manifest, hvorledes eleverne kan arbejde problemorienteret, forholde sig kildekritisk og afdække væsentlige aspekter omkring historiebrug....

Von der Straße ins Labor: Die Modifikation der Sprachproduktion bei lauten Fahrgeräuschen

DEFF Research Database (Denmark)

Landgraf, Rabea; Niebuhr, Oliver; Schmidt, Gerhard

2015-01-01

jeweils gleichen Geräuschbelastungen Sprachaufnahmen durchgeführt. Während frühere Arbeiten zur Lombard-Sprache überwiegend prosodische und segmentelle Aspekte betrachteten, wurden in dieser Arbeit vor allem kommunikative Parameter der Gesprächssteuerung untersucht. Die Ergebnisse zeigen, dass der im...

Hvad er textil design?

DEFF Research Database (Denmark)

Riisberg, Vibeke

2002-01-01

I denne forelæsning fokuseres på textildesign udfra følgende fire aspekter: Konstruktion, taktilitet, funktion og dekoration. Via konstruktionen bliver textilet en fysisk realitet, taktilitet bibringer det specifikke egenskaber, der har betydning for anvendelsen og appellerer til følesansen. Funk...

The "Special" World: Stalin's Power Apparatus and the Soviet System's Secret Structures of Communication"

DEFF Research Database (Denmark)

Villaume, Poul

2009-01-01

Bogomtale - aspekter af Niels Erik Rosenfeldts store disputats om Stalin-tidens hemmelige magt- og kommunikationsapparat diskuteres. Bogen fokuserer på systemets struktur, anatomi, procedurer og beslutningsprocesser, men sociologisk bureaukrati-teori kunne med fordel være anvendt. Værket vil være...

Interrogating Diaspora

DEFF Research Database (Denmark)

Pærregaard, Karsten

2010-01-01

Kapitlet diskuterer generelt de analytiske muligheder og begrænsninger for brugen af diasporabegrebet og undersøger, hvordan det kan anvendes på et studie af peruansk migration med særlig henblik på migrationens politiske, solidariske og klassemæssige aspekter....

La storia di Griselda. Affinità genetiche e tipologiche

DEFF Research Database (Denmark)

Olsen, Michel

2012-01-01

Griseldahistorien, oprindelig stammende fra Boccaccios Decameron, genfindes i mange litteraturer. Man har redegjort for forholdet mellem de forskellige versioner ved stemmaer. Et interessant aspekt er imidlertid at en version der ikke kan stamme ned fra en anden alligevel kan udvise slægtsskab me...

Når mødet med livet bliver et møde med døden

DEFF Research Database (Denmark)

Flodager, Helle

2009-01-01

Begrebsanalysen undersøger, hvilken aktuel status begrebet sorg i relation til perinatal spædbarnsdød har i sygeplejedisciplinen. Hertil anvendes Rodgers metodiske og filosofiske begrebsforståelse. De tre aspekter definition, betydning og anvendelse giver information om begrebets aktuelle status og...

Development of mouse dorsal root ganglia: an autoradiographic and quantitative study

International Nuclear Information System (INIS)

Lawson, S.N.; Biscoe, T.J.

1979-01-01

Pulse labelling with tritiated thymidine was used to determine the cell birthdays of dorsal root ganglion (DRG) neurons in foetal mice. The peak number of cell birthdays occurred at 11.5 days foetal age in cervical DRGs, and at 12.5 days in lumbar DRGs. The satellite cells were becoming heavily labelled by day 13.5 in lumbar and some hours earlier in cervical regions. A very sharp peak of satellite cell labelling was seen at 13 days in the lumbar region. Evidence for the existence of more than one neuronal cell type is presented. The earliest cells to stop dividing were part of a widely spread distribution which included all the large neurons. The birthdays of the population of small neurons began later and continued for at least 48 h after division of the large cells had ceased. (author)

[Seasonal distribution of diagnoses and DRG in trauma surgery].

Science.gov (United States)

von Dercks, N; Melz, R; Hepp, P; Marquass, B; Theopold, J; Josten, C

2011-11-01

Recording DRGs and diagnoses allows their distribution to be shown over the course of the year. Thus, cumulative seasonal occurrence of diseases can be detected. From 2004 to 2010 we recorded 22,293 main diagnoses and DRGs at the clinic for trauma surgery. Injuries with the same localization and treatment were pooled. The most frequent injuries were concussion, followed by spinal and lower leg fractures. They showed no seasonal accumulation. Proximal fractures of the humerus occurred approx. 25% more often in winter and ankle fractures about 33% more frequently. The diagnosis of osteoarthritis of the knee is twice as high in the winter as in the summer. It has to be verified if logistic conclusions of these results can lead to more efficiency in a hospital. The underlying analysis is applicable for every hospital and poses a valid controlling tool.

Tempus og aspekt med særligt henblik på italiensk

Directory of Open Access Journals (Sweden)

Svend Bach

2003-05-01

Full Text Available This paper intends to discuss some fundamental issues regarding tense and aspect in connection with a presentation of the Italian system of morphologically marked distinctions within the categories of tense and aspect; but it is also intended as a basis for studies in the function of tense and aspect in literary narrative (a matter to which I have dedicated the studies mentioned in the list of references. However, my main view is that inscribing presumed textual functions into the general definitions of morphemes (along the lines originally indicated by Benveniste and Weinrich, does not contribute to our understanding of texts, but will rather create obstacles for it. In fact I can see no valid alternative to describing tense in terms of 'time'. As others before me, I divide tenses in two groups on the basis of the distinctive semantic feature [+/-past]; Italian has two simple tenses in each group, and – corresponding to each of the four simple tenses – compound tenses formed with an auxiliary + the perfect participle, and semantically characterized by the fact that they signify a state as a consequence of an anterior state, process or event signified as espectually perfective. Compound tenses are thus morphologically as well as semantically complex: they differ with regard only to the tense and aspect of the 'consequence level' as expressed by the form of the auxiliary. This means that each tense, even the compound ones, are defined without taking into account a 'point of reference' or similar concepts: compound tenses express in themselves temporal location thanks to their auxiliary verb. Such semantic complexity is of particular importance in the case of the present perfect and the past perfect, both of which have two typical uses according to the predominance of the consequence level signified by their auxiliary or to the state/process/event signified by their lexeme (i.e. the past participle. This view entails an almost complete

Tempus og aspekt med særligt henblik på italiensk

Directory of Open Access Journals (Sweden)

Svend Bach

2003-04-01

Full Text Available This paper intends to discuss some fundamental issues regarding tense and aspect in connection with a presentation of the Italian system of morphologically marked distinctions within the categories of tense and aspect; but it is also intended as a basis for studies in the function of tense and aspect in literary narrative (a matter to which I have dedicated the studies mentioned in the list of references. However, my main view is that inscribing presumed textual functions into the general definitions of morphemes (along the lines originally indicated by Benveniste and Weinrich, does not contribute to our understanding of texts, but will rather create obstacles for it. In fact I can see no valid alternative to describing tense in terms of 'time'. As others before me, I divide tenses in two groups on the basis of the distinctive semantic feature [+/-past]; Italian has two simple tenses in each group, and – corresponding to each of the four simple tenses – compound tenses formed with an auxiliary + the perfect participle, and semantically characterized by the fact that they signify a state as a consequence of an anterior state, process or event signified as espectually perfective. Compound tenses are thus morphologically as well as semantically complex: they differ with regard only to the tense and aspect of the 'consequence level' as expressed by the form of the auxiliary. This means that each tense, even the compound ones, are defined without taking into account a 'point of reference' or similar concepts: compound tenses express in themselves temporal location thanks to their auxiliary verb. Such semantic complexity is of particular importance in the case of the present perfect and the past perfect, both of which have two typical uses according to the predominance of the consequence level signified by their auxiliary or to the state/process/event signified by their lexeme (i.e. the past participle. This view entails an almost complete

Wie nutzen deutsche Tiermedizinerinnen und Tiermediziner soziale Netzwerke? Eine Untersuchung am Beispiel des tiermedizinischen Netzwerks „NOVICE“ [How do German veterinarians use social networks? A study, using the example of the 'NOVICE' veterinary medicine network

Directory of Open Access Journals (Sweden)

Schaper, Elisabeth

2013-02-01

Full Text Available [english] Objective: NOVICE (Network Of Veterinary ICT in Education, , is a professional online social network for veterinarians, lecturers and students of veterinary medicine as well as for e-Learning advisers and others working in establishments that teach veterinary medicine. This study sets out to investigate to what extent German veterinarians, lecturers, students of veterinary medicine and e-Learning representatives would accept a specialist network, what requirements would have to be met by an online social network, how to use web 2.0 tools , and what advantages a specialist network could offer. Methodology: The investigation was carried out by analysing data from the Elgg platform database as well as using Google Analytics. Annual focus group surveys and individual interviews were carried out in order to perform an analysis of acceptance among network users.Results: 1961 users from 73 different countries registered on the NOVICE site between 1 September 2010 and 21 March 2012. Germany represents the biggest user group, with 565 users (28.81%. During this period, most individual hits on the website came from Germany too. In total, 24.83% of all members are active, while 19.22% of German members participate actively. In terms of gender, there are significantly more female members than male members, both in the NOVICE network as a whole as well as in Germany. The most used web 2.0 tools are chat and email messaging services as well as writing wikis and contributing to forum discussions. The focus group surveys showed that respondents generally make use of other online communities too. Active members generally use more web 2.0 tools than in other networks, while passive members are generally more reluctant in all networks. All participants of the survey welcomed the idea of having a network specifically set up for the profession and believe that it could be very useful for veterinary medicine.Conclusions: The network and its membership

Kosten SAP-beheer met vier knoppen te besturen

NARCIS (Netherlands)

Heemstra, F.J.; Jonker, A.; Kusters, R.J.

2007-01-01

Over de beheerkosten van ERP-systemen is weinig bekend. Er is sprake van een Babylonische spraakverwarring, zeggen de auteurs van dit artikel. Vijf ondernemingen hebben de hoofden bij elkaar gestoken en zijn op onderzoek uitgegaan. Het onderzoek leert dat slechts vier factoren bepalend zijn voor de

De kosten-effectiviteit van preventie - een verkennende studie

NARCIS (Netherlands)

Dirkmaat T; van Genugten MLL; de Wit GA; PZO

2003-01-01

The concern about prevention programmes being expensive prompted this study into their cost-effectiveness. This report describes preventive health care programmes that are very cost-effective or even cost-saving. By means of semi-structured interviews, 35 Dutch experts in the fields of prevention

Moderne Groupware-Umgebung am KIT: Microsoft SharePoint 2013

OpenAIRE

Grindler, Sabine; Wörl, Ronny

2014-01-01

Anwender aus den Bereichen Verwaltung, Forschung und Lehre am Karlsruher Institut für Technologie nutzen Microsoft SharePoint Teamseiten als zentrale Groupware-Plattform. Seit letztem Jahr ist die aktuelle Version SharePoint 2013 im Einsatz. Ein Mehrwert der neuen Plattform ist die Office Web Apps Technologie, die eine gemeinsame Bearbeitung von Office-Dokumenten im Web-Browser ermöglicht. Die einfache Zusammenarbeit mit internen und externen Partnern erhöht ebenfalls die Akzeptanz für die Ve...

Hassrede und Katzenbilder : Wie können im globalen Netz nationale Gesetze respektiert werden?

OpenAIRE

Kettemann, Matthias C.

2017-01-01

Der Zugang zum Internet ist die Voraussetzung, um online aktiv zu sein, zu kommunizieren oder einzukaufen. Zugang allein reicht aber nicht: Erst sogenannte Internet-Intermediäre (oder Internet-Inhalt-Vermittler) wie Google, Facebook oder Amazon ermöglichen es, das Internet zu nutzen, um über Social Media zu kommunizieren, auf Musik, Filme und Texte zuzugreifen oder überhaupt erst via Suchmaschine passende Online-Angebote ausfindig zu machen. Intermediäre verbinden Nutzer mit dem Internet, sie...

Risk-adjusted capitation funding models for chronic disease in Australia: alternatives to casemix funding.

Science.gov (United States)

Antioch, K M; Walsh, M K

2002-01-01

Under Australian casemix funding arrangements that use Diagnosis-Related Groups (DRGs) the average price is policy based, not benchmarked. Cost weights are too low for State-wide chronic disease services. Risk-adjusted Capitation Funding Models (RACFM) are feasible alternatives. A RACFM was developed for public patients with cystic fibrosis treated by an Australian Health Maintenance Organization (AHMO). Adverse selection is of limited concern since patients pay solidarity contributions via Medicare levy with no premium contributions to the AHMO. Sponsors paying premium subsidies are the State of Victoria and the Federal Government. Cost per patient is the dependent variable in the multiple regression. Data on DRG 173 (cystic fibrosis) patients were assessed for heteroskedasticity, multicollinearity, structural stability and functional form. Stepwise linear regression excluded non-significant variables. Significant variables were 'emergency' (1276.9), 'outlier' (6377.1), 'complexity' (3043.5), 'procedures' (317.4) and the constant (4492.7) (R(2)=0.21, SE=3598.3, F=14.39, Probpayment (constant). The model explained 21% of the variance in cost per patient. The payment rate is adjusted by a best practice annual admission rate per patient. The model is a blended RACFM for in-patient, out-patient, Hospital In The Home, Fee-For-Service Federal payments for drugs and medical services; lump sum lung transplant payments and risk sharing through cost (loss) outlier payments. State and Federally funded home and palliative services are 'carved out'. The model, which has national application via Coordinated Care Trials and by Australian States for RACFMs may be instructive for Germany, which plans to use Australian DRGs for casemix funding. The capitation alternative for chronic disease can improve equity, allocative efficiency and distributional justice. The use of Diagnostic Cost Groups (DCGs) is a promising alternative classification system for capitation arrangements.

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia.

Science.gov (United States)

Zafirah, S A; Nur, Amrizal Muhammad; Puteh, Sharifa Ezat Wan; Aljunid, Syed Mohamed

2018-01-25

The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG ® ) Casemix System in a teaching hospital in Malaysia. Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG ® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG ® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG ® code was RM654,303.91. The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

Impact of the Transition to ICD-10 on Medicare Payment

Data.gov (United States)

U.S. Department of Health & Human Services — Although the transition from the ICD-9-CM to the ICD-10 version of MS-DRGs resulted in 1.68 percent of the patients being assigned to a different MS-DRG, payment...

Luhmanns sociologiske systemteori

DEFF Research Database (Denmark)

Keiding, Tina Bering

2012-01-01

meget om ledelseskommunikationens mulighedsbetingelser. Ved at anskue ledelse som interventionskommunikation, og dermed som kommunikation, der lige som undervisning, coaching og terapi sigter mod at indvirke på andre systemer, bliver det muligt at komme tætter på netop det interventionsmæssige aspekt af...

Sex og orientalisme

DEFF Research Database (Denmark)

Necef, Mehmet Ümit

2007-01-01

I sit indflydesesrige værk ''Orientalisme'' nærmest dæmoniserer den palæstinensisk-amerikanske litteraturprofessor Edward Said de seksuelle relationer mellem orientalere og vestlige intellektuelle, der i 1800- og 1900-tallet rejste i Orienten. Men ved at udelukke centrale aspekter af den seksuali...

Pariisi kord = Paris' move / João Francisco Figueira

Index Scriptorium Estoniae

Figueira, João Francisco, 1968-

2009-01-01

Pariisi nõustamisprojektide rahvusvahelisest võistlusest "Le Grand Pari(s)". Sooviti saada julget ja elluviidavat projekti Pariisi arenguks aastani 2050. Osales kümme kutsutud arhitektide, planeerijate ja ekspertide töörühma. Osade tööde mõningaid aspekte tutvustav käsitlus

Danmarks rolle i de globale værdikæder for konventionel og certificeret soja og palmeolie

DEFF Research Database (Denmark)

Bosselmann, Aske Skovmand; Gylling, Morten

2012-01-01

Dette notat kortlægger Danmarks rolle i de globale handelsveje for soja og palmeolie ved brug af import- og eksportstatistikker, fremlægger de økonomiske aspekter ved import og brug af certificeret soja og palmeolie, og diskuterer, hvorvidt certificeringsordningerne kan beskrives som legitime og ...

Geriatrie en die Behoefte aan Geriatriese Dienste in Suid-Mrika

African Journals Online (AJOL)

12 Okt 1974 ... Om tot 'n beter gebiedsafbakening van begrippe te kom kan gemeld word dat gerontologie die vakgebied ... logie nie alleen tot biologiese prosesse beperk nie maar word sosiale aspekte ingesluit, met ander .... bizarre clinical phenomena and variant responses to treatment'.' Toegespitste mediese aandag ...

ESD renews old-fashioned pedagogics in Thai schools

DEFF Research Database (Denmark)

Breiting, Søren

2007-01-01

Om nogle vigtige aspekter af udviklingen af skoler i Thailand under det thailandske undervisningsministerium med dansk bistand, og hvor temaet 'Styrkelse af miljøundervisningen i Thailand' blev brugt til pædagogisk fornyelse på alle niveauer og mere generel skoleudvikling, samtidig med at der ske...

Obamas opgør med Bush låser ham i dronekrig

DEFF Research Database (Denmark)

Ulrich, Philip Christian

2013-01-01

En helt central del af Obamas valgkamp i 2008 var et opgør med dele af Bush administrationens krig mod terror. Obama er dog blevet fanget i en kontroversiel dronepolitik på grund af hans manglende succes med de indenrigspolitiske aspekter af opgøret...

Nye oplysninger om bl.a. miljømæssig risikovurdering af PAT-protein og glufosinatammonium herbicider. Zea mays (Bt11). Supplerende materiale om Bt11. Modtaget 21-02-2005, deadline 29-03-2005, svar 07-03-2005

DEFF Research Database (Denmark)

Strandberg, Morten Tune

2005-01-01

Mail: Det tilsendte supplerende materiale om Bt-11 majsen (mail pr. 21-02-2005) omhandler bl.a. eventuelle uønskede konsekvenser ved ulovlig anvendelse af glufosinat ammonium herbicider i forbindelse med dyrkningen. Vi har allerede indraget dette aspekt i forbindelse med den økologiske risikovurd...

Ensretting, segmentering og unnvikende strategier

DEFF Research Database (Denmark)

Steinholt, Yngvar B.; Wickström, David-Emil

2008-01-01

Gjennom eksempler fra russisk populærmusikk, film og media, undersøker denne artikkelen sentrale aspekter ved populærkulturelle identiteter i dagens Russland. I hvilken grad inviterer det populærkulturelle feltet til deltagelse og identifikasjonsprosesser? Vore funn tyder på at det ideologiske...

This Way Brouwn

DEFF Research Database (Denmark)

van der Meijden, Peter Alexander

2013-01-01

Artiklen udforsker den surinamsk/hollandske kunstner Stanley Brouwns værk "This Way Brouwn" (1962-nu) som en hybrid mellem arkiv og performance. Mere specifikt stiller artiklen, primært igennem Jacques Derridas essay "Archive Fever" skarpt på arkivets og performancekunstens tidsmæssige aspekt, fo...

Witz, Lust und Aggression

DEFF Research Database (Denmark)

Rösing, Lilian Munk

2014-01-01

Artiklen beskæftiger sig med forholdet mellem vits, lyst og aggression med udgangspunkt i lysten ved aggressiv litterær humor, eksemplificeret ved tekststeder fra Shakespeares Hamlet. Der argumenteres for, at aggressionen eller angrebet er et fælles centralt aspekt ved Sigmund Freuds og Friedrich...

Etisk afgørende øjeblikke – en pragmatisk-dualistisk forskningsetik

DEFF Research Database (Denmark)

Johansen, Martin Blok

2017-01-01

Forskningsetik handler om samtlige de etiske aspekter af forskning lige fra undfangelsen af en idé til formidlingen og konsekvenserne af den. Derfor er det påfaldende, at forskningsetiske problemstillinger ofte blot har en slags appendikskarakter, hvor det i et kort, separat afsnit fortælles...

Those Ecological, Economical Fluxus Events

DEFF Research Database (Denmark)

van der Meijden, Peter Alexander

2013-01-01

Artiklen udforsker, med udgangspunkt i Fluxusforsker Hannah Higgins' definition af Fluxusværkerne som "eksperientielle", Fluxus' problematiske forhold til arkivet. Ved hjælp af analyser af udvalgte værker af George Brecht og Mieko (Shieko) Shiomi konkluderes der, at Fluxusværkerne selv har aspekter...

Psykoterapi og eksistentiel fænomenologi

DEFF Research Database (Denmark)

Hvordan ser eksistentiel terapi ud i dag, og hvor er den på vej hen? Hvordan bidrager det eksistentielfænomenologiske perspektiv til at belyse andre aktuelle tilgange såvel som væsentlige, tværgående aspekter i psykoterapien? Antologien her er både en introduktion til det 21. århundredes eksisten......Hvordan ser eksistentiel terapi ud i dag, og hvor er den på vej hen? Hvordan bidrager det eksistentielfænomenologiske perspektiv til at belyse andre aktuelle tilgange såvel som væsentlige, tværgående aspekter i psykoterapien? Antologien her er både en introduktion til det 21. århundredes...... dens teoretiske grundlag. Der præsenteres eksempler på, hvordan tilgangen gør sig gældende i psykoterapeutisk praksis. Centrale problematikker som selvoverskridelse, autenticitet og livsduelighed diskuteres indgående. Relationer til psykoanalysen, Kierkegaard og kognitiv terapi tages op med fokus på...

Website-analyse

DEFF Research Database (Denmark)

Thorlacius, Lisbeth

2009-01-01

eller blindgyder, når han/hun besøger sitet. Studier i design og analyse af de visuelle og æstetiske aspekter i planlægning og brug af websites har imidlertid kun i et begrænset omfang været under reflektorisk behandling. Det er baggrunden for dette kapitel, som indleder med en gennemgang af æstetikkens......Websitet er i stigende grad det foretrukne medie inden for informationssøgning,virksomhedspræsentation, e-handel, underholdning, undervisning og social kontakt. I takt med denne voksende mangfoldighed af kommunikationsaktiviteter på nettet, er der kommet mere fokus på at optimere design og...... planlægning af de funktionelle og indholdsmæssige aspekter ved websites. Der findes en stor mængde teori- og metodebøger, som har specialiseret sig i de tekniske problemstillinger i forbindelse med interaktion og navigation, samt det sproglige indhold på websites. Den danske HCI (Human Computer Interaction...

Morphologische Veränderung des Beckenbodens und klinisches Outcome nach Resektionsrektopexie bei Beckenbodeninsuffizienz : Eine explorative, deskriptive Studie anhand der dynamischen Beckenboden-MRT

OpenAIRE

Busse, Anika

2013-01-01

Der Beckenboden und insbesondere die Beckenbodeninsuffizienz mit ihren Folgeerkrankungen wie anale Inkontinenz und Obstipationen sind nach wie vor ein Tabuthema. Aufgrund der steigenden Prävalenz, der damit verbundenen steigenden Kosten für das Gesundheitssystem und aufgrund der deutlichen Beeinflussung der Lebensqualität ist es wichtig effektive diagnostische Möglichkeiten und Therapien zu besitzen. Ziel dieser vorliegenden Studie sollte es somit sein das Outcome nach Resektionsrektopexie be...

Normzahlen, Toleranzen, Passungen

Science.gov (United States)

Böge, Gert; Böge, Wolfgang

Vor allem wegen der Kosten ist es sinnvoll, sich beim Festlegen von Maßen aller Art auf Vorzugszahlen zu beschränken (Baugrößen, Drehzahlen, Drehmomente, Leistungen, Drücke usw.). Man verwendet dazu eine geometrisch gestufte Zahlenfolge (siehe Teil Mathematik). Abb. 40.1 zeigt, dass bei der geometrischen Stufung die Werte im unteren Bereich fein, im oberen grob gestuft sind. Das ist nicht nur technisch sinnvoll.

Ein wellenbasiertes stochastisches Modell zur Vorhersage der Erdbebenlast

OpenAIRE

Bretschneider, Jörg

2007-01-01

Starke Erdbeben stellen weltweit ein hohes Risiko für urbane Zentren dar, dem unter anderem durch Methoden der aseismischen Bauwerksbemessung begegnet wird. Grundlage hierfür bilden Annahmen und Erfahrungswissen über die lokale seismische Bodenbeschleunigung, Grenzen sind hingegen durch die zusätzlichen Kosten gesetzt. Die Schadensbilanz der Starkbeben der letzten Jahre, auch in den Industrieländern, verdeutlicht die Notwendigkeit, die Konzepte und Methoden des erdbebensicheren Bauens weiter ...

DoD Alcohol and Substance Abuse Consortium Award

Science.gov (United States)

2017-10-01

formerly ORG 34517) in Veterans with Co-morbid PTSD/AUD” (Principal Investigator: Dewleen G. Baker, MD) The primary objective of this study is to...test the efficacy, safety, and tolerability of a novel GR antagonist PT150 (formerly ORG 34517) for AUD/PTSD dual diagnosis treatment in veterans. The...Pharmacotherapies for Alcohol and Substance Abuse (PASA) Consortium PI: Rick Williams, PhD & Thomas Kosten, MD Org : RTI International Study Research Planning

Planung von Stückgut-Umschlagbereichen mit Hilfe wissensbasierter Bewertungsmethoden

OpenAIRE

Freudl, Gunther

2007-01-01

Die sich verschärfende Wettbewerbsituation auf dem Markt und der damit steigende Konkurrenzdruck zwischen den Unternehmen erfordert ein Ausschöpfen vorhandener Rationalisierungspotentiale. Dies gilt auch für den Umschlagsektor, denn hier entstehen aufgrund der häufig noch umständlichen Handhabungsvorgänge vermeidbare Kosten. Die Automatisierung, die im innerbetrieblichen Bereich schon weit fortgeschritten, dagegen bei der Verladung bislang eher sporadisch anzutreffen ist, bietet sich als eine...

3D-Druck von Kunststoff-Medizinprodukten

OpenAIRE

Polzin, Christian; Seitz, Hermann

2012-01-01

Das Additive Manufacturing gewinnt im Bereich der Medizintechnik zur Herstellung von Prototypen bis hin zu Endprodukten zunehmend an Bedeutung. Ein großes Hemmnis stellen allerdings die relativ hohen Fertigungskosten dar. Hier bietet der verstärkte Einsatz der 3D-Drucktechnologie (3D Printing) ein erhebliches Potential zur Reduktion der Kosten. Aus dieser Motivation heraus wurde ein 3D-Druckverfahren zur Herstellung biokompatibler, sterilisierbarer Kunststoffmodelle entwickelt. Beim 3D-Druck-...

Loyalty Profiling - Erfolgsdimensionen und Modellansätze eines effizienten und effektiven Customer Relationship Management

OpenAIRE

Lafleur, Martin J.

2009-01-01

Loyalty Profiling bezeichnet einen Managementansatz, der die Komplexität und wesentliche Effekte der Kundenbindung in Abhängigkeit von persönlichen Merkmalen quantitativ modelliert. Darin enthaltene Profilabgleiche von Bindungspotenzialen vs. Maßnahmenwirkungen (Effektivität) sowie Erträgen aus geändertem Kundenverhalten vs. Kosten der Maßnahmen (Effizienz) werden durch Anwendungsbeispiele für die Automobilindustrie und eine computergestützte Umsetzung veranschaulicht.

Vom Geheimen und Verborgenen : Enthüllen und Entdecken in der Medizin

NARCIS (Netherlands)

Nagenborg, Michael; Müller, Sabine; Müller, Melanie; Rosentreter, Michael

2017-01-01

Wer den kleinsten Teil seines Geheimnisses hingibt, hat den anderen nicht mehr in der Gewalt, so Jean Paul. Diese Erkenntnis findet sich auch in dem Titel des vorliegenden Bands reflektiert, in dem Aspekte des „Verborgenen“ und „Geheimen“ in der Medizin interdisziplinär untersucht werden. Aus

Contextual factors and motivators of the accounting developments in Estonian local goverments / Toomas Haldma, Helje Jõgi

Index Scriptorium Estoniae

Haldma, Toomas, 1957-

2006-01-01

Siirdeperioodil on Eesti kohalike omavalitsuste (KOV) süsteem läbi teinud nii finants- kui administratiivreformi, mis mõjutavad majandusarvestuse kontseptuaalseid aspekte. Etapilise lähenemise teoreetilistest seisukohtadest lähtudes analüüsitakse KOV-de arevestussüsteemi arengut läbi Eesti majandusarvestuse kolme arenguetapi

,t'.: O.)IISPIIONG EN ONTWIKKELIN •• VAN ItIE ONDERRI ••F'LM

African Journals Online (AJOL)

4. Die onderrigfilms wat vir skole bestaan het, het aspekte soos verhale, tegniese vakke, geografie, geskiedenis, taal en higiene gedek. Bogenoemde films was egter baie beperk in terme van opvoedkundige waarde aangesien dit bestaan het uit materiaal wat vanaf kommersiele films afkomstig was en later aangepas is Die.

Mart Saali ja Lüütsepa Jaani taevaskäigud. Protestantlikest ilmutustest, nende poeesiast ja motiivistikust / Andreas Kalkun

Index Scriptorium Estoniae

Kalkun, Andreas, 1977-

2006-01-01

Analüüsitakse kahe 18. sajandi lõpul sündinud ning vennastekogudusest inspireeritud usulise ärkamise ja nn taevaskäijate liikumisega seotud eesti mehe ilmutusi. Kirjeldatakse ka protestantlike voolude ja sektidega seotud ilmutustenägijate traditsiooni ning teatud aspekte kristlikus ilmutustenägemise loos üldse

Panik i rummet

DEFF Research Database (Denmark)

Pedersen, Peter Ole

2017-01-01

Artikel om overvågning og film med fokus på den særlige Home invasion-genre, der er udbredt både i Hollywood-blockbusters, horrorfilm og moderne klassikere. Det psykologiske, statusmæssige og politiske aspekt hos husejeren diskuteres gennem David Finchers 2002-thriller Panic Room....

Die ontwikkeling van menslike potensiaal in die Republiek van Suid ...

African Journals Online (AJOL)

Erna Kinsey

Dit het dus ook te doen met lewenstandaard, aangesien lewenstandaard `n bepalende faktor is met betrekking tot die optimale ontwikkeling van menslike potensiaal. Ander minder materiële aspekte van menslike potensiaal het te doen met menslike vryheid, waaronder vryheid van spraak, beweging en keuse ter sake is.

Is everything that is allowed for Jupiter also allowed for an ox? / Romano Prodi, Igor Gräzin

Index Scriptorium Estoniae

Prodi, Romano, 1939-

2002-01-01

Euroopa Nõukogu presidendi Romano Prodi ja Eesti tuntuima euroskeptiku Igor Gräzini seisukohtade võrdlus erinevates EL-i puudutavates küsimustes. Autorid analüüsivad EL-iga liitumise mõju Eestile, pidades silmas julgeolekut, põllumajandustoetusi, iseseisvuse säilimist, majanduslikku arengut ja teisi aspekte

The psychological experience of women who survived HELLP ...

African Journals Online (AJOL)

Die tema van nie weet en beswyming en/of surrealistiese ervaring ondersteun die kognitiewe aspekte van die HELLP sindroom. Temas wat gevoelens van geen beheer, warrelwind en/of vinnige tempo en ondersteuning uitgesprek het, het saam opgetree om die ervaring te bind. Ten slotte,emosies soos woede, ...

Stedets Lyd

DEFF Research Database (Denmark)

Kreutzfeldt, Jacob

2015-01-01

lydlige aspekt. Grundantagelsen er, at radioreportagen i kraft af dens indeksikalske lyd afspejler, reflekterer og udvikler måder hvorpå den moderne verden er blevet erfaret. Reportagens form er ikke bare et tilfældigt resultat af samspillet mellem teknologi, reporter og stof, den afspejler og producerer...

Policy Aspects

DEFF Research Database (Denmark)

Dolin, Jens; Bruun, Jesper; Constantinou, Costas

2018-01-01

andre interessenter retningslinjer for at sikre, at evaluering forbedrer læring i STM-uddannelse. Dette kapitel beskriver, hvordan det andet mål, de politikorienterede aspekter, blev behandlet i ASSIST-ME. Det beskriver oprettelsen af ​​nationale interessentpaneler (NSP) ved hjælp af social network...

Brexit: Was steht für den britischen Finanzsektor auf dem Spiel?

OpenAIRE

Miethe, Jakob; Pothier, David

2016-01-01

Der Austritt des Vereinigten Königreichs aus der Europäischen Union hat weitreichende Implikationen für die britische Finanzbranche. London ist die bisherige Finanzhauptstadt Europas. Dort ansässige Finanzinstitutionen können spezielle EU-Rechte nutzen, um Dienstleistungen im gesamten Binnenmarkt anzubieten. Das Vereinigte Königreich erfüllt somit gegenwärtig zwei Funktionen im europäischen Finanzsystem: Erstens ist es ein Knotenpunkt für Firmenkundengeschäfte großer europäischer Banken und z...

Online-Marketing in der Computerbranche: Eine Bestandsaufnahme

OpenAIRE

Fritz, Wolfgang; Kerner, Martin; Könnecke, Stefan

1997-01-01

In Deutschland ansässige Unternehmen der Computerbranche sehen im Internet das wichtigste Medium für ihr Online-Marketing, mit weitem Vorsprung vor den kommerziellen Online-Diensten T-Online, CompuServe und America Online. Den größten Nutzen ihrer Internet-Präsenz versprechen sich diese Unternehmen für die Präsentation von Neuprodukten, die Erbringung medialer Service- und Hotline-Dienste, die Öffentlichkeitsarbeit (PR) und den direkten Kundenkontakt. Wesentlich zurückhaltender beurteilen sie...

[IHE (Integrating the Healthcare Enterprise): a new approach for the improvement of digital communication in healthcare].

Science.gov (United States)

Wein, B B

2003-02-01

Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information.

IHE (Integrating the Healthcare Enterprise): A new approach for the improvement of digital communication in healthcare

International Nuclear Information System (INIS)

Wein, B.B.

2003-01-01

Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information. (orig.) [de

Condition monitoring for offshore wind parks. A module for ensuring plant availability and risk minimization; Condition Monitoring fuer Offshore-Windparks. Ein Baustein zur Sicherstellung der Anlagenverfuegbarkeit und zur Risikominimierung

Energy Technology Data Exchange (ETDEWEB)

Hoering, B. [Deutsche Montan Technologie GmbH, Essen (Germany). Engine Logic Division

2003-07-01

The economic success of offshore wind energy and hence its competitiveness alongside conventional energy generation depends to a major extent on the reliability and availability of the installations. The profitability is determined, as is efficiency, by the costs for operation and maintenance over the whole plant life. Only plants with low operational management costs are therefore attractive in the long-term for the market and will help create customer satisfaction and loyalty. Because the costs for servicing and maintenance of offshore installations will be several times higher than for onshore facilities, the manufacturers and operators are called upon to think about new approaches to monitoring and maintaining offshore wind turbines. (orig.) [German] Der wirtschaftliche Erfolg der Offshore-Windenergie und somit die Konkurrenzfaehigkeit gegenueber konventioneller Energiegewinnung haengt massgeblich von der Zuverlaessigkeit und der Verfuegbarkeit der Anlagen ab. Die Wirtschaftlichkeit wird neben dem Wirkungsgrad durch die Kosten fuer Betrieb und Wartung waehrend der gesamten Anlagenlebensdauer bestimmt. Nur Anlagen mit geringen Betriebsfuehrungskosten sind daher fuer den Markt langfristig attraktiv und tragen zur Kundenzufriedenheit und -bindung bei. Weil die Kosten fuer Wartung und Instandhaltung von Offshore-Anlagen um ein vielfaches hoeher sein werden als bei Onshore-Anlagen, sind die Hersteller und Betreiber aufgefordert, ueber neue Konzepte der Windenergieanlagen-(WEA-)Ueberwachung und -instandhaltung nachzudenken. (orig.)

''Routine'' brain CT in psychiatric patients - does it make sense?; ''Routine''-Schaedel-CT in der psychiatrischen Diagnostik

Energy Technology Data Exchange (ETDEWEB)

Pickuth, D.; Heywang-Koebrunner, S.H.; Spielmann, R.P. [Martin-Luther-Universitaet Halle-Wittenberg, Halle (Germany). Klinik und Poliklinik fuer Diagnostische Radiologie

1999-11-01

Purpose: To prospectively assess the spectrum of brain CT findings in psychiatric patients and to determine the number of patients that had an underlying cause for the symptoms. Patients and methods: Over a period of six months, 142 patients (78 males, 64 females; median age 61 [18-91] years) were referred for CT brain scans. Their scans were reviewed, along with the clinical information that was provided in the request form. All the hard copies were reviewed to assess areas of ischaemia, infarction, atrophy, tumours, and haematomas. The majority of requests were to exclude vascular event or space-occupying lesions. Clinical indications included mood disorders (depression, mania), schizophrenic disorders, dementia, personality and behavioural disorders. Results: 31 (22%) were normal. 111 (78%) had varying degrees of ischaemia, infarction and cerebral/cerebellar atrophy. 7 (4.9%) had space-occupying lesions which included two gliomas and five meningiomas. There were two chronic subdural haematomas and one arteriovenous malformation. Conclusion: 1. In our series, pathologic findings in 'routine' brain CT's were encountered in 78%. 2. The incidence of brain tumours was 4.9%, compared with 0.00005% of the general population. 3. CT scanning in psychiatric patients is cost-effective and especially indicated when there is an atypical presentation, or inadequate response to standard treatment. (orig.) [German] Hintergrund: Bei psychiatrischen Patienten wird vielerorts routinemaessig eine kraniale Computertomographie (CCT) durchgefuehrt. Ob der Nutzen die Kosten rechtfertigt, wurde im Rahmen einer Prospektivstudie untersucht. Patienten und Methode: In einem Zeitraum von 6 Monaten wurde bei 142 psychiatrischen Patienten (78 Maenner, 64 Frauen, 18-91 Jahre, Median 61 Jahre) ein CCT angefertigt. Die Untersuchung erfolgt nativ in 5-mm-Schichtdicke, bei klinischem Verdacht auf eine intrakraniale Raumforderung auch kontrastverstaerkt. Ueberweisungsdiagnosen waren v

Homeobox gene expression in adult dorsal root ganglia: Is regeneration a recapitulation of development?

NARCIS (Netherlands)

Vogelaar, C.F.

2003-01-01

Neurons of the peripheral nervous system are able to regenerate their peripheral axons after injury, leading to complete recovery of sensory and motor function. The sciatic nerve crush model is frequently used to study peripheral nerve regeneration. Sensory neurons in the dorsal root ganglia (DRGs)

Fagreferentkonferansen 2012 i Kristiansand

Directory of Open Access Journals (Sweden)

Therese S. Skagen

2012-09-01

Full Text Available Universitetet i Agder arrangerte Fagreferentkonferansen 2012 som hadde et innholdsrikt og interessant program. Ulike aspekter ved bibliotekets tjenester ble belyst, fra undervisning av studenter og styrking av informasjonskompetanse, til tjeneste for forskere og forskningsmiljøer og samlingsutvikling med brukerstyrte innkjøp av e-bøker.

Globalisation, etnisk diversitet og pluralistisk sundhedsfremme

DEFF Research Database (Denmark)

Singla, Rashmi

. Derudover fokuseres på de særlige aspekter og ressourcer blandt de etniske minoriteter. Processer som transnationalisme og diaspora, som fører til pluralistiske sundhedsfremme praksisser(såsom yoga og meditation mv.) inddrages. Sådanne holistiske praksisser kan endvidere være sundhedsfremmende for både...

Opening-up to foreign banks in a transition economy : a case of Ukraine / Janek Uiboupin

Index Scriptorium Estoniae

Uiboupin, Janek, 1976-

2006-01-01

Siirderiikide arengus on erilise tähtsusega pangandussektori areng ja reformid, oluliseks etapiks on turu liberaliseerimine ja avamine väliskapitalile. Artikkel uurib esmalt teoreetiliselt välispankade turule sisenemise võimalikke positiivseid ning negatiivseid aspekte, seejärel antakse ülevaade Ukraina pangandussektori arengust ning välispankadest Ukrainas

ERKI moeshow kui karnevallik nähtus 1980. aastate Nõukogude Eestis / Laura Paju, Ester Võsu

Index Scriptorium Estoniae

Paju, Laura

2008-01-01

Analüüsitakse Eesti NSV Riikliku Kunstiinstituudi (ERKI) tudengite korraldatud moeshowde karnevallikke aspekte, lähtudes vene filosoofi, kirjandusteadlase ja semiootiku Mihhail Bahtini karnevaliteooriast. Eesmärgiks oli ka kunagiste korraldajate ja aktiivsete osalejate arvamused ja kuidas nad neid sündmusi tänapäeval mõtestavad

High Intensity Training (HIT) en High Intensity Interval Training (HIIT) bij patiënten met chronische non-specifieke lage rugpijn: effecten op fysieke parameters en subjectieve pijnbeleving

OpenAIRE

Nuyttens, Jelle; Vuylsteke, Michiel

2016-01-01

Niet-specifieke chronische lage rugpijn (NSCLRP) zorgt via directe en indirecte kosten voor een enorme economische last in onze huidige maatschappij. Tot op heden wordt een grote variëteit aan trainingsprogramma's aangewend in de behandeling van lage rugpijn, maar er bestaat weinig consensus omtrent de ideale trainingsintensiteit. In deze pilotstudie werd de bruikbaarheid en het effect van de combinatie 'High-Intensity Interval Training (HIIT)' en 'High-Intensity Training (HIT)' op pijn, acti...

Nanomaterials for future generation Lithium-Sulphur batteries: Final report : collaborative project : subproject: Nanostructured carbons for carbon-sulfur nanocomposites : time of the project: From 01 May 2012 to 30 June 2015, reporting period: From 01 May 2012 to 30 June 2015

OpenAIRE

Kaskel, Stefan; Dörfler, Susanne; Oschatz, Martin; Nickel, Winfried; Hippauf, Felix

2015-01-01

Elektromobilität verspricht ein großes Potential, aber weitere Innovationen sind nötig, um die Nachteile der Elektrofahrzeuge gegenüber Verbrennungsmotor betriebenen Fahrzeugen auszugleichen. Limitierend wirken sich vor allem die Kosten und die Energiedichte der Batterie aus. Letztere begrenzt im Wesentlichen die rein elektrische Reichweite der Elektrofahrzeuge. Lithium-Ionen-Batterien nach Stand der Technik erreichen ca. 200 Wh kg-1. Neue Batterien mit signifikant höherer Energiedichte wären...

Additive Fertigungsverfahren mit Praxisbeispielen: Vortrag gehalten beim Praxisforum 3D-Druck, 3D-Druck in Produktentwicklung und Fertigung - Anwendungen und Potenziale, 24.03.15, Landshut

OpenAIRE

Seidel, Christian

2015-01-01

Für die Additive Fertigung von Metallen und Kunststoffen gibt es verschiedenen Methoden und Funktionsprinzipien. Die Potenziale liegen unter anderem in der Formgebungsfreiheit, der Ressourceneffizienz und der Personalisierung. In den nächsten Jahren ist mit einem weiteren Rückgang der Kosten pro hergestelltem Volumen zu rechnen. Mit Hilfe der Bionik wird die Natur als Vorbild abstrahiert und findet Einsatz bei technischen Anwendungen. Als Beispiele für Additive Fertigungsverfahren sind der fu...

Neue Komponenten für das generative Fertigungsverfahren des 3D-Drucks

OpenAIRE

Presser, Jonas

2012-01-01

Kunststoffprodukte haben sich seit den fünfziger Jahren wegen ihrer Zähigkeit und ihres geringen Gewichts, aber auch wegen ihrer Verarbeitbarkeit durch das Schmel-ze¬verfahren des Spritzgusses durchgesetzt. Die Formenvielfalt und Akkuratesse, die der Spritzguss in schneller und preiswerter Produktion erlaubt, ist unerreicht. Aller¬dings muss dem Spritzguss immer der Bau eines Formwerkzeuges vorgeschaltet werden. Dessen Kosten amortisieren sich in der Großserienproduktion, nicht aber bei Klein...

The price of air pollution; De prijs van luchtverontreiniging

Energy Technology Data Exchange (ETDEWEB)

Hiemstra-Holtkamp, I.V.L. [Astma Fonds, Leusden (Netherlands)

2006-04-15

The mortality in the Netherlands as a result of exposure to particulates is 18,000 per year. Less known is the high number of cases of sickness cased by air pollution and related cost for the Dutch society. [Dutch] Het sterftecijfer in Nederland als gevolg van blootstelling aan fijn stof is jaarlijks circa 18.000. Minder bekend is de verhoogde ziektelast die luchtverontreiniging veroorzaakt en de kosten die daarmee gepaard gaan voor de Nederlandse samenleving.

Research of Medical Expenditure among Inpatients with Unstable Angina Pectoris in a Single Center

Directory of Open Access Journals (Sweden)

Suo-Wei Wu

2017-01-01

Conclusions: The classification of DRGs by adopting the type of surgery as the main branch node to develop cost control standards in inpatient treatment of unstable angina pectoris is conducive in standardizing the diagnosis and treatment behaviors of the hospital and reducing economic burdens among patients.

Bosnia ja Kosovo riigiloomise õppetunnid / Karin Maandi

Index Scriptorium Estoniae

Maandi, Karin

2005-01-01

OSCE missiooni koosseisus Kosovos ning Bosnias ja Hertsegoviinas viibinud Karin Maandi kirjeldab aspekte, mis on olnud olulised stabiilsuse tagamisel Balkanil ja Afganistanis. Autori sõnul ei võta välismaailm konflikti sekkudes tihti arvesse, et konfliktist on puudutatud paljud valdkonnad ja et pakutud lahendused peavad sobima kohalikesse oludesse. Lisa: Õppetunnid

Housing Culture: Scandinavian Perspectives

DEFF Research Database (Denmark)

Roesdahl, Else

2009-01-01

Artiklen giver en oversigt over både traditioner og nye tendenser i udforskningen af boligkultur i de nordiske lande. Desuden diskuteres konkrete aspekter af moderne forskning på dette felt i Danmark, Norge, Sverige, Island og Grønland. Eksemplerne rækker fra vikingetid til senmiddelalder og omfa...

God skik-standarder og retssikkerhed

DEFF Research Database (Denmark)

Sørensen, Marie Jull

2012-01-01

Forfatteren belyser god skik-begrebet som grundlag for retlige afgørelser og vurderer retssikkerhedsmæssige aspekter heraf. Det er en del af den moderne retsudvikling, at lovgivningsmagten fastsætter retlige standarder, herunder god skik på udvalgte retsområder, hvilket giver en række fordele i et...

China's energy revolution - measuring the status quo, modelling regional dynamics & assessing global impacts

DEFF Research Database (Denmark)

2015-01-01

værktøjer er udviklet i denne forbindelse. Den underliggende teori bag forskningen stammer fra en række forskellige discipliner, såsom energi og kraft ingeniørvidenskab, makro- og energi økonomi, samt kraft-projekt finansiering. Det interdisciplinære aspekt udtrykker sig ved harmoniseringen af den Kinesiske...

Measuring sustainable homes

DEFF Research Database (Denmark)

Olesen, Gitte Gylling Hammershøj; Knudstrup, Mary-Ann; Heiselberg, Per

2011-01-01

Paperet studerer Active House Visionen og Active House Specifikation ”work-in-progress” for at identificere parametre til måling af fremtidens bæredygtig hjem. Fremgangsmåde er baseret på Mixed Methods Research strategi hvor målingerne er relateret til både kvantitative og kvalitative aspekter i...

Wissen aus analogen Märkten für Innovationen nutzen

DEFF Research Database (Denmark)

Poetz, Marion K.; Leimüller, Gertraud

2014-01-01

, dass Unternehmen systematisch externe Innovationsquellen erschließen. In den meisten Fällen beschränkt sich dies jedoch auf offene Innovationsprozesse in Kooperation mit Kunden, Lieferanten oder Mitbewerbern innerhalb der eigenen Industrie. Dieser Buchbeitrag präsentiert, wann und warum es für...

X-ray diagnostics - benefits and risks; Roentgendiagnostik - Nutzen und Risiken

Energy Technology Data Exchange (ETDEWEB)

Bartholomaeus, Melanie (comp.)

2016-10-15

The brochure on benefits and risks of X-ray diagnostics discusses the following issues: X radiation - a pioneering discovery and medical sensation, fundamentals of X radiation, frequency of X-ray examinations in Germany in relation to CT imaging, radiation doses resulting from X-ray diagnostics, benefits of X-ray diagnostics - indication and examples, risks - measures for radiation exposure reductions, avoidance of unnecessary examinations.

Disposal of sewage sludge - problems and options; Klaerschlammentsorgung - Probleme und Moeglichkeiten

Energy Technology Data Exchange (ETDEWEB)

Kobelt, G.

2000-06-01

Sewage sludge production cannot be avoided. In consequence, the sewage sludge produced must either be utilised or combusted for heat and power generation. [German] Da Klaerschlaemme bei der Abwasserreinigung zwangsmaessig anfallen, ist ihre Vermeidung im Sinne des Paragraphen 4 (1), 1 des KrW/AbfG nicht moeglich. Deshalb muss es das Ziel einer vernuenftigen und geordneten Klaerschlammwirtschaft sein, den groesstmoeglichen Anteil des gesamten Schlammaufkommens, wie es das Gesetz ebenfalls vorschreibt, stofflich zu verwerten oder zur Gewinnung von Energie zu nutzen (energetische Verwertung). (orig.)

Gas distribution systems. A constant in the energy transition; Gasnetze. Eine Konstante im Energiewandel

Energy Technology Data Exchange (ETDEWEB)

Bahke, Ralph [ONTRAS - VNG Gastransport GmbH, Leipzig (Germany)

2013-06-15

In the course of the energy transition the gas network infrastructure and the supply of renewable gases provide a valuable potential to be exploited. However the given the regulatory framework are blocking the necessary reorientation and thus hinder the achievement of politically set climate protection targets. [German] Im Zuge der Energiewende bieten die Gasnetzinfrastruktur und die Einspeisung regenerativer Gase ein wertvolles Potenzial, das es zu nutzen gilt. Die gegebenen regulatorischen Rahmenbedingungen blockieren jedoch die dafuer noetige Umorientierung und behindern damit die Erreichung der politisch gesetzten Klimaschutzziele.

Hospital billing for blood processing and transfusion for inpatient stays.

Science.gov (United States)

McCue, Michael J; Nayar, Preethy

2009-07-01

Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.

Casemix funding in Australia.

Science.gov (United States)

Braithwaite, J; Hindle, D; Phelan, P D; Hanson, R

1998-06-01

Casemix funding for hospitals with the use of diagnosis-related groups (DRGs), which organise patients' conditions into similar clinical categories with similar costs, was introduced in Australia five years ago. It has been applied in different ways and to a greater or lesser extent in different Australian States. Only Victoria and South Australia have implemented casemix funding across all healthcare services. Attempts have been made to formally evaluate its impact, but they have not met the required scientific standards in controlling for confounding factors. Casemix funding remains a much-discussed issue. In this Debate, Braithwaite and Hindle take a contrary position, largely to stimulate policy debate; Phelan defends the casemix concept and advocates retaining its best features; and Hanson adds a plea for consumer input.

Energy for Germany 2000. Facts, views and positions in a global trend. Goals of the global and national policies in the 21st century: Competitive strength, assured supply, environmental compatibility; Energie fuer Deutschland 2000. Fakten, Perspektiven und Positionen im globalen Kontext. Schwerpunktthema 'Ziel globaler und nationaler Energiepolitik im 21. Jahrhundert: Wettbewerbsfaehig - versorgungssicher - umweltvertraeglich'

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-07-01

The publication is based on the publication 'Energy for Tomorrow's World - Acting Now.', which was published by the World Energy Council in 2000. It presents an analysis of the current situation and contains suggestions for actions that should be taken in the period up to 2020. While national energy policy will still be required, it can only be successful if global aspects are not neglected. This includes the consideration of the responsibility of the industrial nations for third world countries. The energy concept presented here intends to take account of the decisive global aspects. [German] Die Darstellung der globalen Aspekte stuetzt sich auf die Standortbestimmung 2000 des Weltenergierates 'Energy for Tomorrow's World - Acting Now.'. Diese Standortbestimmung unterzieht die Anfang der 90er Jahre erschienene globale Studie des Weltenergierates einer kritischen Ueberpruefung, stellt Abweichungen von den damals angenommenen Entwicklungsperspektiven fest und gibt vor allem konkrete Handlungsempfehlungen fuer die Zeit bis zum Jahr 2020, also fuer die Zeitspanne, die konkret ueberschaubar und gestaltbar ist. Die neue Standortbestimmung des Weltenergierates unterstreicht, dass nationale Energiepolitik zwar weiterhin notwendig ist, aber nur dann auf Dauer erfolgreich sein wird, wenn sie auf diese globalen Aspekte ausgerichtet ist. Dazu gehoert auch, dass westliche, entwickelte Laender sich bewusst sind, dass eine nationale Energiepolitik zu Lasten der Dritten Welt nicht nur keine Zukunft hat, sondern vor allem nicht zu verantworten ist. Dies gilt natuerlich ebenso fuer die Umweltpolitik. An diesen Massstaeben wird sich auch das konkrete Energiekonzept messen lassen muessen, das nun fuer die Bundesrepublik Deutschland auf der Basis des 'Energiedialogs 2000' erarbeitet werden soll. Mit der hier vorgelegten Publikation will das Deutsche Nationale Komitee des Weltenergierates dazu beitragen, dass in diesem Energiekonzept die

Entrepreneurship as a tool of an economic policy : background, factors and possibilities / Raivo Linnas

Index Scriptorium Estoniae

Linnas, Raivo

2006-01-01

Majandusliku arengu ja edu saavutamine majanduspoliitika kujundamise ja elluviimise kaudu ei ole kiiresti muutuvas maailmas enam ainuüksi klassikaliste majandusteooriate mõjuväljas. Lisaks klassikalistele üldtunnustatud majandusteooriatele on oluline arvestada teisi teooriaid ja reaalelu mõjureid ning aspekte. Maailmas toimuvate poliitiliste, sotsiaalsete, majanduslike jt sündmuste mõju majanduspoliitika kujunemisele

Supervisand og supervisor

DEFF Research Database (Denmark)

Jacobsen, Claus Haugaard

2007-01-01

Kapitlet redegør for aspekter ved det komplekse forhold mellem supervisand og supervisor, og der anlægges en række forskellige perspektiver. Først beskrives forholdet fra supervisandens perspektiv. At indtræde i rollen som supervisand er, foruden at være lærerigt og fagligt udviklende, ofte også ...

Hjertets algoritmer

DEFF Research Database (Denmark)

Dahlager, Lisa

2015-01-01

Artiklen undersøger hvordan vi kan forstå bevidsthedens virkemåde, den algoritmer, og hvordan denne forståelse kan omsættes i psykoterapi til at skabe læring, kreativitet og helbredelse. Den er komponeret som en fuga med syv satser, syv algoritmer, der hver udtrykker et aspekt af bevidstheden....

Læringsarenaer i menneskearbejdet. Forførende retorik, ambivalente aktører og neoliberal nøjsomhed

DEFF Research Database (Denmark)

Lundgaard Andersen, Linda

2012-01-01

I menneskearbejdet er læring et uafvendeligt aspekt. I det sociale, det frivillige felt eller på arbejdsmarkedet hvor menneskers udvikling står i centrum kan læring være en drivkraft, en forandring, en stilstand eller en modstand. Men læring er ikke kun reserveret til oplysningens, modkvalificeri...

Østtyskland i omvæltning - kan IKT bringe tyske sundhedsaktører i samme båd?

DEFF Research Database (Denmark)

Wentzer, Helle

2008-01-01

Problematikken om affolkning af ydre landområder og manglen på sundhedstilbud er velkendt. Ambient Assisted Living, udtrykker et nyt aspekt inden for telemedicin og IKT, der søger at inddrage borgerens dagligdag og bolig i højere grad. Artiklen giver et portræt af Ambient Assisted Living i Berlin...

An Anglo-German dialogue the Munich lectures on the history of international relations

CERN Document Server

Birke, Adolf M; Searle, Alaric

2015-01-01

Die Prinz-Albert-Gesellschaft hat sich zur Aufgabe gemacht, die britisch-deutschen Beziehungen in Wissenschaft, Kultur und Politik zu pflegen. Alljährlich finden unter dieser Prämisse Tagungen statt, deren Beiträge in den Prinz-Albert-Studien veröffentlicht werden und die viele interessante Aspekte der britisch-deutschen Beziehungen verdeutlichen.

Sakraalne ruum / Aleksander Sprohgis

Index Scriptorium Estoniae

Sprohgis, Aleksander

2011-01-01

Töö sihiks oli kaardistada mõningaid aspekte küsimusest, kuidas inimesed kogevad jumalat. Kirjeldatakse sakraalset ruumi kui kohta, kus otsitakse tunnetuslikku kontakti, vaadeldakse inimese minapilti ja tunnetuses toimuvat, analüüsides erinevaid meeli ning lõpuks püütakse läbi isikliku kogemuse uurida ja seletada oma tunnetust sakraalses ruumis

Lean-Prinzipien für verbesserte Kosteneffizienz: Instandhaltungseffizienz durch Lean Maintenance

OpenAIRE

Bandow, G.; Schmidt, A.

2008-01-01

Die Bedeutung der Instandhaltung nimmt weiter zu. In einem Lean Umfeld mit einer immer verschwendungsärmeren Produktion stehen nicht nur die Kosteneffizienz und Verfügbarkeit der Produktionsmittel im Fokus. Unplanmäßige Stillstände kosten Geld und gefährden häufig auch Personal und Produkt. Lean Maintenance vermeidet Verschwendung und optimiert so die Effektivität und Effizienz der Instandhaltung. Das zielgerichtete Zusammenspiel von Menschen, Prozessen und Technik garantiert dabei den Erfolg...