Acceptance model of a Hospital Information System.

Science.gov (United States)

Handayani, P W; Hidayanto, A N; Pinem, A A; Hapsari, I C; Sandhyaduhita, P I; Budi, I

2017-03-01

The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0. The study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users' opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals. Based on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS. Copyright © 2016

To provide care and be cared for in a multiple-bed hospital room.

Science.gov (United States)

Persson, Eva; Määttä, Sylvia

2012-12-01

To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Hospital daily outpatient visits forecasting using a combinatorial model based on ARIMA and SES models.

Science.gov (United States)

Luo, Li; Luo, Le; Zhang, Xinli; He, Xiaoli

2017-07-10

Accurate forecasting of hospital outpatient visits is beneficial for the reasonable planning and allocation of healthcare resource to meet the medical demands. In terms of the multiple attributes of daily outpatient visits, such as randomness, cyclicity and trend, time series methods, ARIMA, can be a good choice for outpatient visits forecasting. On the other hand, the hospital outpatient visits are also affected by the doctors' scheduling and the effects are not pure random. Thinking about the impure specialty, this paper presents a new forecasting model that takes cyclicity and the day of the week effect into consideration. We formulate a seasonal ARIMA (SARIMA) model on a daily time series and then a single exponential smoothing (SES) model on the day of the week time series, and finally establish a combinatorial model by modifying them. The models are applied to 1 year of daily visits data of urban outpatients in two internal medicine departments of a large hospital in Chengdu, for forecasting the daily outpatient visits about 1 week ahead. The proposed model is applied to forecast the cross-sectional data for 7 consecutive days of daily outpatient visits over an 8-weeks period based on 43 weeks of observation data during 1 year. The results show that the two single traditional models and the combinatorial model are simplicity of implementation and low computational intensiveness, whilst being appropriate for short-term forecast horizons. Furthermore, the combinatorial model can capture the comprehensive features of the time series data better. Combinatorial model can achieve better prediction performance than the single model, with lower residuals variance and small mean of residual errors which needs to be optimized deeply on the next research step.

Hospital-based expert model for health technology procurement planning in hospitals.

Science.gov (United States)

Miniati, R; Cecconi, G; Frosini, F; Dori, F; Regolini, J; Iadanza, E; Biffi Gentili, G

2014-01-01

Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.

Cycling empirical antibiotic therapy in hospitals: meta-analysis and models.

Directory of Open Access Journals (Sweden)

Pia Abel zur Wiesch

2014-06-01

Full Text Available The rise of resistance together with the shortage of new broad-spectrum antibiotics underlines the urgency of optimizing the use of available drugs to minimize disease burden. Theoretical studies suggest that coordinating empirical usage of antibiotics in a hospital ward can contain the spread of resistance. However, theoretical and clinical studies came to different conclusions regarding the usefulness of rotating first-line therapy (cycling. Here, we performed a quantitative pathogen-specific meta-analysis of clinical studies comparing cycling to standard practice. We searched PubMed and Google Scholar and identified 46 clinical studies addressing the effect of cycling on nosocomial infections, of which 11 met our selection criteria. We employed a method for multivariate meta-analysis using incidence rates as endpoints and find that cycling reduced the incidence rate/1000 patient days of both total infections by 4.95 [9.43-0.48] and resistant infections by 7.2 [14.00-0.44]. This positive effect was observed in most pathogens despite a large variance between individual species. Our findings remain robust in uni- and multivariate metaregressions. We used theoretical models that reflect various infections and hospital settings to compare cycling to random assignment to different drugs (mixing. We make the realistic assumption that therapy is changed when first line treatment is ineffective, which we call "adjustable cycling/mixing". In concordance with earlier theoretical studies, we find that in strict regimens, cycling is detrimental. However, in adjustable regimens single resistance is suppressed and cycling is successful in most settings. Both a meta-regression and our theoretical model indicate that "adjustable cycling" is especially useful to suppress emergence of multiple resistance. While our model predicts that cycling periods of one month perform well, we expect that too long cycling periods are detrimental. Our results suggest that

Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

DEFF Research Database (Denmark)

Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

2018-01-01

. CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...

Model construction of nursing service satisfaction in hospitalized tumor patients.

Science.gov (United States)

Chen, Yongyi; Liu, Jingshi; Xiao, Shuiyuan; Liu, Xiangyu; Tang, Xinhui; Zhou, Yujuan

2014-01-01

This study aims to construct a satisfaction model on nursing service in hospitalized tumor patients. Using questionnaires, data about hospitalized tumor patients' expectation, quality perception and satisfaction of hospital nursing service were obtained. A satisfaction model of nursing service in hospitalized tumor patients was established through empirical study and by structural equation method. This model was suitable for tumor specialized hospital, with reliability and validity. Patient satisfaction was significantly affected by quality perception and patient expectation. Patient satisfaction and patient loyalty was also affected by disease pressure. Hospital brand was positively correlated with patient satisfaction and patient loyalty, negatively correlated with patient complaint. Patient satisfaction was positively correlated with patient loyalty, patient complaints, and quality perception, and negatively correlated with disease pressure and patient expectation. The satisfaction model on nursing service in hospitalized tumor patients fits well. By this model, the quality of hospital nursing care may be improved.

Negotiating jurisdiction in the workplace: a multiple-case study of nurse prescribing in hospital settings.

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; Dijk, L. van; Groenewegen, P.P.; Francke, A.L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

Negotiating jurisdiction in the workplace: A multiple-case study of nurse prescribing in hospital settings

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P.P.; Francke, A.L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

Negotiating jurisdiction in the workplace : A multiple-case study of nurse prescribing in hospital settings

NARCIS (Netherlands)

Kroezen, M.; Mistiaen, P.; van Dijk, L.; Groenewegen, P. P.; Francke, A. L.

2014-01-01

This paper reports on a multiple-case study of prescribing by nurse specialists in Dutch hospital settings. Most analyses of interprofessional negotiations over professional boundaries take a macro sociological approach and ignore workplace jurisdictions. Yet boundary blurring takes place and

[First aid and management of multiple trauma: in-hospital trauma care].

Science.gov (United States)

Boschin, Matthias; Vordemvenne, Thomas

2012-11-01

Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

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

Science.gov (United States)

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

2018-02-08

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

Patient choice modelling: how do patients choose their hospitals?

Science.gov (United States)

Smith, Honora; Currie, Christine; Chaiwuttisak, Pornpimol; Kyprianou, Andreas

2018-06-01

As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient's choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient's choice of hospital rather than statistics available on the Internet.

Multiple Indicator Stationary Time Series Models.

Science.gov (United States)

Sivo, Stephen A.

2001-01-01

Discusses the propriety and practical advantages of specifying multivariate time series models in the context of structural equation modeling for time series and longitudinal panel data. For time series data, the multiple indicator model specification improves on classical time series analysis. For panel data, the multiple indicator model…

[The multiple social roles of female lay caretakers of hospitalized children].

Science.gov (United States)

Wegner, Wiliam; Pedro, Eva Neri Rubim

2010-06-01

This is a qualitative, descriptive, exploratory, and interventionist research carried out with nine female lay caretakers of children undergoing oncologic treatment. The objectives were to present the multiple social roles performed by female lay caretakers of children with cancer and to discuss the caretaker's role in society. The study was carried out between March and April, 2007, at Hospital de Clinicas de Porto Alegre, Rio Grande do Sul, Brazil. The data collection was performed with the focal group technique. The results were examined through the analysis of thematic content, which evidenced the multiple social roles performed by women, the main group of caretakers in society, regardless of the context. Final considerations enhance a discussion in the educational, political and social levels about the redistribution of social roles, particularly family responsibility between men and women. The participation of the nursing staff can take place through the comprehension of those roles imposed by the context and facilitate family inclusion in the care relationship.

Integrated Specialized Early-Course Psychosis Treatment Services - University Psychiatric Hospital Vrapce Model.

Science.gov (United States)

Ostojić, DraŽenka; Čulo, Ilaria; Silić, Ante; Kos, Suzana; Savić, Aleksandar

2018-06-01

First episode of psychosis presents a critical period in terms of numerous associated risks, but also possibilities for effective therapeutic interventions. There is a continued focus on early interventions in prodromal states and early course of frank psychosis, aimed at ensuring faster remission, reducing relapses, achieving better long-term functioning, and preventing adverse outcomes linked to untreated psychosis and chronic psychotic disorders. A number of different specialized treatment models and services exist trying to close knowledge gaps and provide clinical interventions to first-episode psychosis (FEP) patients, but there is still no generally accepted standard of care informing our every-day practice. FEP and early-course psychosis specialized treatment model developed in 2004 in University Psychiatric Hospital Vrapce rests on integration of care across different organization units and clinical presentation acuity levels and patient needs (intensive care, FEP inpatient unit, FEP outpatient services including day hospital). Such integration of FEP services allows for flexible entry point on multiple levels, earlier structuring of therapeutic alliance for those requiring inpatient care, reduction of risks associated with FEP, quicker formation of long-term treatment plans, reduction of delay in accessing specialized services, and a more coordinated diagnostic process and recruitment of FEP patient population. Detailed evaluations of outcomes and comparisons with different treatment models are necessary in order to assess strengths and weaknesses of each specific model and inform modifications to current practice models.

Using a modified technology acceptance model in hospitals.

Science.gov (United States)

Aggelidis, Vassilios P; Chatzoglou, Prodromos D

2009-02-01

The use of information technology in the health care sector and especially in hospitals offers great potential for improving the quality of services provided and the efficiency and effectiveness of the personnel, but also for reducing the organizational expenses. However, the main question that arises according to the literature is whether hospital personnel are willing to use state of the art information technology while performing their tasks. This study attempts to address this issue by developing and testing a modified technology acceptance model taking into consideration other relevant models found in the literature. The original TAM has been extended to include some exogenous variables in order to examine HIS acceptance by Greek hospital personnel. Correlation, explanatory and confirmation factor analysis was performed to test the reliability and validity of the measurement model. The structural equation modeling technique has also been used to evaluate the causal model. The results indicate that perceived usefulness, ease of use, social influence, attitude, facilitating conditions and self-efficacy significantly affect hospital personnel behavioral intention. Training has a strong indirect impact on behavioral intention through the mediators of facilitating condition and ease of use. Furthermore, the existence of significant positive effects between self-efficacy and social influence, perceived usefulness and anxiety, and facilitating conditions and social influence is also supported. The proposed model can explain 87% of the variance of behavioral intention indicating that the core constructs of the technology acceptance models have a strong and statistically significant influence on hospital personnel usage intention.

Correlations in multiple production on nuclei and Glauber model of multiple scattering

International Nuclear Information System (INIS)

Zoller, V.R.; Nikolaev, N.N.

1982-01-01

Critical analysis of possibility for describing correlation phenomena during multiple production on nuclei within the framework of the Glauber multiple seattering model generalized for particle production processes with Capella, Krziwinski and Shabelsky has been performed. It was mainly concluded that the suggested generalization of the Glauber model gives dependences on Ng(Np) (where Ng-the number of ''grey'' tracess, and Np-the number of protons flying out of nucleus) and, eventually, on #betta# (where #betta#-the number of intranuclear interactions) contradicting experience. Independent of choice of relation between #betta# and Ng(Np) in the model the rapidity corrletor Rsub(eta) is overstated in the central region and understated in the region of nucleus fragmentation. In mean multiplicities these two contradictions of experience are disguised with random compensation and agreement with experience in Nsub(S) (function of Ng) cannot be an argument in favour of the model. It is concluded that eiconal model doesn't permit to quantitatively describe correlation phenomena during the multiple production on nuclei

Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team.

Science.gov (United States)

Harrison, David A; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B; Gwinnutt, Carl; Nolan, Jerry P; Rowan, Kathryn M

2014-08-01

The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Risk models for two outcomes-return of spontaneous circulation (ROSC) for greater than 20min and survival to hospital discharge-were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC>20min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC>20min (c index 0.81 versus 0.72). Validated risk models for ROSC>20min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team☆

Science.gov (United States)

Harrison, David A.; Patel, Krishna; Nixon, Edel; Soar, Jasmeet; Smith, Gary B.; Gwinnutt, Carl; Nolan, Jerry P.; Rowan, Kathryn M.

2014-01-01

Aim The National Cardiac Arrest Audit (NCAA) is the UK national clinical audit for in-hospital cardiac arrest. To make fair comparisons among health care providers, clinical indicators require case mix adjustment using a validated risk model. The aim of this study was to develop and validate risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team in UK hospitals. Methods Risk models for two outcomes—return of spontaneous circulation (ROSC) for greater than 20 min and survival to hospital discharge—were developed and validated using data for in-hospital cardiac arrests between April 2011 and March 2013. For each outcome, a full model was fitted and then simplified by testing for non-linearity, combining categories and stepwise reduction. Finally, interactions between predictors were considered. Models were assessed for discrimination, calibration and accuracy. Results 22,479 in-hospital cardiac arrests in 143 hospitals were included (14,688 development, 7791 validation). The final risk model for ROSC > 20 min included: age (non-linear), sex, prior length of stay in hospital, reason for attendance, location of arrest, presenting rhythm, and interactions between presenting rhythm and location of arrest. The model for hospital survival included the same predictors, excluding sex. Both models had acceptable performance across the range of measures, although discrimination for hospital mortality exceeded that for ROSC > 20 min (c index 0.81 versus 0.72). Conclusions Validated risk models for ROSC > 20 min and hospital survival following in-hospital cardiac arrest have been developed. These models will strengthen comparative reporting in NCAA and support local quality improvement. PMID:24830872

Assessment of private hospital portals: A conceptual model

Directory of Open Access Journals (Sweden)

Mehdi Alipour-Hafezi

2016-01-01

Full Text Available Introduction: Hospital portals, as the first virtual entry, play an important role in connecting people with hospital and also presenting hospital virtual services. The main purpose of this article was to suggest a conceptual model to improve Tehran private hospital portals. The suggested model can be used by all the health portals that are in the same circumstances and all the health portals which are in progress. Method: This is a practical research, using evaluative survey research method. Research population includes all the private hospital portals in Tehran, 34 portals, and ten top international hospital portals. Data gathering tool used in this research was a researcher-made checklist including 14 criteria and 77 sub-criteria with their weight score. In fact, objective observation with the mentioned checklist was used to gather information. Descriptive statistics were used to analyze the data and tables and graphs were used to present the organized data. Also, data were analyzed using independent t-test. Conceptual modeling technique was used to design the model and demonstration method was used to evaluate the proposed model. In this regard, SPSS statistical software was used to perform the tests. Results:The comparative study between the two groups of portals, TPH and WTH, in the 14 main criteria showed that the value of t-test in contact information criteria was 0.862, portal page specification was -1.378, page design criteria -1.527, updating pages -0.322, general information and access roads -3.161, public services -7.302, patient services -4.154, patient data -8.703, research and education -9.155, public relationship -3.009, page technical specifications -4.726, telemedicine -7.488, pharmaceutical services -6.183, and financial services -2.782. Finally, the findings demonstrated that Tehran private hospital portals in criterion of contact information were favorable; page design criteria were relatively favorable; page technical

Change management in Iranian hospitals: social factors model

Directory of Open Access Journals (Sweden)

B. Delgoshaei

2012-02-01

Full Text Available Background: Continuous change in the complex health care environments is a major challenge for administrative managers. This study aimed to design a change model to facilitate change implementation in the Iranian hospitals. Methods: This is a descriptive and comparative study. The data were collected through library search and in-depth interview with 15 hospital managers. Nine well-established change theories developed by Lewin, Action Research, Kotter, Ackerman- Anderson and Anderson, Prosci , Kilman, Beer, Continuum, and Gelicher were compared. Common denominators of the theories were identified and tabulated. Experienced hospital managers’ suggestions about social factors were acquired. The initial model was designed and validated using the Delphi Technique. Results: The majority of the selected change models emphasize the significance of social factors in change implementation such as effective communication, organizational climate and culture, and leadership. The results from the interviews indicate that low readiness to change, lack of confidence (or trust for change, and autocratic leadership style ,and poor communication could hinder the change process. Conclusion: Based on the model developed in the study, effective communication, readiness of employees, and a contingency leadership/management combined could lead to successful implementation of change in the hospital.

Maturity of hospital information systems: Most important influencing factors.

Science.gov (United States)

Vidal Carvalho, João; Rocha, Álvaro; Abreu, António

2017-07-01

Maturity models facilitate organizational management, including information systems management, with hospital organizations no exception. This article puts forth a study carried out with a group of experts in the field of hospital information systems management with a view to identifying the main influencing factors to be included in an encompassing maturity model for hospital information systems management. This study is based on the results of a literature review, which identified maturity models in the health field and relevant influencing factors. The development of this model is justified to the extent that the available maturity models for the hospital information systems management field reveal multiple limitations, including lack of detail, absence of tools to determine their maturity and lack of characterization for stages of maturity structured by different influencing factors.

[Hospital organizational analysis based on the Mintzberg model: the case of Sheikh Zayed Hospital, Rabat].

Science.gov (United States)

Makhloufi, Imane; Saadi, Janad; El Hiki, Lahcen; El Hassani, Amine

2012-01-01

The new system of hospital governance requires health institutions to develop new managerial, financial and social skills beyond their public service duties. As part of this new approach, the organizational modernization of hospitals involves introducing good management practices. However, managing the transition requires taking into account the specificities of existing organizational systems. Organizational systems are generally difficult to model and involve diverse and sometimes competing interests, concerns, habits, languages, cultures, tools and representations. This explains the high failure rate observed in hospital development projects at an organizational level. A number of organizational theories from a range of disciplines (sociology, biology, history, etc.) have examined the question of organization in hospitals. The many theories developed in this area are not incompatible. Rather, they form a set of useful tools for the analysis of organizational management. The purpose of this study was to conduct an organizational analysis of Sheikh Zayed Hospital (Rabat) based on the Mintzberg model as a prerequisite for the development and implementation of a restructuring plan.

Testing for Nonuniform Differential Item Functioning with Multiple Indicator Multiple Cause Models

Science.gov (United States)

Woods, Carol M.; Grimm, Kevin J.

2011-01-01

In extant literature, multiple indicator multiple cause (MIMIC) models have been presented for identifying items that display uniform differential item functioning (DIF) only, not nonuniform DIF. This article addresses, for apparently the first time, the use of MIMIC models for testing both uniform and nonuniform DIF with categorical indicators. A…

SUMMIT (Serially Unified Multicenter Multiple Sclerosis Investigation): creating a repository of deeply phenotyped contemporary multiple sclerosis cohorts.

Science.gov (United States)

Bove, Riley; Chitnis, Tanuja; Cree, Bruce Ac; Tintoré, Mar; Naegelin, Yvonne; Uitdehaag, Bernard Mj; Kappos, Ludwig; Khoury, Samia J; Montalban, Xavier; Hauser, Stephen L; Weiner, Howard L

2017-08-01

There is a pressing need for robust longitudinal cohort studies in the modern treatment era of multiple sclerosis. Build a multiple sclerosis (MS) cohort repository to capture the variability of disability accumulation, as well as provide the depth of characterization (clinical, radiologic, genetic, biospecimens) required to adequately model and ultimately predict a patient's course. Serially Unified Multicenter Multiple Sclerosis Investigation (SUMMIT) is an international multi-center, prospectively enrolled cohort with over a decade of comprehensive follow-up on more than 1000 patients from two large North American academic MS Centers (Brigham and Women's Hospital (Comprehensive Longitudinal Investigation of Multiple Sclerosis at the Brigham and Women's Hospital (CLIMB; BWH)) and University of California, San Francisco (Expression/genomics, Proteomics, Imaging, and Clinical (EPIC))). It is bringing online more than 2500 patients from additional international MS Centers (Basel (Universitätsspital Basel (UHB)), VU University Medical Center MS Center Amsterdam (MSCA), Multiple Sclerosis Center of Catalonia-Vall d'Hebron Hospital (Barcelona clinically isolated syndrome (CIS) cohort), and American University of Beirut Medical Center (AUBMC-Multiple Sclerosis Interdisciplinary Research (AMIR)). We provide evidence for harmonization of two of the initial cohorts in terms of the characterization of demographics, disease, and treatment-related variables; demonstrate several proof-of-principle analyses examining genetic and radiologic predictors of disease progression; and discuss the steps involved in expanding SUMMIT into a repository accessible to the broader scientific community.

Clinical, laboratory, and demographic determinants of hospitalization due to dengue in 7613 patients: A retrospective study based on hierarchical models.

Science.gov (United States)

da Silva, Natal Santos; Undurraga, Eduardo A; da Silva Ferreira, Elis Regina; Estofolete, Cássia Fernanda; Nogueira, Maurício Lacerda

2018-01-01

In Brazil, the incidence of hospitalization due to dengue, as an indicator of severity, has drastically increased since 1998. The objective of our study was to identify risk factors associated with subsequent hospitalization related to dengue. We analyzed 7613 dengue confirmed via serology (ELISA), non-structural protein 1, or polymerase chain reaction amplification. We used a hierarchical framework to generate a multivariate logistic regression based on a variety of risk variables. This was followed by multiple statistical analyses to assess hierarchical model accuracy, variance, goodness of fit, and whether or not this model reliably represented the population. The final model, which included age, sex, ethnicity, previous dengue infection, hemorrhagic manifestations, plasma leakage, and organ failure, showed that all measured parameters, with the exception of previous dengue, were statistically significant. The presence of organ failure was associated with the highest risk of subsequent dengue hospitalization (OR=5·75; CI=3·53-9·37). Therefore, plasma leakage and organ failure were the main indicators of hospitalization due to dengue, although other variables of minor importance should also be considered to refer dengue patients to hospital treatment, which may lead to a reduction in avoidable deaths as well as costs related to dengue. Copyright © 2017 Elsevier B.V. All rights reserved.

Graphical modeling and query language for hospitals.

Science.gov (United States)

Barzdins, Janis; Barzdins, Juris; Rencis, Edgars; Sostaks, Agris

2013-01-01

So far there has been little evidence that implementation of the health information technologies (HIT) is leading to health care cost savings. One of the reasons for this lack of impact by the HIT likely lies in the complexity of the business process ownership in the hospitals. The goal of our research is to develop a business model-based method for hospital use which would allow doctors to retrieve directly the ad-hoc information from various hospital databases. We have developed a special domain-specific process modelling language called the MedMod. Formally, we define the MedMod language as a profile on UML Class diagrams, but we also demonstrate it on examples, where we explain the semantics of all its elements informally. Moreover, we have developed the Process Query Language (PQL) that is based on MedMod process definition language. The purpose of PQL is to allow a doctor querying (filtering) runtime data of hospital's processes described using MedMod. The MedMod language tries to overcome deficiencies in existing process modeling languages, allowing to specify the loosely-defined sequence of the steps to be performed in the clinical process. The main advantages of PQL are in two main areas - usability and efficiency. They are: 1) the view on data through "glasses" of familiar process, 2) the simple and easy-to-perceive means of setting filtering conditions require no more expertise than using spreadsheet applications, 3) the dynamic response to each step in construction of the complete query that shortens the learning curve greatly and reduces the error rate, and 4) the selected means of filtering and data retrieving allows to execute queries in O(n) time regarding the size of the dataset. We are about to continue developing this project with three further steps. First, we are planning to develop user-friendly graphical editors for the MedMod process modeling and query languages. The second step is to do evaluation of usability the proposed language and tool

Hospital information system: reusability, designing, modelling, recommendations for implementing.

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Huet, B

1998-01-01

The aims of this paper are to precise some essential conditions for building reuse models for hospital information systems (HIS) and to present an application for hospital clinical laboratories. Reusability is a general trend in software, however reuse can involve a more or less part of design, classes, programs; consequently, a project involving reusability must be precisely defined. In the introduction it is seen trends in software, the stakes of reuse models for HIS and the special use case constituted with a HIS. The main three parts of this paper are: 1) Designing a reuse model (which objects are common to several information systems?) 2) A reuse model for hospital clinical laboratories (a genspec object model is presented for all laboratories: biochemistry, bacteriology, parasitology, pharmacology, ...) 3) Recommendations for generating plug-compatible software components (a reuse model can be implemented as a framework, concrete factors that increase reusability are presented). In conclusion reusability is a subtle exercise of which project must be previously and carefully defined.

Nurse-directed care model in a psychiatric hospital: a model for clinical accountability.

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E-Morris, Marlene; Caldwell, Barbara; Mencher, Kathleen J; Grogan, Kimberly; Judge-Gorny, Margaret; Patterson, Zelda; Christopher, Terrian; Smith, Russell C; McQuaide, Teresa

2010-01-01

The focus on recovery for persons with severe and persistent mental illness is leading state psychiatric hospitals to transform their method of care delivery. This article describes a quality improvement project involving a hospital's administration and multidisciplinary state-university affiliation that collaborated in the development and implementation of a nursing care delivery model in a state psychiatric hospital. The quality improvement project team instituted a new model to promote the hospital's vision of wellness and recovery through utilization of the therapeutic relationship and greater clinical accountability. Implementation of the model was accomplished in 2 phases: first, the establishment of a structure to lay the groundwork for accountability and, second, the development of a mechanism to provide a clinical supervision process for staff in their work with clients. Effectiveness of the model was assessed by surveys conducted at baseline and after implementation. Results indicated improvement in clinical practices and client living environment. As a secondary outcome, these improvements appeared to be associated with increased safety on the units evidenced by reduction in incidents of seclusion and restraint. Restructuring of the service delivery system of care so that clients are the center of clinical focus improves safety and can enhance the staff's attention to work with clients on their recovery. The role of the advanced practice nurse can influence the recovery of clients in state psychiatric hospitals. Future research should consider the impact on clients and their perceptions of the new service models.

Hospital costs of multiple-birth and singleton-birth children during the first 5 years of life and the role of assisted reproductive technology.

Science.gov (United States)

Chambers, Georgina M; Hoang, Van Phuong; Lee, Evelyn; Hansen, Michele; Sullivan, Elizabeth A; Bower, Carol; Chapman, Michael

2014-11-01

The unprecedented increase in multiple births during the past 3 decades is a major public health concern and parallels the uptake of medically assisted conception. The economic implications of such births are not well understood. To conduct a comprehensive economic and health services assessment of the frequency, duration, and cost of hospital admissions during the first 5 years of life for singleton, twin, and higher-order multiple (HOM) children and to examine the contribution of assisted reproductive technology (ART) to the incidence and cost of multiple births. A retrospective population cohort study using individually linked birth, hospital, and death records among 233,850 infants born in Western Australia between October 1993 and September 2003, and followed up to September 2008. Multiple-gestation delivery and ART conception. Odds of stillbirth, prematurity and low birth weight, frequency and length of hospital admissions, the mean costs by plurality, and the independent effect of prematurity on childhood costs. Of 226,624 singleton, 6941 twin, and 285 HOM infants, 1.0% of singletons, 15.4% of twins, and 34.7% of HOM children were conceived following ART. Compared with singletons, twins and HOMs were 3.4 and 9.6 times, respectively, more likely to be stillborn and were 6.4 and 36.7 times, respectively, more likely to die during the neonatal period. Twins and HOMs were 18.7 and 525.1 times, respectively, more likely to be preterm, and 3.6 and 2.8 times, respectively, more likely to be small for gestational age. The mean hospital costs of a singleton, twin, and HOM child to age 5 years were $2730, $8993, and $24,411 (in 2009-2010 US dollars), respectively, with cost differences concentrated in the neonatal period and during the first year of life. Almost 15% of inpatient costs for multiple births could have been avoided if ART twins and HOMs had been born as singletons. Compared with singletons, multiple-birth infants consume significantly more hospital

Modelling Hospital Materials Management Processes

Directory of Open Access Journals (Sweden)

Raffaele Iannone

2013-06-01

integrated and detailed analysis and description model for hospital materials management data and tasks, which is able to tackle information from patient requirements to usage, from replenishment requests to supplying and handling activities. The model takes account of medical risk reduction, traceability and streamlined processes perspectives. Second, the paper translates this information into a business process model and mathematical formalization.The study provides a useful guide to the various relevant technology‐related, management and business issues, laying the foundations of an efficient reengineering of the supply chain to reduce healthcare costs and improve the quality of care.

Multiple physical signs detection and decision support system for hospitalized older adults

International Nuclear Information System (INIS)

Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J

2015-01-01

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Smart monitoring systems automate patient monitoring tasks and thereby improve patient workflow management. Moreover, expert systems have the potential to assist clinicians and improve their performance by accurately executing repetitive tasks, to which humans are ill-suited. Clinicians working in hospital wards are responsible for conducting a multitude of tasks which require constant vigilance, and thus the need for a smart decision support system has arisen. In particular, wireless patient monitoring systems are emerging as a low cost, reliable and accurate means of healthcare delivery.Vital signs monitoring systems are rapidly becoming part of today’s healthcare delivery. The paradigm has shifted from traditional and manual recording to computer-based electronic records and, further, to handheld devices as versatile and innovative healthcare monitoring systems. The current study focuses on interpreting multiple physical signs and early warning for hospitalized older adults so that severe consequences can be minimized. Data from a total of 30 patients have been collated in New Zealand hospitals under local and national ethics approvals. The system records blood pressure, heart rate (pulse), oxygen saturation (SpO2), ear temperature and blood glucose levels from hospitalized patients and transfers this information to a web-based software application for remote monitoring and further interpretation. Ultimately, this system is aimed to achieve a high level of agreement with clinicians’ interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia to generate early warnings. The performance of the vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between

Israeli hospital preparedness for terrorism-related multiple casualty incidents: can the surge capacity and injury severity distribution be better predicted?

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Kosashvili, Yona; Aharonson-Daniel, L; Daniel, Limor A; Peleg, Kobi; Horowitz, Ariel; Laor, Danny; Blumenfeld, Amir

2009-07-01

The incidence of large-scale urban attacks on civilian populations has significantly increased across the globe over the past decade. These incidents often result in Hospital Multiple Casualty Incidents (HMCI), which are very challenging to hospital teams. 15 years ago the Emergency and Disaster Medicine Division in the Israeli Ministry of Health defined a key of 20 percent of each hospital's bed capacity as its readiness for multiple casualties. Half of those casualties are expected to require immediate medical treatment. This study was performed to evaluate the efficacy of the current readiness guidelines based on the epidemiology of encountered HMCIs. A retrospective study of HMCIs was recorded in the Israeli Defense Force (IDF) home front command and the Israeli National Trauma Registry (ITR) between November 2000 and June 2003. An HMCI is defined by the Emergency and Disaster Medicine Division in the Israeli Ministry of Health as >or=10 casualties or >or=4 suffering from injuries with an ISS>or=16 arriving to a single hospital. The study includes a total of 32 attacks, resulting in 62 HMCIs and 1292 casualties. The mean number of arriving casualties to a single hospital was 20.8+/-13.3 (range 4-56, median 16.5). In 95% of the HMCIs the casualty load was concept may improve the utilisation of national emergency health resources both in the preparation phase and on real time.

A financial planning model for estimating hospital debt capacity.

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Hopkins, D S; Heath, D; Levin, P J

1982-01-01

A computer-based financial planning model was formulated to measure the impact of a major capital improvement project on the fiscal health of Stanford University Hospital. The model had to be responsive to many variables and easy to use, so as to allow for the testing of numerous alternatives. Special efforts were made to identify the key variables that needed to be presented in the model and to include all known links between capital investment, debt, and hospital operating expenses. Growth in the number of patient days of care was singled out as a major source of uncertainty that would have profound effects on the hospital's finances. Therefore this variable was subjected to special scrutiny in terms of efforts to gauge expected demographic trends and market forces. In addition, alternative base runs of the model were made under three distinct patient-demand assumptions. Use of the model enabled planners at the Stanford University Hospital (a) to determine that a proposed modernization plan was financially feasible under a reasonable (that is, not unduly optimistic) set of assumptions and (b) to examine the major sources of risk. Other than patient demand, these sources were found to be gross revenues per patient, operating costs, and future limitations on government reimbursement programs. When the likely financial consequences of these risks were estimated, both separately and in combination, it was determined that even if two or more assumptions took a somewhat more negative turn than was expected, the hospital would be able to offset adverse consequences by a relatively minor reduction in operating costs. PMID:7111658

Modeling Rabbit Responses to Single and Multiple Aerosol ...

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Journal Article Survival models are developed here to predict response and time-to-response for mortality in rabbits following exposures to single or multiple aerosol doses of Bacillus anthracis spores. Hazard function models were developed for a multiple dose dataset to predict the probability of death through specifying dose-response functions and the time between exposure and the time-to-death (TTD). Among the models developed, the best-fitting survival model (baseline model) has an exponential dose-response model with a Weibull TTD distribution. Alternative models assessed employ different underlying dose-response functions and use the assumption that, in a multiple dose scenario, earlier doses affect the hazard functions of each subsequent dose. In addition, published mechanistic models are analyzed and compared with models developed in this paper. None of the alternative models that were assessed provided a statistically significant improvement in fit over the baseline model. The general approach utilizes simple empirical data analysis to develop parsimonious models with limited reliance on mechanistic assumptions. The baseline model predicts TTDs consistent with reported results from three independent high-dose rabbit datasets. More accurate survival models depend upon future development of dose-response datasets specifically designed to assess potential multiple dose effects on response and time-to-response. The process used in this paper to dev

Product-market differentiation: a strategic planning model for community hospitals.

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Milch, R A

1980-01-01

Community hospitals would seem to have every reason to identify and capitalize on their product-market strengths. The strategic marketing/planning model provides a framework for rational analysis of the community hospital dilemma and for developing sensible solutions to the complex problems of accelerating hospital price-inflation.

SPD-based Logistics Management Model of Medical Consumables in Hospitals

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LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei; YANG, Shanlin

2016-01-01

Background: With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. Methods: We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. Results: We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. Conclusion: The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China. PMID:27957435

SPD-based Logistics Management Model of Medical Consumables in Hospitals.

Science.gov (United States)

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei; Yang, Shanlin

2016-10-01

With the rapid development of health services, the progress of medical science and technology, and the improvement of materials research, the consumption of medical consumables (MCs) in medical activities has increased in recent years. However, owing to the lack of effective management methods and the complexity of MCs, there are several management problems including MC waste, low management efficiency, high management difficulty, and frequent medical accidents. Therefore, there is urgent need for an effective logistics management model to handle these problems and challenges in hospitals. We reviewed books and scientific literature (by searching the articles published from 2010 to 2015 in Engineering Village database) to understand supply chain related theories and methods and performed field investigations in hospitals across many cities to determine the actual state of MC logistics management of hospitals in China. We describe the definition, physical model, construction, and logistics operation processes of the supply, processing, and distribution (SPD) of MC logistics because of the traditional SPD model. With the establishment of a supply-procurement platform and a logistics lean management system, we applied the model to the MC logistics management of Anhui Provincial Hospital with good effects. The SPD model plays a critical role in optimizing the logistics procedures of MCs, improving the management efficiency of logistics, and reducing the costs of logistics of hospitals in China.

Rural model dedicated education unit: partnership between college and hospital.

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Harmon, Lisa M

2013-02-01

This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

A model of antibiotic-resistant bacterial epidemics in hospitals

OpenAIRE

Webb, Glenn F.; D'Agata, Erika M. C.; Magal, Pierre; Ruan, Shigui

2005-01-01

The emergence of drug-resistant strains of bacteria is an increasing threat to society, especially in hospital settings. Many antibiotics that were formerly effective in combating bacterial infections in hospital patients are no longer effective because of the evolution of resistant strains, which compromises medical care worldwide. In this article, we formulate a two-level population model to quantify key elements in nosocomial (hospital-acquired) infections. At the bacteria level, patients ...

Optimization Model for Capacity Management and Bed Scheduling for Hospital

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Sitepu, Suryati; Mawengkang, Herman; Husein, Ismail

2018-01-01

Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing.. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management.

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Eeckloo, Kristof; Van Herck, Gustaaf; Van Hulle, Cynthia; Vleugels, Arthur

2004-04-01

As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.

Modelling length of hospital stay in motor victims

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Mercedes Ayuso-Gutiérrez

2015-03-01

Full Text Available Objective. To analyze which socio-demographic and other factors related to motor injuries affect the length of hospital recovery stay. Materials and methods. In the study a sample of 17 932 motor accidents was used. All the crashes occurred in Spain between 2000 and 2007. Different regression models were fitted to data to identify and measure the impact of a set of explanatory regressors. Results. Time of hospital stay for men is on average 41% larger than for women. When the victim has a fracture as a consequence of the accident, the mean time of hospital stay is multiplied by five. Injuries located in lower extremities, the head and abdomen are associated with greater hospitalization lengths. Conclusions. Gender, age and type of victim, as well as the location and nature of injuries, are found to be factors that have significant impact on the expected length of hospital stay.

After the Recall: Reexamining Multiple Magnet Ingestion at a Large Pediatric Hospital.

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Rosenfield, Daniel; Strickland, Matt; Hepburn, Charlotte Moore

2017-07-01

To evaluate the effectiveness of a mandatory product recall on the frequency of multiple mini-magnet ingestion at a large tertiary pediatric hospital, and to examine the morbidity and mortality associated with these ingestions. In this retrospective chart review, we searched our institution's electronic patient record for patients aged magnetic foreign bodies between 2002 and 2015, a period that included the mandatory product recall. We compared the frequency and character of ingestions before and after the recall. Comparing the postrecall years (January 1, 2014, to December 31, 2015) with the 2 years immediately preceding the recall year (January 1, 2011, to December 31, 2012) yields an incidence rate ratio of 0.34 (95% CI, 0.18-0.64) for all magnet ingestions and 0.20 (95% CI, 0.08-0.53) for ingestion of multiple magnets. Based on the Fisher exact test, the incidence of both magnet ingestion (P magnet ingestion (P magnet ingestion decreased. There were no deaths in either study period. There was a significant decrease in multiple mini-magnet ingestion following a mandatory product recall. This study supports the effectiveness of the recall, which should bolster efforts to keep it in place in jurisdictions where it is being appealed. More broadly, the result provides general evidence of a recall helping decrease further harm from a product that carries a potential hazard. Copyright © 2017 Elsevier Inc. All rights reserved.

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

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Weiner, B J; Alexander, J A

1993-08-01

We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

Impact of emotional competence on supportive care needs, anxiety and depression symptoms of cancer patients: a multiple mediation model.

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Baudry, A-S; Lelorain, S; Mahieuxe, M; Christophe, V

2018-01-01

The aim of this study was to test the effect of intrapersonal and interpersonal emotional competence on cancer patients' supportive care needs, as mediated by anxiety and depression symptoms. Cross-sectional design: 137 cancer patients (42% breast or ovarian cancer, 58% gastrointestinal cancer) in 4 French hospitals completed the Profile of Emotional Competence (PEC), the Hospital Anxiety and Depression Scale (HADS), and the Supportive Care Needs Survey Short Form (SCNS-SF). Bootstrap methods with PROCESS Macro were used to test multiple mediation models. Emotional competence presented a direct or indirect beneficial effect on the satisfaction of supportive care needs, anxiety and depression symptoms. As expected, anxiety and depression symptoms had also strong positive correlations with unmet needs. All multiple mediation models were significant, except for physical needs: intrapersonal and interpersonal emotional competence impacted anxiety and depression symptoms, which in turn impacted psychological, sexual, care/support, and information needs. These innovative results show the important effect of patients' emotional competence on their supportive care need satisfaction, as mediated by anxiety and depression. Consequently, patients with high emotional competence may require less psychosocial input from medical clinicians. Thus, emotional competence may be integrated into health models and psychosocial interventions to improve patient adjustment. Further investigation is, however, needed to know which are the most beneficial specific emotional competences and at what point of the cancer pathway.

Geometrical model of multiple production

International Nuclear Information System (INIS)

Chikovani, Z.E.; Jenkovszky, L.L.; Kvaratshelia, T.M.; Struminskij, B.V.

1988-01-01

The relation between geometrical and KNO-scaling and their violation is studied in a geometrical model of multiple production of hadrons. Predictions concerning the behaviour of correlation coefficients at future accelerators are given

Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

Directory of Open Access Journals (Sweden)

Kleinschmidt Immo

2006-10-01

Full Text Available Abstract Background Malaria is a leading cause of hospitalization and in-hospital mortality among children in Africa, yet, few studies have described the spatial distribution of the two outcomes. Here spatial regression models were applied, aimed at quantifying spatial variation and risk factors associated with malaria hospitalization and in-hospital mortality. Methods Paediatric ward register data from Zomba district, Malawi, between 2002 and 2003 were used, as a case study. Two spatial models were developed. The first was a Poisson model applied to analyse hospitalization and minimum mortality rates, with age and sex as covariates. The second was a logistic model applied to individual level data to analyse case-fatality rate, adjusting for individual covariates. Results and conclusion Rates of malaria hospitalization and in-hospital mortality decreased with age. Case fatality rate was associated with distance, age, wet season and increased if the patient was referred to the hospital. Furthermore, death rate was high on first day, followed by relatively low rate as length of hospital stay increased. Both outcomes showed substantial spatial heterogeneity, which may be attributed to the varying determinants of malaria risk, health services availability and accessibility, and health seeking behaviour. The increased risk of mortality of children referred from primary health facilities may imply inadequate care being available at the referring facility, or the referring facility are referring the more severe cases which are expected to have a higher case fatality rate. Improved prognosis as the length of hospital stay increased suggest that appropriate care when available can save lives. Reducing malaria burden may require integrated strategies encompassing availability of adequate care at primary facilities, introducing home or community case management as well as encouraging early referral, and reinforcing interventions to interrupt malaria

Multiplicity Control in Structural Equation Modeling

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Cribbie, Robert A.

2007-01-01

Researchers conducting structural equation modeling analyses rarely, if ever, control for the inflated probability of Type I errors when evaluating the statistical significance of multiple parameters in a model. In this study, the Type I error control, power and true model rates of famsilywise and false discovery rate controlling procedures were…

Performance Evaluation of Sadoghi Hospital Based on «EFQM» Organizational Excellence Model

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A Sanayeei

2013-04-01

Full Text Available Introduction: Realm of health care that organizations have faced in recent years has been described with high level of dynamism and development. To survive in such conditions, performance evaluation can have an effective role in satisfying proper quality for services. This study aimed to evaluate the performance of Shahid Sadoghi Yazd hospital through EFQM approach. Methods: This was a descriptive cross-sectional study. Data collection instrument was EFQM organization Excellence Model questionnaire which was completed by all the managers. The research data was gathered from a sample of 302 patients, staff, personnel and medical staff working in different parts of the hospital. Random stratified samples were selected and descriptive statistics were utilized in order to analyze the data. Results: The results revealed that Shahid Sadoughi hospital acquired 185.41 points out of the total 500 points considered in the model EFQM. In other words, the rating reflects the fact that regarding the defined desired position, the hospital has not achieved the desired rating. Conclusion: Since the hospital performance is posited in a low-middle class, much more attention is required in regard to therapeutic management in this hospital. Therefore, codifying an efficient and effective program to improve the hospital performance is necessary. Furthermore, it seems that EFQM model can be considered as a comprehensive model for performance evaluation in hospitals.

BUSINESS MODEL IN THE HOSPITALITY INDUSTRY, FROM TRADITIONAL TO OPEN INNOVATION

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Mihaela DIACONU

2017-07-01

Full Text Available The paper highlights the importance of information and communication technology in valorising the behavior of the tourism consumer by including it in new business models.The business model is considered a form of innovation to gain value for all stakeholders in the hospitality industry. On the basis of the very rich specialty literature, the paper presents the particularities of the model of hospitality industry, both the traditional model and the innovative business model.

[Psychopathology of anxiety-phobic disorders that led to hospitalization in a psychiatric hospital].

Science.gov (United States)

Chugunov, D A; Schmilovitch, A A

To study the psychopathology of anxiety-phobic disorders and motives of hospitalization of patients in a psychiatric hospital. One hundred and thirty-two patients were examined, 72 patients of the main group were admitted to general psychiatric departments, 60 patients of the control group in the sanatorium psychiatric departments. Clinical-psychopathological, follow-up, psychometric and statistical methods were used. Patients with hospital anxiety-phobic disorders had agoraphobia with panic disorder, social phobias, hypochondriacal phobias, specific phobias and multiple phobias. The main reasons for hospitalization were: the intensity of anxiety-phobic disorders, contrast content of phobias, multiplicity of anxiety-phobic disorders, ambulance calls, personality accentuations and rental aims.

Relative efficiency of joint-model and full-conditional-specification multiple imputation when conditional models are compatible: The general location model.

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Seaman, Shaun R; Hughes, Rachael A

2018-06-01

Estimating the parameters of a regression model of interest is complicated by missing data on the variables in that model. Multiple imputation is commonly used to handle these missing data. Joint model multiple imputation and full-conditional specification multiple imputation are known to yield imputed data with the same asymptotic distribution when the conditional models of full-conditional specification are compatible with that joint model. We show that this asymptotic equivalence of imputation distributions does not imply that joint model multiple imputation and full-conditional specification multiple imputation will also yield asymptotically equally efficient inference about the parameters of the model of interest, nor that they will be equally robust to misspecification of the joint model. When the conditional models used by full-conditional specification multiple imputation are linear, logistic and multinomial regressions, these are compatible with a restricted general location joint model. We show that multiple imputation using the restricted general location joint model can be substantially more asymptotically efficient than full-conditional specification multiple imputation, but this typically requires very strong associations between variables. When associations are weaker, the efficiency gain is small. Moreover, full-conditional specification multiple imputation is shown to be potentially much more robust than joint model multiple imputation using the restricted general location model to mispecification of that model when there is substantial missingness in the outcome variable.

A simulation model of hospital management based on cost accounting analysis according to disease.

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Tanaka, Koji; Sato, Junzo; Guo, Jinqiu; Takada, Akira; Yoshihara, Hiroyuki

2004-12-01

Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

A Predictive Model for Readmissions Among Medicare Patients in a California Hospital.

Science.gov (United States)

Duncan, Ian; Huynh, Nhan

2017-11-17

Predictive models for hospital readmission rates are in high demand because of the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP). The LACE index is one of the most popular predictive tools among hospitals in the United States. The LACE index is a simple tool with 4 parameters: Length of stay, Acuity of admission, Comorbidity, and Emergency visits in the previous 6 months. The authors applied logistic regression to develop a predictive model for a medium-sized not-for-profit community hospital in California using patient-level data with more specific patient information (including 13 explanatory variables). Specifically, the logistic regression is applied to 2 populations: a general population including all patients and the specific group of patients targeted by the CMS penalty (characterized as ages 65 or older with select conditions). The 2 resulting logistic regression models have a higher sensitivity rate compared to the sensitivity of the LACE index. The C statistic values of the model applied to both populations demonstrate moderate levels of predictive power. The authors also build an economic model to demonstrate the potential financial impact of the use of the model for targeting high-risk patients in a sample hospital and demonstrate that, on balance, whether the hospital gains or loses from reducing readmissions depends on its margin and the extent of its readmission penalties.

Exploring hospitality within hospital meals by means of visual methodologies

DEFF Research Database (Denmark)

Justesen, Lise

2016-01-01

ABSTRACT This paper reflects the application of visual methodologies adapted in an explorative study on hospitality and hospital meals. It takes point of departure in a multi-sited ethnographic fieldwork placed at a general hospital in 2012. Visual methodologies were applied in multiple ways....... This includes visual methodologies as part of observation and interview strategies. The paper presents and discusses how the application of different visual methodologies can contribute to the construction of ethnographical knowledge on hospitality and hospital meals. Finally ethical considerations as well...

A partial test of a hospital behavioral model.

Science.gov (United States)

Hornbrook, M C; Goldfarb, M G

1983-01-01

The influence of hospital and community characteristics on the behavior of five dimensions of hospital output is examined in this article. These dimensions are the level of emergency stand-by capacity, total admissions, the diagnosis-mix of admissions and the hospital's 'style of practice' with regard to ancillary services and length of stay. A simultaneous equations model is estimated with data from a sample of 63 New England short-term general hospitals for 1970. The findings suggest that various types of short-term general hospitals have distinctive preferences for emergency capacity, volume, case mix and style of practice, and that style of practice may be more appropriately viewed as a rate of resource use per day. Specific findings of interest include the positive interdependence between protection against running out of emergency beds and length of stay, and between length of stay and ancillary service use. Hospitals that admit greater numbers of patients tend to treat more severely ill patients, and sicker patients tend to go to larger hospitals. Hospitals that provide more ancillary services tend to attract the more acutely ill patients. Relationships among other elements of the hospital's utility function represent trade-offs, i.e. substitution, in a constrained world. Among the exogenous factors, patient preferences and ability to pay have strong associations with the types of care provided by hospitals. Highly educated, high income communities, for example, tend to prefer risk averse, service intensive hospital output. Teaching hospitals are shown to prefer higher protection levels, service-intensive patterns of care, and higher admissions levels. Self-paying patients tend to be admitted for more discretionary types of diagnoses and to receive longer diagnosis-specific lengths of stay. A relatively greater supply of physician specialists in the market area is associated with increased use of ancillary services in the hospital. If replicated, these

Improving Safe Sleep Modeling in the Hospital through Policy Implementation.

Science.gov (United States)

Heitmann, Rachel; Nilles, Ester K; Jeans, Ashley; Moreland, Jackie; Clarke, Chris; McDonald, Morgan F; Warren, Michael D

2017-11-01

Introduction Sleep-related infant deaths are major contributors to Tennessee's high infant mortality rate. The purpose of this initiative was to evaluate the impact of policy-based efforts to improve modeling of safe sleep practices by health care providers in hospital settings across Tennessee. Methods Safe sleep policies were developed and implemented at 71 hospitals in Tennessee. Policies, at minimum, were required to address staff training on the American Academy of Pediatrics' safe sleep recommendations, correct modeling of infant safe sleep practices, and parent education. Hospital data on process measures related to training and results of crib audits were compiled for analysis. Results The overall observance of infants who were found with any risk factors for unsafe sleep decreased 45.6% (p ≤ 0.001) from the first crib audit to the last crib audit. Significant decreases were noted for specific risk factors, including infants found asleep not on their back, with a toy or object in the crib, and not sleeping in a crib. Significant improvements were observed at hospitals where printed materials or video were utilized for training staff compared to face-to-face training. Discussion Statewide implementation of the hospital policy intervention resulted in significant reductions in infants found in unsafe sleep situations. The most common risk factors for sleep-related infant deaths can be modeled in hospitals. This effort has the potential to reduce sleep-related infant deaths and ultimately infant mortality.

AN EFFICIENT PATIENT INFLOW PREDICTION MODEL FOR HOSPITAL RESOURCE MANAGEMENT

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Kottalanka Srikanth

2017-07-01

Full Text Available There has been increasing demand in improving service provisioning in hospital resources management. Hospital industries work with strict budget constraint at the same time assures quality care. To achieve quality care with budget constraint an efficient prediction model is required. Recently there has been various time series based prediction model has been proposed to manage hospital resources such ambulance monitoring, emergency care and so on. These models are not efficient as they do not consider the nature of scenario such climate condition etc. To address this artificial intelligence is adopted. The issues with existing prediction are that the training suffers from local optima error. This induces overhead and affects the accuracy in prediction. To overcome the local minima error, this work presents a patient inflow prediction model by adopting resilient backpropagation neural network. Experiment are conducted to evaluate the performance of proposed model inter of RMSE and MAPE. The outcome shows the proposed model reduces RMSE and MAPE over existing back propagation based artificial neural network. The overall outcomes show the proposed prediction model improves the accuracy of prediction which aid in improving the quality of health care management.

Integration of multiple, excess, backup, and expected covering models

OpenAIRE

M S Daskin; K Hogan; C ReVelle

1988-01-01

The concepts of multiple, excess, backup, and expected coverage are defined. Model formulations using these constructs are reviewed and contrasted to illustrate the relationships between them. Several new formulations are presented as is a new derivation of the expected covering model which indicates more clearly the relationship of the model to other multi-state covering models. An expected covering model with multiple time standards is also presented.

Evolving Four Part Harmony Using a Multiple Worlds Model

DEFF Research Database (Denmark)

Scirea, Marco; Brown, Joseph Alexander

2015-01-01

This application of the Multiple Worlds Model examines a collaborative fitness model for generating four part harmonies. In this model we have multiple populations and the fitness of the individuals is based on the ability of a member from each population to work with the members of other...

Bilevel Fuzzy Chance Constrained Hospital Outpatient Appointment Scheduling Model

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Xiaoyang Zhou

2016-01-01

Full Text Available Hospital outpatient departments operate by selling fixed period appointments for different treatments. The challenge being faced is to improve profit by determining the mix of full time and part time doctors and allocating appointments (which involves scheduling a combination of doctors, patients, and treatments to a time period in a department optimally. In this paper, a bilevel fuzzy chance constrained model is developed to solve the hospital outpatient appointment scheduling problem based on revenue management. In the model, the hospital, the leader in the hierarchy, decides the mix of the hired full time and part time doctors to maximize the total profit; each department, the follower in the hierarchy, makes the decision of the appointment scheduling to maximize its own profit while simultaneously minimizing surplus capacity. Doctor wage and demand are considered as fuzzy variables to better describe the real-life situation. Then we use chance operator to handle the model with fuzzy parameters and equivalently transform the appointment scheduling model into a crisp model. Moreover, interactive algorithm based on satisfaction is employed to convert the bilevel programming into a single level programming, in order to make it solvable. Finally, the numerical experiments were executed to demonstrate the efficiency and effectiveness of the proposed approaches.

Heart failure re-admission: measuring the ever shortening gap between repeat heart failure hospitalizations.

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Jeffrey A Bakal

Full Text Available Many quality-of-care and risk prediction metrics rely on time to first rehospitalization even though heart failure (HF patients may undergo several repeat hospitalizations. The aim of this study is to compare repeat hospitalization models. Using a population-based cohort of 40,667 patients, we examined both HF and all cause re-hospitalizations using up to five years of follow-up. Two models were examined: the gap-time model which estimates the adjusted time between hospitalizations and a multistate model which considered patients to be in one of four states; community-dwelling, in hospital for HF, in hospital for any reason, or dead. The transition probabilities and times were then modeled using patient characteristics and number of repeat hospitalizations. We found that during the five years of follow-up roughly half of the patients returned for a subsequent hospitalization for each repeat hospitalization. Additionally, we noted that the unadjusted time between hospitalizations was reduced ∼40% between each successive hospitalization. After adjustment each additional hospitalization was associated with a 28 day (95% CI: 22-35 reduction in time spent out of hospital. A similar pattern was seen when considering the four state model. A large proportion of patients had multiple repeat hospitalizations. Extending the gap between hospitalizations should be an important goal of treatment evaluation.

Methods and Models for Capacity and Patient Flow Analysis in Hospital Sector

DEFF Research Database (Denmark)

Kozlowski, Dawid

at a private hospital in Denmark or at a hospital abroad if the public healthcare system is unable to provide treatment within the stated maximum waiting time guarantee. A queue modelling approach is used to analyse the potential negative consequences of the policy on the utilization of public hospital......This thesis is concerned about the novel applications of operations research methods for capacity and flow analysis within hospital sector. The first part of the thesis presents a detailed Discrete-Event Simulation (DES) model that has been developed as an analytical tool designed to facilitate...... by an improved patient flow. The specially developed structure of the model facilitates its reuse at different units, with no advanced modelling skills required in day-to-day use. This feature amplifies the usefulness of DES in conducting comprehensive patient flow analyses at any department with emergency...

Double-multiple streamtube model for Darrieus in turbines

Science.gov (United States)

Paraschivoiu, I.

1981-01-01

An analytical model is proposed for calculating the rotor performance and aerodynamic blade forces for Darrieus wind turbines with curved blades. The method of analysis uses a multiple-streamtube model, divided into two parts: one modeling the upstream half-cycle of the rotor and the other, the downstream half-cycle. The upwind and downwind components of the induced velocities at each level of the rotor were obtained using the principle of two actuator disks in tandem. Variation of the induced velocities in the two parts of the rotor produces larger forces in the upstream zone and smaller forces in the downstream zone. Comparisons of the overall rotor performance with previous methods and field test data show the important improvement obtained with the present model. The calculations were made using the computer code CARDAA developed at IREQ. The double-multiple streamtube model presented has two major advantages: it requires a much shorter computer time than the three-dimensional vortex model and is more accurate than multiple-streamtube model in predicting the aerodynamic blade loads.

Optimization of hospital ward resources with patient relocation using Markov chain modeling

DEFF Research Database (Denmark)

Andersen, Anders Reenberg; Nielsen, Bo Friis; Reinhardt, Line Blander

2017-01-01

available to the hospital. Patient flow is modeled using a homogeneous continuous-time Markov chain and optimization is conducted using a local search heuristic. Our model accounts for patient relocation, which has not been done analytically in literature with similar scope. The study objective is to ensure...... are distributed. Furthermore, our heuristic is found to efficiently derive the optimal solution. Applying our model to the hospital case, we found that relocation of daily arrivals can be reduced by 11.7% by re-distributing beds that are already available to the hospital....

An evaluation of systemic reforms of public hospitals: the Sanming model in China.

Science.gov (United States)

Fu, Hongqiao; Li, Ling; Li, Mingqiang; Yang, Chunyu; Hsiao, William

2017-10-01

Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Modeling an integrated hospital management planning problem using integer optimization approach

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Sitepu, Suryati; Mawengkang, Herman; Irvan

2017-09-01

Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

The epidemiology of multiple sclerosis in Scotland: inferences from hospital admissions.

Directory of Open Access Journals (Sweden)

Adam E Handel

2011-01-01

Full Text Available Multiple sclerosis (MS is a neurological disorder with a highly characteristic disease distribution. Prevalence and incidence in general increase with increasing distance from the equator. Similarly the female to male sex ratio increases with increasing latitude. Multiple possible risk factors have been hypothesised for this epidemiological trend, including human leukocyte antigen allele frequencies, ultraviolet exposure and subsequent vitamin D levels, smoking and Epstein-Barr virus. In this study we undertook a study of medical records across Scotland on an NHS health board level of resolution to examine the epidemiology of MS in this region.We calculated the number and rate of patient-linked hospital admissions throughout Scotland between 1997 and 2009 from the Scottish Morbidity Records. We used weighted-regression to examine correlations between these measures of MS, and latitude and smoking prevalence. We found a highly significant relationship between MS patient-linked admissions and latitude (r weighted by standard error (r(sw = 0.75, p = 0.002. There was no significant relationship between smoking prevalence and MS patient-linked admissions.There is a definite latitudinal effect on MS risk across Scotland, arising primarily from an excess of female MS patients at more Northerly latitudes. Whether this is a true gradient or whether a threshold effect may apply at particular latitude will be revealed only by further research. A number of genetic and environmental factors may underlie this effect.

Prediction of Clinical Deterioration in Hospitalized Adult Patients with Hematologic Malignancies Using a Neural Network Model.

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Scott B Hu

Full Text Available Clinical deterioration (ICU transfer and cardiac arrest occurs during approximately 5-10% of hospital admissions. Existing prediction models have a high false positive rate, leading to multiple false alarms and alarm fatigue. We used routine vital signs and laboratory values obtained from the electronic medical record (EMR along with a machine learning algorithm called a neural network to develop a prediction model that would increase the predictive accuracy and decrease false alarm rates.Retrospective cohort study.The hematologic malignancy unit in an academic medical center in the United States.Adult patients admitted to the hematologic malignancy unit from 2009 to 2010.None.Vital signs and laboratory values were obtained from the electronic medical record system and then used as predictors (features. A neural network was used to build a model to predict clinical deterioration events (ICU transfer and cardiac arrest. The performance of the neural network model was compared to the VitalPac Early Warning Score (ViEWS. Five hundred sixty five consecutive total admissions were available with 43 admissions resulting in clinical deterioration. Using simulation, the neural network outperformed the ViEWS model with a positive predictive value of 82% compared to 24%, respectively.We developed and tested a neural network-based prediction model for clinical deterioration in patients hospitalized in the hematologic malignancy unit. Our neural network model outperformed an existing model, substantially increasing the positive predictive value, allowing the clinician to be confident in the alarm raised. This system can be readily implemented in a real-time fashion in existing EMR systems.

Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

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Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine

2017-03-01

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

Science.gov (United States)

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services. PMID:28112020

Establishing a Cloud Computing Success Model for Hospitals in Taiwan.

Science.gov (United States)

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

Directory of Open Access Journals (Sweden)

Jiunn-Woei Lian PhD

2017-01-01

Full Text Available The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality and system quality directly affect cloud computing satisfaction, whereas service quality indirectly affects the satisfaction through trust. In other words, trust serves as the mediator between service quality and satisfaction. This cloud computing success model will help hospitals evaluate or achieve success after adopting private cloud computing health care services.

Multiple model cardinalized probability hypothesis density filter

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Georgescu, Ramona; Willett, Peter

2011-09-01

The Probability Hypothesis Density (PHD) filter propagates the first-moment approximation to the multi-target Bayesian posterior distribution while the Cardinalized PHD (CPHD) filter propagates both the posterior likelihood of (an unlabeled) target state and the posterior probability mass function of the number of targets. Extensions of the PHD filter to the multiple model (MM) framework have been published and were implemented either with a Sequential Monte Carlo or a Gaussian Mixture approach. In this work, we introduce the multiple model version of the more elaborate CPHD filter. We present the derivation of the prediction and update steps of the MMCPHD particularized for the case of two target motion models and proceed to show that in the case of a single model, the new MMCPHD equations reduce to the original CPHD equations.

Predictive value of the transtheoretical model to smoking cessation in hospitalized patients with cardiovascular disease.

Science.gov (United States)

Chouinard, Maud-Christine; Robichaud-Ekstrand, Sylvie

2007-02-01

Several authors have questioned the transtheoretical model. Determining the predictive value of each cognitive-behavioural element within this model could explain the multiple successes reported in smoking cessation programmes. The purpose of this study was to predict point-prevalent smoking abstinence at 2 and 6 months, using the constructs of the transtheoretical model, when applied to a pooled sample of individuals who were hospitalized for a cardiovascular event. The study follows a predictive correlation design. Recently hospitalized patients (n=168) with cardiovascular disease were pooled from a randomized, controlled trial. Independent variables of the predictive transtheoretical model comprise stages and processes of change, pros and cons to quit smoking (decisional balance), self-efficacy, and social support. These were evaluated at baseline, 2 and 6 months. Compared to smokers, individuals who abstained from smoking at 2 and 6 months were more confident at baseline to remain non-smokers, perceived less pros and cons to continue smoking, utilized less consciousness raising and self-re-evaluation experiential processes of change, and received more positive reinforcement from their social network with regard to their smoke-free behaviour. Self-efficacy and stages of change at baseline were predictive of smoking abstinence after 6 months. Other variables found to be predictive of smoking abstinence at 6 months were an increase in self-efficacy; an increase in positive social support behaviour and a decrease of the pros within the decisional balance. The results partially support the predictive value of the transtheoretical model constructs in smoking cessation for cardiovascular disease patients.

Mean multiplicity in the Regge models with rising cross sections

International Nuclear Information System (INIS)

Chikovani, Z.E.; Kobylisky, N.A.; Martynov, E.S.

1979-01-01

Behaviour of the mean multiplicity and the total cross section σsub(t) of hadron-hadron interactions is considered in the framework of the Regge models at high energies. Generating function was plotted for models of dipole and froissaron, and the mean multiplicity and multiplicity moments were calculated. It is shown that approximately ln 2 S (energy square) in the dipole model, which is in good agreement with the experiment. It is also found that in various Regge models approximately σsub(t)lnS

Designing Customer Relationship Management Model in Hospital

OpenAIRE

Mohammad Abbaszadeh; Roohollah Askari; Morad Alizadeh; Mohammad Amin Bahrami

2017-01-01

Background: Customer relationship management is a modern marketing concept which is also considered as a successful business strategy. The present study aimed to design a customer relationship management model in the hospital. Methods: The study is an applied research performed in 2 phases of 1) texts investigation and 2) the experts' opinions to achieve consensus. Data were analyzed using SPSS 18 software along with descriptive statistics. Results: The designed model included areas of ...

Reprodaetion of an animal model of multiple intestinal injuries mimicking "lethal triad" caused by severe penetrating abdominal trauma

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Peng-fei WANG

2011-03-01

Full Text Available Objective To reproduce an animal model of multi-intestinal injuries with "lethal triad" characterized by low body temperature,acidosis and coagulopathy.Methods Six female domestic outbred pigs were anesthetized,and the carotid artery and jugular vein were cannulated for monitoring the blood pressure and heart rate and for infusion of fluid.The animals were shot with a gun to create a severe penetrating abdominal trauma.Immediately after the shooting,50% of total blood volume(35ml/kg hemorrhage was drawn from the carotid artery in 20min.After a 40min shock period,4h of pre-hospital phase was mimicked by normal saline(NS resuscitation to maintain systolic blood pressure(SBP > 80mmHg or mean arterial pressure(MAP > 60mmHg.When SBP > 80mmHg or MAP > 60mmHg,no fluid infusion or additional bleeding was given.Hemodynamic parameters were recorded,and pathology of myocardium,lung,small intestine and liver was observed.Results There were multiple intestinal perforations(8-10 site injuries/pig leading to intra-abdominal contamination,mesenteric injury(1-2 site injuries/pig resulted in partial intestinal ischemia and intra-abdominal hemorrhage,and no large colon and mesenteric vascular injury.One pig died before the completion of the model establishment(at the end of pre-hospital resuscitation.The typical symptoms of trauma-induced hemorrhagic shock were observed in survival animals.Low temperature(33.3±0.5℃,acidosis(pH=7.242±0.064,and coagulopathy(protrombin time and activated partial thromboplasting time prolonged were observed after pre-hospital resuscitation.Pathology showed that myocardium,lung,small intestine and liver were severely injured.Conclusions A new model,simulating three stages of "traumatic hemorrhagic shock,pre-hospital recovery and hospital treatment" and inducing the "lethal triad" accompanied with abdominal pollution,has been successfully established.This model has good stability and high reproducibility.The survival animals can be

Developing models for the prediction of hospital healthcare waste generation rate.

Science.gov (United States)

Tesfahun, Esubalew; Kumie, Abera; Beyene, Abebe

2016-01-01

An increase in the number of health institutions, along with frequent use of disposable medical products, has contributed to the increase of healthcare waste generation rate. For proper handling of healthcare waste, it is crucial to predict the amount of waste generation beforehand. Predictive models can help to optimise healthcare waste management systems, set guidelines and evaluate the prevailing strategies for healthcare waste handling and disposal. However, there is no mathematical model developed for Ethiopian hospitals to predict healthcare waste generation rate. Therefore, the objective of this research was to develop models for the prediction of a healthcare waste generation rate. A longitudinal study design was used to generate long-term data on solid healthcare waste composition, generation rate and develop predictive models. The results revealed that the healthcare waste generation rate has a strong linear correlation with the number of inpatients (R(2) = 0.965), and a weak one with the number of outpatients (R(2) = 0.424). Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching and private). In these models, the number of inpatients and outpatients were revealed to be significant factors on the quantity of waste generated. The influence of the number of inpatients and outpatients treated varies at different hospitals. Therefore, different models were developed based on the types of hospitals. © The Author(s) 2015.

Predicting the cumulative risk of death during hospitalization by modeling weekend, weekday and diurnal mortality risks.

Science.gov (United States)

Coiera, Enrico; Wang, Ying; Magrabi, Farah; Concha, Oscar Perez; Gallego, Blanca; Runciman, William

2014-05-21

Current prognostic models factor in patient and disease specific variables but do not consider cumulative risks of hospitalization over time. We developed risk models of the likelihood of death associated with cumulative exposure to hospitalization, based on time-varying risks of hospitalization over any given day, as well as day of the week. Model performance was evaluated alone, and in combination with simple disease-specific models. Patients admitted between 2000 and 2006 from 501 public and private hospitals in NSW, Australia were used for training and 2007 data for evaluation. The impact of hospital care delivered over different days of the week and or times of the day was modeled by separating hospitalization risk into 21 separate time periods (morning, day, night across the days of the week). Three models were developed to predict death up to 7-days post-discharge: 1/a simple background risk model using age, gender; 2/a time-varying risk model for exposure to hospitalization (admission time, days in hospital); 3/disease specific models (Charlson co-morbidity index, DRG). Combining these three generated a full model. Models were evaluated by accuracy, AUC, Akaike and Bayesian information criteria. There was a clear diurnal rhythm to hospital mortality in the data set, peaking in the evening, as well as the well-known 'weekend-effect' where mortality peaks with weekend admissions. Individual models had modest performance on the test data set (AUC 0.71, 0.79 and 0.79 respectively). The combined model which included time-varying risk however yielded an average AUC of 0.92. This model performed best for stays up to 7-days (93% of admissions), peaking at days 3 to 5 (AUC 0.94). Risks of hospitalization vary not just with the day of the week but also time of the day, and can be used to make predictions about the cumulative risk of death associated with an individual's hospitalization. Combining disease specific models with such time varying- estimates appears to

Strategic plan modelling by hospital senior administration to integrate diversity management.

Science.gov (United States)

Newhouse, John J

2010-11-01

Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

Exploring the networking behaviors of hospital organizations.

Science.gov (United States)

Di Vincenzo, Fausto

2018-05-08

Despite an extensive body of knowledge exists on network outcomes and on how hospital network structures may contribute to the creation of outcomes at different levels of analysis, less attention has been paid to understanding how and why hospital organizational networks evolve and change. The aim of this paper is to study the dynamics of networking behaviors of hospital organizations. Stochastic actor-based model for network dynamics was used to quantitatively examine data covering six-years of patient transfer relations among 35 hospital organizations. Specifically, the study investigated about determinants of patient transfer evolution modeling partner selection choice as a combination of multiple organizational attributes and endogenous network-based processes. The results indicate that having overlapping specialties and treating patients with the same case-mix decrease the likelihood of observing network ties between hospitals. Also, results revealed as geographical proximity and membership of the same LHA have a positive impact on the networking behavior of hospitals organizations, there is a propensity in the network to choose larger hospitals as partners, and to transfer patients between hospitals facing similar levels of operational uncertainty. Organizational attributes (overlapping specialties and case-mix), institutional factors (LHA), and geographical proximity matter in the formation and shaping of hospital networks over time. Managers can benefit from the use of these findings by clearly identifying the role and strategic positioning of their hospital with respect to the entire network. Social network analysis can yield novel information and also aid policy makers in the formation of interventions, encouraging alliances among providers as well as planning health system restructuring.

Multiple model adaptive control with mixing

Science.gov (United States)

Kuipers, Matthew

Despite the remarkable theoretical accomplishments and successful applications of adaptive control, the field is not sufficiently mature to solve challenging control problems requiring strict performance and safety guarantees. Towards addressing these issues, a novel deterministic multiple-model adaptive control approach called adaptive mixing control is proposed. In this approach, adaptation comes from a high-level system called the supervisor that mixes into feedback a number of candidate controllers, each finely-tuned to a subset of the parameter space. The mixing signal, the supervisor's output, is generated by estimating the unknown parameters and, at every instant of time, calculating the contribution level of each candidate controller based on certainty equivalence. The proposed architecture provides two characteristics relevant to solving stringent, performance-driven applications. First, the full-suite of linear time invariant control tools is available. A disadvantage of conventional adaptive control is its restriction to utilizing only those control laws whose solutions can be feasibly computed in real-time, such as model reference and pole-placement type controllers. Because its candidate controllers are computed off line, the proposed approach suffers no such restriction. Second, the supervisor's output is smooth and does not necessarily depend on explicit a priori knowledge of the disturbance model. These characteristics can lead to improved performance by avoiding the unnecessary switching and chattering behaviors associated with some other multiple adaptive control approaches. The stability and robustness properties of the adaptive scheme are analyzed. It is shown that the mean-square regulation error is of the order of the modeling error. And when the parameter estimate converges to its true value, which is guaranteed if a persistence of excitation condition is satisfied, the adaptive closed-loop system converges exponentially fast to a closed

Models of governance in multihospital systems. Implications for hospital and system-level decision-making.

Science.gov (United States)

Morlock, L L; Alexander, J A

1986-12-01

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In

Design of Xen Hybrid Multiple Police Model

Science.gov (United States)

Sun, Lei; Lin, Renhao; Zhu, Xianwei

2017-10-01

Virtualization Technology has attracted more and more attention. As a popular open-source virtualization tools, XEN is used more and more frequently. Xsm, XEN security model, has also been widespread concern. The safety status classification has not been established in the XSM, and it uses the virtual machine as a managed object to make Dom0 a unique administrative domain that does not meet the minimum privilege. According to these questions, we design a Hybrid multiple police model named SV_HMPMD that organically integrates multiple single security policy models include DTE,RBAC,BLP. It can fullfill the requirement of confidentiality and integrity for security model and use different particle size to different domain. In order to improve BLP’s practicability, the model introduce multi-level security labels. In order to divide the privilege in detail, we combine DTE with RBAC. In order to oversize privilege, we limit the privilege of domain0.

Prioritizing Public- Private Partnership Models for Public Hospitals of Iran Based on Performance Indicators

Directory of Open Access Journals (Sweden)

Mohammad Asghari Jaafarabadi

2012-12-01

Full Text Available Background: The present study was conducted to scrutinize Public- Private Partnership (PPP models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals.Methods: In this mixed (quantitative-qualitative study, systematic review and expert panel hasbeen done to identify varied models of PPP as well as performance indicators. In the second stepwe prioritized performance indicator and PPP models based on selected performance indicatorsby Analytical Hierarchy process (AHP technique. The data were analyzed by Excel 2007 andExpert Choice11 software’s.Results: In quality – effectiveness area, indicators like the rate of hospital infections(100%, hospital accidents prevalence rate (73%, pure rate of hospital mortality (63%, patientsatisfaction percentage (53%, in accessibility equity area indicators such as average inpatientwaiting time (100% and average outpatient waiting time (74%, and in financial – efficiency area,indicators including average length of stay (100%, bed occupation ratio (99%, specific incometo total cost ratio (97% have been chosen to be the most key performance indicators. In the prioritizationof the PPP models clinical outsourcing, management, privatization, BOO (build, own,operate and non-clinical outsourcing models, achieved high priority for various performance indicatorareas.Conclusion: This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.

Prioritizing public- private partnership models for public hospitals of iran based on performance indicators.

Science.gov (United States)

Gholamzadeh Nikjoo, Raana; Jabbari Beyrami, Hossein; Jannati, Ali; Asghari Jaafarabadi, Mohammad

2012-01-01

The present study was conducted to scrutinize Public- Private Partnership (PPP) models in public hospitals of different countries based on performance indicators in order to se-lect appropriated models for Iran hospitals. In this mixed (quantitative-qualitative) study, systematic review and expert panel has been done to identify varied models of PPP as well as performance indicators. In the second step we prioritized performance indicator and PPP models based on selected performance indicators by Analytical Hierarchy process (AHP) technique. The data were analyzed by Excel 2007 and Expert Choice11 software's. In quality - effectiveness area, indicators like the rate of hospital infections (100%), hospital accidents prevalence rate (73%), pure rate of hospital mortality (63%), patient satisfaction percentage (53%), in accessibility equity area indicators such as average inpatient waiting time (100%) and average outpatient waiting time (74%), and in financial - efficiency area, indicators including average length of stay (100%), bed occupation ratio (99%), specific income to total cost ratio (97%) have been chosen to be the most key performance indicators. In the pri¬oritization of the PPP models clinical outsourcing, management, privatization, BOO (build, own, operate) and non-clinical outsourcing models, achieved high priority for various performance in¬dicator areas. This study had been provided the most common PPP options in the field of public hospitals and had gathered suitable evidences from experts for choosing appropriate PPP option for public hospitals. Effect of private sector presence in public hospital performance, based on which PPP options undertaken, will be different.

Supersymmetric U(1)' model with multiple dark matters

International Nuclear Information System (INIS)

Hur, Taeil; Lee, Hye-Sung; Nasri, Salah

2008-01-01

We consider a scenario where a supersymmetric model has multiple dark matter particles. Adding a U(1) ' gauge symmetry is a well-motivated extension of the minimal supersymmetric standard model (MSSM). It can cure the problems of the MSSM such as the μ problem or the proton decay problem with high-dimensional lepton number and baryon number violating operators which R parity allows. An extra parity (U parity) may arise as a residual discrete symmetry after U(1) ' gauge symmetry is spontaneously broken. The lightest U-parity particle (LUP) is stable under the new parity becoming a new dark matter candidate. Up to three massive particles can be stable in the presence of the R parity and the U parity. We numerically illustrate that multiple stable particles in our model can satisfy both constraints from the relic density and the direct detection, thus providing a specific scenario where a supersymmetric model has well-motivated multiple dark matters consistent with experimental constraints. The scenario provides new possibilities in the present and upcoming dark matter searches in the direct detection and collider experiments

Multiple Social Networks, Data Models and Measures for

DEFF Research Database (Denmark)

Magnani, Matteo; Rossi, Luca

2017-01-01

Multiple Social Network Analysis is a discipline defining models, measures, methodologies, and algorithms to study multiple social networks together as a single social system. It is particularly valuable when the networks are interconnected, e.g., the same actors are present in more than one...

Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

Science.gov (United States)

Baxter, Pamela E; Hewko, Sarah J; Pfaff, Kathryn A; Cleghorn, Laura; Cunningham, Barbara J; Elston, Dawn; Cummings, Greta G

2015-08-01

Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Multiple Response Regression for Gaussian Mixture Models with Known Labels.

Science.gov (United States)

Lee, Wonyul; Du, Ying; Sun, Wei; Hayes, D Neil; Liu, Yufeng

2012-12-01

Multiple response regression is a useful regression technique to model multiple response variables using the same set of predictor variables. Most existing methods for multiple response regression are designed for modeling homogeneous data. In many applications, however, one may have heterogeneous data where the samples are divided into multiple groups. Our motivating example is a cancer dataset where the samples belong to multiple cancer subtypes. In this paper, we consider modeling the data coming from a mixture of several Gaussian distributions with known group labels. A naive approach is to split the data into several groups according to the labels and model each group separately. Although it is simple, this approach ignores potential common structures across different groups. We propose new penalized methods to model all groups jointly in which the common and unique structures can be identified. The proposed methods estimate the regression coefficient matrix, as well as the conditional inverse covariance matrix of response variables. Asymptotic properties of the proposed methods are explored. Through numerical examples, we demonstrate that both estimation and prediction can be improved by modeling all groups jointly using the proposed methods. An application to a glioblastoma cancer dataset reveals some interesting common and unique gene relationships across different cancer subtypes.

Clarification of the antecedents of hospital nurse organizational citizenship behavior -- an example from a Taiwan regional hospital.

Science.gov (United States)

Chu, Cheng-I; Lee, Ming-Shinn; Hsu, Hsiang-Ming; Chen, I-Chi

2005-12-01

Organizational citizenship behaviors (OCB) are deemed indispensable due to their importance in promoting positive relationships among employees and involving employees in the organization's activities. OCB is believed to facilitate attainment of a hospital's goals and enhance a hospital's performance. The aim of this study is to extend the work of previous studies by providing an integrated model of OCB and demonstrate its applicability in a non-Western culture. Questionnaires were completed by 314 non-supervisory hospital nurses, each of whom was given a supervisor rating for their OCB. Exploratory factor analysis was used to assess the convergent and discriminant validity of the variables in the model. Multiple regression analysis was used because it provided estimates of net effects and explanatory power. The results showed that job satisfaction, supervisor support, job involvement, and procedural justices had significant effects on the nurses' citizenship behaviors. Since the study used a non-Western site in one of Taiwan's health care institutions, its overall findings should contribute to further understanding of the cross-cultural aspects of OCB.

Quantifying the economic impact of communication inefficiencies in U.S. hospitals.

Science.gov (United States)

Agarwal, Ritu; Sands, Daniel Z; Schneider, Jorge Díaz

2010-01-01

Care delivery is a complex enterprise that involves multiple interactions among multiple stakeholders. Effective communication between these dispersed parties is critical to ensuring quality and safety and improves operational efficiencies. Time and motion studies in hospital settings provide strong evidence that care providers-doctors and nurses-spend a significant proportion of their time obtaining or providing information (i.e., communicating). Yet, surprisingly, no studies attempt to quantify the economic waste associated with communication inefficiencies in hospital settings at a national level. Our research focuses on developing models for quantifying the economic burden on hospitals of poor communications. We developed a conceptual model of the effects of poor communications in hospitals that isolates four outcomes: (1) efficiency of resource utilization, (2) effectiveness of core operations, (3) quality of work life, and (4) service quality, identifying specific metrics for each outcome. We developed estimates of costs associated with wasted physician time, wasted nurse time, and increase in length of stay caused by communication inefficiencies across all U.S. hospitals, using primary data collected from interviews in seven hospitals and secondary data from a literature review, the Bureau of Labor Statistics (BLS), and the Agency for Healthcare Research and Quality (AHRQ). We find that U.S. hospitals waste over $12 billion annually as a result of communication inefficiency among care providers. Increase in length of stay accounts for 53 percent of the annual economic burden. A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies. We note that our estimates are conservative as they do not include all dimensions of economic waste arising from poor communications. The economic burden of communication inefficiency in U.S. hospitals is substantial. Information technologies and process redesign may help alleviate some of

SDG and qualitative trend based model multiple scale validation

Science.gov (United States)

Gao, Dong; Xu, Xin; Yin, Jianjin; Zhang, Hongyu; Zhang, Beike

2017-09-01

Verification, Validation and Accreditation (VV&A) is key technology of simulation and modelling. For the traditional model validation methods, the completeness is weak; it is carried out in one scale; it depends on human experience. The SDG (Signed Directed Graph) and qualitative trend based multiple scale validation is proposed. First the SDG model is built and qualitative trends are added to the model. And then complete testing scenarios are produced by positive inference. The multiple scale validation is carried out by comparing the testing scenarios with outputs of simulation model in different scales. Finally, the effectiveness is proved by carrying out validation for a reactor model.

A Multiple Items EPQ/EOQ Model for a Vendor and Multiple Buyers System with Considering Continuous and Discrete Demand Simultaneously

Science.gov (United States)

Jonrinaldi; Rahman, T.; Henmaidi; Wirdianto, E.; Zhang, D. Z.

2018-03-01

This paper proposed a mathematical model for multiple items Economic Production and Order Quantity (EPQ/EOQ) with considering continuous and discrete demand simultaneously in a system consisting of a vendor and multiple buyers. This model is used to investigate the optimal production lot size of the vendor and the number of shipments policy of orders to multiple buyers. The model considers the multiple buyers’ holding cost as well as transportation cost, which minimize the total production and inventory costs of the system. The continuous demand from any other customers can be fulfilled anytime by the vendor while the discrete demand from multiple buyers can be fulfilled by the vendor using the multiple delivery policy with a number of shipments of items in the production cycle time. A mathematical model is developed to illustrate the system based on EPQ and EOQ model. Solution procedures are proposed to solve the model using a Mixed Integer Non Linear Programming (MINLP) and algorithm methods. Then, the numerical example is provided to illustrate the system and results are discussed.

Mathematical modelling : a tool for hospital infection control

NARCIS (Netherlands)

Grundmann, H; Hellriegel, B

Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

Mathematical modelling: a tool for hospital infection control

NARCIS (Netherlands)

Grundmann, Hajo; Hellriegel, B.

2006-01-01

Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

Mathematical modelling: a tool for hospital infection control.

NARCIS (Netherlands)

Grundmann, Hajo; Hellriegel, B

2006-01-01

Health-care-associated infections caused by antibiotic-resistant pathogens have become a menace in hospitals worldwide and infection control measures have lead to vastly different outcomes in different countries. During the past 6 years, a theoretical framework based on mathematical models has

Multiple commodities in statistical microeconomics: Model and market

Science.gov (United States)

Baaquie, Belal E.; Yu, Miao; Du, Xin

2016-11-01

A statistical generalization of microeconomics has been made in Baaquie (2013). In Baaquie et al. (2015), the market behavior of single commodities was analyzed and it was shown that market data provides strong support for the statistical microeconomic description of commodity prices. The case of multiple commodities is studied and a parsimonious generalization of the single commodity model is made for the multiple commodities case. Market data shows that the generalization can accurately model the simultaneous correlation functions of up to four commodities. To accurately model five or more commodities, further terms have to be included in the model. This study shows that the statistical microeconomics approach is a comprehensive and complete formulation of microeconomics, and which is independent to the mainstream formulation of microeconomics.

Unemployment and Causes of Hospital Admission Considering Different Analytical Approaches

DEFF Research Database (Denmark)

Berg-Beckhoff, Gabriele; Gulis, Gabriel; Kronborg Bak, Carsten

2016-01-01

and circulatory disease. Register-based data was analysed for the period of 2006 to 2009. In the cross-sectional analysis, a multiple logistic regression model was conducted based on the year 2006 and cohort information from the same year onward up to 2009 was available for a cox regression model. Social welfare...... compensated unemployment and both types of disease specific hospital admission was associated statistically significant in the cross-sectional analysis. With regard to circulatory disease, the cohort approach suggests that social welfare compensated unemployment might lead to hospital admission due...... to the disease. Given the significant results in the cross-sectional analysis for hospital admission due to cancer, the unfound cohort effect might indicate a reverse causation suggesting that the disease caused joblessness and finally, social welfare compensated unemployment and not vice versa. Comparing...

AgMIP Training in Multiple Crop Models and Tools

Science.gov (United States)

Boote, Kenneth J.; Porter, Cheryl H.; Hargreaves, John; Hoogenboom, Gerrit; Thornburn, Peter; Mutter, Carolyn

2015-01-01

The Agricultural Model Intercomparison and Improvement Project (AgMIP) has the goal of using multiple crop models to evaluate climate impacts on agricultural production and food security in developed and developing countries. There are several major limitations that must be overcome to achieve this goal, including the need to train AgMIP regional research team (RRT) crop modelers to use models other than the ones they are currently familiar with, plus the need to harmonize and interconvert the disparate input file formats used for the various models. Two activities were followed to address these shortcomings among AgMIP RRTs to enable them to use multiple models to evaluate climate impacts on crop production and food security. We designed and conducted courses in which participants trained on two different sets of crop models, with emphasis on the model of least experience. In a second activity, the AgMIP IT group created templates for inputting data on soils, management, weather, and crops into AgMIP harmonized databases, and developed translation tools for converting the harmonized data into files that are ready for multiple crop model simulations. The strategies for creating and conducting the multi-model course and developing entry and translation tools are reviewed in this chapter.

Work ability among hospital food service professionals: multiple associated variables require comprehensive intervention.

Science.gov (United States)

Fischer, Frida Marina; Martinez, Maria Carmen

2012-01-01

The work of hospital food service is characterized by demands that can be associated with work ability--WA. The aim of this study was to evaluate factors associated with WA among hospital food service professionals and recommend intervention measures. This is a cross sectional study carried out in 2009, conducted in a hospital of São Paulo, Brazil. Participants were 76 (96.2%) of the eligible. They filled out a questionnaire including socio-demographic data, life styles, working conditions and WA. Multivariate linear regression analyses were performed. Factors associated with WA were age (p = 0.051), over commitment (p = 0.011), effort-reward ratio (p = 0.002) and work injuries (p work injuries is consistent with the theoretical model that demonstrated that health status is the basis to maintain the WA. The association of effort-reward imbalance shows that issues related with work organization are relevant for these workers. The association of overcommittment suggests that workers recognize their responsibility with the therapeutic processes of patients. Results showed a number of features of different nature that should be taken into account when implementing measures to improve the WA, to be applied at different levels: individual, task and institutional.

Efficient Adoption and Assessment of Multiple Process Improvement Reference Models

Directory of Open Access Journals (Sweden)

Simona Jeners

2013-06-01

Full Text Available A variety of reference models such as CMMI, COBIT or ITIL support IT organizations to improve their processes. These process improvement reference models (IRMs cover different domains such as IT development, IT Services or IT Governance but also share some similarities. As there are organizations that address multiple domains and need to coordinate their processes in their improvement we present MoSaIC, an approach to support organizations to efficiently adopt and conform to multiple IRMs. Our solution realizes a semantic integration of IRMs based on common meta-models. The resulting IRM integration model enables organizations to efficiently implement and asses multiple IRMs and to benefit from synergy effects.

A stochastic mathematical model to locate field hospitals under disruption uncertainty for large-scale disaster preparedness

Directory of Open Access Journals (Sweden)

Nezir Aydin

2016-03-01

Full Text Available In this study, we consider field hospital location decisions for emergency treatment points in response to large scale disasters. Specifically, we developed a two-stage stochastic model that determines the number and locations of field hospitals and the allocation of injured victims to these field hospitals. Our model considers the locations as well as the failings of the existing public hospitals while deciding on the location of field hospitals that are anticipated to be opened. The model that we developed is a variant of the P-median location model and it integrates capacity restrictions both on field hospitals that are planned to be opened and the disruptions that occur in existing public hospitals. We conducted experiments to demonstrate how the proposed model can be utilized in practice in a real life problem case scenario. Results show the effects of the failings of existing hospitals, the level of failure probability and the capacity of projected field hospitals to deal with the assessment of any given emergency treatment system’s performance. Crucially, it also specifically provides an assessment on the average distance within which a victim needs to be transferred in order to be treated properly and then from this assessment, the proportion of total satisfied demand is then calculated.

The Application of Collaborative Business Intelligence Technology in the Hospital SPD Logistics Management Model.

Science.gov (United States)

Liu, Tongzhu; Shen, Aizong; Hu, Xiaojian; Tong, Guixian; Gu, Wei

2017-06-01

We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers.

Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan.

Science.gov (United States)

Miyata, Hiroaki; Hashimoto, Hideki; Horiguchi, Hiromasa; Fushimi, Kiyohide; Matsuda, Shinya

2010-05-19

Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index > or = 0.8; hospitals with c-index /=0.8 and were classified as the higher c-index group. A significantly higher proportion of hospitals in the lower c-index group were specialized hospitals and hospitals with convalescent wards. The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

Queueing network model for obstetric patient flow in a hospital.

Science.gov (United States)

Takagi, Hideaki; Kanai, Yuta; Misue, Kazuo

2016-03-03

A queueing network is used to model the flow of patients in a hospital using the observed admission rate of patients and the histogram for the length of stay for patients in each ward. A complete log of orders for every movement of all patients from room to room covering two years was provided to us by the Medical Information Department of the University of Tsukuba Hospital in Japan. We focused on obstetric patients, who are generally hospitalized at random times throughout the year, and we analyzed the patient flow probabilistically. On admission, each obstetric patient is assigned to a bed in one of the two wards: one for normal delivery and the other for high-risk delivery. Then, the patient may be transferred between the two wards before discharge. We confirm Little's law of queueing theory for the patient flow in each ward. Next, we propose a new network model of M/G/ ∞ and M/M/ m queues to represent the flow of these patients, which is used to predict the probability distribution for the number of patients staying in each ward at the nightly census time. Although our model is a very rough and simplistic approximation of the real patient flow, the predicted probability distribution shows good agreement with the observed data. The proposed method can be used for capacity planning of hospital wards to predict future patient load in each ward.

Coding response to a case-mix measurement system based on multiple diagnoses.

Science.gov (United States)

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

Science.gov (United States)

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

Adaptive Active Noise Suppression Using Multiple Model Switching Strategy

Directory of Open Access Journals (Sweden)

Quanzhen Huang

2017-01-01

Full Text Available Active noise suppression for applications where the system response varies with time is a difficult problem. The computation burden for the existing control algorithms with online identification is heavy and easy to cause control system instability. A new active noise control algorithm is proposed in this paper by employing multiple model switching strategy for secondary path varying. The computation is significantly reduced. Firstly, a noise control system modeling method is proposed for duct-like applications. Then a multiple model adaptive control algorithm is proposed with a new multiple model switching strategy based on filter-u least mean square (FULMS algorithm. Finally, the proposed algorithm was implemented on Texas Instruments digital signal processor (DSP TMS320F28335 and real time experiments were done to test the proposed algorithm and FULMS algorithm with online identification. Experimental verification tests show that the proposed algorithm is effective with good noise suppression performance.

When children with profound multiple disabilities are hospitalized: A cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care.

Science.gov (United States)

Seliner, Brigitte; Latal, Bea; Spirig, Rebecca

2016-07-01

We aimed to assess parental burden of care, satisfaction with family-centered care, and quality of life (HRQoL) of parents and their hospitalized children with profound intellectual and multiple disabilities (PIMD), and determine the relationship among these factors. A cross-sectional study using printed questionnaires and qualitative questions was undertaken at a Swiss University Children's Hospital. The 117 parents (98 mothers, 19 fathers) studied indicated a substantial impact on burden of care and parental health-related quality of life. Significant correlations with the hospitalized children's well-being were rs = .408 for burden of care and rs -.368 for quality of life. Qualitative results showed parents struggling to safeguard their children and worrying most about the children's well-being. Health professionals need to be aware of parental burden and that the perception of the children's well-being and the parents' efforts determine their support needs. Easing parents' burden and fostering confidence in the hospitalized children's well-being requires coordination of care provided by advanced nurse specialists, with an institutional framework that clarifies parental collaboration. © 2016, Wiley Periodicals, Inc.

The Application of Collaborative Business Intelligence Technology in the Hospital SPD Logistics Management Model

Science.gov (United States)

LIU, Tongzhu; SHEN, Aizong; HU, Xiaojian; TONG, Guixian; GU, Wei

2017-01-01

Background: We aimed to apply collaborative business intelligence (BI) system to hospital supply, processing and distribution (SPD) logistics management model. Methods: We searched Engineering Village database, China National Knowledge Infrastructure (CNKI) and Google for articles (Published from 2011 to 2016), books, Web pages, etc., to understand SPD and BI related theories and recent research status. For the application of collaborative BI technology in the hospital SPD logistics management model, we realized this by leveraging data mining techniques to discover knowledge from complex data and collaborative techniques to improve the theories of business process. Results: For the application of BI system, we: (i) proposed a layered structure of collaborative BI system for intelligent management in hospital logistics; (ii) built data warehouse for the collaborative BI system; (iii) improved data mining techniques such as supporting vector machines (SVM) and swarm intelligence firefly algorithm to solve key problems in hospital logistics collaborative BI system; (iv) researched the collaborative techniques oriented to data and business process optimization to improve the business processes of hospital logistics management. Conclusion: Proper combination of SPD model and BI system will improve the management of logistics in the hospitals. The successful implementation of the study requires: (i) to innovate and improve the traditional SPD model and make appropriate implement plans and schedules for the application of BI system according to the actual situations of hospitals; (ii) the collaborative participation of internal departments in hospital including the department of information, logistics, nursing, medical and financial; (iii) timely response of external suppliers. PMID:28828316

A cost-analysis model for anticoagulant treatment in the hospital setting.

Science.gov (United States)

Mody, Samir H; Huynh, Lynn; Zhuo, Daisy Y; Tran, Kevin N; Lefebvre, Patrick; Bookhart, Brahim

2014-07-01

Rivaroxaban is the first oral factor Xa inhibitor approved in the US to reduce the risk of stroke and blood clots among people with non-valvular atrial fibrillation, treat deep vein thrombosis (DVT), treat pulmonary embolism (PE), reduce the risk of recurrence of DVT and PE, and prevent DVT and PE after knee or hip replacement surgery. The objective of this study was to evaluate the costs from a hospital perspective of treating patients with rivaroxaban vs other anticoagulant agents across these five populations. An economic model was developed using treatment regimens from the ROCKET-AF, EINSTEIN-DVT and PE, and RECORD1-3 randomized clinical trials. The distribution of hospital admissions used in the model across the different populations was derived from the 2010 Healthcare Cost and Utilization Project database. The model compared total costs of anticoagulant treatment, monitoring, inpatient stay, and administration for patients receiving rivaroxaban vs other anticoagulant agents. The length of inpatient stay (LOS) was determined from the literature. Across all populations, rivaroxaban was associated with an overall mean cost savings of $1520 per patient. The largest cost savings associated with rivaroxaban was observed in patients with DVT or PE ($6205 and $2742 per patient, respectively). The main driver of the cost savings resulted from the reduction in LOS associated with rivaroxaban, contributing to ∼90% of the total savings. Furthermore, the overall mean anticoagulant treatment cost was lower for rivaroxaban vs the reference groups. The distribution of patients across indications used in the model may not be generalizable to all hospitals, where practice patterns may vary, and average LOS cost may not reflect the actual reimbursements that hospitals received. From a hospital perspective, the use of rivaroxaban may be associated with cost savings when compared to other anticoagulant treatments due to lower drug cost and shorter LOS associated with

Assessment of hospital performance with a case-mix standardized mortality model using an existing administrative database in Japan

Directory of Open Access Journals (Sweden)

Fushimi Kiyohide

2010-05-01

Full Text Available Abstract Background Few studies have examined whether risk adjustment is evenly applicable to hospitals with various characteristics and case-mix. In this study, we applied a generic prediction model to nationwide discharge data from hospitals with various characteristics. Method We used standardized data of 1,878,767 discharged patients provided by 469 hospitals from July 1 to October 31, 2006. We generated and validated a case-mix in-hospital mortality prediction model using 50/50 split sample validation. We classified hospitals into two groups based on c-index value (hospitals with c-index ≥ 0.8; hospitals with c-index Results The model demonstrated excellent discrimination as indicated by the high average c-index and small standard deviation (c-index = 0.88 ± 0.04. Expected mortality rate of each hospital was highly correlated with observed mortality rate (r = 0.693, p Conclusion The model fits well to a group of hospitals with a wide variety of acute care events, though model fit is less satisfactory for specialized hospitals and those with convalescent wards. Further sophistication of the generic prediction model would be recommended to obtain optimal indices to region specific conditions.

Development Customer Knowledge Management (Ckm) Models in Purbalingga Hospitality Using Soft Systems Methodology (Ssm)

OpenAIRE

Chasanah, Nur; Sensuse, Dana Indra; Lusa, Jonathan Sofian

2014-01-01

Development of the tourism sector is part of the national development efforts that are being implemented in Indonesia. This research was conducted with the customer to make an overview of knowledge management models to address the existing problems in hospitality in the hospitality Purbalingga as supporting tourism Purbalingga. The model depicts a series of problem-solving activities that result in the hospitality, especially in Purbalingga. This research was action research with methods of S...

A test for the parameters of multiple linear regression models ...

African Journals Online (AJOL)

A test for the parameters of multiple linear regression models is developed for conducting tests simultaneously on all the parameters of multiple linear regression models. The test is robust relative to the assumptions of homogeneity of variances and absence of serial correlation of the classical F-test. Under certain null and ...

Parametric modeling for damped sinusoids from multiple channels

DEFF Research Database (Denmark)

Zhou, Zhenhua; So, Hing Cheung; Christensen, Mads Græsbøll

2013-01-01

frequencies and damping factors are then computed with the multi-channel weighted linear prediction method. The estimated sinusoidal poles are then matched to each channel according to the extreme value theory of distribution of random fields. Simulations are performed to show the performance advantages......The problem of parametric modeling for noisy damped sinusoidal signals from multiple channels is addressed. Utilizing the shift invariance property of the signal subspace, the number of distinct sinusoidal poles in the multiple channels is first determined. With the estimated number, the distinct...... of the proposed multi-channel sinusoidal modeling methodology compared with existing methods....

A model for diagnosing and explaining multiple disorders.

Science.gov (United States)

Jamieson, P W

1991-08-01

The ability to diagnose multiple interacting disorders and explain them in a coherent causal framework has only partially been achieved in medical expert systems. This paper proposes a causal model for diagnosing and explaining multiple disorders whose key elements are: physician-directed hypotheses generation, object-oriented knowledge representation, and novel explanation heuristics. The heuristics modify and link the explanations to make the physician aware of diagnostic complexities. A computer program incorporating the model currently is in use for diagnosing peripheral nerve and muscle disorders. The program successfully diagnoses and explains interactions between diseases in terms of underlying pathophysiologic concepts. The model offers a new architecture for medical domains where reasoning from first principles is difficult but explanation of disease interactions is crucial for the system's operation.

Establishing a Cloud Computing Success Model for Hospitals in Taiwan

OpenAIRE

Lian, Jiunn-Woei

2017-01-01

The purpose of this study is to understand the critical quality-related factors that affect cloud computing success of hospitals in Taiwan. In this study, private cloud computing is the major research target. The chief information officers participated in a questionnaire survey. The results indicate that the integration of trust into the information systems success model will have acceptable explanatory power to understand cloud computing success in the hospital. Moreover, information quality...

An investigation of multidisciplinary complex health care interventions - steps towards an integrative treatment model in the rehabilitation of People with Multiple Sclerosis

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Skovgaard Lasse

2012-04-01

Full Text Available Abstract Background The Danish Multiple Sclerosis Society initiated a large-scale bridge building and integrative treatment project to take place from 2004–2010 at a specialized Multiple Sclerosis (MS hospital. In this project, a team of five conventional health care practitioners and five alternative practitioners was set up to work together in developing and offering individualized treatments to 200 people with MS. The purpose of this paper is to present results from the six year treatment collaboration process regarding the development of an integrative treatment model. Discussion The collaborative work towards an integrative treatment model for people with MS, involved six steps: 1 Working with an initial model 2 Unfolding the different treatment philosophies 3 Discussing the elements of the Intervention-Mechanism-Context-Outcome-scheme (the IMCO-scheme 4 Phrasing the common assumptions for an integrative MS program theory 5 Developing the integrative MS program theory 6 Building the integrative MS treatment model. The model includes important elements of the different treatment philosophies represented in the team and thereby describes a common understanding of the complexity of the courses of treatment. Summary An integrative team of practitioners has developed an integrative model for combined treatments of People with Multiple Sclerosis. The model unites different treatment philosophies and focuses on process-oriented factors and the strengthening of the patients’ resources and competences on a physical, an emotional and a cognitive level.

Application of Multiple Evaluation Models in Brazil

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Rafael Victal Saliba

2008-07-01

Full Text Available Based on two different samples, this article tests the performance of a number of Value Drivers commonly used for evaluating companies by finance practitioners, through simple regression models of cross-section type which estimate the parameters associated to each Value Driver, denominated Market Multiples. We are able to diagnose the behavior of several multiples in the period 1994-2004, with an outlook also on the particularities of the economic activities performed by the sample companies (and their impacts on the performance through a subsequent analysis with segregation of companies in the sample by sectors. Extrapolating simple multiples evaluation standards from analysts of the main financial institutions in Brazil, we find that adjusting the ratio formulation to allow for an intercept does not provide satisfactory results in terms of pricing errors reduction. Results found, in spite of evidencing certain relative and absolute superiority among the multiples, may not be generically representative, given samples limitation.

The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

Science.gov (United States)

Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

2016-10-10

Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

Applying the High Reliability Health Care Maturity Model to Assess Hospital Performance: A VA Case Study.

Science.gov (United States)

Sullivan, Jennifer L; Rivard, Peter E; Shin, Marlena H; Rosen, Amy K

2016-09-01

The lack of a tool for categorizing and differentiating hospitals according to their high reliability organization (HRO)-related characteristics has hindered progress toward implementing and sustaining evidence-based HRO practices. Hospitals would benefit both from an understanding of the organizational characteristics that support HRO practices and from knowledge about the steps necessary to achieve HRO status to reduce the risk of harm and improve outcomes. The High Reliability Health Care Maturity (HRHCM) model, a model for health care organizations' achievement of high reliability with zero patient harm, incorporates three major domains critical for promoting HROs-Leadership, Safety Culture, and Robust Process Improvement ®. A study was conducted to examine the content validity of the HRHCM model and evaluate whether it can differentiate hospitals' maturity levels for each of the model's components. Staff perceptions of patient safety at six US Department of Veterans Affairs (VA) hospitals were examined to determine whether all 14 HRHCM components were present and to characterize each hospital's level of organizational maturity. Twelve of the 14 components from the HRHCM model were detected; two additional characteristics emerged that are present in the HRO literature but not represented in the model-teamwork culture and system-focused tools for learning and improvement. Each hospital's level of organizational maturity could be characterized for 9 of the 14 components. The findings suggest the HRHCM model has good content validity and that there is differentiation between hospitals on model components. Additional research is needed to understand how these components can be used to build the infrastructure necessary for reaching high reliability.

A validation of ground ambulance pre-hospital times modeled using geographic information systems.

Science.gov (United States)

Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

2012-10-03

Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

Deterministic integer multiple firing depending on initial state in Wang model

Energy Technology Data Exchange (ETDEWEB)

Xie Yong [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China)]. E-mail: yxie@mail.xjtu.edu.cn; Xu Jianxue [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China); Jiang Jun [Institute of Nonlinear Dynamics, MSSV, Department of Engineering Mechanics, Xi' an Jiaotong University, Xi' an 710049 (China)

2006-12-15

We investigate numerically dynamical behaviour of the Wang model, which describes the rhythmic activities of thalamic relay neurons. The model neuron exhibits Type I excitability from a global view, but Type II excitability from a local view. There exists a narrow range of bistability, in which a subthreshold oscillation and a suprathreshold firing behaviour coexist. A special firing pattern, integer multiple firing can be found in the certain part of the bistable range. The characteristic feature of such firing pattern is that the histogram of interspike intervals has a multipeaked structure, and the peaks are located at about integer multiples of a basic interspike interval. Since the Wang model is noise-free, the integer multiple firing is a deterministic firing pattern. The existence of bistability leads to the deterministic integer multiple firing depending on the initial state of the model neuron, i.e., the initial values of the state variables.

Deterministic integer multiple firing depending on initial state in Wang model

International Nuclear Information System (INIS)

Xie Yong; Xu Jianxue; Jiang Jun

2006-01-01

We investigate numerically dynamical behaviour of the Wang model, which describes the rhythmic activities of thalamic relay neurons. The model neuron exhibits Type I excitability from a global view, but Type II excitability from a local view. There exists a narrow range of bistability, in which a subthreshold oscillation and a suprathreshold firing behaviour coexist. A special firing pattern, integer multiple firing can be found in the certain part of the bistable range. The characteristic feature of such firing pattern is that the histogram of interspike intervals has a multipeaked structure, and the peaks are located at about integer multiples of a basic interspike interval. Since the Wang model is noise-free, the integer multiple firing is a deterministic firing pattern. The existence of bistability leads to the deterministic integer multiple firing depending on the initial state of the model neuron, i.e., the initial values of the state variables

Multiple regression and beyond an introduction to multiple regression and structural equation modeling

CERN Document Server

Keith, Timothy Z

2014-01-01

Multiple Regression and Beyond offers a conceptually oriented introduction to multiple regression (MR) analysis and structural equation modeling (SEM), along with analyses that flow naturally from those methods. By focusing on the concepts and purposes of MR and related methods, rather than the derivation and calculation of formulae, this book introduces material to students more clearly, and in a less threatening way. In addition to illuminating content necessary for coursework, the accessibility of this approach means students are more likely to be able to conduct research using MR or SEM--and more likely to use the methods wisely. Covers both MR and SEM, while explaining their relevance to one another Also includes path analysis, confirmatory factor analysis, and latent growth modeling Figures and tables throughout provide examples and illustrate key concepts and techniques For additional resources, please visit: http://tzkeith.com/.

New Hybrid Variational Recovery Model for Blurred Images with Multiplicative Noise

DEFF Research Database (Denmark)

Dong, Yiqiu; Zeng, Tieyong

2013-01-01

A new hybrid variational model for recovering blurred images in the presence of multiplicative noise is proposed. Inspired by previous work on multiplicative noise removal, an I-divergence technique is used to build a strictly convex model under a condition that ensures the uniqueness...

A Generic Discrete-Event Simulation Model for Outpatient Clinics in a Large Public Hospital

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Waressara Weerawat

2013-01-01

Full Text Available The orthopedic outpatient department (OPD ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES simulation. Key Performance Indicators (KPIs are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.

Mathematical Modeling of Loop Heat Pipes with Multiple Capillary Pumps and Multiple Condensers. Part 1; Stead State Stimulations

Science.gov (United States)

Hoang, Triem T.; OConnell, Tamara; Ku, Jentung

2004-01-01

Loop Heat Pipes (LHPs) have proven themselves as reliable and robust heat transport devices for spacecraft thermal control systems. So far, the LHPs in earth-orbit satellites perform very well as expected. Conventional LHPs usually consist of a single capillary pump for heat acquisition and a single condenser for heat rejection. Multiple pump/multiple condenser LHPs have shown to function very well in ground testing. Nevertheless, the test results of a dual pump/condenser LHP also revealed that the dual LHP behaved in a complicated manner due to the interaction between the pumps and condensers. Thus it is redundant to say that more research is needed before they are ready for 0-g deployment. One research area that perhaps compels immediate attention is the analytical modeling of LHPs, particularly the transient phenomena. Modeling a single pump/single condenser LHP is difficult enough. Only a handful of computer codes are available for both steady state and transient simulations of conventional LHPs. No previous effort was made to develop an analytical model (or even a complete theory) to predict the operational behavior of the multiple pump/multiple condenser LHP systems. The current research project offered a basic theory of the multiple pump/multiple condenser LHP operation. From it, a computer code was developed to predict the LHP saturation temperature in accordance with the system operating and environmental conditions.

A Bayesian Hierarchical Model for Relating Multiple SNPs within Multiple Genes to Disease Risk

Directory of Open Access Journals (Sweden)

Lewei Duan

2013-01-01

Full Text Available A variety of methods have been proposed for studying the association of multiple genes thought to be involved in a common pathway for a particular disease. Here, we present an extension of a Bayesian hierarchical modeling strategy that allows for multiple SNPs within each gene, with external prior information at either the SNP or gene level. The model involves variable selection at the SNP level through latent indicator variables and Bayesian shrinkage at the gene level towards a prior mean vector and covariance matrix that depend on external information. The entire model is fitted using Markov chain Monte Carlo methods. Simulation studies show that the approach is capable of recovering many of the truly causal SNPs and genes, depending upon their frequency and size of their effects. The method is applied to data on 504 SNPs in 38 candidate genes involved in DNA damage response in the WECARE study of second breast cancers in relation to radiotherapy exposure.

Predictive performance models and multiple task performance

Science.gov (United States)

Wickens, Christopher D.; Larish, Inge; Contorer, Aaron

1989-01-01

Five models that predict how performance of multiple tasks will interact in complex task scenarios are discussed. The models are shown in terms of the assumptions they make about human operator divided attention. The different assumptions about attention are then empirically validated in a multitask helicopter flight simulation. It is concluded from this simulation that the most important assumption relates to the coding of demand level of different component tasks.

Classification and regression tree (CART) model to predict pulmonary tuberculosis in hospitalized patients.

Science.gov (United States)

Aguiar, Fabio S; Almeida, Luciana L; Ruffino-Netto, Antonio; Kritski, Afranio Lineu; Mello, Fernanda Cq; Werneck, Guilherme L

2012-08-07

Tuberculosis (TB) remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART) model was generated and validated. The area under the ROC curve (AUC), sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear) and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with clinical suspicion of TB in tertiary health facilities in

Classification and regression tree (CART model to predict pulmonary tuberculosis in hospitalized patients

Directory of Open Access Journals (Sweden)

Aguiar Fabio S

2012-08-01

Full Text Available Abstract Background Tuberculosis (TB remains a public health issue worldwide. The lack of specific clinical symptoms to diagnose TB makes the correct decision to admit patients to respiratory isolation a difficult task for the clinician. Isolation of patients without the disease is common and increases health costs. Decision models for the diagnosis of TB in patients attending hospitals can increase the quality of care and decrease costs, without the risk of hospital transmission. We present a predictive model for predicting pulmonary TB in hospitalized patients in a high prevalence area in order to contribute to a more rational use of isolation rooms without increasing the risk of transmission. Methods Cross sectional study of patients admitted to CFFH from March 2003 to December 2004. A classification and regression tree (CART model was generated and validated. The area under the ROC curve (AUC, sensitivity, specificity, positive and negative predictive values were used to evaluate the performance of model. Validation of the model was performed with a different sample of patients admitted to the same hospital from January to December 2005. Results We studied 290 patients admitted with clinical suspicion of TB. Diagnosis was confirmed in 26.5% of them. Pulmonary TB was present in 83.7% of the patients with TB (62.3% with positive sputum smear and HIV/AIDS was present in 56.9% of patients. The validated CART model showed sensitivity, specificity, positive predictive value and negative predictive value of 60.00%, 76.16%, 33.33%, and 90.55%, respectively. The AUC was 79.70%. Conclusions The CART model developed for these hospitalized patients with clinical suspicion of TB had fair to good predictive performance for pulmonary TB. The most important variable for prediction of TB diagnosis was chest radiograph results. Prospective validation is still necessary, but our model offer an alternative for decision making in whether to isolate patients with

MFAM: Multiple Frequency Adaptive Model-Based Indoor Localization Method.

Science.gov (United States)

Tuta, Jure; Juric, Matjaz B

2018-03-24

This paper presents MFAM (Multiple Frequency Adaptive Model-based localization method), a novel model-based indoor localization method that is capable of using multiple wireless signal frequencies simultaneously. It utilizes indoor architectural model and physical properties of wireless signal propagation through objects and space. The motivation for developing multiple frequency localization method lies in the future Wi-Fi standards (e.g., 802.11ah) and the growing number of various wireless signals present in the buildings (e.g., Wi-Fi, Bluetooth, ZigBee, etc.). Current indoor localization methods mostly rely on a single wireless signal type and often require many devices to achieve the necessary accuracy. MFAM utilizes multiple wireless signal types and improves the localization accuracy over the usage of a single frequency. It continuously monitors signal propagation through space and adapts the model according to the changes indoors. Using multiple signal sources lowers the required number of access points for a specific signal type while utilizing signals, already present in the indoors. Due to the unavailability of the 802.11ah hardware, we have evaluated proposed method with similar signals; we have used 2.4 GHz Wi-Fi and 868 MHz HomeMatic home automation signals. We have performed the evaluation in a modern two-bedroom apartment and measured mean localization error 2.0 to 2.3 m and median error of 2.0 to 2.2 m. Based on our evaluation results, using two different signals improves the localization accuracy by 18% in comparison to 2.4 GHz Wi-Fi-only approach. Additional signals would improve the accuracy even further. We have shown that MFAM provides better accuracy than competing methods, while having several advantages for real-world usage.

MFAM: Multiple Frequency Adaptive Model-Based Indoor Localization Method

Directory of Open Access Journals (Sweden)

Jure Tuta

2018-03-01

Full Text Available This paper presents MFAM (Multiple Frequency Adaptive Model-based localization method, a novel model-based indoor localization method that is capable of using multiple wireless signal frequencies simultaneously. It utilizes indoor architectural model and physical properties of wireless signal propagation through objects and space. The motivation for developing multiple frequency localization method lies in the future Wi-Fi standards (e.g., 802.11ah and the growing number of various wireless signals present in the buildings (e.g., Wi-Fi, Bluetooth, ZigBee, etc.. Current indoor localization methods mostly rely on a single wireless signal type and often require many devices to achieve the necessary accuracy. MFAM utilizes multiple wireless signal types and improves the localization accuracy over the usage of a single frequency. It continuously monitors signal propagation through space and adapts the model according to the changes indoors. Using multiple signal sources lowers the required number of access points for a specific signal type while utilizing signals, already present in the indoors. Due to the unavailability of the 802.11ah hardware, we have evaluated proposed method with similar signals; we have used 2.4 GHz Wi-Fi and 868 MHz HomeMatic home automation signals. We have performed the evaluation in a modern two-bedroom apartment and measured mean localization error 2.0 to 2.3 m and median error of 2.0 to 2.2 m. Based on our evaluation results, using two different signals improves the localization accuracy by 18% in comparison to 2.4 GHz Wi-Fi-only approach. Additional signals would improve the accuracy even further. We have shown that MFAM provides better accuracy than competing methods, while having several advantages for real-world usage.

Modeling interdependencies between business and communication processes in hospitals.

Science.gov (United States)

Brigl, Birgit; Wendt, Thomas; Winter, Alfred

2003-01-01

The optimization and redesign of business processes in hospitals is an important challenge for the hospital information management who has to design and implement a suitable HIS architecture. Nevertheless, there are no tools available specializing in modeling information-driven business processes and the consequences on the communication between information processing, tools. Therefore, we will present an approach which facilitates the representation and analysis of business processes and resulting communication processes between application components and their interdependencies. This approach aims not only to visualize those processes, but to also to evaluate if there are weaknesses concerning the information processing infrastructure which hinder the smooth implementation of the business processes.

Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

Directory of Open Access Journals (Sweden)

Eleanor M Winpenny

2016-11-01

Full Text Available Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs, nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

E-HOSPITAL - A Digital Workbench for Hospital Operations and Services Planning Using Information Technology and Algebraic Languages.

Science.gov (United States)

Gartner, Daniel; Padman, Rema

2017-01-01

In this paper, we describe the development of a unified framework and a digital workbench for the strategic, tactical and operational hospital management plan driven by information technology and analytics. The workbench can be used not only by multiple stakeholders in the healthcare delivery setting, but also for pedagogical purposes on topics such as healthcare analytics, services management, and information systems. This tool combines the three classical hierarchical decision-making levels in one integrated environment. At each level, several decision problems can be chosen. Extensions of mathematical models from the literature are presented and incorporated into the digital platform. In a case study using real-world data, we demonstrate how we used the workbench to inform strategic capacity planning decisions in a multi-hospital, multi-stakeholder setting in the United Kingdom.

Medical Student Education in State Psychiatric Hospitals: A Survey of US State Hospitals.

Science.gov (United States)

Nurenberg, Jeffry R; Schleifer, Steven J; Kennedy, Cheryl; Walker, Mary O; Mayerhoff, David

2016-04-01

State hospitals may be underutilized in medical education. US state psychiatric hospitals were surveyed on current and potential psychiatry medical student education. A 10-item questionnaire, with multiple response formats, was sent to identified hospitals in late 2012. Ninety-seven of 221 hospitals contacted responded. Fifty-three (55%) reported current medical student education programs, including 27 clinical clerkship rotations. Education and training in other disciplines was prevalent in hospitals both with and without medical students. The large majority of responders expressed enthusiasm about medical education. The most frequent reported barrier to new programs was geographic distance from the school. Limited resources were limiting factors for hospitals with and without current programs. Only a minority of US state hospitals may be involved in medical student education. While barriers such as geographic distance may be difficult to overcome, responses suggest opportunities for expanding medical education in the state psychiatric hospitals.

Forecasting asthma-related hospital admissions in London using negative binomial models.

Science.gov (United States)

Soyiri, Ireneous N; Reidpath, Daniel D; Sarran, Christophe

2013-05-01

Health forecasting can improve health service provision and individual patient outcomes. Environmental factors are known to impact chronic respiratory conditions such as asthma, but little is known about the extent to which these factors can be used for forecasting. Using weather, air quality and hospital asthma admissions, in London (2005-2006), two related negative binomial models were developed and compared with a naive seasonal model. In the first approach, predictive forecasting models were fitted with 7-day averages of each potential predictor, and then a subsequent multivariable model is constructed. In the second strategy, an exhaustive search of the best fitting models between possible combinations of lags (0-14 days) of all the environmental effects on asthma admission was conducted. Three models were considered: a base model (seasonal effects), contrasted with a 7-day average model and a selected lags model (weather and air quality effects). Season is the best predictor of asthma admissions. The 7-day average and seasonal models were trivial to implement. The selected lags model was computationally intensive, but of no real value over much more easily implemented models. Seasonal factors can predict daily hospital asthma admissions in London, and there is a little evidence that additional weather and air quality information would add to forecast accuracy.

Intriguing model significantly reduces boarding of psychiatric patients, need for inpatient hospitalization.

Science.gov (United States)

2015-01-01

As new approaches to the care of psychiatric emergencies emerge, one solution is gaining particular traction. Under the Alameda model, which has been put into practice in Alameda County, CA, patients who are brought to regional EDs with emergency psychiatric issues are quickly transferred to a designated emergency psychiatric facility as soon as they are medically stabilized. This alleviates boarding problems in area EDs while also quickly connecting patients with specialized care. With data in hand on the model's effectiveness, developers believe the approach could alleviate boarding problems in other communities as well. The model is funded by through a billing code established by California's Medicaid program for crisis stabilization services. Currently, only 22% of the patients brought to the emergency psychiatric facility ultimately need to be hospitalized; the other 78% are able to go home or to an alternative situation. In a 30-day study of the model, involving five community hospitals in Alameda County, CA, researchers found that ED boarding times were as much as 80% lower than comparable ED averages, and that patients were stabilized at least 75% of the time, significantly reducing the need for inpatient hospitalization.

A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.

Science.gov (United States)

Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L

2007-11-01

This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

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

Science.gov (United States)

Kramer, Jeffrey; Santerre, Rexford E

2010-01-01

This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.

A Multiple-room, Continuous Beam Delivery, Hadron-therapy Installation

Science.gov (United States)

Méot, F.

A proton-therapy hospital installation, based on multiple beam extraction systems from a fixed-field synchrotron, is presented and commented. Potential interest as hospital operation efficiency, as well as estimates of the impact of continuous, multiple-port extraction, on the cost of a session, are discussed.

Applications of Bayesian approach in modelling risk of malaria-related hospital mortality

Directory of Open Access Journals (Sweden)

Simbeye Jupiter S

2008-02-01

Full Text Available Abstract Background Malaria is a major public health problem in Malawi, however, quantifying its burden in a population is a challenge. Routine hospital data provide a proxy for measuring the incidence of severe malaria and for crudely estimating morbidity rates. Using such data, this paper proposes a method to describe trends, patterns and factors associated with in-hospital mortality attributed to the disease. Methods We develop semiparametric regression models which allow joint analysis of nonlinear effects of calendar time and continuous covariates, spatially structured variation, unstructured heterogeneity, and other fixed covariates. Modelling and inference use the fully Bayesian approach via Markov Chain Monte Carlo (MCMC simulation techniques. The methodology is applied to analyse data arising from paediatric wards in Zomba district, Malawi, between 2002 and 2003. Results and Conclusion We observe that the risk of dying in hospital is lower in the dry season, and for children who travel a distance of less than 5 kms to the hospital, but increases for those who are referred to the hospital. The results also indicate significant differences in both structured and unstructured spatial effects, and the health facility effects reveal considerable differences by type of facility or practice. More importantly, our approach shows non-linearities in the effect of metrical covariates on the probability of dying in hospital. The study emphasizes that the methodological framework used provides a useful tool for analysing the data at hand and of similar structure.

Multivariate Analysis of Factors Influencing Length of Hospital Stay after Coronary Artery Bypass Surgery in Tehran, Iran

Directory of Open Access Journals (Sweden)

Amin Torabipour

2016-03-01

Full Text Available Length of hospital stay (LOS is a key indicator for hospital management. Reducing hospital stay is a priority for all health systems. We aimed to determine the length of hospital stay following Coronary Artery Bypass Surgery (CABG based on its clinical and non-clinical factors. A cross-sectional study of 649 consecutive patients who underwent coronary artery bypass graft surgery was conducted in Imam Khomeini and Shariati university hospitals, Tehran, Iran. Data was analyzed by using non-parametric univariate tests and multiple linier regression models. Thirty seven independent variables including pre-operative, intra-operative and post-operative variables were analyzed. Finally, an appropriate model was constructed based on the associated factors. The results showed that 70.3% of the patients were male, and the mean age of the patients was 59.3 ± 10.4 years. The Mean (±SD and median of the LOS were 11.7 ± 7.1 and 9 days, respectively. Of 37 investigated variables, 24 qualitative and quantitative variables were significantly associated with length of stay (p<0.05. Multiple linear regression analysis showed that independent variables including age, medical insurance type, body mass index, and prior myocardial infarction; admission day, admission season, Cross-clamp time, pump usage, admission type, the number of laboratory tests and the number of specialty consultation had more effect on the hospital stay. We concluded that some significant factors influencing hospital stay after CABG were predictable and modifiable by hospital managers and decision makers to manage hospital beds.

Multilevel joint competing risk models

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Karunarathna, G. H. S.; Sooriyarachchi, M. R.

2017-09-01

Joint modeling approaches are often encountered for different outcomes of competing risk time to event and count in many biomedical and epidemiology studies in the presence of cluster effect. Hospital length of stay (LOS) has been the widely used outcome measure in hospital utilization due to the benchmark measurement for measuring multiple terminations such as discharge, transferred, dead and patients who have not completed the event of interest at the follow up period (censored) during hospitalizations. Competing risk models provide a method of addressing such multiple destinations since classical time to event models yield biased results when there are multiple events. In this study, the concept of joint modeling has been applied to the dengue epidemiology in Sri Lanka, 2006-2008 to assess the relationship between different outcomes of LOS and platelet count of dengue patients with the district cluster effect. Two key approaches have been applied to build up the joint scenario. In the first approach, modeling each competing risk separately using the binary logistic model, treating all other events as censored under the multilevel discrete time to event model, while the platelet counts are assumed to follow a lognormal regression model. The second approach is based on the endogeneity effect in the multilevel competing risks and count model. Model parameters were estimated using maximum likelihood based on the Laplace approximation. Moreover, the study reveals that joint modeling approach yield more precise results compared to fitting two separate univariate models, in terms of AIC (Akaike Information Criterion).

Multiple Scattering Model for Optical Coherence Tomography with Rytov Approximation

KAUST Repository

Li, Muxingzi

2017-01-01

of speckles due to multiple scatterers within the coherence length, and other random noise. Motivated by the above two challenges, a multiple scattering model based on Rytov approximation and Gaussian beam optics is proposed for the OCT setup. Some previous

Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-01-01

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

Science.gov (United States)

Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

2016-06-24

Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

MODEL PENSKORAN PARTIAL CREDIT PADA BUTIR MULTIPLE TRUE-FALSE BIDANG FISIKA

Directory of Open Access Journals (Sweden)

Wasis Wasis

2013-01-01

Full Text Available Tujuan penelitian ini menghasilkan model penskoran politomus untuk respons butir multiple true-false, sehingga dapat mengestimasi secara lebih akurat kemampuan di bidang fisika. Pengembangan penskoran menggunakan Four-D model dan diuji akurasinya melalui penelitian empiris dan simulasi. Penelitian empiris menggunakan 15 butir multiple true-false yang diambil dari soal UMPTN tahun 1996-2006 dan dikenakan pada 410 mahasiswa baru FMIPA Universitas Negeri Surabaya angkatan tahun 2007. Respons peserta tes diskor dengan tiga model partial credit (PCM I; II; dan III dan secara dikotomus. Hasil penskoran dianalisis dengan program Quest untuk mendapat-kan estimasi tingkat kesukaran butir (δ dan estimasi ke-mampuan peserta (θ untuk menentukan nilai fungsi informasi tes dan kesalahan baku estimasi. Penelitian simulasi mengguna-kan data bangkitan berdasarkan parameter empiris (δ dan θ memakai program statistik SAS dan akurasi estimasinya di-analisis dengan metode root mean squared error (RMSE. Hasil penelitian ini menunjukkan: (i Penskoran PCM dengan pem-bobotan mampu mengestimasi kemampuan lebih akurat di-bandingkan tanpa pembobotan maupun secara dikotomus; (ii Semakin banyak jumlah kategori dalam penskoran partial credit, semakin akurat. Kata kunci: model penskoran partial credit, butir multiple true-false ____________________________________________________________ THE PARTIAL CREDIT SCORING MODEL FOR THE MULTIPLE TRUE-FALSE BUTIRS IN PHYSICS Abstract This study is an attempt to overcome the weaknesses. This study aims to produce a polytomous scoring model for responses to multiple true-false butirs in order to get a more accurate estimation of abilities in physics. It adopts the Four-D model and its accuracy is assessed through empirical and simulation studies. The empirical study employed 15 multiple true-false butirs taken from the New Students Entrance Test of State University the year of 1996–2006. It administered to 410 new students enrolled

A taxonomy of nursing care organization models in hospitals.

Science.gov (United States)

Dubois, Carl-Ardy; D'Amour, Danielle; Tchouaket, Eric; Rivard, Michèle; Clarke, Sean; Blais, Régis

2012-08-28

Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the

Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

Science.gov (United States)

Torun, Nazan; Celik, Yusuf; Younis, Mustafa Z

2013-01-01

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

A collaborative scheduling model for the supply-hub with multiple suppliers and multiple manufacturers.

Science.gov (United States)

Li, Guo; Lv, Fei; Guan, Xu

2014-01-01

This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

A Technique of Fuzzy C-Mean in Multiple Linear Regression Model toward Paddy Yield

Science.gov (United States)

Syazwan Wahab, Nur; Saifullah Rusiman, Mohd; Mohamad, Mahathir; Amira Azmi, Nur; Che Him, Norziha; Ghazali Kamardan, M.; Ali, Maselan

2018-04-01

In this paper, we propose a hybrid model which is a combination of multiple linear regression model and fuzzy c-means method. This research involved a relationship between 20 variates of the top soil that are analyzed prior to planting of paddy yields at standard fertilizer rates. Data used were from the multi-location trials for rice carried out by MARDI at major paddy granary in Peninsular Malaysia during the period from 2009 to 2012. Missing observations were estimated using mean estimation techniques. The data were analyzed using multiple linear regression model and a combination of multiple linear regression model and fuzzy c-means method. Analysis of normality and multicollinearity indicate that the data is normally scattered without multicollinearity among independent variables. Analysis of fuzzy c-means cluster the yield of paddy into two clusters before the multiple linear regression model can be used. The comparison between two method indicate that the hybrid of multiple linear regression model and fuzzy c-means method outperform the multiple linear regression model with lower value of mean square error.

A Conceptual Model for Analysing Management Development in the UK Hospitality Industry

Science.gov (United States)

Watson, Sandra

2007-01-01

This paper presents a conceptual, contingent model of management development. It explains the nature of the UK hospitality industry and its potential influence on MD practices, prior to exploring dimensions and relationships in the model. The embryonic model is presented as a model that can enhance our understanding of the complexities of the…

Areas of Hospitality Management and Stakeholders in Recruitment and Selection Multiple Case Study: Estanplaza, Travel in and Transamérica.

Directory of Open Access Journals (Sweden)

Thiago Sbarai Santos Alves

2014-06-01

Full Text Available This research aims to analyze the relationships between recruitment and selection and its stakeholders, considering the areas of hospitality and its characteristics as influential factors to recruit and select new employees. The research approach was qualitative methodologies for the study of multiple cases, which contributed to the form of empirical research. For this investigation were selected by three chains together features that enabled a comparative analysis of the study, which were used for data collection, three sources of evidence: interviews, direct observations and documentation. The selected networks, Estanplaza Hotels, Hotels Transamerica and Travel Inn Hotels The overall goal was to understand the processes used in recruitment and selection set features the fields of hospitality. From this issue were established specific objectives: to observe the dynamics of recruitment and selection of chains; analyze the content related to the fields of hospitality in the tools used in the process of recruitment and selection, and meet stakeholders in this area. The research was conducted through interviews with managers of lodging facilities and with stakeholders in the area of recruitment and selection, based on a semistructured interview guide. Through this research, we found that some features of the fields of hospitality are considered in the process of recruitment and selection. Chains surveyed, however, point out that it is necessary to use tools and processes that enable this type of analysis.

Reduction of bias in neutron multiplicity assay using a weighted point model

Energy Technology Data Exchange (ETDEWEB)

Geist, W. H. (William H.); Krick, M. S. (Merlyn S.); Mayo, D. R. (Douglas R.)

2004-01-01

Accurate assay of most common plutonium samples was the development goal for the nondestructive assay technique of neutron multiplicity counting. Over the past 20 years the technique has been proven for relatively pure oxides and small metal items. Unfortunately, the technique results in large biases when assaying large metal items. Limiting assumptions, such as unifoh multiplication, in the point model used to derive the multiplicity equations causes these biases for large dense items. A weighted point model has been developed to overcome some of the limitations in the standard point model. Weighting factors are detemiined from Monte Carlo calculations using the MCNPX code. Monte Carlo calculations give the dependence of the weighting factors on sample mass and geometry, and simulated assays using Monte Carlo give the theoretical accuracy of the weighted-point-model assay. Measured multiplicity data evaluated with both the standard and weighted point models are compared to reference values to give the experimental accuracy of the assay. Initial results show significant promise for the weighted point model in reducing or eliminating biases in the neutron multiplicity assay of metal items. The negative biases observed in the assay of plutonium metal samples are caused by variations in the neutron multiplication for neutrons originating in various locations in the sample. The bias depends on the mass and shape of the sample and depends on the amount and energy distribution of the ({alpha},n) neutrons in the sample. When the standard point model is used, this variable-multiplication bias overestimates the multiplication and alpha values of the sample, and underestimates the plutonium mass. The weighted point model potentially can provide assay accuracy of {approx}2% (1 {sigma}) for cylindrical plutonium metal samples < 4 kg with {alpha} < 1 without knowing the exact shape of the samples, provided that the ({alpha},n) source is uniformly distributed throughout the

Psychosocial risks associated with multiple births resulting from assisted reproduction: a Spanish sample.

Science.gov (United States)

Roca de Bes, Montserrat; Gutierrez Maldonado, José; Gris Martínez, José M

2009-09-01

To determine the psychosocial risks associated with multiple births (twins or triplets) resulting from assisted reproductive technology (ART). Transverse study. Infertility units of a university hospital and a private hospital. Mothers and fathers of children between 6 months and 4 years conceived by ART (n = 123). The sample was divided into three groups: parents of singletons (n = 77), twins (n = 37), and triplets (n = 9). The questionnaire was self-administered by patients. It was either completed at the hospital or mailed to participants' homes. Scales measured material needs, quality of life, social stigma, depression, stress, and marital satisfaction. Logistic regression models were applied. Significant odds ratios were obtained for the number of children, material needs, social stigma, quality of life, and marital satisfaction. The results were more significant for data provided by mothers than by fathers. The informed consent form handed out at the beginning of ART should include information on the high risk of conceiving twins and triplets and on the possible psychosocial consequences of multiple births. As soon as a multiple pregnancy is confirmed, it would be useful to provide information on support groups and institutions. Psychological advice should also be given to the parents.

From job stress to intention to leave among hospital nurses: A structural equation modelling approach.

Science.gov (United States)

Lo, Wen-Yen; Chien, Li-Yin; Hwang, Fang-Ming; Huang, Nicole; Chiou, Shu-Ti

2018-03-01

The aim of this study was to examine the structural relationships linking job stress to leaving intentions through job satisfaction, depressed mood and stress adaptation among hospital nurses. High turnover among nurses is a global concern. Structural relationships linking job stress to leaving intentions have not been thoroughly examined. Two nationwide cross-sectional surveys of full-time hospital staff in 2011 and 2014. The study participants were 26,945 and 19,386 full-time clinical nurses in 2011 and 2014 respectively. Structural equation modelling was used to examine the interrelationships among the study variables based on the hypothesized model. We used cross-validation procedures to ensure the stability and validity of the model in the two samples. There were five main paths from job stress to intention to leave the hospital. In addition to the direct path, job stress directly affected job satisfaction and depressed mood, which in turn affected intention to leave the hospital. Stress adaptation mitigated the effects of job stress on job satisfaction and depressed mood, which led to intention to leave the hospital. Intention to leave the hospital preceded intention to leave the profession. Those variables explained about 55% of the variance in intention to leave the profession in both years. The model fit was good for both samples, suggesting validity of the model. Strategies to decrease turnover intentions among nurses could focus on creating a less stressful work environment, increasing job satisfaction and stress adaptation and decreasing depressed mood. Hospitals should cooperate in this issue to decrease nurse turnover. © 2017 John Wiley & Sons Ltd.

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

Science.gov (United States)

Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

Infinite Multiple Membership Relational Modeling for Complex Networks

DEFF Research Database (Denmark)

Mørup, Morten; Schmidt, Mikkel Nørgaard; Hansen, Lars Kai

Learning latent structure in complex networks has become an important problem fueled by many types of networked data originating from practically all fields of science. In this paper, we propose a new non-parametric Bayesian multiplemembership latent feature model for networks. Contrary to existing...... multiplemembership models that scale quadratically in the number of vertices the proposedmodel scales linearly in the number of links admittingmultiple-membership analysis in large scale networks. We demonstrate a connection between the single membership relational model and multiple membership models and show...

Analysis of the quality of hospital information systems in Isfahan teaching hospitals based on the DeLone and McLean model.

Science.gov (United States)

Saghaeiannejad-Isfahani, Sakineh; Saeedbakhsh, Saeed; Jahanbakhsh, Maryam; Habibi, Mahboobeh

2015-01-01

Quality is one of the most important criteria for the success of an information system, which refers to its desirable features of the processing system itself. The aim of this study was the analysis of system quality of hospital information systems (HIS) in teaching hospitals of Isfahan based on the DeLone and McLean model. This research was an applied and analytical-descriptive study. It was performed in teaching hospitals of Isfahan in 2010. The research population consisted of the HIS's users, system designers and hospital information technology (IT) authorities who were selected by random sampling method from users' group (n = 228), and system designers and IT authorities (n = 52) using census method. The data collection tool was two researcher-designed questionnaires. Questionnaires' reliability was estimated by using Cronbach's alpha was calculated. It was 97.1% for the system designers and IT authorities' questionnaire and 92.3% for system users' questionnaire. Findings showed that the mean of system quality score in a variety of HIS and among different hospitals was significantly different and not the same (P value ≥ 0.05). In general, Kosar (new version) system and Rahavard Rayaneh system have dedicated the highest and the lowest mean scores to themselves. The system quality criterion overall mean was 59.6% for different HIS and 57.5% among different hospitals respectively. According to the results of the research, it can be stated that based on the applied model, the investigated systems were relatively desirable in terms of quality. Thus, in order to achieve a good optimal condition, it is necessary to pay particular attention to the improving factors of system quality, type of activity, type of specialty and hospital ownership type.

A nurse-led model at public academic hospitals maintains high adherence to colorectal cancer surveillance guidelines.

Science.gov (United States)

Symonds, Erin L; Simpson, Kalindra; Coats, Michelle; Chaplin, Angela; Saxty, Karen; Sandford, Jayne; Young Am, Graeme P; Cock, Charles; Fraser, Robert; Bampton, Peter A

2018-06-18

To examine the compliance of colorectal cancer surveillance decisions for individuals at greater risk with current evidence-based guidelines and to determine whether compliance differs between surveillance models. Prospective auditing of compliance of surveillance decisions with evidence-based guidelines (NHMRC) in two decision-making models: nurse coordinator-led decision making in public academic hospitals and physician-led decision making in private non-academic hospitals. Selected South Australian hospitals participating in the Southern Co-operative Program for the Prevention of Colorectal Cancer (SCOOP). Proportions of recall recommendations that matched NHMRC guideline recommendations (March-May 2015); numbers of surveillance colonoscopies undertaken more than 6 months ahead of schedule (January-December 2015); proportions of significant neoplasia findings during the 15 years of SCOOP operation (2000-2015). For the nurse-led/public academic hospital model, the recall interval recommendation following 398 of 410 colonoscopies (97%) with findings covered by NHMRC guidelines corresponded to the guideline recommendations; for the physician-led/private non-academic hospital model, this applied to 257 of 310 colonoscopies (83%) (P < 0.001). During 2015, 27% of colonoscopies in public academic hospitals (mean, 27 months; SD, 13 months) and 20% of those in private non-academic hospitals (mean, 23 months; SD, 12 months) were performed more than 6 months earlier than scheduled, in most cases because of patient-related factors (symptoms, faecal occult blood test results). The ratio of the numbers of high risk adenomas to cancers increased from 6.6:1 during 2001-2005 to 16:1 during 2011-2015. The nurse-led/public academic hospital model for decisions about colorectal cancer surveillance intervals achieves a high degree of compliance with guideline recommendations, which should relieve burdening of colonoscopy resources.

Optimization of the Darrieus wind turbines with double-multiple-streamtube model

International Nuclear Information System (INIS)

Paraschivoiu, I.

1985-01-01

This paper discusses a new improvement of the double-multiple-stream tube model by considering the stream tube expansion effects on the Darrieus wind turbine. These effects, allowing a more realistic modeling of the upwind/downwind flow field asymmetries inherent in the Darrieus rotor, were calculated by using CARDAAX computer code. When the dynamic stall is introduced in the double-multiple-stream tube model, the aerodynamic loads and performance show significant changes in the range of low tip-speed ratio

Application of multiple objective models to water resources planning and management

International Nuclear Information System (INIS)

North, R.M.

1993-01-01

Over the past 30 years, we have seen the birth and growth of multiple objective analysis from an idea without tools to one with useful applications. Models have been developed and applications have been researched to address the multiple purposes and objectives inherent in the development and management of water resources. A practical approach to multiple objective modelling incorporates macroeconomic-based policies and expectations in order to optimize the results from both engineering (structural) and management (non-structural) alternatives, while taking into account the economic and environmental trade-offs. (author). 27 refs, 4 figs, 3 tabs

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.

A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

Directory of Open Access Journals (Sweden)

Guo Li

2014-01-01

Full Text Available This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment.

A Collaborative Scheduling Model for the Supply-Hub with Multiple Suppliers and Multiple Manufacturers

Science.gov (United States)

Lv, Fei; Guan, Xu

2014-01-01

This paper investigates a collaborative scheduling model in the assembly system, wherein multiple suppliers have to deliver their components to the multiple manufacturers under the operation of Supply-Hub. We first develop two different scenarios to examine the impact of Supply-Hub. One is that suppliers and manufacturers make their decisions separately, and the other is that the Supply-Hub makes joint decisions with collaborative scheduling. The results show that our scheduling model with the Supply-Hub is a NP-complete problem, therefore, we propose an auto-adapted differential evolution algorithm to solve this problem. Moreover, we illustrate that the performance of collaborative scheduling by the Supply-Hub is superior to separate decision made by each manufacturer and supplier. Furthermore, we also show that the algorithm proposed has good convergence and reliability, which can be applicable to more complicated supply chain environment. PMID:24892104

The Effect of ISO 9001 and the EFQM Model on Improving Hospital Performance: A Systematic Review.

Science.gov (United States)

Yousefinezhadi, Taraneh; Mohamadi, Efat; Safari Palangi, Hossein; Akbari Sari, Ali

2015-12-01

This study aimed to explore the effect of the International Organization for Standardization (ISO) ISO 9001 standard and the European foundation for quality management (EFQM) model on improving hospital performance. PubMed, Embase and the Cochrane Library databases were searched. In addition, Elsevier and Springer were searched as main publishers in the field of health sciences. We included empirical studies with any design that had used ISO 9001 or the EFQM model to improve the quality of healthcare. Data were collected and tabulated into a data extraction sheet that was specifically designed for this study. The collected data included authors' names, country, year of publication, intervention, improvement aims, setting, length of program, study design, and outcomes. Seven out of the 121 studies that were retrieved met the inclusion criteria. Three studies assessed the EFQM model and four studies assessed the ISO 9001 standard. Use of the EFQM model increased the degree of patient satisfaction and the number of hospital admissions and reduced the average length of stay, the delay on the surgical waiting list, and the number of emergency re-admissions. ISO 9001 also increased the degree of patient satisfaction and patient safety, increased cost-effectiveness, improved the hospital admissions process, and reduced the percentage of unscheduled returns to the hospital. Generally, there is a lack of robust and high quality empirical evidence regarding the effects of ISO 9001 and the EFQM model on the quality care provided by and the performance of hospitals. However, the limited evidence shows that ISO 9001 and the EFQM model might improve hospital performance.

Testing the "Work Ability House" Model in hospital workers.

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Martinez, Maria Carmen; Latorre, Maria do Rosário Dias de Oliveira; Fischer, Frida Marina

2016-01-01

To test the Work Ability House model, verifying the hierarchy of proposed dimensions, among a group of hospital workers. A cohort study (2009-2011) was conducted with a sample of 599 workers from a hospital in the city of São Paulo. A questionnaire including sociodemographics, lifestyle and working conditions was used. The Brazilian versions of Job Stress Scale, Effort-Reward Imbalance, Work-Related Activities That May Contribute To Job-Related Pain and/or Injury, and the Work Ability Index (WAI) were also used. A hierarchical logistic regression analysis was performed: the independent variables were allocated into levels according to the dimensions of the theoretical model in order to evaluate the factors associated with work ability. Variables associated with impairment of work ability in each dimension were as follows: (a) sociodemographics: age work injuries (p = 0.029), (c) professional competence: low educational level (p = 0.008), (d) values : intensified in overcommitment (p work: intensification of effort-reward imbalance (p = 0.009) and high demands (p = 0.040). The results confirmed the dimensions proposed for the Work Ability House model, indicating that it is valid as a representation of a multidimensional construct of multifactorial determination and can be used in the management of work ability.

Multiple Time Series Ising Model for Financial Market Simulations

International Nuclear Information System (INIS)

Takaishi, Tetsuya

2015-01-01

In this paper we propose an Ising model which simulates multiple financial time series. Our model introduces the interaction which couples to spins of other systems. Simulations from our model show that time series exhibit the volatility clustering that is often observed in the real financial markets. Furthermore we also find non-zero cross correlations between the volatilities from our model. Thus our model can simulate stock markets where volatilities of stocks are mutually correlated

Health behaviors and quality of life predictors for risk of hospitalization in an electronic health record-linked biobank

Directory of Open Access Journals (Sweden)

Takahashi PY

2015-08-01

Full Text Available Paul Y Takahashi,1,2 Euijung Ryu,3 Janet E Olson,3 Erin M Winkler,4 Matthew A Hathcock,3 Ruchi Gupta,3 Jeff A Sloan,3 Jyotishman Pathak,3 Suzette J Bielinski,3 James R Cerhan3 1Division of Primary Care Internal Medicine, 2Department of Internal Medicine, 3Department of Health Sciences Research, 4Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA Background: Hospital risk stratification models using electronic health records (EHRs often use age and comorbid health burden. Our primary aim was to determine if quality of life or health behaviors captured in an EHR-linked biobank can predict future risk of hospitalization. Methods: Participants in the Mayo Clinic Biobank completed self-administered questionnaires at enrollment that included quality of life and health behaviors. Participants enrolled as of December 31, 2010 were followed for one year to ascertain hospitalization. Data on comorbidities and hospitalization were derived from the Mayo Clinic EHR. Hazard ratios (HR and 95% confidence interval (CI were used, adjusted for age and sex. We used gradient boosting machines models to integrate multiple factors. Different models were compared using C-statistic. Results: Of the 8,927 eligible Mayo Clinic Biobank participants, 834 (9.3% were hospitalized. Self-perceived health status and alcohol use had the strongest associations with risk of hospitalization. Compared to participants with excellent self-perceived health, those reporting poor/fair health had higher risk of hospitalization (HR =3.66, 95% CI 2.74–4.88. Alcohol use was inversely associated with hospitalization (HR =0.57 95% CI 0.45–0.72. The gradient boosting machines model estimated self-perceived health as the most influential factor (relative influence =16%. The predictive ability of the model based on comorbidities was slightly higher than the one based on the self-perceived health (C-statistic =0.67 vs 0.65. Conclusion: This study demonstrates that self

Hospital nurses' wellbeing at work: a theoretical model.

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Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi

2015-09-01

To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.

Depression and pain: testing of serial multiple mediators

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Wongpakaran T

2016-07-01

Full Text Available Tinakon Wongpakaran,1 Nahathai Wongpakaran,1 Sitthinant Tanchakvaranont,2 Putipong Bookkamana,3 Manee Pinyopornpanish,1 Kamonporn Wannarit,4 Sirina Satthapisit,5 Daochompu Nakawiro,6 Thanita Hiranyatheb,6 Kulvadee Thongpibul7 1Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand; 2Department of Psychiatry, Queen Savang Vadhana Memorial Hospital, Chonburi, Kingdom of Thailand; 3Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Kingdom of Thailand; 4Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 5Department of Psychiatry, Khon Kaen Regional Hospital, Khon Kaen, Kingdom of Thailand; 6Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Kingdom of Thailand; 7Department of Psychology, Faculty of Humanities, Chiang Mai University, Chiang Mai, Kingdom of Thailand Purpose: Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders.Participants and methods: An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36, the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed.Results: Perceived stress, self-sacrificing interpersonal style, and cognitive

Alternative approaches to reliability modeling of a multiple engineered barrier system

International Nuclear Information System (INIS)

Ananda, M.M.A.; Singh, A.K.

1994-01-01

The lifetime of the engineered barrier system used for containment of high-level radioactive waste will significantly impact the total performance of a geological repository facility. Currently two types of designs are under consideration for an engineered barrier system, single engineered barrier system and multiple engineered barrier system. Multiple engineered barrier system consists of several metal barriers and the waste form (cladding). Some recent work show that a significant improvement of performance can be achieved by utilizing multiple engineered barrier systems. Considering sequential failures for each barrier, we model the reliability of the multiple engineered barrier system. Weibull and exponential lifetime distributions are used through out the analysis. Furthermore, the number of failed engineered barrier systems in a repository at a given time is modeled using a poisson approximation

Risk factors associated with malnutrition in hospitalized patients

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Roberta Flores Marquezini FRAGAS

2016-06-01

Full Text Available ABSTRACT Objective To identify factors associated with malnutrition in patients hospitalized in general public hospitals of the city of Manaus, Amazonas, Brazil. Methods This cross-sectional study included 397 patients of both sexes aged more than 18 years, staying at three public hospitals in Manaus, Amazonas. The patients were submitted to anthropometric and subjective global assessments, the latter being the main diagnostic method. For association analyses between malnutrition (dependent variable and other covariates, we used contingency table for variable selection and multiple logistic regression for independent effect test between exposure and outcome. The strength of association between the variables was expressed as odds ratio, with a 95% confidence interval. The analyses were performed by Epi Info 7.0. Results Among the risk factors associated with hospital malnutrition, hospital stays longer than 15 days, when analyzed alone, nearly tripled the odds of malnutrition. However, in the final model, the variables that remained associated were: persistent change in diet, presence of gastrointestinal symptoms, recent weight loss, weight loss in the last six months, cancer, and age higher than 60 years. Conclusion Malnutrition is recurrent in hospitals, and the factors associated with malnutrition can be identified on admission, allowing adequate monitoring during hospital stay. Therefore, a more effective performance of nutritional screening and monitoring programs is critical.

Teaching hospital performance: towards a community of shared values?

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Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

2014-01-01

This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Feedback structure based entropy approach for multiple-model estimation

Institute of Scientific and Technical Information of China (English)

Shen-tu Han; Xue Anke; Guo Yunfei

2013-01-01

The variable-structure multiple-model (VSMM) approach, one of the multiple-model (MM) methods, is a popular and effective approach in handling problems with mode uncertainties. The model sequence set adaptation (MSA) is the key to design a better VSMM. However, MSA methods in the literature have big room to improve both theoretically and practically. To this end, we propose a feedback structure based entropy approach that could find the model sequence sets with the smallest size under certain conditions. The filtered data are fed back in real time and can be used by the minimum entropy (ME) based VSMM algorithms, i.e., MEVSMM. Firstly, the full Markov chains are used to achieve optimal solutions. Secondly, the myopic method together with particle filter (PF) and the challenge match algorithm are also used to achieve sub-optimal solutions, a trade-off between practicability and optimality. The numerical results show that the proposed algorithm provides not only refined model sets but also a good robustness margin and very high accuracy.

A PDP model of the simultaneous perception of multiple objects

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Henderson, Cynthia M.; McClelland, James L.

2011-06-01

Illusory conjunctions in normal and simultanagnosic subjects are two instances where the visual features of multiple objects are incorrectly 'bound' together. A connectionist model explores how multiple objects could be perceived correctly in normal subjects given sufficient time, but could give rise to illusory conjunctions with damage or time pressure. In this model, perception of two objects benefits from lateral connections between hidden layers modelling aspects of the ventral and dorsal visual pathways. As with simultanagnosia, simulations of dorsal lesions impair multi-object recognition. In contrast, a large ventral lesion has minimal effect on dorsal functioning, akin to dissociations between simple object manipulation (retained in visual form agnosia and semantic dementia) and object discrimination (impaired in these disorders) [Hodges, J.R., Bozeat, S., Lambon Ralph, M.A., Patterson, K., and Spatt, J. (2000), 'The Role of Conceptual Knowledge: Evidence from Semantic Dementia', Brain, 123, 1913-1925; Milner, A.D., and Goodale, M.A. (2006), The Visual Brain in Action (2nd ed.), New York: Oxford]. It is hoped that the functioning of this model might suggest potential processes underlying dorsal and ventral contributions to the correct perception of multiple objects.

Key performance indicators in hospital based on balanced scorecard model

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Hamed Rahimi

2017-01-01

Full Text Available Introduction: Performance measurement is receiving increasing verification all over the world. Nowadays in a lot of organizations, irrespective of their type or size, performance evaluation is the main concern and a key issue for top administrators. The purpose of this study is to organize suitable key performance indicators (KPIs for hospitals’ performance evaluation based on the balanced scorecard (BSC. Method: This is a mixed method study. In order to identify the hospital’s performance indicators (HPI, first related literature was reviewed and then the experts’ panel and Delphi method were used. In this study, two rounds were needed for the desired level of consensus. The experts rated the importance of the indicators, on a five-point Likert scale. In the consensus calculation, the consensus percentage was calculated by classifying the values 1-3 as not important (0 and 4-5 to (1 as important. Simple additive weighting technique was used to rank the indicators and select hospital’s KPIs. The data were analyzed by Excel 2010 software. Results: About 218 indicators were obtained from a review of selected literature. Through internal expert panel, 77 indicators were selected. Finally, 22 were selected for KPIs of hospitals. Ten indicators were selected in internal process perspective and 5, 4, and 3 indicators in finance, learning and growth, and customer, respectively. Conclusion: This model can be a useful tool for evaluating and comparing the performance of hospitals. However, this model is flexible and can be adjusted according to differences in the target hospitals. This study can be beneficial for hospital administrators and it can help them to change their perspective about performance evaluation.

Selection of asset investment models by hospitals: examination of influencing factors, using Switzerland as an example.

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Eicher, Bernhard

2016-10-01

Hospitals are responsible for a remarkable part of the annual increase in healthcare expenditure. This article examines one of the major cost drivers, the expenditure for investment in hospital assets. The study, conducted in Switzerland, identifies factors that influence hospitals' investment decisions. A suggestion on how to categorize asset investment models is presented based on the life cycle of an asset, and its influencing factors defined based on transaction cost economics. The influence of five factors (human asset specificity, physical asset specificity, uncertainty, bargaining power, and privacy of ownership) on the selection of an asset investment model is examined using a two-step fuzzy-set Qualitative Comparative Analysis. The research shows that outsourcing-oriented asset investment models are particularly favored in the presence of two combinations of influencing factors: First, if technological uncertainty is high and both human asset specificity and bargaining power of a hospital are low. Second, if assets are very specific, technological uncertainty is high and there is a private hospital with low bargaining power, outsourcing-oriented asset investment models are favored too. Using Qualitative Comparative Analysis, it can be demonstrated that investment decisions of hospitals do not depend on isolated influencing factors but on a combination of factors. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

MODEL PENSKORAN PARTIAL CREDIT PADA BUTIR MULTIPLE TRUE-FALSE BIDANG FISIKA

OpenAIRE

Wasis Wasis

2013-01-01

Tujuan penelitian ini menghasilkan model penskoran politomus untuk respons butir multiple true-false, sehingga dapat mengestimasi secara lebih akurat kemampuan di bidang fisika. Pengembangan penskoran menggunakan Four-D model dan diuji akurasinya melalui penelitian empiris dan simulasi. Penelitian empiris menggunakan 15 butir multiple true-false yang diambil dari soal UMPTN tahun 1996-2006 dan dikenakan pada 410 mahasiswa baru FMIPA Universitas Negeri Surabaya angkatan tahun 2007. Respons pes...

[Children's medically complex diseases unit. A model required in all our hospitals].

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Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

2018-01-01

The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Hybrid approaches for multiple-species stochastic reaction–diffusion models

International Nuclear Information System (INIS)

Spill, Fabian; Guerrero, Pilar; Alarcon, Tomas; Maini, Philip K.; Byrne, Helen

2015-01-01

Reaction–diffusion models are used to describe systems in fields as diverse as physics, chemistry, ecology and biology. The fundamental quantities in such models are individual entities such as atoms and molecules, bacteria, cells or animals, which move and/or react in a stochastic manner. If the number of entities is large, accounting for each individual is inefficient, and often partial differential equation (PDE) models are used in which the stochastic behaviour of individuals is replaced by a description of the averaged, or mean behaviour of the system. In some situations the number of individuals is large in certain regions and small in others. In such cases, a stochastic model may be inefficient in one region, and a PDE model inaccurate in another. To overcome this problem, we develop a scheme which couples a stochastic reaction–diffusion system in one part of the domain with its mean field analogue, i.e. a discretised PDE model, in the other part of the domain. The interface in between the two domains occupies exactly one lattice site and is chosen such that the mean field description is still accurate there. In this way errors due to the flux between the domains are small. Our scheme can account for multiple dynamic interfaces separating multiple stochastic and deterministic domains, and the coupling between the domains conserves the total number of particles. The method preserves stochastic features such as extinction not observable in the mean field description, and is significantly faster to simulate on a computer than the pure stochastic model. - Highlights: • A novel hybrid stochastic/deterministic reaction–diffusion simulation method is given. • Can massively speed up stochastic simulations while preserving stochastic effects. • Can handle multiple reacting species. • Can handle moving boundaries

Hybrid approaches for multiple-species stochastic reaction–diffusion models

Energy Technology Data Exchange (ETDEWEB)

Spill, Fabian, E-mail: fspill@bu.edu [Department of Biomedical Engineering, Boston University, 44 Cummington Street, Boston, MA 02215 (United States); Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139 (United States); Guerrero, Pilar [Department of Mathematics, University College London, Gower Street, London WC1E 6BT (United Kingdom); Alarcon, Tomas [Centre de Recerca Matematica, Campus de Bellaterra, Edifici C, 08193 Bellaterra (Barcelona) (Spain); Departament de Matemàtiques, Universitat Atonòma de Barcelona, 08193 Bellaterra (Barcelona) (Spain); Maini, Philip K. [Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, Oxford OX2 6GG (United Kingdom); Byrne, Helen [Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, Oxford OX2 6GG (United Kingdom); Computational Biology Group, Department of Computer Science, University of Oxford, Oxford OX1 3QD (United Kingdom)

2015-10-15

Reaction–diffusion models are used to describe systems in fields as diverse as physics, chemistry, ecology and biology. The fundamental quantities in such models are individual entities such as atoms and molecules, bacteria, cells or animals, which move and/or react in a stochastic manner. If the number of entities is large, accounting for each individual is inefficient, and often partial differential equation (PDE) models are used in which the stochastic behaviour of individuals is replaced by a description of the averaged, or mean behaviour of the system. In some situations the number of individuals is large in certain regions and small in others. In such cases, a stochastic model may be inefficient in one region, and a PDE model inaccurate in another. To overcome this problem, we develop a scheme which couples a stochastic reaction–diffusion system in one part of the domain with its mean field analogue, i.e. a discretised PDE model, in the other part of the domain. The interface in between the two domains occupies exactly one lattice site and is chosen such that the mean field description is still accurate there. In this way errors due to the flux between the domains are small. Our scheme can account for multiple dynamic interfaces separating multiple stochastic and deterministic domains, and the coupling between the domains conserves the total number of particles. The method preserves stochastic features such as extinction not observable in the mean field description, and is significantly faster to simulate on a computer than the pure stochastic model. - Highlights: • A novel hybrid stochastic/deterministic reaction–diffusion simulation method is given. • Can massively speed up stochastic simulations while preserving stochastic effects. • Can handle multiple reacting species. • Can handle moving boundaries.

Modeling a Single SEP Event from Multiple Vantage Points Using the iPATH Model

Science.gov (United States)

Hu, Junxiang; Li, Gang; Fu, Shuai; Zank, Gary; Ao, Xianzhi

2018-02-01

Using the recently extended 2D improved Particle Acceleration and Transport in the Heliosphere (iPATH) model, we model an example gradual solar energetic particle event as observed at multiple locations. Protons and ions that are energized via the diffusive shock acceleration mechanism are followed at a 2D coronal mass ejection-driven shock where the shock geometry varies across the shock front. The subsequent transport of energetic particles, including cross-field diffusion, is modeled by a Monte Carlo code that is based on a stochastic differential equation method. Time intensity profiles and particle spectra at multiple locations and different radial distances, separated in longitudes, are presented. The results shown here are relevant to the upcoming Parker Solar Probe mission.

Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.

Science.gov (United States)

Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

2014-11-01

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Science.gov (United States)

Bruce, Lisa; Li, Nien-Chen; Mooney, Ann; Maddux, Franklin W.

2014-01-01

Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions (“down in the dumps” and “downhearted and blue”). A high depressive affect score corresponded with an average response of “some of the time” or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively. Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models. Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future

Variability of patient safety culture in Belgian acute hospitals.

Science.gov (United States)

Vlayen, Annemie; Schrooten, Ward; Wami, Welcome; Aerts, Marc; Barrado, Leandro Garcia; Claes, Neree; Hellings, Johan

2015-06-01

The aim of this study was to measure differences in safety culture perceptions within Belgian acute hospitals and to examine variability based on language, work area, staff position, and work experience. The Hospital Survey on Patient Safety Culture was distributed to hospitals participating in the national quality and safety program (2007-2009). Hospitals were invited to participate in a comparative study. Data of 47,136 respondents from 89 acute hospitals were used for quantitative analysis. Percentages of positive response were calculated on 12 dimensions. Generalized estimating equations models were fitted to explore differences in safety culture. Handoffs and transitions, staffing, and management support for patient safety were considered as major problem areas. Dutch-speaking hospitals had higher odds of positive perceptions for most dimensions in comparison with French-speaking hospitals. Safety culture scores were more positive for respondents working in pediatrics, psychiatry, and rehabilitation compared with the emergency department, operating theater, and multiple hospital units. We found an important gap in safety culture perceptions between leaders and assistants within disciplines. Administration and middle management had lower perceptions toward patient safety. Respondents working less than 1 year in the current hospital had more positive safety culture perceptions in comparison with all other respondents. Large comparative databases provide the opportunity to identify distinct high and low scoring groups. In our study, language, work area, and profession were identified as important safety culture predictors. Years of experience in the hospital had only a small effect on safety culture perceptions.

Endodontic flare-ups: comparison of incidence between single and multiple visits procedures in patients attending a Nigerian teaching hospital.

Science.gov (United States)

Oginni, Ao; Udoye, C I

2004-12-01

The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

Impact of comorbidities on hospitalization costs following hip fracture.

Science.gov (United States)

Nikkel, Lucas E; Fox, Edward J; Black, Kevin P; Davis, Charles; Andersen, Lucille; Hollenbeak, Christopher S

2012-01-04

Hip fractures are common in the elderly, and patients with hip fractures frequently have comorbid illnesses. Little is known about the relationship between comorbid illness and hospital costs or length of stay following the treatment of hip fracture in the United States. We hypothesized that specific individual comorbid illnesses and multiple comorbid illnesses would be directly related to the hospitalization costs and the length of stay for older patients following hip fracture. With use of discharge data from the 2007 Nationwide Inpatient Sample, 32,440 patients who were fifty-five years or older with an isolated, closed hip fracture were identified. Using generalized linear models, we estimated the impact of comorbidities on hospitalization costs and length of stay, controlling for patient, hospital, and procedure characteristics. Hypertension, deficiency anemias, and fluid and electrolyte disorders were the most common comorbidities. The patients had a mean of three comorbidities. Only 4.9% of patients presented without comorbidities. The average estimated cost in our reference patient was $13,805. The comorbidity with the largest increased hospitalization cost was weight loss or malnutrition, followed by pulmonary circulation disorders. Most other comorbidities significantly increased the cost of hospitalization. Compared with internal fixation of the hip fracture, hip arthroplasty increased hospitalization costs significantly. Comorbidities significantly affect the cost of hospitalization and length of stay following hip fracture in older Americans, even while controlling for other variables.

Dealing with Multiple Solutions in Structural Vector Autoregressive Models.

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Beltz, Adriene M; Molenaar, Peter C M

2016-01-01

Structural vector autoregressive models (VARs) hold great potential for psychological science, particularly for time series data analysis. They capture the magnitude, direction of influence, and temporal (lagged and contemporaneous) nature of relations among variables. Unified structural equation modeling (uSEM) is an optimal structural VAR instantiation, according to large-scale simulation studies, and it is implemented within an SEM framework. However, little is known about the uniqueness of uSEM results. Thus, the goal of this study was to investigate whether multiple solutions result from uSEM analysis and, if so, to demonstrate ways to select an optimal solution. This was accomplished with two simulated data sets, an empirical data set concerning children's dyadic play, and modifications to the group iterative multiple model estimation (GIMME) program, which implements uSEMs with group- and individual-level relations in a data-driven manner. Results revealed multiple solutions when there were large contemporaneous relations among variables. Results also verified several ways to select the correct solution when the complete solution set was generated, such as the use of cross-validation, maximum standardized residuals, and information criteria. This work has immediate and direct implications for the analysis of time series data and for the inferences drawn from those data concerning human behavior.

A taxonomy of nursing care organization models in hospitals

Science.gov (United States)

2012-01-01

Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice

Dynamic Bus Travel Time Prediction Models on Road with Multiple Bus Routes.

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Bai, Cong; Peng, Zhong-Ren; Lu, Qing-Chang; Sun, Jian

2015-01-01

Accurate and real-time travel time information for buses can help passengers better plan their trips and minimize waiting times. A dynamic travel time prediction model for buses addressing the cases on road with multiple bus routes is proposed in this paper, based on support vector machines (SVMs) and Kalman filtering-based algorithm. In the proposed model, the well-trained SVM model predicts the baseline bus travel times from the historical bus trip data; the Kalman filtering-based dynamic algorithm can adjust bus travel times with the latest bus operation information and the estimated baseline travel times. The performance of the proposed dynamic model is validated with the real-world data on road with multiple bus routes in Shenzhen, China. The results show that the proposed dynamic model is feasible and applicable for bus travel time prediction and has the best prediction performance among all the five models proposed in the study in terms of prediction accuracy on road with multiple bus routes.

Dynamic Bus Travel Time Prediction Models on Road with Multiple Bus Routes

Science.gov (United States)

Bai, Cong; Peng, Zhong-Ren; Lu, Qing-Chang; Sun, Jian

2015-01-01

Accurate and real-time travel time information for buses can help passengers better plan their trips and minimize waiting times. A dynamic travel time prediction model for buses addressing the cases on road with multiple bus routes is proposed in this paper, based on support vector machines (SVMs) and Kalman filtering-based algorithm. In the proposed model, the well-trained SVM model predicts the baseline bus travel times from the historical bus trip data; the Kalman filtering-based dynamic algorithm can adjust bus travel times with the latest bus operation information and the estimated baseline travel times. The performance of the proposed dynamic model is validated with the real-world data on road with multiple bus routes in Shenzhen, China. The results show that the proposed dynamic model is feasible and applicable for bus travel time prediction and has the best prediction performance among all the five models proposed in the study in terms of prediction accuracy on road with multiple bus routes. PMID:26294903

Green communication: The enabler to multiple business models

DEFF Research Database (Denmark)

Lindgren, Peter; Clemmensen, Suberia; Taran, Yariv

2010-01-01

Companies stand at the forefront of a new business model reality with new potentials - that will change their basic understanding and practice of running their business models radically. One of the drivers to this change is green communication, its strong relation to green business models and its...... possibility to enable lower energy consumption. This paper shows how green communication enables innovation of green business models and multiple business models running simultaneously in different markets to different customers.......Companies stand at the forefront of a new business model reality with new potentials - that will change their basic understanding and practice of running their business models radically. One of the drivers to this change is green communication, its strong relation to green business models and its...

Hospitals and organizational models based on the intensity of treatment: the internist's point of view

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Giuseppe Chesi

2012-01-01

Full Text Available IntroductionThe type of patients being treated in our hospitals has changed significantly. Today's patients are much older with more complicated, polypathological problems. As a result, hospital organization and management structures must also change, particularly in Internal Medicine. A widely discussed approach, organization according to “intensity of treatment,” could be an appropriate solution from an organizational viewpoint that would also satisfy these new demands.Materials and methodsWith the aid of a questionnaire sent to internists working in the hospitals of Italy's Emilia-Romagna region and the review of the relevant medical literature, we defined structural, organizational, technological, managerial, and staffing characteristics to better determine and classify this model. We analyzed questionnaire responses of 31 internists heading operative units in their hospitals, a relatively homogeneous subgroup with experience in organizing and managing healthcare as well as its clinical aspects.ResultsAnalysis of these questionnaires revealed important points concerning the model: 1 an accurate identification of the medical care on which to base the model; 2 a well-defined strategy for differentiated allocation of staff to structural and technological areas depending on the level of medical care provided in the area; 3 an accurate definition of the types and features of patients targeted by each level of medical care; 4 an early exchange (starting from the patient's arrival in the Emergency Department of information and medical knowledge among Emergency Department physicians and those present during the initial stages of hospitalization; 5 a precise definition of responsibilities in the different areas, operative and collaborative stages among different physicians and medical staff, the different disciplines involved in the process.ConclusionsAmong the physicians responsible for managing complex areas of Internal Medicine in Emilia

An individual-based model of transmission of resistant bacteria in a veterinary teaching hospital.

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Neeraj Suthar

Full Text Available Veterinary nosocomial infections caused by antibiotic resistant bacteria cause increased morbidity, higher cost and length of treatment and increased zoonotic risk because of the difficulty in treating them. In this study, an individual-based model was developed to investigate the effects of movements of canine patients among ten areas (transmission points within a veterinary teaching hospital, and the effects of these movements on transmission of antibiotic susceptible and resistant pathogens. The model simulates contamination of transmission points, healthcare workers, and patients as well as the effects of decontamination of transmission points, disinfection of healthcare workers, and antibiotic treatments of canine patients. The model was parameterized using data obtained from hospital records, information obtained by interviews with hospital staff, and the published literature. The model suggested that transmission resulting from contact with healthcare workers was common, and that certain transmission points (housing wards, diagnostics room, and the intensive care unit presented higher risk for transmission than others (lobby and surgery. Sensitivity analyses using a range of parameter values demonstrated that the risk of acquisition of colonization by resistant pathogens decreased with shorter patient hospital stays (P<0.0001, more frequent decontamination of transmission points and disinfection of healthcare workers (P<0.0001 and better compliance of healthcare workers with hygiene practices (P<0.0001. More frequent decontamination of heavily trafficked transmission points was especially effective at reducing transmission of the model pathogen.

HOW COULD HOSPITALS ACT IN AN AGEING SOCIETY?

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Leuca Mirela

2011-12-01

Full Text Available The demographic changes are of great importance for all European societies. Their impact and effects have multiple, deep facets. Each European healthcare and welfare system will be facing considerable changes in the new demographic context. The hospital sector plays an important role in each health system. This paper focuses on the impact of the demographic changes on hospitals, presents and analyzes statistical data for the German hospitals sector in order to underline the importance of the older age groups for the number of the hospital inpatient cases, the provided range of medical services and disciplines and for the hospital disease costs. The paper also reveals main findings from 30 interviews conducted in 2010 with German health experts (from hospitals, health insurance companies, universities, institutes and regional healthcare policy makers that accepted to answer questions referring to the demographic impact on the German healthcare system and hospital sector. The results of the interviews show that hospitals will have to act and react to the demographic changes. German hospitals might play different roles in the healthcare service provision for older people when engaging in new models of integrated care that will have to be developed. Processes, structures, human resources expertise, hospital service provision and medical departments will undergo major changes in response to the demographic challenges. Networks, centres of excellence for older persons and integrated care will probably be indispensable structures of the German healthcare system in the future. Strategic partnerships with pre- and post-hospital healthcare service providers are considered to be top priorities for German hospitals when facing the demographic challenge. Central case management and process optimization can be essential factors of success in the hospital care of the older, multimorbid patients. Acute geriatric medicine will be a main quality feature for the

Food production and service in UK hospitals.

Science.gov (United States)

Ahmed, Mohamed; Jones, Eleri; Redmond, Elizabeth; Hewedi, Mahmoud; Wingert, Andreas; Gad El Rab, Mohamed

2015-01-01

The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food. Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations. Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. The paper identifies opportunities for enhancing hospital food production systems. The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.

The Impact of Hospital Size on CMS Hospital Profiling.

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Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J

2016-04-01

The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.

PFI redux? Assessing a new model for financing hospitals.

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Hellowell, Mark

2013-11-01

There is a growing need for investments in hospital facilities to improve the efficiency and quality of health services. In recent years, publicly financed hospital organisations in many countries have utilised private finance arrangements, variously called private finance initiatives (PFIs), public-private partnerships (PPPs) or P3s, to address their capital requirements. However, such projects have become more difficult to implement since the onset of the global financial crisis, which has led to a reduction in the supply of debt capital and an increase in its price. In December 2012, the government of the United Kingdom outlined a comprehensive set of reforms to the private finance model in order to revive this important source of capital for hospital investments. This article provides a critical assessment of the 'Private Finance 2' reforms, focusing on their likely impact on the supply and cost of capital. It concludes that constraints in supply are likely to continue, in part due to regulatory constraints facing both commercial banks and institutional investors, while the cost of capital is likely to increase, at least in the short term. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

An extension of the multiple-trapping model

International Nuclear Information System (INIS)

Shkilev, V. P.

2012-01-01

The hopping charge transport in disordered semiconductors is considered. Using the concept of the transport energy level, macroscopic equations are derived that extend a multiple-trapping model to the case of semiconductors with both energy and spatial disorders. It is shown that, although both types of disorder can cause dispersive transport, the frequency dependence of conductivity is determined exclusively by the spatial disorder.

The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization.

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Aliberti, Márlon J R; Suemoto, Claudia K; Fortes-Filho, Sileno Q; Melo, Juliana A; Trindade, Carolina B; Kasai, Juliana Y T; Altona, Marcelo; Apolinario, Daniel; Jacob-Filho, Wilson

2016-10-01

Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6-hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self-reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost-effectiveness. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

A Multiple Model Prediction Algorithm for CNC Machine Wear PHM

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Huimin Chen

2011-01-01

Full Text Available The 2010 PHM data challenge focuses on the remaining useful life (RUL estimation for cutters of a high speed CNC milling machine using measurements from dynamometer, accelerometer, and acoustic emission sensors. We present a multiple model approach for wear depth estimation of milling machine cutters using the provided data. The feature selection, initial wear estimation and multiple model fusion components of the proposed algorithm are explained in details and compared with several alternative methods using the training data. The final submission ranked #2 among professional and student participants and the method is applicable to other data driven PHM problems.

Developing a model for the adequate description of electronic communication in hospitals.

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Saboor, Samrend; Ammenwerth, Elske

2011-01-01

Adequate information and communication systems (ICT) can help to improve the communication in hospitals. Changes to the ICT-infrastructure of hospitals must be planed carefully. In order to support a comprehensive planning, we presented a classification of 81 common errors of the electronic communication on the MIE 2008 congress. Our objective now was to develop a data model that defines specific requirements for an adequate description of electronic communication processes We first applied the method of explicating qualitative content analysis on the error categorization in order to determine the essential process details. After this, we applied the method of subsuming qualitative content analysis on the results of the first step. A data model for the adequate description of electronic communication. This model comprises 61 entities and 91 relationships. The data model comprises and organizes all details that are necessary for the detection of the respective errors. It can be for either used to extend the capabilities of existing modeling methods or as a basis for the development of a new approach.

Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injury.

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Ritter, Anne C; Wagner, Amy K; Szaflarski, Jerzy P; Brooks, Maria M; Zafonte, Ross D; Pugh, Mary Jo V; Fabio, Anthony; Hammond, Flora M; Dreer, Laura E; Bushnik, Tamara; Walker, William C; Brown, Allen W; Johnson-Greene, Doug; Shea, Timothy; Krellman, Jason W; Rosenthal, Joseph A

2016-09-01

Posttraumatic seizures (PTS) are well-recognized acute and chronic complications of traumatic brain injury (TBI). Risk factors have been identified, but considerable variability in who develops PTS remains. Existing PTS prognostic models are not widely adopted for clinical use and do not reflect current trends in injury, diagnosis, or care. We aimed to develop and internally validate preliminary prognostic regression models to predict PTS during acute care hospitalization, and at year 1 and year 2 postinjury. Prognostic models predicting PTS during acute care hospitalization and year 1 and year 2 post-injury were developed using a recent (2011-2014) cohort from the TBI Model Systems National Database. Potential PTS predictors were selected based on previous literature and biologic plausibility. Bivariable logistic regression identified variables with a p-value models. Multivariable logistic regression modeling with backward-stepwise elimination was used to determine reduced prognostic models and to internally validate using 1,000 bootstrap samples. Fit statistics were calculated, correcting for overfitting (optimism). The prognostic models identified sex, craniotomy, contusion load, and pre-injury limitation in learning/remembering/concentrating as significant PTS predictors during acute hospitalization. Significant predictors of PTS at year 1 were subdural hematoma (SDH), contusion load, craniotomy, craniectomy, seizure during acute hospitalization, duration of posttraumatic amnesia, preinjury mental health treatment/psychiatric hospitalization, and preinjury incarceration. Year 2 significant predictors were similar to those of year 1: SDH, intraparenchymal fragment, craniotomy, craniectomy, seizure during acute hospitalization, and preinjury incarceration. Corrected concordance (C) statistics were 0.599, 0.747, and 0.716 for acute hospitalization, year 1, and year 2 models, respectively. The prognostic model for PTS during acute hospitalization did not

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

Science.gov (United States)

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

Readmissions due to traffic accidents at a general hospital.

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Paiva, Luciana; Monteiro, Damiana Aparecida Trindade; Pompeo, Daniele Alcalá; Ciol, Márcia Aparecida; Dantas, Rosana Aparecida Spadotti; Rossi, Lídia Aparecida

2015-01-01

to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents. victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories. among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%). The causes of the return to the hospital were: need to continue the surgical treatment (63.2%), surgical site infection (26.3%) and fall related to the physical sequelae of the trauma (10.5%). The rehospitalization rate corresponded to 174/1,000 people/year. the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

Readmissions due to traffic accidents at a general hospital

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Luciana Paiva

2015-08-01

Full Text Available AbstractObjective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents.Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories.Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%. The causes of the return to the hospital were: need to continue the surgical treatment (63.2%, surgical site infection (26.3% and fall related to the physical sequelae of the trauma (10.5%. The rehospitalization rate corresponded to 174/1,000 people/year.Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.

Management strategies in hospitals: scenario planning

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Ghanem, Mohamed

2015-06-01

Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Management strategies in hospitals: scenario planning.

Science.gov (United States)

Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

2015-01-01

Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

Comparison of childbirth care models in public hospitals, Brazil.

Science.gov (United States)

Vogt, Sibylle Emilie; Silva, Kátia Silveira da; Dias, Marcos Augusto Bastos

2014-04-01

To compare collaborative and traditional childbirth care models. Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

Hospital Medicine (Part 1): what is wrong with acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.

Selecting Tools to Model Integer and Binomial Multiplication

Science.gov (United States)

Pratt, Sarah Smitherman; Eddy, Colleen M.

2017-01-01

Mathematics teachers frequently provide concrete manipulatives to students during instruction; however, the rationale for using certain manipulatives in conjunction with concepts may not be explored. This article focuses on area models that are currently used in classrooms to provide concrete examples of integer and binomial multiplication. The…

Comparative study between a QCD inspired model and a multiple diffraction model

International Nuclear Information System (INIS)

Luna, E.G.S.; Martini, A.F.; Menon, M.J.

2003-01-01

A comparative study between a QCD Inspired Model (QCDIM) and a Multiple Diffraction Model (MDM) is presented, with focus on the results for pp differential cross section at √s = 52.8 GeV. It is shown that the MDM predictions are in agreement with experimental data, except for the dip region and that the QCDIM describes only the diffraction peak region. Interpretations in terms of the corresponding eikonals are also discussed. (author)

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

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Shadi Baniasadi

Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

Microbial contamination of single-and multiple-dose vials after opening in a pulmonary teaching hospital

Directory of Open Access Journals (Sweden)

Shadi Baniasadi

2013-02-01

Full Text Available OBJECTIVES: Intravenous therapy is a complex procedure usually requiring the preparation of the medication in the clinical area before administration to the patient. Breaches in aseptic technique may result in microbial contaminations of vials which is a potential cause of different avoidable infections. We aimed to investigate the prevalence and pattern of microbial contamination of single- and multiple-dose vials in the largest pulmonary teaching hospital in Iran. METHODS: In a period of 2 months, opened single- and multiple-dose vials from different wards were sampled by a pharmacist. The name of the medication, ward, labeling of the vials, the date of opening, and storing temperature were recorded for each vial. Remained contents of each vial were cultured using appropriate bacterial and fungal growth media. RESULTS: Microbial contamination was identified in 11 of 205 (5.36% of vials. The highest contamination rate was 14.28% for vials used in interventional bronchoscopy unit. The most frequent contaminated medication was insulin. Gram-positive bacteria (81.82% were more significantly involved than gram-negative ones (9.09% and fungi (9.09%, with the highest frequency for Staphylococcus epidermidis . CONCLUSIONS: Our data demonstrate that repeated use of vials especially if basic sterility measures are disobeyed can cause microbial contamination of administered products to the patients. Infection preventionists are responsible to train health care workers regarding aseptic techniques and apply guidelines for aseptic handling of intravenous solutions.

Health impact assessments in hospital community benefit: A multiple case study of the use of HIAs at Children’s Hospital Colorado

Directory of Open Access Journals (Sweden)

Gregory Jackson Tung

2017-09-01

Full Text Available Objective:  To explore the use of Health Impact Assessments (HIAs within non-profit hospital community benefit activities. Methods:  We constructed case studies of three HIAs that were conducted in collaboration with Children’s Hospital Colorado as part of the hospital’s community benefit portfolio. These HIAs were part of a pilot that was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. Results:  HIAs provided Children’s Hospital Colorado with a transparent and systematic process for generating evidence-based recommendations with community and stakeholder feedback within the hospital’s community benefit activities. HIAs were used to generate recommendations to inform community benefit planning activities and to generate public policy recommendations to enhance child health. The case studies highlighted several issues that need to be addressed in order to further advance the use of HIA within hospital community benefit activities including: use of HIA on explicit health issues, hospital capacity for HIA, potentially broadening the scope of HIA recommendations, and the use of HIA to generate recommendations from broad priority areas. Conclusion: HIAs can help meet the need for established, evidence-based, and stakeholder responsive tools and processes to be used within non-profit hospital community benefit activities. In meeting this need, the non-profit hospital community benefit area can potentially serve as a major institutional home for the practice of HIA. There is a need for additional research and practice innovation to further explore and refine the use of HIA within non-profit hospital community benefit activities.

Developing a model for hospital inherent safety assessment: Conceptualization and validation.

Science.gov (United States)

Yari, Saeed; Akbari, Hesam; Gholami Fesharaki, Mohammad; Khosravizadeh, Omid; Ghasemi, Mohammad; Barsam, Yalda; Akbari, Hamed

2018-01-01

Paying attention to the safety of hospitals, as the most crucial institute for providing medical and health services wherein a bundle of facilities, equipment, and human resource exist, is of significant importance. The present research aims at developing a model for assessing hospitals' safety based on principles of inherent safety design. Face validity (30 experts), content validity (20 experts), construct validity (268 examples), convergent validity, and divergent validity have been employed to validate the prepared questionnaire; and the items analysis, the Cronbach's alpha test, ICC test (to measure reliability of the test), composite reliability coefficient have been used to measure primary reliability. The relationship between variables and factors has been confirmed at 0.05 significance level by conducting confirmatory factor analysis (CFA) and structural equations modeling (SEM) technique with the use of Smart-PLS. R-square and load factors values, which were higher than 0.67 and 0.300 respectively, indicated the strong fit. Moderation (0.970), simplification (0.959), substitution (0.943), and minimization (0.5008) have had the most weights in determining the inherent safety of hospital respectively. Moderation, simplification, and substitution, among the other dimensions, have more weight on the inherent safety, while minimization has the less weight, which could be due do its definition as to minimize the risk.

Improving financial performance by modeling and analysis of radiology procedure scheduling at a large community hospital.

Science.gov (United States)

Lu, Lingbo; Li, Jingshan; Gisler, Paula

2011-06-01

Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.

Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase.

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Benning, Amirta; Dixon-Woods, Mary; Nwulu, Ugochi; Ghaleb, Maisoon; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Kotecha, Amit; Derrington, M Clare; Lilford, Richard

2011-02-03

To independently evaluate the impact of the second phase of the Health Foundation's Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients' satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting NHS hospitals in England. Nine hospitals participating in SPI2 and nine matched control hospitals. The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. One of the scores (organisational climate) showed a significant (P = 0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P = 0.010) and 12 hour (2.4, 1.1 to 5.0; P = 0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P

Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase

Science.gov (United States)

Benning, Amirta; Dixon-Woods, Mary; Nwulu, Ugochi; Ghaleb, Maisoon; Dawson, Jeremy; Barber, Nick; Franklin, Bryony Dean; Girling, Alan; Hemming, Karla; Carmalt, Martin; Rudge, Gavin; Naicker, Thirumalai; Kotecha, Amit; Derrington, M Clare

2011-01-01

Objective To independently evaluate the impact of the second phase of the Health Foundation’s Safer Patients Initiative (SPI2) on a range of patient safety measures. Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients’ satisfaction, mortality in intensive care, rates of hospital acquired infection). Setting NHS hospitals in England. Participants Nine hospitals participating in SPI2 and nine matched control hospitals. Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital. Results One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal

Hong Kong Hospital Authority resource efficiency evaluation: Via a novel DEA-Malmquist model and Tobit regression model.

Science.gov (United States)

Guo, Hainan; Zhao, Yang; Niu, Tie; Tsui, Kwok-Leung

2017-01-01

The Hospital Authority (HA) is a statutory body managing all the public hospitals and institutes in Hong Kong (HK). In recent decades, Hong Kong Hospital Authority (HKHA) has been making efforts to improve the healthcare services, but there still exist some problems like unfair resource allocation and poor management, as reported by the Hong Kong medical legislative committee. One critical consequence of these problems is low healthcare efficiency of hospitals, leading to low satisfaction among patients. Moreover, HKHA also suffers from the conflict between limited resource and growing demand. An effective evaluation of HA is important for resource planning and healthcare decision making. In this paper, we propose a two-phase method to evaluate HA efficiency for reducing healthcare expenditure and improving healthcare service. Specifically, in Phase I, we measure the HKHA efficiency changes from 2000 to 2013 by applying a novel DEA-Malmquist index with undesirable factors. In Phase II, we further explore the impact of some exogenous factors (e.g., population density) on HKHA efficiency by Tobit regression model. Empirical results show that there are significant differences between the efficiencies of different hospitals and clusters. In particular, it is found that the public hospital serving in a richer district has a relatively lower efficiency. To a certain extent, this reflects the socioeconomic reality in HK that people with better economic condition prefers receiving higher quality service from the private hospitals.

Introduction to the role of model of value-based medicine in the development of private hospitals

OpenAIRE

Shou-ping CHEN

2014-01-01

Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals. 

A Discrete Events Delay Differential System Model for Transmission of Vancomycin-Resistant Enterococcus (VRE) in Hospitals

Science.gov (United States)

2010-09-19

estimated directly form the surveillance data Infection control measures were implemented in the form of health care worker hand - hygiene before and after...hospital infections , is used to motivate possibilities of modeling nosocomial infec- tion dynamics. This is done in the context of hospital monitoring and...model development. Key Words: Delay equations, discrete events, nosocomial infection dynamics, surveil- lance data, inverse problems, parameter

Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.

Science.gov (United States)

Basic, David; Hartwell, Tabitha J

2015-01-01

To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness. This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models. The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37-3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17-2.85) and those with injury (OR: 2.35, 95% CI: 1.15-4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; Pcare shows that falls in the hospital are significantly associated with new placement in a nursing home. Given the predominantly negative experiences and the financial costs associated with placement in a nursing home, fall prevention should be a high priority in older people hospitalized with acute illness.

Towards Integration of CAx Systems and a Multiple-View Product Modeller in Mechanical Design

Directory of Open Access Journals (Sweden)

H. Song

2005-01-01

Full Text Available This paper deals with the development of an integration framework and its implementation for the connexion of CAx systems and multiple-view product modelling. The integration framework is presented regarding its conceptual level and the implementation level is described currently with the connexion of a functional modeller, a multiple-view product modeller, an optimisation module and a CAD system. The integration between the multiple-view product modeller and CATIA V5 based on the STEP standard is described in detail. Finally, the presented works are discussed and future research developments are suggested. 

Optimized production planning model for a multi-plant cultivation system under uncertainty

Science.gov (United States)

Ke, Shunkui; Guo, Doudou; Niu, Qingliang; Huang, Danfeng

2015-02-01

An inexact multi-constraint programming model under uncertainty was developed by incorporating a production plan algorithm into the crop production optimization framework under the multi-plant collaborative cultivation system. In the production plan, orders from the customers are assigned to a suitable plant under the constraints of plant capabilities and uncertainty parameters to maximize profit and achieve customer satisfaction. The developed model and solution method were applied to a case study of a multi-plant collaborative cultivation system to verify its applicability. As determined in the case analysis involving different orders from customers, the period of plant production planning and the interval between orders can significantly affect system benefits. Through the analysis of uncertain parameters, reliable and practical decisions can be generated using the suggested model of a multi-plant collaborative cultivation system.

Economic analysis of an epilepsy outreach model of care in a university hospital setting.

Science.gov (United States)

Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

2017-07-01

The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

Science.gov (United States)

Hammer, Antje; Ommen, Oliver; Röttger, Julia; Pfaff, Holger

2012-01-01

The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

Positive effect of human milk feeding during NICU hospitalization on 24 month neurodevelopment of very low birth weight infants: an Italian cohort study.

Directory of Open Access Journals (Sweden)

Dino Gibertoni

Full Text Available The aim of this study was to determine the effect of human milk feeding during NICU hospitalization on neurodevelopment at 24 months of corrected age in very low birth weight infants. A cohort of 316 very low birth weight newborns (weight ≤ 1500 g was prospectively enrolled in a follow-up program on admission to the Neonatal Intensive Care Unit of S. Orsola Hospital, Bologna, Italy, from January 2005 to June 2011. Neurodevelopment was evaluated at 24 months corrected age using the Griffiths Mental Development Scale. The effect of human milk nutrition on neurodevelopment was first investigated using a multiple linear regression model, to adjust for the effects of gestational age, small for gestational age, complications at birth and during hospitalization, growth restriction at discharge and socio-economic status. Path analysis was then used to refine the multiple regression model, taking into account the relationships among predictors and their temporal sequence. Human milk feeding during NICU hospitalization and higher socio-economic status were associated with better neurodevelopment at 24 months in both models. In the path analysis model intraventricular hemorrhage-periventricular leukomalacia and growth restriction at discharge proved to be directly and independently associated with poorer neurodevelopment. Gestational age and growth restriction at birth had indirect significant effects on neurodevelopment, which were mediated by complications that occurred at birth and during hospitalization, growth restriction at discharge and type of feeding. In conclusion, our findings suggest that mother's human milk feeding during hospitalization can be encouraged because it may improve neurodevelopment at 24 months corrected age.

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan.

Science.gov (United States)

Lin, Chih-Yuan; Huang, Ai-Ling; Minas, Harry; Cohen, Alex

2009-01-02

Yuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and

Parametric Optimization of Hospital Design

DEFF Research Database (Denmark)

Holst, Malene Kirstine; Kirkegaard, Poul Henning; Christoffersen, L.D.

2013-01-01

Present paper presents a parametric performancebased design model for optimizing hospital design. The design model operates with geometric input parameters defining the functional requirements of the hospital and input parameters in terms of performance objectives defining the design requirements...... and preferences of the hospital with respect to performances. The design model takes point of departure in the hospital functionalities as a set of defined parameters and rules describing the design requirements and preferences....

COST VOLUME PROFIT MODEL, THE BREAK -EVEN POINT AND THE DECISION MAKING PROCESS IN THE HOSPITALITY INDUSTRY

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Scorte Carmen

2010-12-01

Full Text Available Management accounting and cost calculation in the hospitality industry is a pathless land. The prezent article is a starting point of a long scientific approach on the domain of the hospitality industry and on the managerial accounting in this area. Our intention is to put the spot light back on the thorny problem of applying Financial Accounting and specifically its implementation in the hospitality industry. One aim of this article is to provide a picture of CVP analysis in decision making with customizing the hospitality industry. To cope with the crisis period, the competition and to achieve the expected profits of the hospitality industry ,managers have the possibility to apply CVP analysis, one of the most simple and useful analytical tools. This paper will address the basic version of the CVP model, exemplifying the main indicators of the particular model for the hospitality industry that can help guide decision-making.

Multiple intracranial aneurysms following radiation therapy for pituitary adenoma

International Nuclear Information System (INIS)

Moriyama, Takumi; Shigemori, Minoru; Hirohata, Yu; Konishi, Jun; Yuge, Tatuo; Tokunaga, Takayuki; Kuramoto, Shinken.

1992-01-01

A rare case is reported in which multiple cerebral aneurysm occurred after radiotherapy. A female aged 51 was hospitalized with a chief complaint of consciousness disorder. The patient was discharged from the hospital 1 year before, after undergoing subtotal extirpation of a tumor through the transsphenoidal sinus in a case of pituitary adenoma, and post-operative radiotherapy (topical 50 Gy). Mild hyperlipidemia associated with hypothyroidism was observed by blood biochemical test during hospitalization. Multiple cerebral infarction was observed by CT scanning and MR imaging. Conservative treatment including intensified endocrine-supplementing treatment was performed. Thyroid gland function and hyperlipidemia improved, but the consciousness disorder occurred suddenly 6 weeks after hospitalization. Subarachnoid hemorrhage and hydrocephalus were observed by CT scanning. Cerebral angiography detected a saccular aneurysm in the trifuraction of the right middle cerebral artery, 3 fusiform aneurysms in the periphery of the right middle cerebral artery, 2 fusiform aneurysms in the posterior cerebral artery. These findings were not observed at the initial hospitalization but were unexceptionally confined to all the irradiation fields. The patient died 8 weeks after hospitalization, and no autoptic findings was obtained. We presumed that radiation vasculopathy, caused by radiation therapy done one year previously, had led to the occurrence of multiple cerebral aneurysms. We think that hyperlipidemia may have acted as an exacerbating factor responsible for these aneurysms. (author)

Clinical Manifestations of Multiple Sclerosis in Taiwanese Children

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J Gordon Millichap

2006-11-01

Full Text Available Twenty-one patients with multiple sclerosis (MS and onset before 18 years were treated over the past 22 years and their records retrospectively analyzed at the National Taiwan University Hospital, Taipei, and Min-Sheng General Hospital, Taoyuan, Taiwan.

A Functional Model of Quality Assurance for Psychiatric Hospitals and Corresponding Staffing Requirements.

Science.gov (United States)

Kamis-Gould, Edna; And Others

1991-01-01

A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…

Introduction to the role of model of value-based medicine in the development of private hospitals

Directory of Open Access Journals (Sweden)

Shou-ping CHEN

2014-01-01

Full Text Available Value-based medicine is the tendency of modern medicine.This paper elaborated the properties of value-based medicine,analyzed the role of model of value-based medicine in modern medicine,and put forward ideas and related measures with the model of value-based medicine to promote the development of private hospitals, which provided some reference for development of private hospitals. 

Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: a structural equation model approach.

Science.gov (United States)

Van Bogaert, Peter; Clarke, Sean; Willems, Riet; Mondelaers, Mieke

2013-07-01

To study the relationships between nurse practice environment, workload, burnout, job outcomes and nurse-reported quality of care in psychiatric hospital staff. Nurses' practice environments in general hospitals have been extensively investigated. Potential variations across practice settings, for instance in psychiatric hospitals, have been much less studied. A cross-sectional design with a survey. A structural equation model previously tested in acute hospitals was evaluated using survey data from a sample of 357 registered nurses, licensed practical nurses, and non-registered caregivers from two psychiatric hospitals in Belgium between December 2010-April 2011. The model included paths between practice environment dimensions and outcome variables, with burnout in a mediating position. A workload measure was also tested as a potential mediator between the practice environment and outcome variables. An improved model, slightly modified from the one validated earlier in samples of acute care nurses, was confirmed. This model explained 50% and 38% of the variance in job outcomes and nurse-reported quality of care respectively. In addition, workload was found to play a mediating role in accounting for job outcomes and significantly improved a model that ultimately explained 60% of the variance in these variables. In psychiatric hospitals as in general hospitals, nurse-physician relationship and other organizational dimensions such as nursing and hospital management were closely associated with perceptions of workload and with burnout and job satisfaction, turnover intentions, and nurse-reported quality of care. Mechanisms linking key variables and differences across settings in these relationships merit attention by managers and researchers. © 2012 Blackwell Publishing Ltd.

SEM Model Medical Solid Waste Hospital Management In Medan City

Science.gov (United States)

Simarmata, Verawaty; Pandia, Setiaty; Mawengkang, Herman

2018-01-01

In daily activities, hospitals, as one of the important health care unit, generate both medical solid waste and non-medical solid waste. The occurrence of medical solid waste could be from the results of treatment activities, such as, in the treatment room for a hospital inpatient, general clinic, a dental clinic, a mother and child clinic, laboratories and pharmacies. Most of the medical solid waste contains infectious and hazardous materials. Therefore it should be managed properly, otherwise it could be a source of new infectious for the community around the hospital as well as for health workers themselves. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. One of the efforts that need to be done in improving the quality of the environment is to undertake waste management activities, because with proper waste management is the most important in order to achieve an optimal degree of human health. Health development in Indonesian aims to achieve a future in which the Indonesian people live in a healthy environment, its people behave clean and healthy, able to reach quality health services, fair and equitable, so as to have optimal health status, health development paradigm anchored to the healthy. The healthy condition of the individual and society can be influenced by the environment. Poor environmental quality is a cause of various health problems. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. This paper proposes a model for managing the medical solid waste in hospitals in Medan city, in order to create healthy environment around hospitals.

The relationship between the C-statistic of a risk-adjustment model and the accuracy of hospital report cards: a Monte Carlo Study.

Science.gov (United States)

Austin, Peter C; Reeves, Mathew J

2013-03-01

Hospital report cards, in which outcomes following the provision of medical or surgical care are compared across health care providers, are being published with increasing frequency. Essential to the production of these reports is risk-adjustment, which allows investigators to account for differences in the distribution of patient illness severity across different hospitals. Logistic regression models are frequently used for risk adjustment in hospital report cards. Many applied researchers use the c-statistic (equivalent to the area under the receiver operating characteristic curve) of the logistic regression model as a measure of the credibility and accuracy of hospital report cards. To determine the relationship between the c-statistic of a risk-adjustment model and the accuracy of hospital report cards. Monte Carlo simulations were used to examine this issue. We examined the influence of 3 factors on the accuracy of hospital report cards: the c-statistic of the logistic regression model used for risk adjustment, the number of hospitals, and the number of patients treated at each hospital. The parameters used to generate the simulated datasets came from analyses of patients hospitalized with a diagnosis of acute myocardial infarction in Ontario, Canada. The c-statistic of the risk-adjustment model had, at most, a very modest impact on the accuracy of hospital report cards, whereas the number of patients treated at each hospital had a much greater impact. The c-statistic of a risk-adjustment model should not be used to assess the accuracy of a hospital report card.

An Empirical Study of Kirkpatrick's Evaluation Model in the Hospitality Industry

Science.gov (United States)

Chang, Ya-Hui Elegance

2010-01-01

This study examined Kirkpatrick's training evaluation model (Kirkpatrick & Kirkpatrick, 2006) by assessing a sales training program conducted at an organization in the hospitality industry. The study assessed the employees' training outcomes of knowledge and skills, job performance, and the impact of the training upon the organization. By…

Validation of statistical models for estimating hospitalization associated with influenza and other respiratory viruses.

Directory of Open Access Journals (Sweden)

Lin Yang

Full Text Available BACKGROUND: Reliable estimates of disease burden associated with respiratory viruses are keys to deployment of preventive strategies such as vaccination and resource allocation. Such estimates are particularly needed in tropical and subtropical regions where some methods commonly used in temperate regions are not applicable. While a number of alternative approaches to assess the influenza associated disease burden have been recently reported, none of these models have been validated with virologically confirmed data. Even fewer methods have been developed for other common respiratory viruses such as respiratory syncytial virus (RSV, parainfluenza and adenovirus. METHODS AND FINDINGS: We had recently conducted a prospective population-based study of virologically confirmed hospitalization for acute respiratory illnesses in persons <18 years residing in Hong Kong Island. Here we used this dataset to validate two commonly used models for estimation of influenza disease burden, namely the rate difference model and Poisson regression model, and also explored the applicability of these models to estimate the disease burden of other respiratory viruses. The Poisson regression models with different link functions all yielded estimates well correlated with the virologically confirmed influenza associated hospitalization, especially in children older than two years. The disease burden estimates for RSV, parainfluenza and adenovirus were less reliable with wide confidence intervals. The rate difference model was not applicable to RSV, parainfluenza and adenovirus and grossly underestimated the true burden of influenza associated hospitalization. CONCLUSION: The Poisson regression model generally produced satisfactory estimates in calculating the disease burden of respiratory viruses in a subtropical region such as Hong Kong.

Multiple Imputation of Predictor Variables Using Generalized Additive Models

NARCIS (Netherlands)

de Jong, Roel; van Buuren, Stef; Spiess, Martin

2016-01-01

The sensitivity of multiple imputation methods to deviations from their distributional assumptions is investigated using simulations, where the parameters of scientific interest are the coefficients of a linear regression model, and values in predictor variables are missing at random. The

Model Seleksi Premi Asuransi Jiwa Dwiguna untuk Kasus Multiple Decrement

OpenAIRE

Cita, Devi Ramana; Pane, Rolan; ', Harison

2015-01-01

This article discusses a select survival model for the case of multiple decrements in evaluating endowment life insurance premium for person currently aged ( + ) years, who is selected at age with ℎ years selection period. The case of multiple decrements in this case is limited to two cases. The calculation of the annual premium is done by prior evaluating of the single premium, and the present value of annuity depends on theconstant force assumption.

Multiplicative surrogate standard deviation: a group metric for the glycemic variability of individual hospitalized patients.

Science.gov (United States)

Braithwaite, Susan S; Umpierrez, Guillermo E; Chase, J Geoffrey

2013-09-01

Group metrics are described to quantify blood glucose (BG) variability of hospitalized patients. The "multiplicative surrogate standard deviation" (MSSD) is the reverse-transformed group mean of the standard deviations (SDs) of the logarithmically transformed BG data set of each patient. The "geometric group mean" (GGM) is the reverse-transformed group mean of the means of the logarithmically transformed BG data set of each patient. Before reverse transformation is performed, the mean of means and mean of SDs each has its own SD, which becomes a multiplicative standard deviation (MSD) after reverse transformation. Statistical predictions and comparisons of parametric or nonparametric tests remain valid after reverse transformation. A subset of a previously published BG data set of 20 critically ill patients from the first 72 h of treatment under the SPRINT protocol was transformed logarithmically. After rank ordering according to the SD of the logarithmically transformed BG data of each patient, the cohort was divided into two equal groups, those having lower or higher variability. For the entire cohort, the GGM was 106 (÷/× 1.07) mg/dl, and MSSD was 1.24 (÷/× 1.07). For the subgroups having lower and higher variability, respectively, the GGM did not differ, 104 (÷/× 1.07) versus 109 (÷/× 1.07) mg/dl, but the MSSD differed, 1.17 (÷/× 1.03) versus 1.31 (÷/× 1.05), p = .00004. By using the MSSD with its MSD, groups can be characterized and compared according to glycemic variability of individual patient members. © 2013 Diabetes Technology Society.

A multiple shock model for common cause failures using discrete Markov chain

International Nuclear Information System (INIS)

Chung, Dae Wook; Kang, Chang Soon

1992-01-01

The most widely used models in common cause analysis are (single) shock models such as the BFR, and the MFR. But, single shock model can not treat the individual common cause separately and has some irrational assumptions. Multiple shock model for common cause failures is developed using Markov chain theory. This model treats each common cause shock as separately and sequently occuring event to implicate the change in failure probability distribution due to each common cause shock. The final failure probability distribution is evaluated and compared with that from the BFR model. The results show that multiple shock model which minimizes the assumptions in the BFR model is more realistic and conservative than the BFR model. The further work for application is the estimations of parameters such as common cause shock rate and component failure probability given a shock,p, through the data analysis

Medical Professionals Designing Hospital Management Models

OpenAIRE

Byg, Vibeke

2016-01-01

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research lit...

Higher Education Program Curricula Models in Tourism and Hospitality Education: A Review of the Literature

Science.gov (United States)

Scotland, Miriam

2006-01-01

The relevancy of program curricula in tourism and hospitality education has been called into question by key stakeholders in light of ongoing changes in the multifaceted tourism and hospitality industry. Various program models have been identified. Program content and quality of student preparedness have been debated. Balance and areas of emphasis…

The Answering Process for Multiple-Choice Questions in Collaborative Learning: A Mathematical Learning Model Analysis

Science.gov (United States)

Nakamura, Yasuyuki; Nishi, Shinnosuke; Muramatsu, Yuta; Yasutake, Koichi; Yamakawa, Osamu; Tagawa, Takahiro

2014-01-01

In this paper, we introduce a mathematical model for collaborative learning and the answering process for multiple-choice questions. The collaborative learning model is inspired by the Ising spin model and the model for answering multiple-choice questions is based on their difficulty level. An intensive simulation study predicts the possibility of…

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

Directory of Open Access Journals (Sweden)

Minas Harry

2009-01-01

Full Text Available Abstract Background Yuli Veterans Hospital (YVH has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Methods Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. Results There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. Discussion There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. Conclusion This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition

Protein structure modeling for CASP10 by multiple layers of global optimization.

Science.gov (United States)

Joo, Keehyoung; Lee, Juyong; Sim, Sangjin; Lee, Sun Young; Lee, Kiho; Heo, Seungryong; Lee, In-Ho; Lee, Sung Jong; Lee, Jooyoung

2014-02-01

In the template-based modeling (TBM) category of CASP10 experiment, we introduced a new protocol called protein modeling system (PMS) to generate accurate protein structures in terms of side-chains as well as backbone trace. In the new protocol, a global optimization algorithm, called conformational space annealing (CSA), is applied to the three layers of TBM procedure: multiple sequence-structure alignment, 3D chain building, and side-chain re-modeling. For 3D chain building, we developed a new energy function which includes new distance restraint terms of Lorentzian type (derived from multiple templates), and new energy terms that combine (physical) energy terms such as dynamic fragment assembly (DFA) energy, DFIRE statistical potential energy, hydrogen bonding term, etc. These physical energy terms are expected to guide the structure modeling especially for loop regions where no template structures are available. In addition, we developed a new quality assessment method based on random forest machine learning algorithm to screen templates, multiple alignments, and final models. For TBM targets of CASP10, we find that, due to the combination of three stages of CSA global optimizations and quality assessment, the modeling accuracy of PMS improves at each additional stage of the protocol. It is especially noteworthy that the side-chains of the final PMS models are far more accurate than the models in the intermediate steps. Copyright © 2013 Wiley Periodicals, Inc.

Interacting Multiple Model (IMM Fifth-Degree Spherical Simplex-Radial Cubature Kalman Filter for Maneuvering Target Tracking

Directory of Open Access Journals (Sweden)

Hua Liu

2017-06-01

Full Text Available For improving the tracking accuracy and model switching speed of maneuvering target tracking in nonlinear systems, a new algorithm named the interacting multiple model fifth-degree spherical simplex-radial cubature Kalman filter (IMM5thSSRCKF is proposed in this paper. The new algorithm is a combination of the interacting multiple model (IMM filter and the fifth-degree spherical simplex-radial cubature Kalman filter (5thSSRCKF. The proposed algorithm makes use of Markov process to describe the switching probability among the models, and uses 5thSSRCKF to deal with the state estimation of each model. The 5thSSRCKF is an improved filter algorithm, which utilizes the fifth-degree spherical simplex-radial rule to improve the filtering accuracy. Finally, the tracking performance of the IMM5thSSRCKF is evaluated by simulation in a typical maneuvering target tracking scenario. Simulation results show that the proposed algorithm has better tracking performance and quicker model switching speed when disposing maneuver models compared with the interacting multiple model unscented Kalman filter (IMMUKF, the interacting multiple model cubature Kalman filter (IMMCKF and the interacting multiple model fifth-degree cubature Kalman filter (IMM5thCKF.

Interacting Multiple Model (IMM) Fifth-Degree Spherical Simplex-Radial Cubature Kalman Filter for Maneuvering Target Tracking.

Science.gov (United States)

Liu, Hua; Wu, Wen

2017-06-13

For improving the tracking accuracy and model switching speed of maneuvering target tracking in nonlinear systems, a new algorithm named the interacting multiple model fifth-degree spherical simplex-radial cubature Kalman filter (IMM5thSSRCKF) is proposed in this paper. The new algorithm is a combination of the interacting multiple model (IMM) filter and the fifth-degree spherical simplex-radial cubature Kalman filter (5thSSRCKF). The proposed algorithm makes use of Markov process to describe the switching probability among the models, and uses 5thSSRCKF to deal with the state estimation of each model. The 5thSSRCKF is an improved filter algorithm, which utilizes the fifth-degree spherical simplex-radial rule to improve the filtering accuracy. Finally, the tracking performance of the IMM5thSSRCKF is evaluated by simulation in a typical maneuvering target tracking scenario. Simulation results show that the proposed algorithm has better tracking performance and quicker model switching speed when disposing maneuver models compared with the interacting multiple model unscented Kalman filter (IMMUKF), the interacting multiple model cubature Kalman filter (IMMCKF) and the interacting multiple model fifth-degree cubature Kalman filter (IMM5thCKF).

Comparing Multiple-Group Multinomial Log-Linear Models for Multidimensional Skill Distributions in the General Diagnostic Model. Research Report. ETS RR-08-35

Science.gov (United States)

Xu, Xueli; von Davier, Matthias

2008-01-01

The general diagnostic model (GDM) utilizes located latent classes for modeling a multidimensional proficiency variable. In this paper, the GDM is extended by employing a log-linear model for multiple populations that assumes constraints on parameters across multiple groups. This constrained model is compared to log-linear models that assume…

Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals.

Science.gov (United States)

Li, Yongjun; Lei, Xiyang; Morton, Alec

2018-02-14

Throughout the world, hospitals are under increasing pressure to become more efficient. Efficiency analysis tools can play a role in giving policymakers insight into which units are less efficient and why. Many researchers have studied efficiencies of hospitals using data envelopment analysis (DEA) as an efficiency analysis tool. However, in the existing literature on DEA-based performance evaluation, a standard assumption of the constant returns to scale (CRS) or the variable returns to scale (VRS) DEA models is that decision-making units (DMUs) use a similar mix of inputs to produce a similar set of outputs. In fact, hospitals with different primary goals supply different services and provide different outputs. That is, hospitals are nonhomogeneous and the standard assumption of the DEA model is not applicable to the performance evaluation of nonhomogeneous hospitals. This paper considers the nonhomogeneity among hospitals in the performance evaluation and takes hospitals in Hong Kong as a case study. An extension of Cook et al. (2013) [1] based on the VRS assumption is developed to evaluated nonhomogeneous hospitals' efficiencies since inputs of hospitals vary greatly. Following the philosophy of Cook et al. (2013) [1], hospitals are divided into homogeneous groups and the product process of each hospital is divided into subunits. The performance of hospitals is measured on the basis of subunits. The proposed approach can be applied to measure the performance of other nonhomogeneous entities that exhibit variable return to scale.

Linear systems with unstructured multiplicative uncertainty: Modeling and robust stability analysis.

Directory of Open Access Journals (Sweden)

Radek Matušů

Full Text Available This article deals with continuous-time Linear Time-Invariant (LTI Single-Input Single-Output (SISO systems affected by unstructured multiplicative uncertainty. More specifically, its aim is to present an approach to the construction of uncertain models based on the appropriate selection of a nominal system and a weight function and to apply the fundamentals of robust stability investigation for considered sort of systems. The initial theoretical parts are followed by three extensive illustrative examples in which the first order time-delay, second order and third order plants with parametric uncertainty are modeled as systems with unstructured multiplicative uncertainty and subsequently, the robust stability of selected feedback loops containing constructed models and chosen controllers is analyzed and obtained results are discussed.

Prognostic Factors for Persistent Leg-Pain in Patients Hospitalized With Acute Sciatica.

Science.gov (United States)

Fjeld, Olaf; Grotle, Margreth; Siewers, Vibeke; Pedersen, Linda M; Nilsen, Kristian Bernhard; Zwart, John-Anker

2017-03-01

Prospective cohort study. To identify potential prognostic factors for persistent leg-pain at 12 months among patients hospitalized with acute severe sciatica. The long-term outcome for patients admitted to hospital with sciatica is generally unfavorable. Results concerning prognostic factors for persistent sciatica are limited and conflicting. A total of 210 patients acutely admitted to hospital for either surgical or nonsurgical treatment of sciatica were consecutively recruited and received a thorough clinical and radiographic examination in addition to responding to a comprehensive questionnaire. Follow-up assessments were done at 6 weeks, 6 months, and 12 months. Potential prognostic factors were measured at baseline and at 6 weeks. The impact of these factors on leg-pain was analyzed by multiple linear regression modeling. A total of 151 patients completed the entire study, 93 receiving nonrandomized surgical treatment. The final multivariate models showed that the following factors were significantly associated with leg-pain at 12 months: high psychosocial risk according to the Örebro Musculosceletal Pain Questionnaire (unstandardized beta coefficient 1.55, 95% confidence interval [CI] 0.72-2.38, P sciatica. 2.

Relay model for recruiting alcohol dependent patients in general hospitals--a single-blind pragmatic randomized trial

DEFF Research Database (Denmark)

Schwarz, Anne-Sophie; Bilberg, Randi; Bjerregaard, Lene Berit Skov

2016-01-01

- The Relay Model. METHOD/DESIGN: The study is a single-blind pragmatic randomized controlled trial including patients admitted to the hospital. The study group (n = 500) will receive an intervention, and the control group (n = 500) will be referred to treatment by usual procedures. All patients complete......://register.clinicaltrials.gov/by identifier: RESCueH_Relay NCT02188043 Project Relay Model for Recruiting Alcohol Dependent Patients in General Hospitals (TRN Registration: 07/09/2014)....

A latent class multiple constraint multiple discrete-continuous extreme value model of time use and goods consumption.

Science.gov (United States)

2016-06-01

This paper develops a microeconomic theory-based multiple discrete continuous choice model that considers: (a) that both goods consumption and time allocations (to work and non-work activities) enter separately as decision variables in the utility fu...

Hospital enterprise Architecture Framework (Study of Iranian University Hospital Organization).

Science.gov (United States)

Haghighathoseini, Atefehsadat; Bobarshad, Hossein; Saghafi, Fatehmeh; Rezaei, Mohammad Sadegh; Bagherzadeh, Nader

2018-06-01

Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals. Copyright © 2018 Elsevier B.V. All rights reserved.

Hybrid approaches for multiple-species stochastic reaction-diffusion models

Science.gov (United States)

Spill, Fabian; Guerrero, Pilar; Alarcon, Tomas; Maini, Philip K.; Byrne, Helen

2015-10-01

Reaction-diffusion models are used to describe systems in fields as diverse as physics, chemistry, ecology and biology. The fundamental quantities in such models are individual entities such as atoms and molecules, bacteria, cells or animals, which move and/or react in a stochastic manner. If the number of entities is large, accounting for each individual is inefficient, and often partial differential equation (PDE) models are used in which the stochastic behaviour of individuals is replaced by a description of the averaged, or mean behaviour of the system. In some situations the number of individuals is large in certain regions and small in others. In such cases, a stochastic model may be inefficient in one region, and a PDE model inaccurate in another. To overcome this problem, we develop a scheme which couples a stochastic reaction-diffusion system in one part of the domain with its mean field analogue, i.e. a discretised PDE model, in the other part of the domain. The interface in between the two domains occupies exactly one lattice site and is chosen such that the mean field description is still accurate there. In this way errors due to the flux between the domains are small. Our scheme can account for multiple dynamic interfaces separating multiple stochastic and deterministic domains, and the coupling between the domains conserves the total number of particles. The method preserves stochastic features such as extinction not observable in the mean field description, and is significantly faster to simulate on a computer than the pure stochastic model.

Hybrid approaches for multiple-species stochastic reaction-diffusion models.

KAUST Repository

Spill, Fabian; Guerrero, Pilar; Alarcon, Tomas; Maini, Philip K; Byrne, Helen

2015-01-01

Reaction-diffusion models are used to describe systems in fields as diverse as physics, chemistry, ecology and biology. The fundamental quantities in such models are individual entities such as atoms and molecules, bacteria, cells or animals, which move and/or react in a stochastic manner. If the number of entities is large, accounting for each individual is inefficient, and often partial differential equation (PDE) models are used in which the stochastic behaviour of individuals is replaced by a description of the averaged, or mean behaviour of the system. In some situations the number of individuals is large in certain regions and small in others. In such cases, a stochastic model may be inefficient in one region, and a PDE model inaccurate in another. To overcome this problem, we develop a scheme which couples a stochastic reaction-diffusion system in one part of the domain with its mean field analogue, i.e. a discretised PDE model, in the other part of the domain. The interface in between the two domains occupies exactly one lattice site and is chosen such that the mean field description is still accurate there. In this way errors due to the flux between the domains are small. Our scheme can account for multiple dynamic interfaces separating multiple stochastic and deterministic domains, and the coupling between the domains conserves the total number of particles. The method preserves stochastic features such as extinction not observable in the mean field description, and is significantly faster to simulate on a computer than the pure stochastic model.

Hybrid approaches for multiple-species stochastic reaction-diffusion models.

KAUST Repository

Spill, Fabian

2015-10-01

Reaction-diffusion models are used to describe systems in fields as diverse as physics, chemistry, ecology and biology. The fundamental quantities in such models are individual entities such as atoms and molecules, bacteria, cells or animals, which move and/or react in a stochastic manner. If the number of entities is large, accounting for each individual is inefficient, and often partial differential equation (PDE) models are used in which the stochastic behaviour of individuals is replaced by a description of the averaged, or mean behaviour of the system. In some situations the number of individuals is large in certain regions and small in others. In such cases, a stochastic model may be inefficient in one region, and a PDE model inaccurate in another. To overcome this problem, we develop a scheme which couples a stochastic reaction-diffusion system in one part of the domain with its mean field analogue, i.e. a discretised PDE model, in the other part of the domain. The interface in between the two domains occupies exactly one lattice site and is chosen such that the mean field description is still accurate there. In this way errors due to the flux between the domains are small. Our scheme can account for multiple dynamic interfaces separating multiple stochastic and deterministic domains, and the coupling between the domains conserves the total number of particles. The method preserves stochastic features such as extinction not observable in the mean field description, and is significantly faster to simulate on a computer than the pure stochastic model.

Risk Prediction Models for Other Cancers or Multiple Sites

Science.gov (United States)

Developing statistical models that estimate the probability of developing other multiple cancers over a defined period of time will help clinicians identify individuals at higher risk of specific cancers, allowing for earlier or more frequent screening and counseling of behavioral changes to decrease risk.

Exclusive description of multiple production on nuclei in the additive quark model. Multiplicity distributions in interactions with heavy nuclei

International Nuclear Information System (INIS)

Levchenko, B.B.; Nikolaev, N.N.

1985-01-01

In the framework of the additive quark model of multiple production on nuclei we calculate the multiplicity distributions of secondary particles and the correlations between secondary particles in πA and pA interactions with heavy nuclei. We show that intranuclear cascades are responsible for up to 50% of the nuclear increase of the multiplicity of fast particles. We analyze the sensitivity of the multiplicities and their correlations to the choice of the quark-hadronization function. We show that with good accuracy the yield of relativistic secondary particles from heavy and intermediate nuclei depends only on the number N/sub p/ of protons knocked out of the nucleus, and not on the mass number of the nucleus (N/sub p/ scaling)

Estimating solid waste generation by hospitality industry during major festivals: A quantification model based on multiple regression.

Science.gov (United States)

Abdulredha, Muhammad; Al Khaddar, Rafid; Jordan, David; Kot, Patryk; Abdulridha, Ali; Hashim, Khalid

2018-04-26

Major-religious festivals hosted in the city of Kerbala, Iraq, annually generate large quantities of Municipal Solid Waste (MSW) which negatively impacts the environment and human health when poorly managed. The hospitality sector, specifically hotels, is one of the major sources of MSW generated during these festivals. Because it is essential to establish a proper waste management system for such festivals, accurate information regarding MSW generation is required. This study therefore investigated the rate of production of MSW from hotels in Kerbala during major festivals. A field questionnaire survey was conducted with 150 hotels during the Arba'een festival, one of the largest festivals in the world, attended by about 18 million participants, to identify how much MSW is produced and what features of hotels impact on this. Hotel managers responded to questions regarding features of the hotel such as size (Hs), expenditure (Hex), area (Ha) and number of staff (Hst). An on-site audit was also carried out with all participating hotels to estimate the mass of MSW generated from these hotels. The results indicate that MSW produced by hotels varies widely. In general, it was found that each hotel guest produces an estimated 0.89 kg of MSW per day. However, this figure varies according to the hotels' rating. Average rates of MSW production from one and four star hotels were 0.83 and 1.22 kg per guest per day, respectively. Statistically, it was found that the relationship between MSW production and hotel features can be modelled with an R 2 of 0.799, where the influence of hotel feature on MSW production followed the order Hs > Hex > Hst. Copyright © 2018 Elsevier Ltd. All rights reserved.

Hospital Acquisitions Before Healthcare Reform.

Science.gov (United States)

McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

2015-01-01

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

Multiple attribute decision making model and application to food safety risk evaluation.

Science.gov (United States)

Ma, Lihua; Chen, Hong; Yan, Huizhe; Yang, Lifeng; Wu, Lifeng

2017-01-01

Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

Implementation of a model of quality control program in the radiodiagnostic service at the general hospital Dos de Mayo

International Nuclear Information System (INIS)

Acosta Reginfo, N.; Ramirez Quijada, R.

1998-01-01

In order to implement a model of quality control program, the General Hospital Dos de Mayo was selected, since it manages a specialized radiology service - defined according to the OMS criteria - This radiology service attends nearly 60 % of total patients of the Hospital. This program intends to be a model for application to another hospitals havings similar characteritics, since any formal quality control program has been implemented in neither private nor public hospitals in the country. The model, while allowing to make measurements of main parameters, also allows to verify that radiation doses to patients, radiation workers and public trend to a level as low as reasonably achievable, and also to yield images with enough diagnostic quality, and to induce work environment with shared responsibility and commitment

Estimation of Extra Length of Stay Attributable to Hospital-Acquired Infections in Adult ICUs Using a Time-Dependent Multistate Model.

Science.gov (United States)

Ohannessian, Robin; Gustin, Marie-Paule; Bénet, Thomas; Gerbier-Colomban, Solweig; Girard, Raphaele; Argaud, Laurent; Rimmelé, Thomas; Guerin, Claude; Bohé, Julien; Piriou, Vincent; Vanhems, Philippe

2018-04-10

The objective of the study was to estimate the length of stay of patients with hospital-acquired infections hospitalized in ICUs using a multistate model. Active prospective surveillance of hospital-acquired infection from January 1, 1995, to December 31, 2012. Twelve ICUs at the University of Lyon hospital (France). Adult patients age greater than or equal to 18 years old and hospitalized greater than or equal to 2 days were included in the surveillance. All hospital-acquired infections (pneumonia, bacteremia, and urinary tract infection) occurring during ICU stay were collected. None. The competitive risks of in-hospital death, transfer, or discharge were considered in estimating the change in length of stay due to infection(s), using a multistate model, time of infection onset. Thirty-three thousand four-hundred forty-nine patients were involved, with an overall hospital-acquired infection attack rate of 15.5% (n = 5,176). Mean length of stay was 27.4 (± 18.3) days in patients with hospital-acquired infection and 7.3 (± 7.6) days in patients without hospital-acquired infection. A multistate model-estimated mean found an increase in length of stay by 5.0 days (95% CI, 4.6-5.4 d). The extra length of stay increased with the number of infected site and was higher for patients discharged alive from ICU. No increased length of stay was found for patients presenting late-onset hospital-acquired infection, more than the 25th day after admission. An increase length of stay of 5 days attributable to hospital-acquired infection in the ICU was estimated using a multistate model in a prospective surveillance study in France. The dose-response relationship between the number of hospitalacquired infection and length of stay and the impact of early-stage hospital-acquired infection may strengthen attention for clinicians to focus interventions on early preventions of hospital-acquired infection in ICU.

Penerapan Model Pembelajaran Atraktif Berbasis Multiple Intelligences Tentang Pemantulan Cahaya pada Cermin

Directory of Open Access Journals (Sweden)

Intan Kusumawati

2016-03-01

Full Text Available Penelitian ini bertujuan untuk mengetahui efektivitas penerapan model pembelajaran atraktif berbasis multiple intelligences dalam meremediasi miskonsepsi siswa tentang pemantulan cahaya pada cermin. Pada penelitian ini digunakan bentuk pre-eksperimental design dengan rancangan one group pretest-post test design. Alat pengumpulan data berupa tes pilihan ganda dengan reasoning. Hasil validitas sebesar 4,08 dan reliabilitas 0,537. Siswa dibagi menjadi lima kelompok kecerdasan, yaitu kelompok linguistic intelligence, mathematical-logical intelligence, visual-spatial intelligence, bodily-khinestetic intelligence, dan musical intelligence. Siswa membahas konsep fisika sesuai kelompok kecerdasannya dalam bentuk pembuatan pantun-puisi, teka-teki silang, menggambar kreatif, drama, dan mengarang lirik lagu. Efektivitas penerapan model pembelajaran multiple intelligences menggunakan persamaan effect size. Ditemukan bahwa skor effect size masing-masing kelompok berkategori tinggi sebesar 5,76; 3,76; 4,60; 1,70; dan 1,34. Penerapan model pembelajaran atraktif berbasis multiple intelligences efektif dalam meremediasi miskonsepsi siswa. Penelitian ini diharapkan dapat digunakan pada materi fisika dan sekolah lainnya.

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

Science.gov (United States)

Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

2017-07-07

The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

A basket two-part model to analyze medical expenditure on interdependent multiple sectors.

Science.gov (United States)

Sugawara, Shinya; Wu, Tianyi; Yamanishi, Kenji

2018-05-01

This study proposes a novel statistical methodology to analyze expenditure on multiple medical sectors using consumer data. Conventionally, medical expenditure has been analyzed by two-part models, which separately consider purchase decision and amount of expenditure. We extend the traditional two-part models by adding the step of basket analysis for dimension reduction. This new step enables us to analyze complicated interdependence between multiple sectors without an identification problem. As an empirical application for the proposed method, we analyze data of 13 medical sectors from the Medical Expenditure Panel Survey. In comparison with the results of previous studies that analyzed the multiple sector independently, our method provides more detailed implications of the impacts of individual socioeconomic status on the composition of joint purchases from multiple medical sectors; our method has a better prediction performance.

MMOSS-I: a CANDU multiple-channel thermosyphoning flow stability model

Energy Technology Data Exchange (ETDEWEB)

Gulshani, P [Atomic Energy of Canada Ltd., Mississauga, ON (Canada); Huynh, H [Hydro-Quebec, Montreal, PQ (Canada)

1996-12-31

This paper presents a multiple-channel flow stability model, dubbed MMOSS, developed to predict the conditions for the onset of flow oscillations in a CANDU-type multiple-channel heat transport system under thermosyphoning conditions. The model generalizes that developed previously to account for the effects of any channel flow reversal. Two-phase thermosyphoning conditions are predicted by thermalhydraulic codes for some postulated accident scenarios in CANDU. Two-phase thermosyphoning experiments in the multiple-channel RD-14M facility have indicated that pass-to-pass out-of-phase oscillations in the loop conditions caused the flow in some of the heated channels to undergo sustained reversal in direction. This channel flow reversal had significant effects on the channel and loop conditions. It is, therefore, important to understand the nature of the oscillations and be able to predict the conditions for the onset of the oscillations or for stable flow in RD-14M and the reactor. For stable flow conditions, oscillation-induced channel flow reversal is not expected. MMOSS was developed for a figure-of-eight system with any number of channels. The system characteristic equation was derived from a linearization of the conservation equations. In this paper, the MMOSS characteristic equation is solved for a system of N identical channel assemblies. The resulting model is called MMOSS-I. This simplification provides valuable physical insight and reasonably accurate results. MMOSS-I and a previously-developed steady-state model THERMOSYPHON are used to predict thermosyphoning flow stability maps for RD-14M and the Gentilly 2 reactor. (author). 11 refs., 7 figs.

Implementing a trustworthy cost-accounting model.

Science.gov (United States)

Spence, Jay; Seargeant, Dan

2015-03-01

Hospitals and health systems can develop an effective cost-accounting model and maximize the effectiveness of their cost-accounting teams by focusing on six key areas: Implementing an enhanced data model. Reconciling data efficiently. Accommodating multiple cost-modeling techniques. Improving transparency of cost allocations. Securing department manager participation. Providing essential education and training to staff members and stakeholders.

Model for nucleus-nucleus, hadron-nucleus and hadron-proton multiplicity distributions

International Nuclear Information System (INIS)

Singh, C.P.; Shyam, M.; Tuli, S.K.

1986-07-01

A model relating hadron-proton, hadron-nucleus and nucleus-nucleus multiplicity distributions is proposed and some interesting consequences are derived. The values of the parameters are the same for all the processes and are given by the QCD hypothesis of ''universal'' hadronic multiplicities which are found to be asymptotically independent of target and beam in hadronic and current induced reactions in particle physics. (author)

The Health Action Process Approach as a motivational model for physical activity self-management for people with multiple sclerosis: a path analysis.

Science.gov (United States)

Chiu, Chung-Yi; Lynch, Ruth T; Chan, Fong; Berven, Norman L

2011-08-01

To evaluate the Health Action Process Approach (HAPA) as a motivational model for physical activity self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis. One hundred ninety-five individuals with MS were recruited from the National Multiple Sclerosis Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Physical Activity Stages of Change Instrument, along with measures for nine predictors (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). The respecified HAPA physical activity model fit the data relatively well (goodness-of-fit index = .92, normed fit index = .91, and comparative fit index = .93) explaining 38% of the variance in physical activity. Recovery self-efficacy, action and coping planning, and perceived barriers directly contributed to the prediction of physical activity. Outcome expectancy significantly influenced intention and the relationship between intention and physical activity is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected physical activity. Severity of MS and action self-efficacy had an inverse relationship with perceived barriers and perceived barriers influenced physical activity. Empirical support was found for the proposed HAPA model of physical activity for people with MS. The HAPA model appears to provide useful information for clinical rehabilitation and health promotion interventions.

Multiple attribute decision making model and application to food safety risk evaluation.

Directory of Open Access Journals (Sweden)

Lihua Ma

Full Text Available Decision making for supermarket food purchase decisions are characterized by network relationships. This paper analyzed factors that influence supermarket food selection and proposes a supplier evaluation index system based on the whole process of food production. The author established the intuitive interval value fuzzy set evaluation model based on characteristics of the network relationship among decision makers, and validated for a multiple attribute decision making case study. Thus, the proposed model provides a reliable, accurate method for multiple attribute decision making.

Hierarchical Multiple Markov Chain Model for Unsupervised Texture Segmentation

Czech Academy of Sciences Publication Activity Database

Scarpa, G.; Gaetano, R.; Haindl, Michal; Zerubia, J.

2009-01-01

Roč. 18, č. 8 (2009), s. 1830-1843 ISSN 1057-7149 R&D Projects: GA ČR GA102/08/0593 EU Projects: European Commission(XE) 507752 - MUSCLE Institutional research plan: CEZ:AV0Z10750506 Keywords : Classification * texture analysis * segmentation * hierarchical image models * Markov process Subject RIV: BD - Theory of Information Impact factor: 2.848, year: 2009 http://library.utia.cas.cz/separaty/2009/RO/haindl-hierarchical multiple markov chain model for unsupervised texture segmentation.pdf

A Convex Variational Model for Restoring Blurred Images with Multiplicative Noise

DEFF Research Database (Denmark)

Dong, Yiqiu; Tieyong Zeng

2013-01-01

In this paper, a new variational model for restoring blurred images with multiplicative noise is proposed. Based on the statistical property of the noise, a quadratic penalty function technique is utilized in order to obtain a strictly convex model under a mild condition, which guarantees...

Comparison of Sleep Latency and Number of SOREMPs in the Home and Hospital With a Modified Multiple Sleep Latency Test: A Randomized Crossover Study.

Science.gov (United States)

Beiske, Kornelia K; Sand, Trond; Rugland, Eyvind; Stavem, Knut

2017-05-01

Comparison of mean sleep latencies and number of sleep-onset rapid eye movement periods (SOREMPs) between modified multiple sleep latency test (MSLT) performed in the unattended home and in-hospital laboratory setting. A randomized crossover single-blinded design. Thirty-four subjects referred to MSLT for suspected hypersomnia or narcolepsy were included. Participants were randomized to perform modified MSLT in the unattended home or in the hospital first. Scores in the two settings were compared using Wilcoxon signed-rank test or exact McNemar test. Agreement between home and hospital categorized mean sleep latency and number of SOREMPs was assessed using simple kappa (κ) and proportion agreement. Agreement between home and hospital mean sleep latency was assessed using a Bland-Altman plot and an intraclass correlation coefficient. There was no difference between home and hospital assessment of mean sleep latency (P = 0.86). Two or more SOREMPs were found more frequently on modified MSLTs performed at home compared with those at the hospital (7 and 2, respectively; P = 0.025). Agreement was moderate for categorized sleep latency (κ = 0.53) and fair for categorized SOREMPs (κ = 0.39) in the 2 settings. Analysis of mean sleep latency using intraclass correlation coefficient showed a very good agreement between the two settings. Group mean sleep latency for home modified MSLTs seems to be reliable compared with that for the attended sleep-laboratory setting. Higher rate of SOREMP in the unattended home suggests that napping in a familiar environment facilitates the transition into REM sleep. Further studies are needed to assess the normal limit, sensitivity, and specificity for SOREMP at home before the clinical utility of home-based napping can be determined.

The empirical content of models with multiple equilibria in economies with social interactions

OpenAIRE

Alberto Bisin; Andrea Moro; Giorgio Topa

2011-01-01

We study a general class of models with social interactions that might display multiple equilibria. We propose an estimation procedure for these models and evaluate its efficiency and computational feasibility relative to different approaches taken to the curse of dimensionality implied by the multiplicity. Using data on smoking among teenagers, we implement the proposed estimation procedure to understand how group interactions affect health-related choices. We find that interaction effects a...

The derivation and validation of a simple model for predicting in-hospital mortality of acutely admitted patients to internal medicine wards.

Science.gov (United States)

Sakhnini, Ali; Saliba, Walid; Schwartz, Naama; Bisharat, Naiel

2017-06-01

Limited information is available about clinical predictors of in-hospital mortality in acute unselected medical admissions. Such information could assist medical decision-making.To develop a clinical model for predicting in-hospital mortality in unselected acute medical admissions and to test the impact of secondary conditions on hospital mortality.This is an analysis of the medical records of patients admitted to internal medicine wards at one university-affiliated hospital. Data obtained from the years 2013 to 2014 were used as a derivation dataset for creating a prediction model, while data from 2015 was used as a validation dataset to test the performance of the model. For each admission, a set of clinical and epidemiological variables was obtained. The main diagnosis at hospitalization was recorded, and all additional or secondary conditions that coexisted at hospital admission or that developed during hospital stay were considered secondary conditions.The derivation and validation datasets included 7268 and 7843 patients, respectively. The in-hospital mortality rate averaged 7.2%. The following variables entered the final model; age, body mass index, mean arterial pressure on admission, prior admission within 3 months, background morbidity of heart failure and active malignancy, and chronic use of statins and antiplatelet agents. The c-statistic (ROC-AUC) of the prediction model was 80.5% without adjustment for main or secondary conditions, 84.5%, with adjustment for the main diagnosis, and 89.5% with adjustment for the main diagnosis and secondary conditions. The accuracy of the predictive model reached 81% on the validation dataset.A prediction model based on clinical data with adjustment for secondary conditions exhibited a high degree of prediction accuracy. We provide a proof of concept that there is an added value for incorporating secondary conditions while predicting probabilities of in-hospital mortality. Further improvement of the model performance

Dynamic coordinated control laws in multiple agent models

International Nuclear Information System (INIS)

Morgan, David S.; Schwartz, Ira B.

2005-01-01

We present an active control scheme of a kinetic model of swarming. It has been shown previously that the global control scheme for the model, presented in [Systems Control Lett. 52 (2004) 25], gives rise to spontaneous collective organization of agents into a unified coherent swarm, via steering controls and utilizing long-range attractive and short-range repulsive interactions. We extend these results by presenting control laws whereby a single swarm is broken into independently functioning subswarm clusters. The transition between one coordinated swarm and multiple clustered subswarms is managed simply with a homotopy parameter. Additionally, we present as an alternate formulation, a local control law for the same model, which implements dynamic barrier avoidance behavior, and in which swarm coherence emerges spontaneously

Hospital charitable lotteries: taking a gamble on systems thinking.

Science.gov (United States)

Reynolds, Jennifer

2013-12-01

The presence of lotteries can be witnessed worldwide. Charitable lotteries are often portrayed as 'good works', and recently, hospitals have utilized them as a popular fundraising vehicle to raise necessary funds to help achieve organizational goals and objectives. Research indicates that lotteries contribute to gambling-related harms; however, research into charitable lotteries has been underdeveloped. Both the gambling and the health care industries are complex and evolving, consisting of many interacting stakeholders with often different and competing interests. This article seeks to present systems thinking as a conceptual framework to help fill the gap in understanding the use of gambling within hospitals and its possible benefits and unforeseen negative consequences. Addressing the gap in knowledge is important to help inform decision making aimed at reducing gambling-related harms. This article proposes how the school of systems thinking, specifically framing hospitals as complex adaptive systems and system dynamics modelling, can be utilized to understand the policy implications of the adoption of lotteries as a revenue source for hospitals. Hospitals have a duty to care, inform and protect. Hospital charitable lotteries have become big business; however, its incorporation into critical funding strategies needs to be carefully understood. Systems thinking theory and methodologies provide an integrated approach to examine this dynamic and evolving fundraising initiative. Findings from this article can inform the development of action strategies, including policy development at multiple levels. © 2013 John Wiley & Sons Ltd.

Evaluation models and criteria of the quality of hospital websites: a systematic review study

OpenAIRE

Jeddi, Fatemeh Rangraz; Gilasi, Hamidreza; Khademi, Sahar

2017-01-01

Introduction Hospital websites are important tools in establishing communication and exchanging information between patients and staff, and thus should enjoy an acceptable level of quality. The aim of this study was to identify proper models and criteria to evaluate the quality of hospital websites. Methods This research was a systematic review study. The international databases such as Science Direct, Google Scholar, PubMed, Proquest, Ovid, Elsevier, Springer, and EBSCO together with regiona...

Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

Directory of Open Access Journals (Sweden)

M Kit Delgado

2013-09-01

Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.

Flexible Modeling of Survival Data with Covariates Subject to Detection Limits via Multiple Imputation.

Science.gov (United States)

Bernhardt, Paul W; Wang, Huixia Judy; Zhang, Daowen

2014-01-01

Models for survival data generally assume that covariates are fully observed. However, in medical studies it is not uncommon for biomarkers to be censored at known detection limits. A computationally-efficient multiple imputation procedure for modeling survival data with covariates subject to detection limits is proposed. This procedure is developed in the context of an accelerated failure time model with a flexible seminonparametric error distribution. The consistency and asymptotic normality of the multiple imputation estimator are established and a consistent variance estimator is provided. An iterative version of the proposed multiple imputation algorithm that approximates the EM algorithm for maximum likelihood is also suggested. Simulation studies demonstrate that the proposed multiple imputation methods work well while alternative methods lead to estimates that are either biased or more variable. The proposed methods are applied to analyze the dataset from a recently-conducted GenIMS study.

A feedback control model for network flow with multiple pure time delays

Science.gov (United States)

Press, J.

1972-01-01

A control model describing a network flow hindered by multiple pure time (or transport) delays is formulated. Feedbacks connect each desired output with a single control sector situated at the origin. The dynamic formulation invokes the use of differential difference equations. This causes the characteristic equation of the model to consist of transcendental functions instead of a common algebraic polynomial. A general graphical criterion is developed to evaluate the stability of such a problem. A digital computer simulation confirms the validity of such criterion. An optimal decision making process with multiple delays is presented.

Multiple Model Adaptive Attitude Control of LEO Satellite with Angular Velocity Constraints

Science.gov (United States)

Shahrooei, Abolfazl; Kazemi, Mohammad Hosein

2018-04-01

In this paper, the multiple model adaptive control is utilized to improve the transient response of attitude control system for a rigid spacecraft. An adaptive output feedback control law is proposed for attitude control under angular velocity constraints and its almost global asymptotic stability is proved. The multiple model adaptive control approach is employed to counteract large uncertainty in parameter space of the inertia matrix. The nonlinear dynamics of a low earth orbit satellite is simulated and the proposed control algorithm is implemented. The reported results show the effectiveness of the suggested scheme.

Multiple intra-hospital transports during relocation to a new critical care unit.

Science.gov (United States)

O'Leary, R-A; Conrick-Martin, I; O'Loughlin, C; Curran, M-R; Marsh, B

2017-11-01

Intra-hospital transport (IHT) of critically ill patients is associated with morbidity and mortality. Mass transfer of patients, as happens with unit relocation, is poorly described. We outline the process and adverse events associated with the relocation of a critical care unit. Extensive planning of the relocation targeted patient and equipment transfer, reduction in clinical pressure prior to the event and patient care during the relocation phase. The setting was a 30-bed, tertiary referral, combined medical and surgical critical care unit, located in a 570-bed hospital that serves as the national referral centre for cardiothoracic surgery and spinal injuries. All stakeholders relevant to the critical care unit relocation were involved, including nursing and medical staff, porters, information technology services, laboratory staff, project development managers, pharmacy staff and building contractors. Mortality at discharge from critical care unit and discharge from hospital were the main outcome measures. A wide range of adverse events were prospectively recorded, as were transfer times. Twenty-one patients underwent IHT, with a median transfer time of 10 min. Two transfers were complicated by equipment failure and three patients experienced an episode of hypotension requiring intervention. There were no cases of central venous or arterial catheter or endotracheal tube dislodgement, and hospital mortality at 30 days was 14%. Although IHT is associated with morbidity and mortality, careful logistical planning allows for efficient transfer with low complication rates.

[Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals].

Science.gov (United States)

Martínez, Cristina; Martínez-Sánchez, Jose M; Antón, Laura; Riccobene, Anna; Fu, Marcela; Quirós, Nuria; Saltó, Esteve; Fernández, Esteve

2016-01-01

To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Improving the Pattern Reproducibility of Multiple-Point-Based Prior Models Using Frequency Matching

DEFF Research Database (Denmark)

Cordua, Knud Skou; Hansen, Thomas Mejer; Mosegaard, Klaus

2014-01-01

Some multiple-point-based sampling algorithms, such as the snesim algorithm, rely on sequential simulation. The conditional probability distributions that are used for the simulation are based on statistics of multiple-point data events obtained from a training image. During the simulation, data...... events with zero probability in the training image statistics may occur. This is handled by pruning the set of conditioning data until an event with non-zero probability is found. The resulting probability distribution sampled by such algorithms is a pruned mixture model. The pruning strategy leads...... to a probability distribution that lacks some of the information provided by the multiple-point statistics from the training image, which reduces the reproducibility of the training image patterns in the outcome realizations. When pruned mixture models are used as prior models for inverse problems, local re...

Hospital benchmarking: are U.S. eye hospitals ready?

Science.gov (United States)

de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

2012-01-01

Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added

The reverse effects of random perturbation on discrete systems for single and multiple population models

International Nuclear Information System (INIS)

Kang, Li; Tang, Sanyi

2016-01-01

Highlights: • The discrete single species and multiple species models with random perturbation are proposed. • The complex dynamics and interesting bifurcation behavior have been investigated. • The reverse effects of random perturbation on discrete systems have been discussed and revealed. • The main results can be applied for pest control and resources management. - Abstract: The natural species are likely to present several interesting and complex phenomena under random perturbations, which have been confirmed by simple mathematical models. The important questions are: how the random perturbations influence the dynamics of the discrete population models with multiple steady states or multiple species interactions? and is there any different effects for single species and multiple species models with random perturbation? To address those interesting questions, we have proposed the discrete single species model with two stable equilibria and the host-parasitoid model with Holling type functional response functions to address how the random perturbation affects the dynamics. The main results indicate that the random perturbation does not change the number of blurred orbits of the single species model with two stable steady states compared with results for the classical Ricker model with same random perturbation, but it can strength the stability. However, extensive numerical investigations depict that the random perturbation does not influence the complexities of the host-parasitoid models compared with the results for the models without perturbation, while it does increase the period of periodic orbits doubly. All those confirm that the random perturbation has a reverse effect on the dynamics of the discrete single and multiple population models, which could be applied in reality including pest control and resources management.

Theoretical Models of Protostellar Binary and Multiple Systems with AMR Simulations

Science.gov (United States)

Matsumoto, Tomoaki; Tokuda, Kazuki; Onishi, Toshikazu; Inutsuka, Shu-ichiro; Saigo, Kazuya; Takakuwa, Shigehisa

2017-05-01

We present theoretical models for protostellar binary and multiple systems based on the high-resolution numerical simulation with an adaptive mesh refinement (AMR) code, SFUMATO. The recent ALMA observations have revealed early phases of the binary and multiple star formation with high spatial resolutions. These observations should be compared with theoretical models with high spatial resolutions. We present two theoretical models for (1) a high density molecular cloud core, MC27/L1521F, and (2) a protobinary system, L1551 NE. For the model for MC27, we performed numerical simulations for gravitational collapse of a turbulent cloud core. The cloud core exhibits fragmentation during the collapse, and dynamical interaction between the fragments produces an arc-like structure, which is one of the prominent structures observed by ALMA. For the model for L1551 NE, we performed numerical simulations of gas accretion onto protobinary. The simulations exhibit asymmetry of a circumbinary disk. Such asymmetry has been also observed by ALMA in the circumbinary disk of L1551 NE.

[Ulysses network: an approach to integral post-ICU treatment of patients with multiple organ dysfunction syndrome].

Science.gov (United States)

Nolla-Salas, M; Monmany-Roca, J; Vázquez-Mata, G

2007-01-01

The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction.

Occupational Accidents among Clinical Staff of Tabriz University Hospitals

Directory of Open Access Journals (Sweden)

Leila Sahebi

2015-07-01

Full Text Available ​Background and Objectives : Occupational health and safety is one of the most important issues in the workplace. The purpose of this study was to explore the one –year prevalence of occupational accidents in Tabriz University hospitals. Materials and Methods : A cross-sectional study was conducted on 400 patients of seven university hospitals using researcher made questionnaire. The hospitals were selected based on their specialty of the service. Then, one hospital was selected from each specialty using random selection method. Univariate and multiple regression analyses were employed. The SPSS version 19 was used for data analysis. Results : The one-year prevalence of workplace accident was %21. Women were encountered in workplace accidents more than men (%31.1 vs. % 26.8. The youngest age group (20-30 years experienced the most workplace accidents (%41.5. Carelessness was the main cause of the workplace accidents (%49.3. Reporting rate of the occupational accidents was% 48.3 and the most common cause for not reporting was the fear of being recognized as a less competent individual. Sick leaves due to the severity of the accident was reported %23 (median: 5 days. Over %90 of the accident victims had experienced severe stress and job pressure within the previous year. In multiple regression models, the young staff (20-30 years with severe stress, job pressure and verbal violence victim had more chance of workplace accident.   Conclusion : In addition to the high prevalence of workplace accidents, intensity and consequences of workplace accidents should be considered as well. Providing appropriate methods including prevention of accidents and education of safety along with the assistance of technical staff, managers and attendants would be helpful.

Multiple meanings of "gift" and its value for organ donation.

Science.gov (United States)

Shaw, Rhonda M; Webb, Robert

2015-05-01

The "gift of life" metaphor is used to promote organ donation where commercialization is prohibited. In this article, we explore how multiple parties involved in organ transfer procedures think of gift terminology by drawing on interview data with transplantation specialists, organ transplant recipients, living directed donors and living nondirected donors. The interviews took place across New Zealand between October 2008 and May 2012, in participants' homes and hospital workplaces. The interviews were transcribed verbatim, coded manually, and thematically analyzed. Although gift language is often viewed as clear-cut, the gift trope has multiple meanings for different constituent and cultural groups, ranging from positive descriptors to obscuring and romanticizing the complexities of transplantation processes. To account for these multiple perspectives, we suggest new ethical models to capture the nuanced phenomenon of organ transfer in ways that recognize the full range of donation and reception experiences. © The Author(s) 2014.

Vehicle coordinated transportation dispatching model base on multiple crisis locations

Science.gov (United States)

Tian, Ran; Li, Shanwei; Yang, Guoying

2018-05-01

Many disastrous events are often caused after unconventional emergencies occur, and the requirements of disasters are often different. It is difficult for a single emergency resource center to satisfy such requirements at the same time. Therefore, how to coordinate the emergency resources stored by multiple emergency resource centers to various disaster sites requires the coordinated transportation of emergency vehicles. In this paper, according to the problem of emergency logistics coordination scheduling, based on the related constraints of emergency logistics transportation, an emergency resource scheduling model based on multiple disasters is established.

A P-value model for theoretical power analysis and its applications in multiple testing procedures

Directory of Open Access Journals (Sweden)

Fengqing Zhang

2016-10-01

Full Text Available Abstract Background Power analysis is a critical aspect of the design of experiments to detect an effect of a given size. When multiple hypotheses are tested simultaneously, multiplicity adjustments to p-values should be taken into account in power analysis. There are a limited number of studies on power analysis in multiple testing procedures. For some methods, the theoretical analysis is difficult and extensive numerical simulations are often needed, while other methods oversimplify the information under the alternative hypothesis. To this end, this paper aims to develop a new statistical model for power analysis in multiple testing procedures. Methods We propose a step-function-based p-value model under the alternative hypothesis, which is simple enough to perform power analysis without simulations, but not too simple to lose the information from the alternative hypothesis. The first step is to transform distributions of different test statistics (e.g., t, chi-square or F to distributions of corresponding p-values. We then use a step function to approximate each of the p-value’s distributions by matching the mean and variance. Lastly, the step-function-based p-value model can be used for theoretical power analysis. Results The proposed model is applied to problems in multiple testing procedures. We first show how the most powerful critical constants can be chosen using the step-function-based p-value model. Our model is then applied to the field of multiple testing procedures to explain the assumption of monotonicity of the critical constants. Lastly, we apply our model to a behavioral weight loss and maintenance study to select the optimal critical constants. Conclusions The proposed model is easy to implement and preserves the information from the alternative hypothesis.

Challenges in LCA modelling of multiple loops for aluminium cans

DEFF Research Database (Denmark)

Niero, Monia; Olsen, Stig Irving

considered the case of closed-loop recycling for aluminium cans, where body and lid are different alloys, and discussed the abovementioned challenge. The Life Cycle Inventory (LCI) modelling of aluminium processes is traditionally based on a pure aluminium flow, therefore neglecting the presence of alloying...... elements. We included the effect of alloying elements on the LCA modelling of aluminium can recycling. First, we performed a mass balance of the main alloying elements (Mn, Fe, Si, Cu) in aluminium can recycling at increasing levels of recycling rate. The analysis distinguished between different aluminium...... packaging scrap sources (i.e. used beverage can and mixed aluminium packaging) to understand the limiting factors for multiple loop aluminium can recycling. Secondly, we performed a comparative LCA of aluminium can production and recycling in multiple loops considering the two aluminium packaging scrap...

A minimal unified model of disease trajectories captures hallmarks of multiple sclerosis

KAUST Repository

Kannan, Venkateshan

2017-03-29

Multiple Sclerosis (MS) is an autoimmune disease targeting the central nervous system (CNS) causing demyelination and neurodegeneration leading to accumulation of neurological disability. Here we present a minimal, computational model involving the immune system and CNS that generates the principal subtypes of the disease observed in patients. The model captures several key features of MS, especially those that distinguish the chronic progressive phase from that of the relapse-remitting. In addition, a rare subtype of the disease, progressive relapsing MS naturally emerges from the model. The model posits the existence of two key thresholds, one in the immune system and the other in the CNS, that separate dynamically distinct behavior of the model. Exploring the two-dimensional space of these thresholds, we obtain multiple phases of disease evolution and these shows greater variation than the clinical classification of MS, thus capturing the heterogeneity that is manifested in patients.

Modelling multiple cycles of static and dynamic recrystallisation using a fully implicit isotropic material model based on dislocation density

Science.gov (United States)

Jansen van Rensburg, Gerhardus J.; Kok, Schalk; Wilke, Daniel N.

2018-03-01

This paper presents the development and numerical implementation of a state variable based thermomechanical material model, intended for use within a fully implicit finite element formulation. Plastic hardening, thermal recovery and multiple cycles of recrystallisation can be tracked for single peak as well as multiple peak recrystallisation response. The numerical implementation of the state variable model extends on a J2 isotropic hypo-elastoplastic modelling framework. The complete numerical implementation is presented as an Abaqus UMAT and linked subroutines. Implementation is discussed with detailed explanation of the derivation and use of various sensitivities, internal state variable management and multiple recrystallisation cycle contributions. A flow chart explaining the proposed numerical implementation is provided as well as verification on the convergence of the material subroutine. The material model is characterised using two high temperature data sets for cobalt and copper. The results of finite element analyses using the material parameter values characterised on the copper data set are also presented.

Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity.

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Lian Leng Low

Full Text Available To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months, an established risk stratification tool.This was a retrospective cohort study of all patients ≥ 21 years of age, who were admitted to a tertiary hospital in Singapore from January 1, 2013 through May 31, 2015. Data were extracted from the hospital's electronic health records. The outcome was defined as unplanned readmissions within 30 days of discharge from the index hospitalization. Candidate predictive variables were broadly grouped into five categories: Patient demographics, social determinants of health, past healthcare utilization, medical comorbidities, and markers of hospitalization severity. Multivariable logistic regression was used to predict the outcome, and receiver operating characteristic analysis was performed to compare our model with the LACE index.74,102 cases were enrolled for analysis. Of these, 11,492 patient cases (15.5% were readmitted within 30 days of discharge. A total of fifteen predictive variables were strongly associated with the risk of 30-day readmissions, including number of emergency department visits in the past 6 months, Charlson Comorbidity Index, markers of hospitalization severity such as 'requiring inpatient dialysis during index admission, and 'treatment with intravenous furosemide 40 milligrams or more' during index admission. Our predictive model outperformed the LACE index by achieving larger area under the curve values: 0.78 (95% confidence interval [CI]: 0.77-0.79 versus 0.70 (95% CI: 0.69-0.71.Several factors are important for the risk of 30-day readmissions

Should researchers use single indicators, best indicators, or multiple indicators in structural equation models?

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Hayduk Leslie A

2012-10-01

Full Text Available Abstract Background Structural equation modeling developed as a statistical melding of path analysis and factor analysis that obscured a fundamental tension between a factor preference for multiple indicators and path modeling’s openness to fewer indicators. Discussion Multiple indicators hamper theory by unnecessarily restricting the number of modeled latents. Using the few best indicators – possibly even the single best indicator of each latent – encourages development of theoretically sophisticated models. Additional latent variables permit stronger statistical control of potential confounders, and encourage detailed investigation of mediating causal mechanisms. Summary We recommend the use of the few best indicators. One or two indicators are often sufficient, but three indicators may occasionally be helpful. More than three indicators are rarely warranted because additional redundant indicators provide less research benefit than single indicators of additional latent variables. Scales created from multiple indicators can introduce additional problems, and are prone to being less desirable than either single or multiple indicators.

A Model of Distraction using new Architectural Mechanisms to Manage Multiple Goals

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Taatgen, Niels; Katidioti, Ioanna; Borst, Jelmer; van Vugt, Marieke; Taatgen, Niels; van Vugt, Marieke; Borst, Jelmer; Mehlhorn, Katja

2015-01-01

Cognitive models assume a one-to-one correspondence between task and goals. We argue that modeling a task by combining multiple goals has several advantages: a task can be constructed from components that are reused from other tasks, and it enables modeling thought processes that compete with or

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences.

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Mousavi, Seyed Mohammad Hadi; Dargahi, Hossein; Mohammadi, Sara

2016-10-01

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it

The impact of stakeholder involvement in hospital policy decision-making: a study of the hospital's business processes.

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Malfait, Simon; Van Hecke, Ann; Hellings, Johan; De Bodt, Griet; Eeckloo, Kristof

2017-02-01

In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.

Modular organization and hospital performance.

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Kuntz, Ludwig; Vera, Antonio

2007-02-01

The concept of modularization represents a modern form of organization, which contains the vertical disaggregation of the firm and the use of market mechanisms within hierarchies. The objective of this paper is to examine whether the use of modular structures has a positive effect on hospital performance. The empirical section makes use of multiple regression analyses and leads to the main result that modularization does not have a positive effect on hospital performance. However, the analysis also finds out positive efficiency effects of two central ideas of modularization, namely process orientation and internal market mechanisms.

Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals.

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Dubois, Carl-Ardy; D'amour, Danielle; Tchouaket, Eric; Clarke, Sean; Rivard, Michèle; Blais, Régis

2013-04-01

To examine the associations of four distinct nursing care organizational models with patient safety outcomes. Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess the associations of those events with four nursing care organizational models. Twenty-two medical units in 11 hospitals in Quebec, Canada, were clustered into 4 nursing care organizational models: 2 professional models and 2 functional models. Two thousand six hundred and ninety-nine were patients hospitalized for at least 48 h on the selected units. Composite of six safety-related events widely-considered sensitive to nursing care: medication administration errors, falls, pneumonia, urinary tract infection, unjustified restraints and pressure ulcers. Events were ultimately sorted into two categories: events 'without major' consequences for patients and events 'with' consequences. After controlling for patient characteristics, patient risk of experiencing one or more events (of any severity) and of experiencing an event with consequences was significantly lower, by factors of 25-52%, in both professional models than in the functional models. Event rates for both functional models were statistically indistinguishable from each other. Data suggest that nursing care organizational models characterized by contrasting staffing, work environment and innovation characteristics may be associated with differential risk for hospitalized patients. The two professional models, which draw mainly on registered nurses (RNs) to deliver nursing services and reflect stronger support for nurses' professional practice, were associated with lower risks than are the two functional models.

Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases.

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Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

2014-09-01

The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Relationship Among Change Fatigue, Resilience, and Job Satisfaction of Hospital Staff Nurses.

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Brown, Robin; Wey, Howard; Foland, Kay

2018-03-08

The purpose of this study was to examine relationships between change fatigue, resilience, and job satisfaction among novice and seasoned hospital staff nurses. Health care is typified by change. Frequent and vast changes in acute care hospitals can take a toll on nurses and cause change fatigue, which has been largely overlooked and under-researched. A descriptive correlational design was employed with 521 hospital staff nurses in one midwestern state. Participants completed three online surveys: (a) Change Fatigue Scale, (b) Connor-Davidson Resilience Scale, and (c) McCloskey/Mueller Satisfaction Scale. In a multiple regression model, job satisfaction had a statistically significant negative association with change fatigue (p job satisfaction among hospital nursing staff being negatively influenced by change fatigue and positively influenced by resilience, although reverse causal connections are also possible. Change fatigue may be increased by larger hospital size (number of beds), and resilience may be increased by higher educational level of hospital staff nurses. The study advanced the nursing knowledge on change fatigue, resilience, and job satisfaction of staff nurses working in acute care hospitals. Engaging in strategies aimed at preventing change fatigue in nursing staff can enhance workplace environments, job satisfaction, and retention of nurses. © 2018 Sigma Theta Tau International.

Respiratory hospitalizations in association with fine PM and its ...

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Despite observed geographic and temporal variation in particulate matter (PM)-related health morbidities, only a small number of epidemiologic studies have evaluated the relation between PM2.5 chemical constituents and respiratory disease. Most assessments are limited by inadequate spatial and temporal resolution of ambient PM measurements and/or by their approaches to examine the role of specific PM components on health outcomes. In a case-crossover analysis using daily average ambient PM2.5 total mass and species estimates derived from the Community Multiscale Air Quality (CMAQ) model and available observations, we examined the association between the chemical components of PM (including elemental and organic carbon, sulfate, nitrate, ammonium, and other remaining) and respiratory hospitalizations in New York State. We evaluated relationships between levels (low, medium, high) of PM constituent mass fractions, and assessed modification of the PM2.5–hospitalization association via models stratified by mass fractions of both primary and secondary PM components. In our results, average daily PM2.5 concentrations in New York State were generally lower than the 24-hr average National Ambient Air Quality Standard (NAAQS). Year-round analyses showed statistically significant positive associations between respiratory hospitalizations and PM2.5 total mass, sulfate, nitrate, and ammonium concentrations at multiple exposure lags (0.5–2.0% per interquartile range [IQR

The use of artificial neural networks and multiple linear regression to predict rate of medical waste generation

International Nuclear Information System (INIS)

Jahandideh, Sepideh; Jahandideh, Samad; Asadabadi, Ebrahim Barzegari; Askarian, Mehrdad; Movahedi, Mohammad Mehdi; Hosseini, Somayyeh; Jahandideh, Mina

2009-01-01

Prediction of the amount of hospital waste production will be helpful in the storage, transportation and disposal of hospital waste management. Based on this fact, two predictor models including artificial neural networks (ANNs) and multiple linear regression (MLR) were applied to predict the rate of medical waste generation totally and in different types of sharp, infectious and general. In this study, a 5-fold cross-validation procedure on a database containing total of 50 hospitals of Fars province (Iran) were used to verify the performance of the models. Three performance measures including MAR, RMSE and R 2 were used to evaluate performance of models. The MLR as a conventional model obtained poor prediction performance measure values. However, MLR distinguished hospital capacity and bed occupancy as more significant parameters. On the other hand, ANNs as a more powerful model, which has not been introduced in predicting rate of medical waste generation, showed high performance measure values, especially 0.99 value of R 2 confirming the good fit of the data. Such satisfactory results could be attributed to the non-linear nature of ANNs in problem solving which provides the opportunity for relating independent variables to dependent ones non-linearly. In conclusion, the obtained results showed that our ANN-based model approach is very promising and may play a useful role in developing a better cost-effective strategy for waste management in future.

A dynamical model of car-following with the consideration of the multiple information of preceding cars

International Nuclear Information System (INIS)

Peng, G.H.; Sun, D.H.

2010-01-01

An improved multiple car-following (MCF) model is proposed, based on the full velocity difference (FVD) model, but taking into consideration multiple information inputs from preceding vehicles. The linear stability condition of the model is obtained by using the linear stability theory. Through nonlinear analysis, the modified Korteweg-de Vries (mKdV) equation is derived to describe the traffic behavior near the critical point. Numerical simulation shows that the proposed model is theoretically an improvement over others, while retaining many strong points in the previous ones by adjusting the information of the multiple leading vehicles.

Hospitality and Tourism Online Review Research: A Systematic Analysis and Heuristic-Systematic Model

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Sunyoung Hlee

2018-04-01

Full Text Available With tremendous growth and potential of online consumer reviews, online reviews of hospitality and tourism are now playing a significant role in consumer attitude and buying behaviors. This study reviewed and analyzed hospitality and tourism related articles published in academic journals. The systematic approach was used to analyze 55 research articles between January 2008 and December 2017. This study presented a brief synthesis of research by investigating content-related characteristics of hospitality and tourism online reviews (HTORs in different market segments. Two research questions were addressed. Building upon our literature analysis, we used the heuristic-systematic model (HSM to summarize and classify the characteristics affecting consumer perception in previous HTOR studies. We believe that the framework helps researchers to identify the research topic in extended HTORs literature and to point out possible direction for future studies.

Multiple sequential failure model: A probabilistic approach to quantifying human error dependency

International Nuclear Information System (INIS)

Samanta

1985-01-01

This paper rpesents a probabilistic approach to quantifying human error dependency when multiple tasks are performed. Dependent human failures are dominant contributors to risks from nuclear power plants. An overview of the Multiple Sequential Failure (MSF) model developed and its use in probabilistic risk assessments (PRAs) depending on the available data are discussed. A small-scale psychological experiment was conducted on the nature of human dependency and the interpretation of the experimental data by the MSF model show remarkable accommodation of the dependent failure data. The model, which provides an unique method for quantification of dependent failures in human reliability analysis, can be used in conjunction with any of the general methods currently used for performing the human reliability aspect in PRAs

In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

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Miguel Hernan Vicco

2015-04-01

Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

Double-multiple streamtube model for studying vertical-axis wind turbines

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Paraschivoiu, Ion

1988-08-01

This work describes the present state-of-the-art in double-multiple streamtube method for modeling the Darrieus-type vertical-axis wind turbine (VAWT). Comparisons of the analytical results with the other predictions and available experimental data show a good agreement. This method, which incorporates dynamic-stall and secondary effects, can be used for generating a suitable aerodynamic-load model for structural design analysis of the Darrieus rotor.

Multiple Surrogate Modeling for Wire-Wrapped Fuel Assembly Optimization

International Nuclear Information System (INIS)

Raza, Wasim; Kim, Kwang-Yong

2007-01-01

In this work, shape optimization of seven pin wire wrapped fuel assembly has been carried out in conjunction with RANS analysis in order to evaluate the performances of surrogate models. Previously, Ahmad and Kim performed the flow and heat transfer analysis based on the three-dimensional RANS analysis. But numerical optimization has not been applied to the design of wire-wrapped fuel assembly, yet. Surrogate models are being widely used in multidisciplinary optimization. Queipo et al. reviewed various surrogates based models used in aerospace applications. Goel et al. developed weighted average surrogate model based on response surface approximation (RSA), radial basis neural network (RBNN) and Krigging (KRG) models. In addition to the three basic models, RSA, RBNN and KRG, the multiple surrogate model, PBA also has been employed. Two geometric design variables and a multi-objective function with a weighting factor have been considered for this problem

Modeling and optimization of a utility system containing multiple extractions steam turbines

International Nuclear Information System (INIS)

Luo, Xianglong; Zhang, Bingjian; Chen, Ying; Mo, Songping

2011-01-01

Complex turbines with multiple controlled and/or uncontrolled extractions are popularly used in the processing industry and cogeneration plants to provide steam of different levels, electric power, and driving power. To characterize thermodynamic behavior under varying conditions, nonlinear mathematical models are developed based on energy balance, thermodynamic principles, and semi-empirical equations. First, the complex turbine is decomposed into several simple turbines from the controlled extraction stages and modeled in series. THM (The turbine hardware model) developing concept is applied to predict the isentropic efficiency of the decomposed simple turbines. Stodola's formulation is also used to simulate the uncontrolled extraction steam parameters. The thermodynamic properties of steam and water are regressed through linearization or piece-wise linearization. Second, comparison between the simulated results using the proposed model and the data in the working condition diagram provided by the manufacturer is conducted over a wide range of operations. The simulation results yield small deviation from the data in the working condition diagram where the maximum modeling error is 0.87% among the compared seven operation conditions. Last, the optimization model of a utility system containing multiple extraction turbines is established and a detailed case is analyzed. Compared with the conventional operation strategy, a maximum of 5.47% of the total operation cost is saved using the proposed optimization model. -- Highlights: → We develop a complete simulation model for steam turbine with multiple extractions. → We test the simulation model using the performance data of commercial turbines. → The simulation error of electric power generation is no more than 0.87%. → We establish a utility system operational optimization model. → The optimal industrial operation scheme featured with 5.47% of cost saving.

[Satisfaction of hospitalized patients in a hospital in Apurimac, Peru].

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Sihuin-Tapia, Elsa Yudy; Gómez-Quispe, Oscar Elisban; Ibáñez-Quispe, Vladimiro

2015-01-01

In order to determine the satisfaction of hospitalized patients in the Sub-regional Hospital of Andahuaylas, 175 patients were surveyed using the Servqual multidimensional model. The estimate of variables associated with the satisfaction of the hospitalized patients was performed by using bivariate and multivariate logistic regression analysis. We found 25.0% satisfaction. Lower levels of satisfaction were associated with having a secondary level education (aOR: 0.05; 95% CI: 0.01 to 0.64) and with having been hospitalized in the surgery department (aOR 0.14, CI: 95%: 0.04 to 0.53). It was concluded that there was a low level of satisfaction with the quality of care received by hospitalized patients and this was associated with the level of education and type of hospital department.

Falls following discharge after an in-hospital fall

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Kessler Lori A

2009-12-01

Full Text Available Abstract Background Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. Methods We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks. Time spent rehospitalized or institutionalized was censored in rate calculations. Results Of 95 hospitalized patients who fell during recruitment, 65 (68% met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days. Seventy-five percent were African-American and 43% were women. Sixteen patients (25% had multiple falls during hospitalization and 23 patients (35% suffered a fall-related injury during hospitalization. Nineteen patients (29% experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4. Twenty-three patients (35% were readmitted and 3(5% died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008. Conclusion Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population.

Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling.

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Katarzyna A Dembek

Full Text Available BACKGROUND: Medical management of critically ill equine neonates (foals can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission. METHODS AND RESULTS: Data from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7 and the lowest (0 scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively. CONCLUSIONS: The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.

Modelling the Dynamics of Intracellular Processes as an Organisation of Multiple Agents

NARCIS (Netherlands)

Bosse, T.; Jonker, C.M.; Treur, J.; Armano, G.; Merelli, E.; Denzinger, J.; Martin, A.; Miles, S.; Tianfield, H.; Unland, R.

2005-01-01

This paper explores how the dynamics of complex biological processes can be modeled as an organisation of multiple agents. This modelling perspective identifies organisational structure occurring in complex decentralised processes and handles complexity of the analysis of the dynamics by structuring

A modeling and numerical algorithm for thermoporomechanics in multiple porosity media for naturally fractured reservoirs

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Kim, J.; Sonnenthal, E. L.; Rutqvist, J.

2011-12-01

Rigorous modeling of coupling between fluid, heat, and geomechanics (thermo-poro-mechanics), in fractured porous media is one of the important and difficult topics in geothermal reservoir simulation, because the physics are highly nonlinear and strongly coupled. Coupled fluid/heat flow and geomechanics are investigated using the multiple interacting continua (MINC) method as applied to naturally fractured media. In this study, we generalize constitutive relations for the isothermal elastic dual porosity model proposed by Berryman (2002) to those for the non-isothermal elastic/elastoplastic multiple porosity model, and derive the coupling coefficients of coupled fluid/heat flow and geomechanics and constraints of the coefficients. When the off-diagonal terms of the total compressibility matrix for the flow problem are zero, the upscaled drained bulk modulus for geomechanics becomes the harmonic average of drained bulk moduli of the multiple continua. In this case, the drained elastic/elastoplastic moduli for mechanics are determined by a combination of the drained moduli and volume fractions in multiple porosity materials. We also determine a relation between local strains of all multiple porosity materials in a gridblock and the global strain of the gridblock, from which we can track local and global elastic/plastic variables. For elastoplasticity, the return mapping is performed for all multiple porosity materials in the gridblock. For numerical implementation, we employ and extend the fixed-stress sequential method of the single porosity model to coupled fluid/heat flow and geomechanics in multiple porosity systems, because it provides numerical stability and high accuracy. This sequential scheme can be easily implemented by using a porosity function and its corresponding porosity correction, making use of the existing robust flow and geomechanics simulators. We implemented the proposed modeling and numerical algorithm to the reaction transport simulator

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals.

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Tan, Amy Cw; Emmerton, Lynne M; Hattingh, Laetitia; La Caze, Adam

2015-01-01

Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes. Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants

Statistical Modeling of the Trends Concerning the Number of Hospitals and Medical Centres in Romania

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Gabriela OPAIT

2017-04-01

Full Text Available This study reveals the technique for to achive the shapes of the mathematical models which put in evidence the distributions of the values concerning the number of Hospitals, respectively Medical Centres, in our country, in the time horizon 2005-2014. In the same time, we can to observe the algorithm applied for to construct forecasts about the evolutions regarding the number of Hospitals and Medical Centres in Romania.

Managers' perceptions of customers' satisfactions with their hospital cafeteria services.

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Johnston, C M; Upton, E M

1991-01-01

It is important that hospital cafeterias deliver products that create customer satisfaction so that financial objectives are met. An exploratory descriptive survey of 12 selected hospital cafeterias used a self-administered questionnaire to determine how satisfied customers were with services provided. It also asked cafeteria managers to give their perceptions of their customers' relative satisfaction/dissatisfaction with the service. Principal components analysis, followed by varimax rotation, identified four underlying constructs of the 15 pre-selected foodservice characteristics used to measure relative satisfaction. A multiple regression model, controlling for country, hospital size and customer demographics, in which the dependent variable was overall rating, found that the independent variables, the underlying rating constructs--food and service--made a much greater impact on overall rating than environment and accessibility. Most cafeteria managers' predictions about their customers' satisfaction were within two standard deviations of their customers' mean scores of satisfaction. While the managers' close association with their service may have accounted for this, it does not necessarily follow that they have the power to implement policy and product improvements.

THE EFFECTS OF HOSPITAL QUALITY OF CARE ON PATIENT BELONGING: STRUCTURAL EQUALITY MODEL AND MEDIATION

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Ali Rıza FİRUZAN

2017-09-01

Full Text Available The aim of the study is to measure the effects of perceived and expected service quality levels on patient loyalty. In total, 370 patients participated in this research. The Structural Equation Modeling (SEM method to test the causal relationship model. The corresponding model in the study emerged as acceptable fit with the model. The result of the study indicate that perceived service quality and patient loyalty are statistically significant and positively related to each other. Additionally, perceived service quality has found to be an important mediator between expected service quality and patient loyalty. After patients have treatment in corresponding hospital, they have been affected by service quality as mush as cost of medication. As patient satisfaction increases, their loyalty increases. It is suggested to hospital management that they might course of action to patients for improving Reliability and Assurance SERVQUAL factors

[Impact of frailty over the functional state of hospitalized elderly].

Science.gov (United States)

García-Cruz, Juan Carlos; García-Peña, Carmen

2016-01-01

Frailty in elderly results from impaired physiological reserve in multiple systems. Establishing if frail elderly inpatients develop more functional impairment at discharge, will allow the development of strategies for preventing or limiting the deterioration in this vulnerable group. Prospective cohort in 133 elderly inpatients. At admission, frailty, functional status, comorbidity and comprehensive geriatric evaluation were determined. The main outcome was functional state at hospital discharge. 64 patients presented frailty (48.1%) and 69 did not present that state (51.9%), with a mean age of 73 and 68 years, respectively. Mean decrement in functional state at discharge was -8.06 % (IC 95 % -10.38 to -5.74), from 97.97 % to 89.91 % (p model, frailty (beta -14.73, IC 95 % -19.39 to -10.07, p decrement. Frailty independently predicts functional impairment at hospital discharge.

Model selection with multiple regression on distance matrices leads to incorrect inferences.

Directory of Open Access Journals (Sweden)

Ryan P Franckowiak

Full Text Available In landscape genetics, model selection procedures based on Information Theoretic and Bayesian principles have been used with multiple regression on distance matrices (MRM to test the relationship between multiple vectors of pairwise genetic, geographic, and environmental distance. Using Monte Carlo simulations, we examined the ability of model selection criteria based on Akaike's information criterion (AIC, its small-sample correction (AICc, and the Bayesian information criterion (BIC to reliably rank candidate models when applied with MRM while varying the sample size. The results showed a serious problem: all three criteria exhibit a systematic bias toward selecting unnecessarily complex models containing spurious random variables and erroneously suggest a high level of support for the incorrectly ranked best model. These problems effectively increased with increasing sample size. The failure of AIC, AICc, and BIC was likely driven by the inflated sample size and different sum-of-squares partitioned by MRM, and the resulting effect on delta values. Based on these findings, we strongly discourage the continued application of AIC, AICc, and BIC for model selection with MRM.

Multiple Temperature Model for Near Continuum Flows

International Nuclear Information System (INIS)

XU, Kun; Liu, Hongwei; Jiang, Jianzheng

2007-01-01

In the near continuum flow regime, the flow may have different translational temperatures in different directions. It is well known that for increasingly rarefied flow fields, the predictions from continuum formulation, such as the Navier-Stokes equations, lose accuracy. These inaccuracies may be partially due to the single temperature assumption in the Navier-Stokes equations. Here, based on the gas-kinetic Bhatnagar-Gross-Krook (BGK) equation, a multitranslational temperature model is proposed and used in the flow calculations. In order to fix all three translational temperatures, two constraints are additionally proposed to model the energy exchange in different directions. Based on the multiple temperature assumption, the Navier-Stokes relation between the stress and strain is replaced by the temperature relaxation term, and the Navier-Stokes assumption is recovered only in the limiting case when the flow is close to the equilibrium with the same temperature in different directions. In order to validate the current model, both the Couette and Poiseuille flows are studied in the transition flow regime

A toy MCT model for multiple glass transitions: Double swallow tail singularity

Energy Technology Data Exchange (ETDEWEB)

Ryzhov, V.N. [Institute for High Pressure Physics, Russian Academy of Sciences, Troitsk 142190, Moscow region (Russian Federation); Moscow Institute of Physics and Technology, 141700 Moscow (Russian Federation); Tareyeva, E.E. [Institute for High Pressure Physics, Russian Academy of Sciences, Troitsk 142190, Moscow region (Russian Federation)

2014-11-07

We propose a toy model to describe in the frame of Mode Coupling Theory multiple glass transitions. The model is based on the postulated simple form for static structure factor as a sum of two delta-functions. This form makes it possible to solve the MCT equations in almost analytical way. The phase diagram is governed by two swallow tails resulting from two A{sub 4} singularities and includes liquid–glass transition and multiple glasses. The diagram has much in common with those of binary and quasibinary systems. - Highlights: • A simple toy model is proposed for description of glass–glass transitions. • The static structure factor of the model has the form of a sum of delta-functions. • The phase diagram contains A{sub 4} bifurcation singularities and A{sub 3} end points. • The results can be applied for the qualitative description of quasibinary systems.

Business intelligence and information systems in hospitals--distribution and usage of BI and HIS in German hospitals.

Science.gov (United States)

Bartsch, Patrick; Lux, Thomas; Wagner, Alexander; Gabriel, Roland

2013-01-01

This paper shows the results of a short survey taken place in February 2013 within German Hospitals. The present studies view is bottom-up and the interviews are done directly with the hospitals CIOs. There are some effects like the G-DRG implementation in Germany that are evident in the results. The survey indicates also the different methods of adapting the solutions, either by having an all-in-one solution by a single provider or by using a modular solution from multiple providers.

Validation and calibration of structural models that combine information from multiple sources.

Science.gov (United States)

Dahabreh, Issa J; Wong, John B; Trikalinos, Thomas A

2017-02-01

Mathematical models that attempt to capture structural relationships between their components and combine information from multiple sources are increasingly used in medicine. Areas covered: We provide an overview of methods for model validation and calibration and survey studies comparing alternative approaches. Expert commentary: Model validation entails a confrontation of models with data, background knowledge, and other models, and can inform judgments about model credibility. Calibration involves selecting parameter values to improve the agreement of model outputs with data. When the goal of modeling is quantitative inference on the effects of interventions or forecasting, calibration can be viewed as estimation. This view clarifies issues related to parameter identifiability and facilitates formal model validation and the examination of consistency among different sources of information. In contrast, when the goal of modeling is the generation of qualitative insights about the modeled phenomenon, calibration is a rather informal process for selecting inputs that result in model behavior that roughly reproduces select aspects of the modeled phenomenon and cannot be equated to an estimation procedure. Current empirical research on validation and calibration methods consists primarily of methodological appraisals or case-studies of alternative techniques and cannot address the numerous complex and multifaceted methodological decisions that modelers must make. Further research is needed on different approaches for developing and validating complex models that combine evidence from multiple sources.

Modeling the effects of influenza vaccination of health care workers in hospital departments

NARCIS (Netherlands)

van den Dool, C.; Bonten, M. J. M.; Hak, E.; Wallinga, J.

2009-01-01

Nowadays health care worker (HCW) vaccination is widely recommended. Although the benefits of this strategy have been demonstrated in long-term care settings, no studies have been performed in regular hospital departments. We adapt a previously developed model of influenza transmission in a

Multiplicative point process as a model of trading activity

Science.gov (United States)

Gontis, V.; Kaulakys, B.

2004-11-01

Signals consisting of a sequence of pulses show that inherent origin of the 1/ f noise is a Brownian fluctuation of the average interevent time between subsequent pulses of the pulse sequence. In this paper, we generalize the model of interevent time to reproduce a variety of self-affine time series exhibiting power spectral density S( f) scaling as a power of the frequency f. Furthermore, we analyze the relation between the power-law correlations and the origin of the power-law probability distribution of the signal intensity. We introduce a stochastic multiplicative model for the time intervals between point events and analyze the statistical properties of the signal analytically and numerically. Such model system exhibits power-law spectral density S( f)∼1/ fβ for various values of β, including β= {1}/{2}, 1 and {3}/{2}. Explicit expressions for the power spectra in the low-frequency limit and for the distribution density of the interevent time are obtained. The counting statistics of the events is analyzed analytically and numerically, as well. The specific interest of our analysis is related with the financial markets, where long-range correlations of price fluctuations largely depend on the number of transactions. We analyze the spectral density and counting statistics of the number of transactions. The model reproduces spectral properties of the real markets and explains the mechanism of power-law distribution of trading activity. The study provides evidence that the statistical properties of the financial markets are enclosed in the statistics of the time interval between trades. A multiplicative point process serves as a consistent model generating this statistics.

Implementation of a multi-variable regression analysis in the assessment of the generation rate and composition of hospital solid waste for the design of a sustainable management system in developing countries.

Science.gov (United States)

Al-Khatib, Issam A; Abu Fkhidah, Ismail; Khatib, Jumana I; Kontogianni, Stamatia

2016-03-01

Forecasting of hospital solid waste generation is a critical challenge for future planning. The composition and generation rate of hospital solid waste in hospital units was the field where the proposed methodology of the present article was applied in order to validate the results and secure the outcomes of the management plan in national hospitals. A set of three multiple-variable regression models has been derived for estimating the daily total hospital waste, general hospital waste, and total hazardous waste as a function of number of inpatients, number of total patients, and number of beds. The application of several key indicators and validation procedures indicates the high significance and reliability of the developed models in predicting the hospital solid waste of any hospital. Methodology data were drawn from existent scientific literature. Also, useful raw data were retrieved from international organisations and the investigated hospitals' personnel. The primal generation outcomes are compared with other local hospitals and also with hospitals from other countries. The main outcome, which is the developed model results, are presented and analysed thoroughly. The goal is this model to act as leverage in the discussions among governmental authorities on the implementation of a national plan for safe hospital waste management in Palestine. © The Author(s) 2016.

Texas hospitals with higher health information technology expenditures have higher revenue: A longitudinal data analysis using a generalized estimating equation model.

Science.gov (United States)

Lee, Jinhyung; Choi, Jae-Young

2016-04-05

The benefits of health information technology (IT) adoption have been reported in the literature, but whether health IT investment increases revenue generation remains an important research question. Texas hospital data obtained from the American Hospital Association (AHA) for 2007-2010 were used to investigate the association of health IT expenses and hospital revenue. The generalized estimation equation (GEE) with an independent error component was used to model the data controlling for cluster error within hospitals. We found that health IT expenses were significantly and positively associated with hospital revenue. Our model predicted that a 100% increase in health IT expenditure would result in an 8% increase in total revenue. The effect of health IT was more associated with gross outpatient revenue than gross inpatient revenue. Increased health IT expenses were associated with greater hospital revenue. Future research needs to confirm our findings with a national sample of hospitals.

Modeling Spatial Dependence of Rainfall Extremes Across Multiple Durations

Science.gov (United States)

Le, Phuong Dong; Leonard, Michael; Westra, Seth

2018-03-01

Determining the probability of a flood event in a catchment given that another flood has occurred in a nearby catchment is useful in the design of infrastructure such as road networks that have multiple river crossings. These conditional flood probabilities can be estimated by calculating conditional probabilities of extreme rainfall and then transforming rainfall to runoff through a hydrologic model. Each catchment's hydrological response times are unlikely to be the same, so in order to estimate these conditional probabilities one must consider the dependence of extreme rainfall both across space and across critical storm durations. To represent these types of dependence, this study proposes a new approach for combining extreme rainfall across different durations within a spatial extreme value model using max-stable process theory. This is achieved in a stepwise manner. The first step defines a set of common parameters for the marginal distributions across multiple durations. The parameters are then spatially interpolated to develop a spatial field. Storm-level dependence is represented through the max-stable process for rainfall extremes across different durations. The dependence model shows a reasonable fit between the observed pairwise extremal coefficients and the theoretical pairwise extremal coefficient function across all durations. The study demonstrates how the approach can be applied to develop conditional maps of the return period and return level across different durations.

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

Science.gov (United States)

Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

2007-01-01

Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

Contraction Options and Optimal Multiple-Stopping in Spectrally Negative Lévy Models

Energy Technology Data Exchange (ETDEWEB)

Yamazaki, Kazutoshi, E-mail: kyamazak@kansai-u.ac.jp [Kansai University, Department of Mathematics, Faculty of Engineering Science (Japan)

2015-08-15

This paper studies the optimal multiple-stopping problem arising in the context of the timing option to withdraw from a project in stages. The profits are driven by a general spectrally negative Lévy process. This allows the model to incorporate sudden declines of the project values, generalizing greatly the classical geometric Brownian motion model. We solve the one-stage case as well as the extension to the multiple-stage case. The optimal stopping times are of threshold-type and the value function admits an expression in terms of the scale function. A series of numerical experiments are conducted to verify the optimality and to evaluate the efficiency of the algorithm.

Contraction Options and Optimal Multiple-Stopping in Spectrally Negative Lévy Models

International Nuclear Information System (INIS)

Yamazaki, Kazutoshi

2015-01-01

This paper studies the optimal multiple-stopping problem arising in the context of the timing option to withdraw from a project in stages. The profits are driven by a general spectrally negative Lévy process. This allows the model to incorporate sudden declines of the project values, generalizing greatly the classical geometric Brownian motion model. We solve the one-stage case as well as the extension to the multiple-stage case. The optimal stopping times are of threshold-type and the value function admits an expression in terms of the scale function. A series of numerical experiments are conducted to verify the optimality and to evaluate the efficiency of the algorithm

The hospital of tomorrow in 10 points.

Science.gov (United States)

Vincent, Jean-Louis; Creteur, Jacques

2017-04-11

Technology has advanced rapidly in recent years and is continuing to do so, with associated changes in multiple areas, including hospital structure and function. Here we describe in 10 points our vision of some of the ways in which we see our hospitals, particularly those in developed countries, evolving in the future, including increased specialization, greater use of telemedicine and robots, the changing place of the intensive care unit, improved pre-hospital and post-hospital management, and improved end-of-life care. New technology is going to increasingly impact how we practice medicine. We must learn how best to adapt to and encompass these changes if we are to achieve maximum benefit from them for ourselves and our patients. Importantly, while the future hospital will be more advanced technologically, it will also be more advanced on a personal, humane patient care level.

Hospital 360°.

Science.gov (United States)

Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia

2015-01-01

There are forces that are greater than the individual performance of each hospital institution and of the health system structural of each country. The world is changing and to face up to the future in the best possible way, we need to understand how contexts and emerging trends link up and how they affect the hospital sector. The Columbian Association of Hospitals and Clinics, ACHC, has thus come up with the Hospital 360° concept which uses hospitals capable of anticipating changing contexts by means of the transition between present and future and takes on board the experience of global, socio-economic, demographic, political, environmental and technological fields as its model. Hospital 360° is an invitation to reinvent processes and institution themselves allowing them to adapt and incorporate a high degree of functional flexibility. Hospital 360° purses goals of efficiency, effectiveness and relevance, but also of impact and sustainability, and is coherent with the internal needs of hospital institutions and society for long-term benefits.

Model Pembelajaran Berbasis Penstimulasian Multiple Intelligences Siswa

Directory of Open Access Journals (Sweden)

Edy Legowo

2017-03-01

Full Text Available Tulisan ini membahas mengenai penerapan teori multiple intelligences dalam pembelajaran di sekolah. Pembahasan diawali dengan menguraikan perkembangan konsep inteligensi dan multiple intelligences. Diikuti dengan menjelaskan dampak teori multiple intelligences dalam bidang pendidikan dan pembelajaran di sekolah. Bagian selanjutnya menguraikan tentang implementasi teori multiple intelligences dalam praktik pembelajaran di kelas yaitu bagaimana pemberian pengalaman belajar siswa yang difasilitasi guru dapat menstimulasi multiple intelligences siswa. Evaluasi hasil belajar siswa dari pandangan penerapan teori multiple intelligences seharusnya dilakukan menggunakan authentic assessment dan portofolio yang lebih memfasilitasi para siswa mengungkapkan atau mengaktualisasikan hasil belajarnya melalui berbagai cara sesuai dengan kekuatan jenis inteligensinya.

A multiple objective mixed integer linear programming model for power generation expansion planning

Energy Technology Data Exchange (ETDEWEB)

Antunes, C. Henggeler; Martins, A. Gomes [INESC-Coimbra, Coimbra (Portugal); Universidade de Coimbra, Dept. de Engenharia Electrotecnica, Coimbra (Portugal); Brito, Isabel Sofia [Instituto Politecnico de Beja, Escola Superior de Tecnologia e Gestao, Beja (Portugal)

2004-03-01

Power generation expansion planning inherently involves multiple, conflicting and incommensurate objectives. Therefore, mathematical models become more realistic if distinct evaluation aspects, such as cost and environmental concerns, are explicitly considered as objective functions rather than being encompassed by a single economic indicator. With the aid of multiple objective models, decision makers may grasp the conflicting nature and the trade-offs among the different objectives in order to select satisfactory compromise solutions. This paper presents a multiple objective mixed integer linear programming model for power generation expansion planning that allows the consideration of modular expansion capacity values of supply-side options. This characteristic of the model avoids the well-known problem associated with continuous capacity values that usually have to be discretized in a post-processing phase without feedback on the nature and importance of the changes in the attributes of the obtained solutions. Demand-side management (DSM) is also considered an option in the planning process, assuming there is a sufficiently large portion of the market under franchise conditions. As DSM full costs are accounted in the model, including lost revenues, it is possible to perform an evaluation of the rate impact in order to further inform the decision process (Author)

Job satisfaction and the work situation of physicians: a survey at a German university hospital.

Science.gov (United States)

Laubach, Wilfried; Fischbeck, Sabine

2007-01-01

Job demands and workload of hospital physicians are increasing. The object of this survey was to examine the factors that constitute job satisfaction and to analyse physicians' work situation in the area of in-patient care. 447 physicians at a German University Hospital received questionnaires with regard to work situation, job satisfaction and personal health. Data were analysed by MANOVA and multiple regression models. A first regression model explained 53% of the variance in satisfaction with "work and profession". Among the explanatory variables "superiors and hierarchy" showed the highest beta-weight (beta = -0.49). "Personal health" also determined job satisfaction, for female physicians stronger (beta = -0.31) than for male physicians (beta = -0.11). In a second regression model on satisfaction with "Financial situation" only 18% of the variance was explained, whereby "work condition on the ward", "personal health" and "collaboration between occupational groups" showed the highest beta-weights. Among resident physicians, work conditions, superiors, hierarchy, transparency and participation in decisions are very important variables for job satisfaction. Improvements in these aspects may improve job satisfaction and help to reduce physician shortage in hospitals.

Predicting 30-day Hospital Readmission with Publicly Available Administrative Database. A Conditional Logistic Regression Modeling Approach.

Science.gov (United States)

Zhu, K; Lou, Z; Zhou, J; Ballester, N; Kong, N; Parikh, P

2015-01-01

This article is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". Hospital readmissions raise healthcare costs and cause significant distress to providers and patients. It is, therefore, of great interest to healthcare organizations to predict what patients are at risk to be readmitted to their hospitals. However, current logistic regression based risk prediction models have limited prediction power when applied to hospital administrative data. Meanwhile, although decision trees and random forests have been applied, they tend to be too complex to understand among the hospital practitioners. Explore the use of conditional logistic regression to increase the prediction accuracy. We analyzed an HCUP statewide inpatient discharge record dataset, which includes patient demographics, clinical and care utilization data from California. We extracted records of heart failure Medicare beneficiaries who had inpatient experience during an 11-month period. We corrected the data imbalance issue with under-sampling. In our study, we first applied standard logistic regression and decision tree to obtain influential variables and derive practically meaning decision rules. We then stratified the original data set accordingly and applied logistic regression on each data stratum. We further explored the effect of interacting variables in the logistic regression modeling. We conducted cross validation to assess the overall prediction performance of conditional logistic regression (CLR) and compared it with standard classification models. The developed CLR models outperformed several standard classification models (e.g., straightforward logistic regression, stepwise logistic regression, random forest, support vector machine). For example, the best CLR model improved the classification accuracy by nearly 20% over the straightforward logistic regression model. Furthermore, the developed CLR models tend to achieve better sensitivity of

Multiplicative Attribute Graph Model of Real-World Networks

Energy Technology Data Exchange (ETDEWEB)

Kim, Myunghwan [Stanford Univ., CA (United States); Leskovec, Jure [Stanford Univ., CA (United States)

2010-10-20

Large scale real-world network data, such as social networks, Internet andWeb graphs, is ubiquitous in a variety of scientific domains. The study of such social and information networks commonly finds patterns and explain their emergence through tractable models. In most networks, especially in social networks, nodes also have a rich set of attributes (e.g., age, gender) associatedwith them. However, most of the existing network models focus only on modeling the network structure while ignoring the features of nodes in the network. Here we present a class of network models that we refer to as the Multiplicative Attribute Graphs (MAG), which naturally captures the interactions between the network structure and node attributes. We consider a model where each node has a vector of categorical features associated with it. The probability of an edge between a pair of nodes then depends on the product of individual attributeattribute similarities. The model yields itself to mathematical analysis as well as fit to real data. We derive thresholds for the connectivity, the emergence of the giant connected component, and show that the model gives rise to graphs with a constant diameter. Moreover, we analyze the degree distribution to show that the model can produce networks with either lognormal or power-law degree distribution depending on certain conditions.