The potential of hospital Website marketing.

Science.gov (United States)

Sanchez, P M

2000-01-01

In recent years, hospital website marketing has witnessed explosive growth. Industry experts cite an almost 100% growth in hospital website marketing over the last several years. At one time lagging in the adoption of Internet technology, hospitals have now begun making significant strides in catching up with other industries. In spite of the general proliferation of hospital websites, however, the full potential of the Internet with its unique characteristics has yet to be realized. In this paper, current trends fueling the growth of hospital website marketing are first explored. Secondly, barriers to realizing the potential of website marketing are investigated. Finally, recommendations for improving hospital website marketing are developed.

PREDICTIVE POTENTIAL FIELD-BASED COLLISION AVOIDANCE FOR MULTICOPTERS

Directory of Open Access Journals (Sweden)

M. Nieuwenhuisen

2013-08-01

Full Text Available Reliable obstacle avoidance is a key to navigating with UAVs in the close vicinity of static and dynamic obstacles. Wheel-based mobile robots are often equipped with 2D or 3D laser range finders that cover the 2D workspace sufficiently accurate and at a high rate. Micro UAV platforms operate in a 3D environment, but the restricted payload prohibits the use of fast state-of-the-art 3D sensors. Thus, perception of small obstacles is often only possible in the vicinity of the UAV and a fast collision avoidance system is necessary. We propose a reactive collision avoidance system based on artificial potential fields, that takes the special dynamics of UAVs into account by predicting the influence of obstacles on the estimated trajectory in the near future using a learned motion model. Experimental evaluation shows that the prediction leads to smoother trajectories and allows to navigate collision-free through passageways.

Potentially preventable hospitalizations in dementia: family caregiver experiences.

Science.gov (United States)

Sadak, Tatiana; Foster Zdon, Susan; Ishado, Emily; Zaslavsky, Oleg; Borson, Soo

2017-07-01

Health crises in persons living with dementia challenge their caregivers to make pivotal decisions, often under pressure, and to act in new ways on behalf of their care recipient. Disruption of everyday routines and heightened stress are familiar consequences of these events. Hospitalization for acute illness or injury is a familiar health crisis in dementia. The focus of this study is to describe the lived experience of dementia family caregivers whose care recipients had a recent unplanned admission, and to identify potential opportunities for developing preventive interventions. Family caregivers (n = 20) of people with dementia who experienced a recent hospitalization due to an ambulatory care sensitive condition or fall-related injury completed phone interviews. Interviews used semi-structured protocols to elicit caregivers' reactions to the hospitalization and recollections of the events leading up to it. Analysis of interview data identified four major themes: (1) caregiver is uncertain how to interpret and act on the change; (2) caregiver is unable to provide necessary care; (3) caregiver experiences a personal crisis in response to the patient's health event; (4) mitigating factors may prevent caregiver crises. This study identifies a need for clinicians and family caregivers to work together to avoid health crises of both caregivers and people with dementia and to enable caregivers to manage the health of their care recipients without sacrificing their own health and wellness.

Prevalence of potential drug–drug interactions among internal medicine ward in University of Gondar Teaching Hospital, Ethiopia

Directory of Open Access Journals (Sweden)

Akshaya Srikanth Bhagavathula

2014-05-01

Conclusion: We have recorded a high rate of prevalence of potential DDI in the internal medicine ward of UOG hospital and a high number of clinically significant DDIs which the most prevalent DDI were of moderate severity. Careful selection of drugs and active pharmaceutical care is encouraged in order to avoid negative consequences of these interactions.

Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records.

Science.gov (United States)

Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo

2016-11-01

The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate

Motorcycle crashes potentially preventable by three crash avoidance technologies on passenger vehicles.

Science.gov (United States)

Teoh, Eric R

2018-07-04

The objective of this study was to identify and quantify the motorcycle crash population that would be potential beneficiaries of 3 crash avoidance technologies recently available on passenger vehicles. Two-vehicle crashes between a motorcycle and a passenger vehicle that occurred in the United States during 2011-2015 were classified by type, with consideration of the functionality of 3 classes of passenger vehicle crash avoidance technologies: frontal crash prevention, lane maintenance, and blind spot detection. Results were expressed as the percentage of crashes potentially preventable by each type of technology, based on all known types of 2-vehicle crashes and based on all crashes involving motorcycles. Frontal crash prevention had the largest potential to prevent 2-vehicle motorcycle crashes with passenger vehicles. The 3 technologies in sum had the potential to prevent 10% of fatal 2-vehicle crashes and 23% of police-reported crashes. However, because 2-vehicle crashes with a passenger vehicle represent fewer than half of all motorcycle crashes, these technologies represent a potential to avoid 4% of all fatal motorcycle crashes and 10% of all police-reported motorcycle crashes. Refining the ability of passenger vehicle crash avoidance systems to detect motorcycles represents an opportunity to improve motorcycle safety. Expanding the capabilities of these technologies represents an even greater opportunity. However, even fully realizing these opportunities can affect only a minority of motorcycle crashes and does not change the need for other motorcycle safety countermeasures such as helmets, universal helmet laws, and antilock braking systems.

Potential gains from hospital mergers in Denmark.

Science.gov (United States)

Kristensen, Troels; Bogetoft, Peter; Pedersen, Kjeld Moeller

2010-12-01

The Danish hospital sector faces a major rebuilding program to centralize activity in fewer and larger hospitals. We aim to conduct an efficiency analysis of hospitals and to estimate the potential cost savings from the planned hospital mergers. We use Data Envelopment Analysis (DEA) to estimate a cost frontier. Based on this analysis, we calculate an efficiency score for each hospital and estimate the potential gains from the proposed mergers by comparing individual efficiencies with the efficiency of the combined hospitals. Furthermore, we apply a decomposition algorithm to split merger gains into technical efficiency, size (scale) and harmony (mix) gains. The motivation for this decomposition is that some of the apparent merger gains may actually be available with less than a full-scale merger, e.g., by sharing best practices and reallocating certain resources and tasks. Our results suggest that many hospitals are technically inefficient, and the expected "best practice" hospitals are quite efficient. Also, some mergers do not seem to lower costs. This finding indicates that some merged hospitals become too large and therefore experience diseconomies of scale. Other mergers lead to considerable cost reductions; we find potential gains resulting from learning better practices and the exploitation of economies of scope. To ensure robustness, we conduct a sensitivity analysis using two alternative returns-to-scale assumptions and two alternative estimation approaches. We consistently find potential gains from improving the technical efficiency and the exploitation of economies of scope from mergers.

Óbitos infantis evitáveis em hospital de referência estadual do Nordeste brasileiro Avoidable infant deaths at a reference hospital in Northeast Brazil

Directory of Open Access Journals (Sweden)

Suely Arruda Vidal

2003-09-01

Full Text Available OBJETIVOS: classificar os óbitos de menores de um ano ocorridos de janeiro a dezembro de 2000, em hospital de referência em Pernambuco, segundo critérios de evitabilidade da causa básica. MÉTODOS: estudo descritivo de corte transversal, utilizando-se como fonte de dados o Sistema de Informação sobre Mortalidade, processado na instituição. As causas básicas presentes nas Declarações de Óbitos, corrigidas a partir do prontuário médico e codificadas segundo as regras da 10 revisão da Classificação Internacional de Doenças, foram agrupadas segundo os critérios de evitabilidade de óbitos propostos pela Fundação SEADE em 1991. Calculou-se o coeficiente de mortalidade infantil hospitalar. RESULTADOS: a maioria dos óbitos estava classificada entre as causas reduzíveis por medidas de atenção à saúde, com mortalidade proporcional de 77,4% (infantil, 75,3% (neonatal e 60,1% (pós-neonatal representando um coeficiente de mortalidade infantil hospitalar de 103,7 óbitos por 1.000 internações. Quase metade era neonatos, desses, 31% eram reduzíveis por diagnóstico e tratamento precoces. No grupo pós-neonatal, 44% foram causadas principalmente pelas doenças infecciosas intestinais e do aparelho respiratório. CONCLUSÕES: os altos percentuais de mortes por causas evitáveis, sugerem problemas de acesso aos serviços de saúde, cobertura e/ou na qualidade da assistência prestada.OBJECTIVES: to classify deaths of children under one year old from January to December 2000, at a public Hospital of Pernambuco, according to avoidable basic causes of death. METHODS: descriptive cross sectional study using data from the Information System on Mortality processed at the Hospital. The basic causes stated in Death Certificates collected from the medical records and codified under the rules of the Tenth International Disease Classification were grouped according to the criteria proposed by the SEADE Foundation (1991. The coefficient of

The effects of cortisol administration on approach-avoidance behavior: An event-related potential study

NARCIS (Netherlands)

Peer, J.M. van; Roelofs, K.; Rotteveel, M.; Dijk, J.G. van; Spinhoven, P.; Ridderinkhof, K.R.

2007-01-01

We investigated the effects of cortisol administration (50 mg) on approach and avoidance tendencies in low and high trait avoidant healthy young men. Event-related brain potentials (ERPs) were measured during a reaction time task, in which participants evaluated the emotional expression of

The Hospital-Acquired Conditions (HAC) reduction program: using cranberry treatment to reduce catheter-associated urinary tract infections and avoid Medicare payment reduction penalties.

Science.gov (United States)

Saitone, T L; Sexton, R J; Sexton Ward, A

2018-01-01

The Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program. The Centers for Medicare and Medicaid Services (CMS) established a total HAC scoring methodology to rank hospitals based upon their HAC performance. Hospitals that rank in the lowest quartile based on their HAC score are subject to a 1% reduction in their total Medicare reimbursements. In FY 2017, 769 hospitals incurred payment reductions totaling $430 million. This study analyzes how improvements in the rate of catheter-associated urinary tract infections (CAUTI), based on the implementation of a cranberry-treatment regimen, impact hospitals' HAC scores and likelihood of avoiding the Medicare-reimbursement penalty. A simulation model is developed and implemented using public data from the CMS' Hospital Compare website to determine how hospitals' unilateral and simultaneous adoption of cranberry to improve CAUTI outcomes can affect HAC scores and the likelihood of a hospital incurring the Medicare payment reduction, given results on cranberry effectiveness in preventing CAUTI based on scientific trials. The simulation framework can be adapted to consider other initiatives to improve hospitals' HAC scores. Nearly all simulated hospitals improved their overall HAC score by adopting cranberry as a CAUTI preventative, assuming mean effectiveness from scientific trials. Many hospitals with HAC scores in the lowest quartile of the HAC-score distribution and subject to Medicare reimbursement reductions can improve their scores sufficiently through adopting a cranberry-treatment regimen to avoid payment reduction. The study was unable to replicate exactly the data used by CMS to establish HAC scores for FY 2018. The study assumes that hospitals subject to the Medicare payment reduction were not using cranberry as a prophylactic treatment for their catheterized patients, but is unable to confirm that this is true in all cases. The study also assumes that hospitalized catheter

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

Science.gov (United States)

Portman, Robert M

2007-06-01

Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive providers of radiologic services at the facilities in exchange for the groups' agreeing to provide and manage all aspects of those services within the hospitals. These exclusive contracts generally result in radiology departments and associated equipment being closed off to physicians who are not part of the contracting groups. Although exclusive contracts offer obvious benefits to the physicians who receive them and obvious disadvantages for those who are excluded, they also present pitfalls for physicians in the chosen group. Part 1 of this article discussed the legal issues raised by exclusive contracts. Part 2 weighs the practical advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts and strategies for avoiding them, as well as provisions that can be included in medical staff bylaws to protect physicians from the automatic termination of privileges when a hospital enters into or terminates an exclusive contract. The remainder of the article provides tips on specific provisions of exclusive contracts that should be included or avoided.

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

Science.gov (United States)

Terra, Sandra Marlene; Byrne, Amanda

2016-01-01

This article reviews the various types of technical and clinical denials that are usually "written off" and proposes strategies to prevent this loss. For purposes of this writing, avoidable technical and clinical denial write-offs are defined as revenue lost from "first-pass" denials rejections. For example, a procedure that requires an authorization is performed without having had an authorization obtained. After appeals and attempts to recoup the revenue, often unsuccessful, the organization ultimately "writes off" the revenue as not collectable. The question to ask is: Are these claims really not collectable or can actionable steps be taken to conserve these dollars and improve the bottom line? Acute care hospitals, physician offices, and clinics. In today's environment, the need to manage costs is ubiquitous. Cost management is on the priority list of all savvy health care executives, even if margins are healthy, revenue is under pressure, and the magnitude of cost reduction needed is greater than what past efforts have achieved. As hospitals and physician clinics prioritize areas for improvement, reduction in lost revenue-especially avoidable lost revenue-should be at the top of the list. Attentively managing claim denial write-offs will significantly reduce lost revenue. There is significant interface between case management and the revenue cycle. Developing core competencies for reducing clinical and technical denials should be a critical imperative in overall cost management strategy. Case managers are well placed to prevent these unnecessary losses through accurate status determination and clinical documentation review. These clinical professionals can also provide insight into work flow and other processes inherent in the preauthorization process.

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

Science.gov (United States)

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

2017-01-13

Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program.

Science.gov (United States)

Lawn, Sharon; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm; Masman, Kevin

2017-08-24

-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.

Causes of Hospital Admissions in Domus

DEFF Research Database (Denmark)

Skov Benthien, Kirstine; Nordly, Mie; von Heymann-Horan, Annika

2018-01-01

CONTEXT: Avoidable hospital admissions are important negative indicators of quality of end-of-life care. Specialized palliative care (SPC) may support patients remaining at home. OBJECTIVES: Therefore, the purpose of this study was to investigate if SPC at home could prevent hospital admissions...... in patients with incurable cancer. METHODS: These are secondary results of Domus: a randomized controlled trial of accelerated transition to SPC with psychological intervention at home (Clinicaltrials.gov: NCT01885637). Participants were patients with incurable cancer and limited antineoplastic treatment...... significantly in overall potentially avoidable admissions. Both groups felt mostly safe about their place of care. CONCLUSION: The intervention did not prevent hospital admissions. Likely, any intervention effects were outweighed by increased identification of problems in the intervention group leading...

The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities.

Science.gov (United States)

Connolly, Martin J; Boyd, Michal; Broad, Joanna B; Kerse, Ngaire; Lumley, Thomas; Whitehead, Noeline; Foster, Susan

2015-01-01

To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Cluster randomized controlled trial. RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. A total of 1998 residents of 18 intervention facilities and 18 control facilities. A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943). Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing......BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...... to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing...

Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage

Directory of Open Access Journals (Sweden)

Alberquilla Angel

2008-02-01

Full Text Available Abstract Background The study of Hospitalizations for ambulatory care sensitive conditions (ACSH has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM and to detect possible differences in ACSH. Methods Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. Results Of all the hospitalizations, 16.5% (64,409 were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p Conclusion A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.

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

Directory of Open Access Journals (Sweden)

Woodhams Victoria

2012-06-01

Full Text Available Abstract Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN. We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED; and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change.

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

Science.gov (United States)

Woodhams, Victoria; de Lusignan, Simon; Mughal, Shakeel; Head, Graham; Debar, Safia; Desombre, Terry; Hilton, Sean; Al Sharifi, Houda

2012-06-10

Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR - Patients at risk of readmission and ACG - Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don't change.

Efficacy of a hospital-wide environmental cleaning protocol on hospital-acquired methicillin-resistant Staphylococcus aureus rates.

Science.gov (United States)

Watson, Paul Andrew; Watson, Luke Robert; Torress-Cook, Alfonso

2016-07-01

Environmental contamination has been associated with over half of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in hospitals. We explored if a hospital-wide environmental and patient cleaning protocol would lower hospital acquired MRSA rates and associated costs. This study evaluates the impact of implementing a hospital-wide environmental and patient cleaning protocol on the rate of MRSA infection and the potential cost benefit of the intervention. A retrospective, pre-post interventional study design was used. The intervention comprised a combination of enhanced environmental cleaning of high touch surfaces, daily washing of patients with benzalkonium chloride, and targeted isolation of patients with active infection. The rate of MRSA infection per 1000 patient days (PD) was compared with the rate after the intervention (Steiros Algorithm ® ) was implemented. A cost-benefit analysis based on the number of MRSA infections avoided was conducted. The MRSA rates decreased by 96% from 3.04 per 1000 PD to 0.11 per 1000 PD ( P reduction in MRSA infections, avoided an estimated $1,655,143 in healthcare costs. Implementation of this hospital-wide protocol appears to be associated with a reduction in the rate of MRSA infection and therefore a reduction in associated healthcare costs.

Triggers of oral lichen planus flares and the potential role of trigger avoidance in disease management.

Science.gov (United States)

Chen, Hannah X; Blasiak, Rachel; Kim, Edwin; Padilla, Ricardo; Culton, Donna A

2017-09-01

Many patients with oral lichen planus (OLP) report triggers of flares, some of which overlap with triggers of other oral diseases, including oral allergy syndrome and oral contact dermatitis. The purpose of this study was to evaluate the prevalence of commonly reported triggers of OLP flares, their overlap with triggers of other oral diseases, and the potential role of trigger avoidance as a management strategy. Questionnaire-based survey of 51 patients with biopsy-proven lichen planus with oral involvement seen in an academic dermatology specialty clinic and/or oral pathology clinic between June 2014 and June 2015. Of the participants, 94% identified at least one trigger of their OLP flares. Approximately half of the participants (51%) reported at least one trigger that overlapped with known triggers of oral allergy syndrome, and 63% identified at least one trigger that overlapped with known triggers of oral contact dermatitis. Emotional stress was the most commonly reported trigger (77%). Regarding avoidance, 79% of the study participants reported avoiding their known triggers in daily life. Of those who actively avoided triggers, 89% reported an improvement in symptoms and 70% reported a decrease in the frequency of flares. Trigger identification and avoidance can play a potentially effective role in the management of OLP. Copyright © 2017 Elsevier Inc. All rights reserved.

Rationale and design of the Aquapheresis Versus Intravenous Diuretics and Hospitalization for Heart Failure (AVOID-HF) trial.

Science.gov (United States)

Costanzo, Maria Rosa; Negoianu, Daniel; Fonarow, Gregg C; Jaski, Brian E; Bart, Bradley A; Heywood, J Thomas; Nabut, Jose L; Schollmeyer, Michael P

2015-09-01

In patients hospitalized with acutely decompensated heart failure, unresolved signs and symptoms of fluid overload have been consistently associated with poor outcomes. Regardless of dosing and type of administration, intravenous loop diuretics have not reduced heart failure events or mortality in patients with acutely decompensated heart failure. The results of trials comparing intravenous loop diuretics to mechanical fluid removal by isolated venovenous ultrafiltration have yielded conflicting results. Studies evaluating early decongestive strategies have shown that ultrafiltration removed more fluid and was associated with fewer heart failure-related rehospitalization than intravenous loop diuretics. In contrast, when used in the setting of worsening renal function, ultrafiltration was associated with poorer renal outcomes and no reduction in heart failure events. The AVOID-HF trial seeks to determine if an early strategy of ultrafiltration in patients with acutely decompensated heart failure is associated with fewer heart failure events at 90 days compared with a strategy based on intravenous loop diuretics. Study subjects from 40 highly experienced institutions are randomized to either early ultrafiltration or intravenous loop diuretics. In both treatment arms, fluid removal therapies are adjusted according to the patients' hemodynamic condition and renal function. The study was unilaterally terminated by the sponsor in the absence of futility and safety concerns after the enrollment of 221 subjects, or 27% of the originally planned sample size of 810 patients. The AVOID-HF trial's principal aim is to compare the safety and efficacy of ultrafiltration vs that of intravenous loop diuretics in patients hospitalized with acutely decompensated heart failure. Because stepped treatment approaches are applied in both ultrafiltration and intravenous loop diuretics groups and the primary end point is time to first heart failure event within 90 days, it is hoped that

Exploring the roots of unintended safety threats associated with the introduction of hospital ePrescribing systems and candidate avoidance and/or mitigation strategies: a qualitative study.

Science.gov (United States)

Mozaffar, Hajar; Cresswell, Kathrin M; Williams, Robin; Bates, David W; Sheikh, Aziz

2017-09-01

Hospital electronic prescribing (ePrescribing) systems offer a wide range of patient safety benefits. Like other hospital health information technology interventions, however, they may also introduce new areas of risk. Despite recent advances in identifying these risks, the development and use of ePrescribing systems is still leading to numerous unintended consequences, which may undermine improvement and threaten patient safety. These negative consequences need to be analysed in the design, implementation and use of these systems. We therefore aimed to understand the roots of these reported threats and identify candidate avoidance/mitigation strategies. We analysed a longitudinal, qualitative study of the implementation and adoption of ePrescribing systems in six English hospitals, each being conceptualised as a case study. Data included semistructured interviews, observations of implementation meetings and system use, and a collection of relevant documents. We analysed data first within and then across the case studies. Our dataset included 214 interviews, 24 observations and 18 documents. We developed a taxonomy of factors underlying unintended safety threats in: (1) suboptimal system design, including lack of support for complex medication administration regimens, lack of effective integration between different systems, and lack of effective automated decision support tools; (2) inappropriate use of systems-in particular, too much reliance on the system and introduction of workarounds; and (3) suboptimal implementation strategies resulting from partial roll-outs/dual systems and lack of appropriate training. We have identified a number of system and organisational strategies that could potentially avoid or reduce these risks. Imperfections in the design, implementation and use of ePrescribing systems can give rise to unintended consequences, including safety threats. Hospitals and suppliers need to implement short- and long-term strategies in terms of the

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

Science.gov (United States)

Buerhaus, Peter I

2009-01-01

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

The Role of Mental Health Disease in Potentially Preventable Hospitalizations: Findings From a Large State.

Science.gov (United States)

Medford-Davis, Laura N; Shah, Rohan; Kennedy, Danielle; Becker, Emilie

2018-01-01

Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors. The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality. The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008. A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date. A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22-1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12-1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66-3.72 for age above 75 years compared with 18-44 y), black race (OR 1.44; 95% CI, 1.43-1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51-1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22-1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17-1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations. Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.

["Lean management" in hospitals: potentials and limitations].

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Glossmann, J P; Schliebusch, O; Diehl, V; Walshe, R

2000-08-15

Little attention has yet been payed on establishing modern and competitive organizational structures in German hospitals. In this paper, we attempt to apply elements of lean management to the work of physicians working in an inpatient setting. Traditional ways of communication and their disadvantages are discussed. These include loss of motivation, bureaucratic structures and a lack of interdisciplinary cooperation. Using Maslow's theory of motivation, possible improvements are discussed, such as the reduction of restrictive job characteristics, an increase of physicians' spheres of competence and the use of their innovative potentials. These suggestions are explained using practical examples. The aim of the study is to contribute to quality management in hospitals by increasing personal responsibilities according to lean management.

Assessing the economic value of avoiding hospital admissions by shifting the management of gram+ acute bacterial skin and skin-structure infections to an outpatient care setting.

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Ektare, V; Khachatryan, A; Xue, M; Dunne, M; Johnson, K; Stephens, J

2015-01-01

To estimate, from a US payer perspective, the cost offsets of treating gram positive acute bacterial skin and skin-structure infections (ABSSSI) with varied hospital length of stay (LOS) followed by outpatient care, as well as the cost implications of avoiding hospital admission. Economic drivers of care were estimated using a literature-based economic model incorporating inpatient and outpatient components. The model incorporated equal efficacy, adverse events (AE), resource use, and costs from literature. Costs of once- and twice-daily outpatient infusions to achieve a 14-day treatment were analyzed. Sensitivity analyses were performed. Costs were adjusted to 2015 US$. Total non-drug medical cost for treatment of ABSSSI entirely in the outpatient setting to avoid hospital admission was the lowest among all scenarios and ranged from $4039-$4924. Total non-drug cost for ABSSSI treated in the inpatient setting ranged from $9813 (3 days LOS) to $18,014 (7 days LOS). Inpatient vs outpatient cost breakdown was: 3 days inpatient ($6657)/11 days outpatient ($3156-$3877); 7 days inpatient ($15,017)/7 days outpatient ($2495-$2997). Sensitivity analyses revealed a key outpatient cost driver to be peripherally inserted central catheter (PICC) costs (average per patient cost of $873 for placement and $205 for complications). Drug and indirect costs were excluded and resource use was not differentiated by ABSSSI type. It was assumed that successful ABSSSI treatment takes up to 14 days per the product labels, and that once-daily and twice-daily antibiotics have equal efficacy. Shifting ABSSSI care to outpatient settings may result in medical cost savings greater than 53%. Typical outpatient scenarios represent 14-37% of total medical cost, with PICC accounting for 28-43% of the outpatient burden. The value of new ABSSSI therapies will be driven by eliminating the need for PICC line, reducing length of stay and the ability to completely avoid a hospital stay.

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

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

2017-01-01

The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.

Harm avoidance in adolescents modulates late positive potentials during affective picture processing.

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Zhang, Wenhai; Lu, Jiamei; Ni, Ziyin; Liu, Xia; Wang, Dahua; Shen, Jiliang

2013-08-01

Research in adults has shown that individual differences in harm avoidance (HA) modulate electrophysiological responses to affective stimuli. To determine whether HA in adolescents modulates affective information processing, we collected event-related potentials from 70 adolescents while they viewed 90 pictures from the Chinese affective picture system. Multiple regressions revealed that HA negatively predicted late positive potential (LPP) for positive pictures and positively predicted for negative pictures; however, HA did not correlate with LPP for neutral pictures. The results suggest that at the late evaluative stage, high-HA adolescents display attentional bias to negative pictures while low-HA adolescents display attentional bias to negative pictures. Moreover, these dissociable attentional patterns imply that individual differences in adolescents' HA modulate the late selective attention mechanism of affective information. Copyright © 2013. Published by Elsevier Ltd.

α1-Adrenoceptors in the hippocampal dentate gyrus involved in learning-dependent long-term potentiation during active-avoidance learning in rats.

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Lv, Jing; Zhan, Su-Yang; Li, Guang-Xie; Wang, Dan; Li, Ying-Shun; Jin, Qing-Hua

2016-11-09

The hippocampus is the key structure for learning and memory in mammals and long-term potentiation (LTP) is an important cellular mechanism responsible for learning and memory. The influences of norepinephrine (NE) on the modulation of learning and memory, as well as LTP, through β-adrenoceptors are well documented, whereas the role of α1-adrenoceptors in learning-dependent LTP is not yet clear. In the present study, we measured extracellular concentrations of NE in the hippocampal dentate gyrus (DG) region using an in-vivo brain microdialysis and high-performance liquid chromatography techniques during the acquisition and extinction of active-avoidance behavior in freely moving conscious rats. Next, the effects of prazosin (an antagonist of α1-adrenoceptor) and phenylephrine (an agonist of the α1-adrenoceptor) on amplitudes of field excitatory postsynaptic potential were measured in the DG region during the active-avoidance behavior. Our results showed that the extracellular concentration of NE in the DG was significantly increased during the acquisition of active-avoidance behavior and gradually returned to the baseline level following extinction training. A local microinjection of prazosin into the DG significantly accelerated the acquisition of the active-avoidance behavior, whereas a local microinjection of phenylephrine retarded the acquisition of the active-avoidance behavior. Furthermore, in all groups, the changes in field excitatory postsynaptic potential amplitude were accompanied by corresponding changes in active-avoidance behavior. Our results suggest that NE activation of α1-adrenoceptors in the hippocampal DG inhibits active-avoidance learning by modulation of synaptic efficiency in rats.

Potential Nematode Alarm Pheromone Induces Acute Avoidance in Caenorhabditis elegans.

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Zhou, Ying; Loeza-Cabrera, Mario; Liu, Zheng; Aleman-Meza, Boanerges; Nguyen, Julie K; Jung, Sang-Kyu; Choi, Yuna; Shou, Qingyao; Butcher, Rebecca A; Zhong, Weiwei

2017-07-01

It is crucial for animal survival to detect dangers such as predators. A good indicator of dangers is injury of conspecifics. Here we show that fluids released from injured conspecifics invoke acute avoidance in both free-living and parasitic nematodes. Caenorhabditis elegans avoids extracts from closely related nematode species but not fruit fly larvae. The worm extracts have no impact on animal lifespan, suggesting that the worm extract may function as an alarm instead of inflicting physical harm. Avoidance of the worm extract requires the function of a cGMP signaling pathway that includes the cGMP-gated channel TAX-2/TAX-4 in the amphid sensory neurons ASI and ASK. Genetic evidence indicates that the avoidance behavior is modulated by the neurotransmitters GABA and serotonin, two common targets of anxiolytic drugs. Together, these data support a model that nematodes use a nematode-specific alarm pheromone to detect conspecific injury. Copyright © 2017 by the Genetics Society of America.

STATE SUPPORT FOR DEVELOPMENT OF PERSONNEL POTENTIAL IN HOSPITALITY IN CHINA

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Yu Yi

2014-01-01

Full Text Available The article considers the state support fordevelopment of personnel potential in hospitality business in China. Hospitality frameshave quantitative and qualitative characteristics. The gap between the needs of business organizations of hospitality for highlyqualified personnel at all levels and theirpresence in such a gigantic scale of countriessuch as China, can only be overcome withthe assistance of the state targeted programplanning. Support for human resourcesdevelopment in the hospitality businessincludes directions - the integration of stateformation, educational institutions and businesses. Further step towards improving thecompetitiveness of Chinese tourism shouldbe to develop a national target program fortraining of hospitality

Reducing potentially preventable complications at the multi hospital level

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Czyz Anne

2011-07-01

Full Text Available Abstract Background This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes. Findings This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs. The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced. At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased. Conclusions Results of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.

New pricing approaches for bundled payments: Leveraging clinical standards and regional variations to target avoidable utilization.

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Hellsten, Erik; Chu, Scally; Crump, R Trafford; Yu, Kevin; Sutherland, Jason M

2016-03-01

Develop pricing models for bundled payments that draw inputs from clinician-defined best practice standards and benchmarks set from regional variations in utilization. Health care utilization and claims data for a cohort of incident Ontario ischemic and hemorrhagic stroke episodes. Episodes of care are created by linking incident stroke hospitalizations with subsequent health service utilization across multiple datasets. Costs are estimated for episodes of care and constituent service components using setting-specific case mix methodologies and provincial fee schedules. Costs are estimated for five areas of potentially avoidable utilization, derived from best practice standards set by an expert panel of stroke clinicians. Alternative approaches for setting normative prices for stroke episodes are developed using measures of potentially avoidable utilization and benchmarks established by the best performing regions. There are wide regional variations in the utilization of different health services within episodes of stroke care. Reconciling the best practice standards with regional utilization identifies significant amounts of potentially avoidable utilization. Normative pricing models for stroke episodes result in increasingly aggressive redistributions of funding. Bundled payment pilots to date have been based on the costs of historical service patterns, which effectively 'bake in' unwarranted and inefficient variations in utilization. This study demonstrates the feasibility of novel clinically informed episode pricing approaches that leverage these variations to target reductions in potentially avoidable utilization. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Pathway from Delirium to Death: Potential In-Hospital Mediators of Excess Mortality.

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Dharmarajan, Kumar; Swami, Sunil; Gou, Ray Y; Jones, Richard N; Inouye, Sharon K

2017-05-01

(1) To determine the relationship of incident delirium during hospitalization with 90-day mortality; (2) to identify potential in-hospital mediators through which delirium increases 90-day mortality. Analysis of data from Project Recovery, a controlled clinical trial of a delirium prevention intervention from 1995 to 1998 with follow-up through 2000. Large academic hospital. Patients ≥70 years old without delirium at hospital admission who were at intermediate-to-high risk of developing delirium and received usual care only. (1) Incident delirium; (2) potential mediators of delirium on death including use of restraining devices (physical restraints, urinary catheters), development of hospital acquired conditions (HACs) (falls, pressure ulcers), and exposure to other noxious insults (sleep deprivation, acute malnutrition, dehydration, aspiration pneumonia); (3) death within 90 days of admission. Among 469 patients, 70 (15%) developed incident delirium. These patients were more likely to experience restraining devices (37% vs 16%, P delirium was 4.2 (95% CI = 2.8-6.3) in bivariable analyses, increased in a graded manner with additional exposures to restraining devices, HACs, and other noxious insults, and declined by 10.9% after addition of these potential mediator categories, providing evidence of mediation. Restraining devices, HACs, and additional noxious insults were more frequent among patients with delirium, increased mortality in a graded manner, and were responsible for a significant percentage of the association of delirium with death. Additional efforts to prevent potential downstream mediators through which delirium increases mortality may help to improve outcomes among hospitalized older adults. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

LENUS (Irish Health Repository)

O’Brien, C

2018-01-01

Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.

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

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

2016-01-01

Introduction: Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs. Methods: Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression. This study was a retrospective cohort review of internal medicine patients admitted between December 1, 2012 and December 31, 2013 at King Abdullah University Hospital, in Jordan. Results: 29% of all hospitalized patients were readmitted during the study period. Among all readmissions, 44% were identified as potentially avoidable. Behavioural factors including smoking, unclear follow-up and discharge planning, and being non-compliant with treatment regimen as well as discharge against medical advice were all associated with increased risk of avoidable readmissions. Conclusion: Implementing evidence based health programs that focus on modifiable behavioural risk factors for both patients and clinicians would yield a higher response in terms of reducing potentially avoidable readmissions, and could reduce direct medical costs. PMID:28413365

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

Directory of Open Access Journals (Sweden)

Mohammad S. Alyahya

2016-08-01

Full Text Available Introduction: Hospital readmissions impose not only an extra burden on health care systems but impact patient health outcomes. Identifying modifiable behavioural risk factors that are possible causes of potentially avoidable readmissions can lower readmission rates and healthcare costs. Methods: Using the core principles of evidence based medicine and public health, the purpose of this study was to develop a heuristic guide that could identify what behavioural risk factors influence hospital readmissions through adopting various methods of analysis including regression models, t-tests, data mining, and logistic regression. This study was a retrospective cohort review of internal medicine patients admitted between December 1, 2012 and December 31, 2013 at King Abdullah University Hospital, in Jordan. Results: 29% of all hospitalized patients were readmitted during the study period. Among all readmissions, 44% were identified as potentially avoidable. Behavioural factors including smoking, unclear follow-up and discharge planning, and being non-compliant with treatment regimen as well as discharge against medical advice were all associated with increased risk of avoidable readmissions. Conclusion: Implementing evidence based health programs that focus on modifiable behavioural risk factors for both patients and clinicians would yield a higher response in terms of reducing potentially avoidable readmissions, and could reduce direct medical costs.

Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study.

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Garnier, Antoine; Rouiller, Nathalie; Gachoud, David; Nachar, Carole; Voirol, Pierre; Griesser, Anne-Claude; Uhlmann, Marc; Waeber, Gérard; Lamy, Olivier

2018-05-14

We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Ship Domain Model for Multi-ship Collision Avoidance Decision-making with COLREGs Based on Artificial Potential Field

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TengFei Wang

2017-03-01

Full Text Available A multi-ship collision avoidance decision-making and path planning formulation is studied in a distributed way. This paper proposes a complete set of solutions for multi-ship collision avoidance in intelligent navigation, by using a top-to-bottom organization to structure the system. The system is designed with two layers: the collision avoidance decision-making and the path planning. Under the general requirements of the International Regulations for Preventing Collisions at Sea (COLREGs, the performance of distributed path planning decision-making for anti-collision is analyzed for both give-way and stand-on ships situations, including the emergency actions taken by the stand-on ship in case of the give-way ship’s fault of collision avoidance measures. The Artificial Potential Field method(APF is used for the path planning in details. The developed APF method combined with the model of ship domain takes the target ships’ speed and course in-to account, so that it can judge the moving characteristics of obstacles more accurately. Simulation results indicate that the system proposed can work effectiveness.

Environmental triggers and avoidance in the management of asthma

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Gautier C

2017-03-01

Full Text Available Clarisse Gautier,1 Denis Charpin1,2 1Department of Pulmonology and Allergy, North Hospital, 2Faculty of Medicine, Aix-Marseille University, Marseille, France Abstract: Identifying asthma triggers forms the basis of environmental secondary prevention. These triggers may be allergenic or nonallergenic. Allergenic triggers include indoor allergens, such as house dust mites (HDMs, molds, pets, cockroaches, and rodents, and outdoor allergens, such as pollens and molds. Clinical observations provide support for the role of HDM exposure as a trigger, although avoidance studies provide conflicting results. Molds and their metabolic products are now considered to be triggers of asthma attacks. Pets, dogs, and especially cats can undoubtedly trigger asthmatic symptoms in sensitized subjects. Avoidance is difficult and rarely adhered to by families. Cockroach allergens contribute to asthma morbidity, and avoidance strategies can lead to clinical benefit. Mouse allergens are mostly found in inner-city dwellings, but their implication in asthma morbidity is debated. In the outdoors, pollens can induce seasonal asthma in sensitized individuals. Avoidance relies on preventing pollens from getting into the house and on minimizing seasonal outdoor exposure. Outdoor molds may lead to severe asthma exacerbations. Nonallergenic triggers include viral infections, active and passive smoking, meteorological changes, occupational exposures, and other triggers that are less commonly involved. Viral infection is the main asthma trigger in children. Active smoking is associated with higher asthma morbidity, and smoking cessation interventions should be personalized. Passive smoking is also a risk factor for asthma exacerbation. The implementation of public smoking bans has led to a reduction in the hospitalization of asthmatic children. Air pollution levels have been linked with asthmatic symptoms, a decrease in lung function, and increased emergency room visits and

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

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

2016-02-01

To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008-2012).

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Weir, Hannah K; Li, Chunyu; Henley, S Jane; Joseph, Djenaba

2017-05-01

Background: Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer-related deaths among screen-eligible adults residing in lower EA counties in the United States. Methods: Mortality and population data were used to examine colorectal cancer deaths (2008-2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed-expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars. Results: County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss. Conclusions: County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer-related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups. Impact: These results estimate the large economic impact of potentially avoidable colorectal cancer-related deaths in economically disadvantaged communities, as measured by lower EA. Cancer Epidemiol Biomarkers Prev; 26(5); 736-42. ©2016 AACR . ©2016 American Association for Cancer Research.

Potential effects of reward and loss avoidance in overweight adolescents.

Science.gov (United States)

Reyes, Sussanne; Peirano, Patricio; Luna, Beatriz; Lozoff, Betsy; Algarín, Cecilia

2015-08-01

Reward system and inhibitory control are brain functions that exert an influence on eating behavior regulation. We studied the differences in inhibitory control and sensitivity to reward and loss avoidance between overweight/obese and normal-weight adolescents. We assessed 51 overweight/obese and 52 normal-weight 15-y-old Chilean adolescents. The groups were similar regarding sex and intelligence quotient. Using Antisaccade and Incentive tasks, we evaluated inhibitory control and the effect of incentive trials (neutral, loss avoidance, and reward) on generating correct and incorrect responses (latency and error rate). Compared to normal-weight group participants, overweight/obese adolescents showed shorter latency for incorrect antisaccade responses (186.0 (95% CI: 176.8-195.2) vs. 201.3 ms (95% CI: 191.2-211.5), P reward (41.0 (95% CI: 34.5-47.5) vs. 49.8% (95% CI: 43.0-55.1), P reward and loss avoidance trials. These findings could suggest that an imbalance of inhibition and reward systems influence their eating behavior.

Avoidable hospitalization among migrants and ethnic minority groups: a systematic review.

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Dalla Zuanna, Teresa; Spadea, Teresa; Milana, Marzio; Petrelli, Alessio; Cacciani, Laura; Simonato, Lorenzo; Canova, Cristina

2017-10-01

The numbers of migrants living in Europe are growing rapidly, and has become essential to assess their access to primary health care (PHC). Avoidable Hospitalization (AH) rates can reflect differences across migrant and ethnic minority groups in the performance of PHC. We aimed to conduct a systematic review of all published studies on AH comparing separately migrants with natives or different racial/ethnic groups, in Europe and elsewhere. We ran a systematic search for original articles indexed in primary electronic databases on AH among migrants or ethnic minorities. Studies presenting AH rates and/or rate ratios between at least two different ethnic minority groups or between migrants and natives were included. Of the 35 papers considered in the review, 28 (80%) were conducted in the United States, 4 in New Zealand, 2 in Australia, 1 in Singapore, and none in Europe. Most of the studies (91%) used a cross-sectional design. The exposure variable was defined in almost all articles by ethnicity, race, or a combination of the two; country of birth was only used in one Australian study. Most of the studies found significant differences in overall AH rates, with minorities (mainly Black and Hispanics) showing higher rates than non-Hispanic Whites. AH has been used, mostly in the US, to compare different racial/ethnic groups, while it has never been used in Europe to assess migrants' access to PHC. Studies comparing AH rates between migrants and natives in European settings can be helpful in filling this lack of evidence. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Years of Life and Productivity Loss from Potentially Avoidable Colorectal Cancer Deaths in U.S. Counties with Lower Educational Attainment (2008–2012)

Science.gov (United States)

Weir, Hannah K.; Li, Chunyu; Henley, S. Jane; Joseph, Djenaba

2018-01-01

Background Educational attainment (EA) is inversely associated with colorectal cancer risk. Colorectal cancer screening can save lives if precancerous polyps or early cancers are found and successfully treated. This study aims to estimate the potential productivity loss (PPL) and associated avoidable colorectal cancer–related deaths among screen-eligible adults residing in lower EA counties in the United States. Methods Mortality and population data were used to examine colorectal cancer deaths (2008–2012) among adults aged 50 to 74 years in lower EA counties, and to estimate the expected number of deaths using the mortality experience from high EA counties. Excess deaths (observed–expected) were used to estimate potential years life lost, and the human capital method was used to estimate PPL in 2012 U.S. dollars. Results County-level colorectal cancer death rates were inversely associated with county-level EA. Of the 100,857 colorectal cancer deaths in lower EA counties, we estimated that more than 21,000 (1 in 5) was potentially avoidable and resulted in nearly $2 billion annual productivity loss. Conclusions County-level EA disparities contribute to a large number of potentially avoidable colorectal cancer–related deaths. Increased prevention and improved screening potentially could decrease deaths and help reduce the associated economic burden in lower EA communities. Increased screening could further reduce deaths in all EA groups. Impact These results estimate the large economic impact of potentially avoidable colorectal cancer–related deaths in economically disadvantaged communities, as measured by lower EA. PMID:28003180

The collision of healthcare and corporate law in a hospital closure case.

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Himes, S M

2001-01-01

This Article analyzes potential conflicts that arise from both the judicial and administrative approval processes that govern the closure of charitable hospitals through a sale of all or substantially all of their assets. Examining the recent closure attempt by the Manhattan Eye, Ear & Throat Hospital as an example, the Article highlights the various public health and corporate law issues that are raised when a not-for-profit hospital seeks closure. The Article thoroughly discusses both the statutorily and judicially required approval schemes applicable to the closure of charitable hospitals. The Article also suggests ways in which these conflicts might be avoided or remedied, as well as gives advice regarding hospital board decisionmaking.

Emergency Department Visits at the End of Life of Patients With Terminal Cancer: Pattern, Causes, and Avoidability.

Science.gov (United States)

Alsirafy, Samy A; Raheem, Ahmad A; Al-Zahrani, Abdullah S; Mohammed, Amrallah A; Sherisher, Mohamed A; El-Kashif, Amr T; Ghanem, Hafez M

2016-08-01

Frequent emergency department visits (EDVs) by patients with terminal cancer indicates aggressive care. The pattern and causes of EDVs in 154 patients with terminal cancer were investigated. The EDVs that started during working hours and ended by home discharge were considered avoidable. During the last 3 months of life, 77% of patients had at least 1 EDV. In total, 309 EDVs were analyzed. The EDVs occurred out of hour in 67%, extended for an average of 3.6 hours, and ended by hospitalization in 52%. The most common chief complaints were pain (46%), dyspnea (13%), and vomiting (12%). The EDVs were considered avoidable in 19% of the visits. The majority of patients with terminal cancer visit the ED before death, mainly because of uncontrolled symptoms. A significant proportion of EDVs at the end of life is potentially avoidable. © The Author(s) 2015.

Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice

DEFF Research Database (Denmark)

Rainville, James; Smeets, Rob J E M; Bendix, Tom

2011-01-01

For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle for recov......For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle...

Causes of conflict and their potential prevention in a rehabilitation hospital

OpenAIRE

Darbutienė, Rita

2010-01-01

Management of public health CAUSES OF CONFLICT AND THEIR POTENTIAL PREVENTION IN A REHABILITATION HOSPITAL Rita Darbutiene Supervisor – doc. dr. Junona Almonaitene Kaunas University of Medicine, Faculty of Public Health, Department of Health Management. Kaunas 2010. 79 p. Aim of study: to determine the attidute of the staff to conflicts occurring in the hospital, to work out a conflict prevention scheme. Goals of study: 1. To establish the most common causes of conflict ...

Mobile Phones as a Potential Vehicle of Infection in a Hospital Setting.

Science.gov (United States)

Chao Foong, Yi; Green, Mark; Zargari, Ahmad; Siddique, Romana; Tan, Vanessa; Brain, Terry; Ogden, Kathryn

2015-01-01

The objective of this article is to investigate the potential role of mobile phones as a reservoir for bacterial colonization and the risk factors for bacterial colonization in a hospital setting. We screened 226 staff members at a regional Australian hospital (146 doctors and 80 medical students) between January 2013 and March 2014. The main outcomes of interest were the types of microorganisms and the amount of contamination of the mobile phones. This study found a high level of bacterial contamination (n = 168/226, 74%) on the mobile phones of staff members in a tertiary hospital, with similar organisms isolated from the staff member's dominant hand and mobile phones. While most of the isolated organisms were normal skin flora, a small percentage were potentially pathogenic (n = 12/226, 5%). Being a junior medical staff was found to be a risk factor for heavy microbial growth (OR 4.00, 95% CI 1.54, 10.37). Only 31% (70/226) of our participants reported cleaning their phones routinely, and only 21% (47/226) reported using alcohol containing wipes on their phones. This study demonstrates that mobile phones are potentially vehicles for pathogenic bacteria in a hospital setting. Only a minority of our participants reported cleaning their phones routinely. Disinfection guidelines utilizing alcohol wipes should be developed and implemented.

Generalization of socially transmitted and instructed avoidance

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Gemma eCameron

2015-06-01

Full Text Available Excessive avoidance behavior, in which an instrumental action prevents an upcoming aversive event, is a defining feature of anxiety disorders. Left unchecked, both fear and avoidance of potentially threatening stimuli may generalize to perceptually related stimuli and situations. The behavioral consequences of generalization mean that aversive learning experiences with specific threats may lead people to infer that classes of related stimuli are threatening, potentially dangerous, and need to be avoided, despite differences in physical form. Little is known about avoidance generalization in humans and the learning pathways by which it may be transmitted. In the present study, we compared two pathways to avoidance, instructions and social observation, on subsequent generalization of avoidance behavior, fear expectancy and physiological arousal. Participants first learned that one cue was a danger cue (conditioned stimulus, CS+ and another was a safety cue (CS-. Groups then were either instructed that a simple avoidance response in the presence of the CS+ cancelled upcoming shock presentations (instructed-learning group or observed a short movie showing a demonstrator performing the avoidance response to prevent shock (observational-learning group. During generalization testing, danger and safety cues were presented along with generalization stimuli that parametrically varied in perceptual similarity to the CS+. Reinstatement of fear and avoidance was also tested. Findings demonstrate, for the first time, generalization of socially transmitted and instructed avoidance: both groups showed comparable generalization gradients in fear expectancy, avoidance behavior and arousal. Return of fear was evident, suggesting that generalized avoidance remains persistent following extinction testing. The utility of the present paradigm for research on avoidance generalization is discussed.

Potential drug-drug interactions with direct oral anticoagulants in elderly hospitalized patients.

Science.gov (United States)

Forbes, Heather L; Polasek, Thomas M

2017-10-01

To determine the prevalence and nature of potential drug-drug interactions (DDIs) with direct oral anticoagulants (DOACs) in elderly hospitalized patients. This was a retrospective observational study. Inclusion criteria were: aged over 65 years; taking apixaban, rivaroxaban or dabigatran; and admitted to the Repatriation General Hospital between April 2014 and July 2015. A list of clinically relevant 'perpetrator' drugs was compiled from product information, the Australian Medicines Handbook, the Australian National Prescribing Service resources, and local health network guidelines. The prevalence and nature of potential DDIs with DOACs was determined by comparing inpatient drug charts with the list of perpetrator drugs. There were 122 patients in the study with a mean age of 82 years. Most patients had nonvalvular atrial fibrillation and were taking DOACs to prevent thrombotic stroke (83%). Overall, 45 patients (37%) had a total of 54 potential DDIs. Thirty-five patients had potential pharmacodynamic DDIs with antidepressants, nonsteroidal anti-inflammatory drugs and antiplatelets (35/122, 29%). Nineteen patients had potential pharmacokinetic DDIs (19/122, 16%). Of these, 68% (13/19) were taking drugs that increase DOAC plasma concentrations (amiodarone, erythromycin, diltiazem or verapamil) and 32% (6/19) were taking drugs that decrease DOAC plasma concentrations (carbamazepine, primidone or phenytoin). There were no cases of patients taking contraindicated interacting drugs. Potential DDIs with DOACs in elderly hospital inpatients are relatively common, particularly interactions that may increase the risk of bleeding. The risk-benefit ratio of DOACs in elderly patients on polypharmacy should always be carefully considered.

Enhancing Medicares Hospital Acquired Conditions Policy

Data.gov (United States)

U.S. Department of Health & Human Services — The current Medicare policy of non-payment to hospitals for Hospital Acquired Conditions (HAC) seeks to avoid payment for preventable complications identified within...

Decomposition of potential efficiency gains from hospital mergers in Greece.

Science.gov (United States)

Flokou, Angeliki; Aletras, Vassilis; Niakas, Dimitris

2017-12-01

This paper evaluates the technical efficiency of 71 Greek public hospitals and examines potential efficiency gains from 13 candidate mergers among them. Efficiency assessments are performed using bootstrapped Data Envelopment Analysis (DEA) whilst merger analysis is conducted by applying the Bogetoft and Wang methodology which allows the overall potential merger gains to be decomposed into three main components of inefficiency, namely technical (or learning), scope (or harmony) and scale (or size) effects. Thus, the analysis provides important insights not only on the magnitude of the potential total efficiency gains but also on their sources. The overall analysis is conducted in the context of a complete methodological framework where methods for outlier detection, returns to scale identification, and bias corrections for DEA estimations are also applied. Mergers are analyzed under the assumptions of constant, variable and non-decreasing returns to scale in an input oriented DEA model with three inputs and three outputs. The main finding of the study indicates that almost all mergers show substantial potential room for efficiency improvement, which is mainly attributed to the pre-merger technical inefficiencies of the individual hospitals and therefore it might be possible to be achieved without the need of implementing full-scale mergers. The same -though, at a lower extent- applies to the harmony effect whilst the size effect shows marginal or even negative gains.

Experiential Avoidance, Mindfulness and Depression in Spinal Cord Injuries

DEFF Research Database (Denmark)

Skinner, Timothy C.; Roberton, Terri; Allison, Garry T.

2010-01-01

) completed a questionnaire including the depression subscale of the Depression Anxiety Stress Scale, the Acceptance and Action Questionnaire (AAQ-2; Bond et al., 2007) and the Mindful Attention Awareness Scale (MAAS; Brown & Ryan, 2003). Thirty per cent of participants scored above the cut-off for possible...... depression, with equal numbers experiencing mild, moderate or severe depression. Mindfulness and experiential avoidance were significantly associated with depression, and were intercorrelated. Further, regression analysis indicated that experiential avoidance mediated the relationship between depression......This preliminary study sought to explore the link between depression, experiential avoidance and mindfulness in people with a spinal cord injury (SCI). We surveyed patients listed on the SCI database at Royal Perth Hospital who had experienced an injury over the last 10 years. Respondents (62...

Disrupted avoidance learning in functional neurological disorder: Implications for harm avoidance theories

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Laurel S. Morris

. We highlight a potential mechanism by which negative contexts interfere with adaptive behaviours in this under-explored disorder. Keywords: Functional neurological disorder, Avoidance learning, Conversion disorder, Amygdala

Cause of death and potentially avoidable deaths in Australian adults with intellectual disability using retrospective linked data.

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Trollor, Julian; Srasuebkul, Preeyaporn; Xu, Han; Howlett, Sophie

2017-02-07

To investigate mortality and its causes in adults over the age of 20 years with intellectual disability (ID). Retrospective population-based standardised mortality of the ID and Comparison cohorts. The ID cohort comprised 42 204 individuals who registered for disability services with ID as a primary or secondary diagnosis from 2005 to 2011 in New South Wales (NSW). The Comparison cohort was obtained from published deaths in NSW from the Australian Bureau of Statistics (ABS) from 2005 to 2011. We measured and compared Age Standardised Mortality Rate (ASMR), Comparative Mortality Figure (CMF), years of productive life lost (YPLL) and proportion of deaths with potentially avoidable causes in an ID cohort with an NSW general population cohort. There were 19 362 adults in the ID cohort which experienced 732 (4%) deaths at a median age of 54 years. Age Standardised Mortality Rates increased with age for both cohorts. Overall comparative mortality figure was 1.3, but was substantially higher for the 20-44 (4.0) and 45-64 (2.3) age groups. YPLL was 137/1000 people in the ID cohort and 49 in the comparison cohort. Cause of death in ID cohort was dominated by respiratory, circulatory, neoplasm and nervous system. After recoding deaths previously attributed to the aetiology of the disability, 38% of deaths in the ID cohort and 17% in the comparison cohort were potentially avoidable. Adults with ID experience premature mortality and over-representation of potentially avoidable deaths. A national system of reporting of deaths in adults with ID is required. Inclusion in health policy and services development and in health promotion programmes is urgently required to address premature deaths and health inequalities for adults with ID. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Potentially stressful situations for nurses considering the condition of accreditation of hospitals

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Priscilla Higashi

2014-01-01

Full Text Available Cross-sectional study that aimed to evaluate and compare the frequency of perceived/self-reported stress by nurses in hospitals with and without accreditation. One conducted in an accredited and two non-accredited hospitals in São Paulo in 2010 and 2011. Data collection included a questionnaire and the Stress Inventory for Nurses, with 262 participants, who evaluated stressful situations in the categories: Intrinsic Factors of Work, Interpersonal Relationships at Work and Stressful Roles in Career. The differences among hospitals concerning nurses’ perception/self-declaration about potentially stressful factors were evaluated by the chi-square test, considering p <0.05 the critical level. Working in an accredited hospital protected against perception/self-declaration of stress caused by stressful factors in the categories: Intrinsic Factors of Work and Stressful Roles in their Career, being a risk factor related to the category Relationships at Work. One concludes that nurses from the accredited hospital perceived/self-reported more stressful factors in situations related to interpersonal relationships.

Potentially avoidable hospitalisation for constipation in Victoria, Australia in 2010-11.

Science.gov (United States)

Ansari, Humaira; Ansari, Zahid; Hutson, John M; Southwell, Bridget R

2014-07-11

When primary care of constipation fails, the patient may need emergency hospitalisation for disimpaction. This study aimed to provide population-based data on the number of unplanned admissions and the cost to the healthcare system for constipation in Victoria, Australia in financial year 2010-11. The Victorian Admitted Episodes Dataset was examined to find the number of emergency hospital separations coded as constipation (ICD-10-AM Code K390). An estimate of costs was determined from the number of weighted inlier equivalent separations (WIES) multiplied by the WEIS price, used by the Victorian Government for funding purposes. There were 3978 emergency separations for constipation in Victoria in 2010-2011, 92% in public hospitals. Fifty-five percent were female and 38% > 75 years old. One third stayed overnight and 1/3 more than 1 day. The emergency bed day rate was 7.1 per 10,000 of population. The estimate of cost, based on WEIS, was approximately $8.3 million. Potential savings could be made by reducing the number of separations in 6 Local Government Areas (LGAs). This study shows that the burden (in number of admissions, emergency bed days and overall direct costs) in managing emergency admissions for constipation in Victoria, Australia, is very significant and likely to be similar in other developed countries. Improved primary healthcare and alternative ways to achieve faecal disimpaction without emergency admission could save the public health system a proportion of this $8.3 million.

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

Science.gov (United States)

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

2017-02-14

To identify the features and effects of a pathway for emergency assessment and referral of patients with suspected transient ischaemic attack (TIA) in order to avoid admission to hospital. Scoping review. PubMed, CINAHL Web of Science, Scopus. Reports of primary research on referral of patients with suspected TIA directly to specialist outpatient services. We screened studies for eligibility and extracted data from relevant studies. Data were analysed to describe setting, assessment and referral processes, treatment, implementation and outcomes. 8 international studies were identified, mostly cohort designs. 4 pathways were used by family doctors and 3 pathways by emergency department physicians. No pathways used by paramedics were found. Referrals were made to specialist clinic either directly or via a 24-hour helpline. Practitioners identified TIA symptoms and risk of further events using a checklist including the ABCD2 tool or clinical assessment. Antiplatelet medication was often given, usually aspirin unless contraindicated. Some patients underwent tests before referral and discharge. 5 studies reported reduced incident of stroke at 90 days, from 6-10% predicted rate to 1.3-2.1% actual rate. Between 44% and 83% of suspected TIA cases in these studies were referred through the pathways. Research literature has focused on assessment and referral by family doctors and ED physicians to reduce hospitalisation of patients with TIA. No pathways for paramedical use were reported. We will use results of this scoping review to inform development of a paramedical referral pathway to be tested in a feasibility trial. ISRCTN85516498. Stage: pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Internet usage and potential impact for acute care hospitals: survey in the United States.

Science.gov (United States)

Hatcher, M

1998-12-01

These survey results are from a national survey of acute care hospitals. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect addresses resulting in a 15% response rate. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. Internet usage including homepages and advertising was measured. Other selected telecommunication applications are analyzed. As demonstration projects from the literature are compared to the survey results, the potential for hospitals is tremendous. Resulting cost savings could be equally impressive. This information will provide a benchmark for hospitals to determine their position relative to Internet technology and to set goals.

Risks in hospitals. Assessment and Management

Directory of Open Access Journals (Sweden)

Bradea Ioana-Alexandra

2014-12-01

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

How a hospital must face a massive emergency: the case of Martini Hospital, Turin

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Antonio Morra

2008-09-01

Full Text Available The terms “disaster” or “surge capability”, referred to hospitals, are often used to define a massive casualty admission. This may be a misleading concept, because emergency may as well arise from inside hospitals, and the last years high figures related to fires in the about 2,000 italian hospitals should suggest a different point of view. In this article the authors describe their experience in hospital preparedness at Ospedale Martini in Turin. Hospital operators regularly attend basic (GOM and advanced (HDM© courses about disaster response and organization, and a specific course is dedicated to operators involved in internal safety (fire emergency. In this courses, computer simulations are widely used, associated with conventional didactic. If education is one of the two cornerstones of disaster preparedness at Ospedale Martini, well designed emergency plans and an effective disaster management are the other one. The Internal Emergency Plan (Fire and Evacuation is aimed to give a proper response to fires and other events arising from inside the hospital and potentially requiring its partial or total evacuation. The Massive Casualties Admission Emergency Plan increases the surge capability of the hospital allowing to take care of a great number of injured people, and at the same time avoiding a dramatic fall in the treatment quality. The “Hospital Disaster Management©” system, created by the authors, is an organizational scheme based on team work. Its aim is to “put order in chaos” when hospitals are facing a disaster. Properly trained physicians and nurses, assigned to key positions, act in this system as Hospital Disaster Managers: their tasks are to coordinate the teams, to manage critical resources and to use the emergency plans as powerful instruments.

Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

Science.gov (United States)

Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John

2015-10-01

Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

Mechanism of avoiding little rip

OpenAIRE

ZHAI Xianghua; XI Ping

2014-01-01

The scalar phantom field Φ leads to various catastrophic fates of the universe including big rip,little rip and other future singularity depending on the choice of its potential.For example,little rip stems from a quadratic potential in general relativity.We suggest a new mechanism to avoid little rip in the 1/R gravity.The phantom field with different potentials,including quadratic,cubic and quantic potentials are studied via numerical calculation in the 1/R gravity with R2 correction.T...

Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable

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Schmier JK

2016-05-01

Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel

Rape avoidance behavior among Slovak women.

Science.gov (United States)

Prokop, Pavol

2013-05-28

Rape has been a recurrent adaptive problem for many species, including humans. Rape is costly to women in terms of disease transmission, partner abandonment, and unwanted pregnancy (among other costs). Therefore, behavioral strategies which allow women to avoid coercive men may have been favored by selection. In line with this evolutionary reasoning, the current research documented that physically stronger women and those in a committed romantic relationship reported more rape avoidance behavior. In addition, virgin women tended to perform more rape avoidance behavior compared with their non-virgin counterparts. Women with high conception risk perceived themselves as physically stronger, which may protect them against a potential rapist. Fear of unwanted pregnancy from rape decreased as age increased, reflecting higher fertility among younger participants. However, older women reported more rape avoidance behavior, which contradicts evolutionary predictions. The results provide some support for evolutionary hypotheses of rape avoidance behavior which suggest that woman's perception of rape is influenced by parental investment and perceived physical condition.

Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

Science.gov (United States)

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

2014-01-01

Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and

Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

Science.gov (United States)

Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

2017-12-01

Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

Science.gov (United States)

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

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

Science.gov (United States)

Rauscher, Simone; Wheeler, John R C

2012-01-01

Increased financial pressures on hospitals have elevated the importance of working capital management, that is, the management of current assets and current liabilities, for hospitals' profitability. Efficient working capital management allows hospitals to reduce their holdings of current assets, such as inventory and accounts receivable, which earn no interest income and require financing with short-term debt. The resulting cash inflows can be reinvested in interest-bearing financial instruments or used to reduce short-term borrowing, thus improving the profitability of the organization. This study examines the relationship between hospitals' profitability and their performance at managing two components of working capital: accounts receivable, measured in terms of hospitals' average collection periods, and accounts payable, measured in terms of hospitals' average payment periods. Panel data derived from audited financial statements for 1,397 bond-issuing, not-for-profit U.S. hospitals for 2000-2007 were analyzed using hospital-level fixed-effects regression analysis. The results show a negative relationship between hospitals' average collection period and profitability. That is, hospitals that collected on their patient revenue faster reported higher profit margins than did hospitals that have larger balances of accounts receivable outstanding. We also found a negative relationship between hospitals' average payment period and their profitability. Hospital managers did not appear to delay paying their vendors. Rather, the findings indicated that more profitable hospitals paid their suppliers faster, possibly to avoid high effective interest rates on outstanding accounts payable, whereas less profitable hospitals waited longer to pay their bills. The findings of this study suggest that working capital management indeed matters for hospitals' profitability. Efforts aimed at reducing large balances in both accounts receivable and accounts payable may frequently be

Avoidance-related EEG asymmetry predicts circulating interleukin-6.

Science.gov (United States)

Shields, Grant S; Moons, Wesley G

2016-03-01

Recent research has linked avoidance-oriented motivational states to elevated pro-inflammatory cytokine levels. According to one of many theories regarding the association between avoidance and cytokine levels, because the evolutionarily basic avoidance system may be activated when an organism is threatened or overwhelmed, an associated inflammatory response may be adaptive for dealing with potential injury in such threatening situations. To examine this hypothesis, we tested whether the neural correlate of avoidance motivation associates with baseline levels of the circulating pro-inflammatory cytokine interleukin-6 (IL-6). Controlling for covariates, greater resting neural activity in the right frontal cortex relative to the left frontal cortex-the neural correlate of avoidance motivation-was associated with baseline IL-6. These results thus support the hypothesis that the avoidance motivational system may be closely linked to systemic inflammatory activity. (c) 2016 APA, all rights reserved).

Avoiding plagiarism in academic writing.

Science.gov (United States)

Anderson, Irene

Plagiarism means taking the work of another and presenting it as one's own, resulting in potential upset for the original author and disrepute for the professions involved. This article aims to explore the issue of plagiarism and some mechanisms for detection and avoidance.

Effects of IFRS adoption on tax avoidance

Directory of Open Access Journals (Sweden)

Renata Nogueira Braga

Full Text Available ABSTRACT This study investigates the association between mandatory International Financial Reporting Standards (IFRS adoption and corporate tax avoidance. In this study, tax avoidance is defined as a reduction in the effective corporate income tax rate through tax planning activities, whether these are legal, questionable, or even illegal. Three measures of tax avoidance are used and factors at the country and firm level (that have already been associated with tax avoidance in prior research are controlled. Using samples that range from 9,389 to 15,423 publicly-traded companies from 35 countries, covering 1999 to 2014, it is found that IFRS adoption is associated with higher levels of corporate tax avoidance, even when the level of book-tax conformity required in the countries and the volume of accruals are controlled, both of which are considered potential determinants of this relationship. Furthermore, the results suggest that after IFRS adoption, firms in higher book-tax conformity environments engage more in tax avoidance than firms in lower book-tax conformity environments. It is also identified that engagement in tax avoidance after IFRS adoption derives not only from accruals management, but also from practices that do not involve accruals. The main conclusion is that companies engage more in tax avoidance after mandatory IFRS adoption.

Potentially avoidable hospitalisation for constipation in Victoria, Australia in 2010–11

Science.gov (United States)

2014-01-01

Background When primary care of constipation fails, the patient may need emergency hospitalisation for disimpaction. This study aimed to provide population-based data on the number of unplanned admissions and the cost to the healthcare system for constipation in Victoria, Australia in financial year 2010–11. Methods The Victorian Admitted Episodes Dataset was examined to find the number of emergency hospital separations coded as constipation (ICD-10-AM Code K390). An estimate of costs was determined from the number of weighted inlier equivalent separations (WIES) multiplied by the WEIS price, used by the Victorian Government for funding purposes. Results There were 3978 emergency separations for constipation in Victoria in 2010–2011, 92% in public hospitals. Fifty-five percent were female and 38% > 75 years old. One third stayed overnight and 1/3 more than 1 day. The emergency bed day rate was 7.1 per 10,000 of population. The estimate of cost, based on WEIS, was approximately $8.3 million. Potential savings could be made by reducing the number of separations in 6 Local Government Areas (LGAs). Conclusions This study shows that the burden (in number of admissions, emergency bed days and overall direct costs) in managing emergency admissions for constipation in Victoria, Australia, is very significant and likely to be similar in other developed countries. Improved primary healthcare and alternative ways to achieve faecal disimpaction without emergency admission could save the public health system a proportion of this $8.3 million. PMID:25015386

Whole-genome sequencing for identification of the source in hospital-acquired Legionnaires' disease

DEFF Research Database (Denmark)

Rosendahl Madsen, A M; Holm, A; Jensen, T G

2017-01-01

Acquisition of Legionnaires' disease is a serious complication of hospitalization. Rapid determination of whether or not the infection is caused by strains of Legionella pneumophila in the hospital environment is crucial to avoid further cases. This study investigated the use of whole-genome sequ......Acquisition of Legionnaires' disease is a serious complication of hospitalization. Rapid determination of whether or not the infection is caused by strains of Legionella pneumophila in the hospital environment is crucial to avoid further cases. This study investigated the use of whole...

Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

DEFF Research Database (Denmark)

Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

2016-01-01

university hospital during a 3-month period (September 2013–November 2013). Patients medication lists (n = 207) were reviewed at the time of admission and all identified PIPs were assessed for potential consequences by clinical pharmacologists. Results There were 349 PIP identified in 1291 prescriptions...... with the probability of PIP. Improving the quality of prescribing might benefit from an interprofessional approach and thus better training of physicians and nurses is needed in order to minimize PIP....

Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach

Science.gov (United States)

de Brantes, Francois; Rastogi, Amita; Painter, Michael

2010-01-01

Objective (or Study Question) To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness. Data Sources/Study Setting A claims database of 3.5 million commercially insured members under age 65. Study Design We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model. Principal Findings We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs. Conclusions By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent. PMID:20662949

Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth

OpenAIRE

Norris, Mark L; Spettigue, Wendy J; Katzman, Debra K

2016-01-01

Mark L Norris,1 Wendy J Spettigue,2 Debra K Katzman3 1Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 2Department of Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 3Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Abstract: Avoidant/restrictive food intak...

Assessing competition avoidance as a basic personality dimension.

Science.gov (United States)

Ryckman, Richard M; Thornton, Bill; Gold, Joel A

2009-03-01

The lack of an adequate psychometric instrument has impeded personality theory testing in the area of competition avoidance. The authors conducted 6 studies in an attempt to remedy this deficiency by constructing an individual-difference measure of competition avoidance. In line with K. Horney's (1937) interpersonal theory of neurosis, participants who were higher in competition avoidance showed higher levels of neuroticism, greater fears of both success and failure, a lower desire to prove themselves in competitive situations, higher levels of self-handicapping, and more maladaptiveness than those participants who were lower in competition avoidance. Also, they were more modest and willing to conform to group standards than were those lower in competition avoidance. The authors discuss the measure's potential usefulness as a diagnostic and assessment tool in academic, athletic, and clinical settings.

Fear-avoidance beliefs and pain avoidance in low back pain--translating research into clinical practice

DEFF Research Database (Denmark)

Rainville, James; Smeets, Rob J E M; Bendix, Tom

2011-01-01

For patients with low back pain, fear-avoidance beliefs (FABs) represent cognitions and emotions that underpin concerns and fears about the potential for physical activities to produce pain and further harm to the spine. Excessive FABs result in heightened disability and are an obstacle...

Avoiding Complications with MPFL Reconstruction.

Science.gov (United States)

Smith, Marvin K; Werner, Brian C; Diduch, David R

2018-05-12

To discuss the potentially significant complications associated with medial patellofemoral ligament (MPFL) reconstruction. Additionally, to review the most current and relevant literature with an emphasis on avoiding these potential complications. Multiple cadaveric studies have characterized the anatomy of the MPFL and the related morphologic abnormalities that contribute to recurrent lateral patellar instability. Such abnormalities include patella alta, excessive tibial tubercle to trochlear grove (TT-TG) distance, trochlear dysplasia, and malalignment. Recent studies have evaluated the clinical outcomes associated with the treatment of concomitant pathology in combination with MPFL reconstruction, which is critical in avoiding recurrent instability and complications. Although there remains a lack of consensus regarding various critical aspects of MPFL reconstruction, certain concepts remain imperative. Our preferred methods and rationales for surgical techniques are described. These include appropriate work up, a combination of procedures to address abnormal morphology, anatomical femoral insertion, safe and secure patellar fixation, appropriate graft length fixation, and thoughtful knee flexion during fixation.

Accidents with potentially hazardous biological material among workers in hospital supporting services.

Science.gov (United States)

Canini, Silvia Rita Marin da Silva; Gir, Elucir; Machado, Alcyone Artiolli

2005-01-01

Descriptive study was carried out to characterize the occupational accidents involving potentially contaminated material among workers of hospital supporting services. The study reviewed records of workers involved in these accidents and attended at a specialized outpatient clinic of a large tertiary care hospital between January 1997 and October 2001. A total of 2814 workers from different professional categories were attended during this period. Of these, 147 (5.2%) belonged to the hospital supporting services and were the victims of 156 accidents, auxiliary cleaning personnel (80.2%), and over a third of the workers had not received any dose of hepatitis B vaccine (35.4%). Most accidents were due to sharp injuries (96.8%) caused by inadequately discarded hollow needles. Chemoprophylaxis for HIV was not indicated in only 23.1% of cases. We conclude that these workers are also exposed to the possibility of acquiring blood-borne pathogens and that periodical education programs are needed.

Multislice Computed Tomography Coronary Angiography at a Local Hospital: Pitfalls and Potential

Energy Technology Data Exchange (ETDEWEB)

Kolnes, K.; Velle, Ose H.; Hareide, S.; Hegbom, K.; Wiseth, R. [Volda Hospital (Norway). Depts. of Radiology and Internal Medicine

2006-09-15

Purpose: To evaluate whether the favorable results achieved with multislice computed tomography (MSCT) of coronary arteries at larger centers could be paralleled at a local hospital. Material and Methods: Fifty consecutive patients with suspected coronary artery disease scheduled for invasive investigation with quantitative coronary angiography (QCA) at a university hospital underwent MSCT with a 16-slice scanner at a local hospital. Diagnostic accuracy of MSCT for coronary artery disease was assessed using a 16-segment coronary artery model with QCA as the gold standard. Results: Segments with diameter 50% stenosis for the 416 assessable segments were 92%, 82%, 53%, and 98%, respectively. Conclusion: Our beginners' experience demonstrated favorable results regarding sensitivity and negative predictive value. The positive predictive value, however, was unsatisfactory. Calcifications were identified as the most important factor for false-positive results with MSCT. With widespread use of MSCT coronary angiography, there is a risk of recruiting patients without significant coronary artery disease to unnecessary and potentially harmful invasive procedures.

Improvement of Inventory Control Using Continuous Review Policy in A Local Hospital at Bandung City, Indonesia

Directory of Open Access Journals (Sweden)

Fina Hafnika

2016-12-01

Full Text Available Abstract. This research was aimed to analyze the excess inventories issue in pharmacy and medical equipment unit at a local hospital in Bandung which affected the service level of the hospital. As one of the busy hospital in Java, proven by the higher amount of the patient/year than in other average Java typical hospital, the hospital needs to concern about the pharmaceutical and medical equipment inventories in order to fulfill patients’ needs and in the same time keeping the inventory level under control. Therefore, an inventory control evaluation was conducted to determine the appropriate number of inventories and time of order to avoid the excessive goods in central warehouse of the hospital. By using probabilistic inventory model and continuous review policy, the pharmaceutical inventory in the hospital was calculated to compare the ideal and actual amount of the average inventory level (AIL. ABC (Always, Better, Control classification also classified in this research to identify the proper item which potentially can be reduced from the inventory. From the analysis, we have discovered that the hospital potentially able to reduce almost Rp 830 million or 57% from the overstock inventory level by using continuous review policy as the basis of inventory control calculation system. Keywords: Continuous review policy, inventory control, EOQ, ROP, AIL

Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections

Directory of Open Access Journals (Sweden)

Andrea L. Lorden

2017-08-01

Full Text Available Background: An estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs and accounted for $9.8 (USD billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events. Aims: To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population. Methods: Retrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics. Findings: We identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91 for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant. Conclusions: Clinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements.

Research on UAV Intelligent Obstacle Avoidance Technology During Inspection of Transmission Line

Science.gov (United States)

Wei, Chuanhu; Zhang, Fei; Yin, Chaoyuan; Liu, Yue; Liu, Liang; Li, Zongyu; Wang, Wanguo

Autonomous obstacle avoidance of unmanned aerial vehicle (hereinafter referred to as UAV) in electric power line inspection process has important significance for operation safety and economy for UAV intelligent inspection system of transmission line as main content of UAV intelligent inspection system on transmission line. In the paper, principles of UAV inspection obstacle avoidance technology of transmission line are introduced. UAV inspection obstacle avoidance technology based on particle swarm global optimization algorithm is proposed after common obstacle avoidance technologies are studied. Stimulation comparison is implemented with traditional UAV inspection obstacle avoidance technology which adopts artificial potential field method. Results show that UAV inspection strategy of particle swarm optimization algorithm, adopted in the paper, is prominently better than UAV inspection strategy of artificial potential field method in the aspects of obstacle avoidance effect and the ability of returning to preset inspection track after passing through the obstacle. An effective method is provided for UAV inspection obstacle avoidance of transmission line.

A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity.

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Begun, James W; Kahn, Linda M; Cunningham, Brooke A; Malcolm, Jan K; Potthoff, Sandra

2017-12-13

Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota metropolitan area in 2015. Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of "community health and connectedness" and "healthy lifestyles and wellness." Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of "chronic disease prevention, management, and screening." Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities. Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

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

Science.gov (United States)

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

2017-04-01

Objectives Reducing health inequalities is an explicit goal of England's health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age-sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in

Fostering design for avoiding small parts in commonly used objects.

Science.gov (United States)

de Koning, Ton; Foltran, Francesca; Gregori, Dario

2012-05-14

Injuries due to the accidental ingestion or aspiration of small parts have became a matter of interest in the last 30 years, focusing on the relationship between a proper prevention and the diminished frequency of occurrences. Small parts in commonly used objects represent a large sector of potential danger, taking explicit mouthing behavior of children in the first four years of life. In this paper the intent is to show the current situation of design projects and legislation around the world, meant to avoid the casual accidents due to manufacturing reasons. Proposed process and quality control standards seek to eliminate production errors and control materials to avoid deviation from the design. The present study draws its data from the Susy Safe registry, a European Commission co-funded project started in February 2005, whose aim is to establish an international registry of cases of Foreign Bodies (FB) injuries in children aged 0-14 years. Information collected from the data base concern age and gender of the child, location, shape, volume, consistency and elipticity of the foreign body, any complication occurred, hospitalization, and behavioral aspects linked to the injury, like the supervision of the parents or the activity concomitant to the injury. Cases are prospectively collected using the Susy Safe system from 06/2005; moreover, also information regarding past consecutive cases available in each center adhering to the project have been entered in the Susy Safe Registry. Data evidenced that the majority of small parts related injuries are related to stationery. The majority of objects (56.7%), were located in the nose, followed by the ears (31.5%). The distribution on incidence of FB injuries by age class shows that the majority of injuries due to small parts in common objects occurred in children older than >3 years. Male and female were affected with the same frequency when concerning the nose, while all other locations showed a higher frequency in males

Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

LENUS (Irish Health Repository)

Hamilton, Hilary

2011-06-13

Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

LENUS (Irish Health Repository)

Gallagher, Paul

2011-11-01

Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

Serving high-risk foods in a high-risk setting: survey of hospital food service practices after an outbreak of listeriosis in a hospital.

Science.gov (United States)

Cokes, Carolyn; France, Anne Marie; Reddy, Vasudha; Hanson, Heather; Lee, Lillian; Kornstein, Laura; Stavinsky, Faina; Balter, Sharon

2011-04-01

Prepared ready-to-eat salads and ready-to-eat delicatessen-style meats present a high risk for Listeria contamination. Because no foodborne illness risk management guidelines exist specifically for US hospitals, a survey of New York City (NYC) hospitals was conducted to characterize policies and practices after a listeriosis outbreak occurred in a NYC hospital. From August through October 2008, a listeriosis outbreak in a NYC hospital was investigated. From February through April 2009, NYC's 61 acute-care hospitals were asked to participate in a telephone survey regarding food safety practices and policies, specifically service of high-risk foods to patients at increased risk for listeriosis. Five patients with medical conditions that put them at high risk for listeriosis had laboratory-confirmed Listeria monocytogenes infection. The Listeria outbreak strain was isolated from tuna salad prepared in the hospital. Fifty-four (89%) of 61 hospitals responded to the survey. Overall, 81% of respondents reported serving ready-to-eat deli meats to patients, and 100% reported serving prepared ready-to-eat salads. Pregnant women, patients receiving immunosuppressive drugs, and patients undergoing chemotherapy were served ready-to-eat deli meats at 77%, 59%, and 49% of hospitals, respectively, and were served prepared ready-to-eat salads at 94%, 89%, and 73% of hospitals, respectively. Only 4 (25%) of 16 respondents reported having a policy that ready-to-eat deli meats must be heated until steaming hot before serving. Despite the potential for severe outcomes of Listeria infection among hospitalized patients, the majority of NYC hospitals had no food preparation policies to minimize risk. Hospitals should implement policies to avoid serving high-risk foods to patients at risk for listeriosis.

Local adaptation and the potential effects of a contaminant on predator avoidance and antipredator responses under global warming: a space-for-time substitution approach

Science.gov (United States)

Janssens, Lizanne; Dinh Van, Khuong; Debecker, Sara; Bervoets, Lieven; Stoks, Robby

2014-01-01

The ability to deal with temperature-induced changes in interactions with contaminants and predators under global warming is one of the outstanding, applied evolutionary questions. For this, it is crucial to understand how contaminants will affect activity levels, predator avoidance and antipredator responses under global warming and to what extent gradual thermal evolution may mitigate these effects. Using a space-for-time substitution approach, we assessed the potential for gradual thermal evolution shaping activity (mobility and foraging), predator avoidance and antipredator responses when Ischnura elegans damselfly larvae were exposed to zinc in a common-garden warming experiment at the mean summer water temperatures of shallow water bodies at southern and northern latitudes (24 and 20°C, respectively). Zinc reduced mobility and foraging, predator avoidance and escape swimming speed. Importantly, high-latitude populations showed stronger zinc-induced reductions in escape swimming speed at both temperatures, and in activity levels at the high temperature. The latter indicates that local thermal adaptation may strongly change the ecological impact of contaminants under global warming. Our study underscores the critical importance of considering local adaptation along natural gradients when integrating biotic interactions in ecological risk assessment, and the potential of gradual thermal evolution mitigating the effects of warming on the vulnerability to contaminants. PMID:24665344

Local adaptation and the potential effects of a contaminant on predator avoidance and antipredator responses under global warming: a space-for-time substitution approach.

Science.gov (United States)

Janssens, Lizanne; Dinh Van, Khuong; Debecker, Sara; Bervoets, Lieven; Stoks, Robby

2014-03-01

The ability to deal with temperature-induced changes in interactions with contaminants and predators under global warming is one of the outstanding, applied evolutionary questions. For this, it is crucial to understand how contaminants will affect activity levels, predator avoidance and antipredator responses under global warming and to what extent gradual thermal evolution may mitigate these effects. Using a space-for-time substitution approach, we assessed the potential for gradual thermal evolution shaping activity (mobility and foraging), predator avoidance and antipredator responses when Ischnura elegans damselfly larvae were exposed to zinc in a common-garden warming experiment at the mean summer water temperatures of shallow water bodies at southern and northern latitudes (24 and 20°C, respectively). Zinc reduced mobility and foraging, predator avoidance and escape swimming speed. Importantly, high-latitude populations showed stronger zinc-induced reductions in escape swimming speed at both temperatures, and in activity levels at the high temperature. The latter indicates that local thermal adaptation may strongly change the ecological impact of contaminants under global warming. Our study underscores the critical importance of considering local adaptation along natural gradients when integrating biotic interactions in ecological risk assessment, and the potential of gradual thermal evolution mitigating the effects of warming on the vulnerability to contaminants.

Combining empirical and theory-based land-use modelling approaches to assess economic potential of biofuel production avoiding iLUC: Argentina as a case study

NARCIS (Netherlands)

Diogo, V.; van der Hilst, F.; van Eijck, J.; Verstegen, J.A.; Hilbert, J.; Carballo, S.; Volante, J.; Faaij, A.

2014-01-01

In this paper, a land-use modelling framework is presented combining empirical and theory-based modelling approaches to determine economic potential of biofuel production avoiding indirect land-use changes (iLUC) resulting from land competition with other functions. The empirical approach explores

System of Monitoring Potential Deceased Organ Donations in Over 200 Hospitals in Poland Using a Web Tool: Implementation and Structure.

Science.gov (United States)

Danek, T; Protasiuk, R; Mańkowski, M; Brutkiewicz, A; Trześniewski, R; Podlińska, I; Milecka, A; Jonas, M; Danielewicz, R; Czerwiński, J

2016-06-01

In 2010 the formation of the Polish Hospitals Network of Organ Donation Coordinators, originated by Poltransplant, began. One of the goals of this project is to report all deaths in hospital ICUs in which a coordinator is posted. The aim of this strategy is to monitor donation potential, following the recruitment process of potential donors and indicating stages of that process that may be improved to increase effective recruitment. Until the end of 2014 all data were forwarded to Poltransplant as Excel files, but since January 1, 2015, reporting and data collection have been are performed using web tool www.koordynator.net. The aim of the paper is to present the essentials in functioning principles, structure, and usage of the www.koordynator.net system, its technical construction, and to display good practices (know-how) tested by 1 country, for countries such as Poland, that contend with organ insufficiency. The application www.koordynator.net allows for remote addition of individual records with information about deceased patients in hospital ICUs, the forwarding of data about potential and actual organ donors, the generation of complete reports about deceased patients in each hospital monthly, and the introduction of historical data. Introduction of a potential donation monitoring system in 209 hospitals with transplant coordinators increases the number of identified potential and effective actual donors due to self-assessment analysis. Eventually, the www.koordynator.net reporting system allowed for external evaluation by coordinators from other hospitals, regional coordinators, and Poltransplant. The system is a modern tool that improves and increases the quality system in the organ donation field (quality assurance program). Copyright © 2016 Elsevier Inc. All rights reserved.

Psychosocial job conditions, fear avoidance beliefs and expected return to work following acute coronary syndrome: a cross-sectional study of fear-avoidance as a potential mediator.

Science.gov (United States)

Söderberg, Mia; Rosengren, Annika; Gustavsson, Sara; Schiöler, Linus; Härenstam, Annika; Torén, Kjell

2015-12-21

Despite improvements in treatment, acute coronary syndrome remains a substantial cause for prolonged sick absences and premature retirement. Knowledge regarding what benefits return to work is limited, especially the effect of psychological processes and psychosocial work factors. The purposes of this cross-sectional study were two-fold: to examine associations between adverse psychosocial job conditions and fear-avoidance beliefs towards work, and to determine whether such beliefs mediated the relationship between work conditions and expected return to work in acute coronary syndrome survivors. Study inclusion criteria: acute myocardial infarction or unstable angina diagnosis, below 65 years of age, being a resident in the West county of Sweden and currently working. In all, 509 individuals (21.8 % women) accepted study participation and for whom all data of study interest were available for analysis. Psychosocial work variables; job demand-control and effort-reward imbalance, were assessed with standard questionnaire batteries. Linear regression models were used to investigate relationships between psychosocial factors and fear-avoidance, and to evaluate mediator effects for fear-avoidance. Both total sample and gender stratified analyses were calculated. Fear-avoidance beliefs about work were associated to psychosocial job environments characterized by high strain (β 1.4; CI 1.2-1.6), active and passive work and high effort-reward imbalance (β 0.6; CI 0.5-0.7). Further, such beliefs also mediated the relationship between adverse work conditions and expected time for return to work. However, these results were only observed in total sample analyses or among or male participants. For women only high strain was linked to fear-avoidance, and these relationships became non-significant when entering chosen confounders. This cross-sectional study showed that acute coronary syndrome survivors, who laboured under adverse psychosocial work conditions, held fear-avoidance

Alternative mechanism of avoiding the big rip or little rip for a scalar phantom field

International Nuclear Information System (INIS)

Xi Ping; Zhai Xianghua; Li Xinzhou

2012-01-01

Depending on the choice of its potential, the scalar phantom field φ (the equation of state parameter w 2 correction. The singularity is avoidable under all these potentials. Hence, we conclude that the avoidance of big or little rip is hardly dependent on special potential.

Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital

Directory of Open Access Journals (Sweden)

Vishal Sehgal

2013-01-01

Full Text Available Background and Aim: Readmission to the hospital within 30 days of discharge from the hospital is a common occurrence. Congestive heart failure is the most common cause of readmissions in the hospital. We hypothesized that irrespective of the admission diagnosis polypharmacy and potentially inappropriate use of medications (PIM leads to readmissions within 30 days of discharge from the hospital. Materials and Methods: A retrospective study was carried out by reviewing the hospital records of 414 patients who were readmitted to the hospital within 30 days of discharge from the hospital between January 2008 and December 2009. The data was stratified to see which patients were on polypharmacy and/or on PIM. Polypharmacy was defined as use of more than 5 medications. PIM was defined as per the modified Beers criteria. Day 0 was defined as the day of discharge and day1 was defined as the day-after Admission to the hospital. Statistical analysis was carried out using a two-way analysis of variance (ANOVA on the data to see if polypharmacy and/or PIM was related to readmission within 30 days of discharge irrespective of admission diagnosis. Results: Polypharmacy was related to hospital readmission at day 1 and day 0, however inappropriate drug use was found to be not related at any day. Polypharmacy and PIM combined had a positive correlation to readmission only on days 1 and 0 and it was statistically significant. The use of minimal and appropriate use of drugs was statistically significant compared to polypharmacy and PIM use. Conclusions: Polypharmacy and PIM are under recognized cause of readmissions to the hospital.

Predictors of avoiding medical care and reasons for avoidance behavior.

Science.gov (United States)

Kannan, Viji Diane; Veazie, Peter J

2014-04-01

Delayed medical care has negative health and economic consequences; interventions have focused on appraising symptoms, with limited success in reducing delay. To identify predictors of care avoidance and reasons for avoiding care. Using the Health Information National Trends Survey (2007), we conducted logistic regressions to identify predictors of avoiding medical visits deemed necessary by the respondents; and, we then conducted similar analyses on reasons given for avoidance behavior. Independent variables included geographic, demographic, socioeconomic, personal health, health behavior, health care system, and cognitive characteristics. Approximately one third of adults avoided doctor visits they had deemed necessary. Although unadjusted associations existed, avoiding needed care was not independently associated with geographic, demographic, and socioeconomic characteristics. Avoidance behavior is characterized by low health self-efficacy, less experience with both quality care and getting help with uncertainty about health, having your feelings attended to by your provider, no usual source of care, negative affect, smoking daily, and fatalistic attitude toward cancer. Reasons elicited for avoidance include preference for self-care or alternative care, dislike or distrust of doctors, fear or dislike of medical treatments, time, and money; respondents also endorsed discomfort with body examinations, fear of having a serious illness, and thoughts of dying. Distinct predictors distinguish each of these reasons. Interventions to reduce patient delay could be improved by addressing the health-related behavioral, belief, experiential, and emotional traits associated with delay. Attention should also be directed toward the interpersonal communications between patients and providers.

The potential migration effect of rural hospital closures

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

Use of portable electronic devices in a hospital setting and their potential for bacterial colonization.

Science.gov (United States)

Khan, Amber; Rao, Amitha; Reyes-Sacin, Carlos; Hayakawa, Kayoko; Szpunar, Susan; Riederer, Kathleen; Kaye, Keith; Fishbain, Joel T; Levine, Diane

2015-03-01

Portable electronic devices are increasingly being used in the hospital setting. As with other fomites, these devices represent a potential reservoir for the transmission of pathogens. We conducted a convenience sampling of devices in 2 large medical centers to identify bacterial colonization rates and potential risk factors. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Active listening: The key of successful communication in hospital managers.

Science.gov (United States)

Jahromi, Vahid Kohpeima; Tabatabaee, Seyed Saeed; Abdar, Zahra Esmaeili; Rajabi, Mahboobeh

2016-03-01

One of the important causes of medical errors and unintentional harm to patients is ineffective communication. The important part of this skill, in case it has been forgotten, is listening. The objective of this study was to determine whether managers in hospitals listen actively. This study was conducted between May and June 2014 among three levels of managers at teaching hospitals in Kerman, Iran. Active Listening skill among hospital managers was measured by self-made Active Listening Skill Scale (ALSS), which consists of the key elements of active listening and has five subscales, i.e., Avoiding Interruption, Maintaining Interest, Postponing Evaluation, Organizing Information, and Showing Interest. The data were analyzed by IBM-SPSS software, version 20, and the Pearson product-moment correlation coefficient, the chi-squared test, and multiple linear regressions. The mean score of active listening in hospital managers was 2.32 out of 3.The highest score (2.27) was obtained by the first-level managers, and the top managers got the lowest score (2.16). Hospital mangers were best in showing interest and worst in avoiding interruptions. The area of employment was a significant predictor of avoiding interruption and the managers' gender was a strong predictor of skill in maintaining interest (p < 0.05). The type of management and education can predict postponing evaluation, and the length of employment can predict showing interest (p < 0.05). There is a necessity for the development of strategies to create more awareness among the hospital managers concerning their active listening skills.

Potential Cost-effectiveness of Early Identification of Hospital-acquired Infection in Critically Ill Patients.

Science.gov (United States)

Tsalik, Ephraim L; Li, Yanhong; Hudson, Lori L; Chu, Vivian H; Himmel, Tiffany; Limkakeng, Alex T; Katz, Jason N; Glickman, Seth W; McClain, Micah T; Welty-Wolf, Karen E; Fowler, Vance G; Ginsburg, Geoffrey S; Woods, Christopher W; Reed, Shelby D

2016-03-01

Limitations in methods for the rapid diagnosis of hospital-acquired infections often delay initiation of effective antimicrobial therapy. New diagnostic approaches offer potential clinical and cost-related improvements in the management of these infections. We developed a decision modeling framework to assess the potential cost-effectiveness of a rapid biomarker assay to identify hospital-acquired infection in high-risk patients earlier than standard diagnostic testing. The framework includes parameters representing rates of infection, rates of delayed appropriate therapy, and impact of delayed therapy on mortality, along with assumptions about diagnostic test characteristics and their impact on delayed therapy and length of stay. Parameter estimates were based on contemporary, published studies and supplemented with data from a four-site, observational, clinical study. Extensive sensitivity analyses were performed. The base-case analysis assumed 17.6% of ventilated patients and 11.2% of nonventilated patients develop hospital-acquired infection and that 28.7% of patients with hospital-acquired infection experience delays in appropriate antibiotic therapy with standard care. We assumed this percentage decreased by 50% (to 14.4%) among patients with true-positive results and increased by 50% (to 43.1%) among patients with false-negative results using a hypothetical biomarker assay. Cost of testing was set at $110/d. In the base-case analysis, among ventilated patients, daily diagnostic testing starting on admission reduced inpatient mortality from 12.3 to 11.9% and increased mean costs by $1,640 per patient, resulting in an incremental cost-effectiveness ratio of $21,389 per life-year saved. Among nonventilated patients, inpatient mortality decreased from 7.3 to 7.1% and costs increased by $1,381 with diagnostic testing. The resulting incremental cost-effectiveness ratio was $42,325 per life-year saved. Threshold analyses revealed the probabilities of developing

Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism.

Science.gov (United States)

Choi, Karmel W; Sikkema, Kathleen J; Vythilingum, Bavi; Geerts, Lut; Faure, Sheila C; Watt, Melissa H; Roos, Annerine; Stein, Dan J

2017-03-15

Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. Limitations included modest sample size, self-report measures, and unmeasured potential confounders. Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa. Copyright © 2017. Published by Elsevier B.V.

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...

Peer conflict avoidance: associations with loneliness, social anxiety, and social avoidance.

Science.gov (United States)

Johnson, H D; LaVoie, J C; Spenceri, M C; Mahoney-Wernli, M A

2001-02-01

Failure to resolve peer conflict is associated with children's reports of loneliness, social anxiety, and social avoidance. Although these relationships are well established, researchers have not examined the association between the avoidance of peer conflict and various adjustment characteristics. The current study examined the association between avoidance of conflict and measures of loneliness, social anxiety, and social avoidance for 59 pupils in Grade 4 (31 boys and 28 girls) and 47 in Grade 8 (22 boys and 25 girls). Volunteers indicated that conflict avoidance based on autonomy, e.g., independence issues, and interpersonal issues, e.g., closeness and cohesion, was associated with scores on loneliness for boys and girls, respectively. Conflict avoidance for emotional and physical well-being and fear of punishment was associated with increased reports of loneliness and social anxiety for children in Grade 4.

Human Robot Interaction for Hybrid Collision Avoidance System for Indoor Mobile Robots

Directory of Open Access Journals (Sweden)

Mazen Ghandour

2017-06-01

Full Text Available In this paper, a novel approach for collision avoidance for indoor mobile robots based on human-robot interaction is realized. The main contribution of this work is a new technique for collision avoidance by engaging the human and the robot in generating new collision-free paths. In mobile robotics, collision avoidance is critical for the success of the robots in implementing their tasks, especially when the robots navigate in crowded and dynamic environments, which include humans. Traditional collision avoidance methods deal with the human as a dynamic obstacle, without taking into consideration that the human will also try to avoid the robot, and this causes the people and the robot to get confused, especially in crowded social places such as restaurants, hospitals, and laboratories. To avoid such scenarios, a reactive-supervised collision avoidance system for mobile robots based on human-robot interaction is implemented. In this method, both the robot and the human will collaborate in generating the collision avoidance via interaction. The person will notify the robot about the avoidance direction via interaction, and the robot will search for the optimal collision-free path on the selected direction. In case that no people interacted with the robot, it will select the navigation path autonomously and select the path that is closest to the goal location. The humans will interact with the robot using gesture recognition and Kinect sensor. To build the gesture recognition system, two models were used to classify these gestures, the first model is Back-Propagation Neural Network (BPNN, and the second model is Support Vector Machine (SVM. Furthermore, a novel collision avoidance system for avoiding the obstacles is implemented and integrated with the HRI system. The system is tested on H20 robot from DrRobot Company (Canada and a set of experiments were implemented to report the performance of the system in interacting with the human and avoiding

How to Recognize and Avoid Potential, Possible, or Probable Predatory Open-Access Publishers, Standalone, and Hijacked Journals.

Science.gov (United States)

Danevska, Lenche; Spiroski, Mirko; Donev, Doncho; Pop-Jordanova, Nada; Polenakovic, Momir

2016-11-01

The Internet has enabled an easy method to search through the vast majority of publications and has improved the impact of scholarly journals. However, it can also pose threats to the quality of published articles. New publishers and journals have emerged so-called open-access potential, possible, or probable predatory publishers and journals, and so-called hijacked journals. It was our aim to increase the awareness and warn scholars, especially young researchers, how to recognize these journals and how to avoid submission of their papers to these journals. Review and critical analysis of the relevant published literature, Internet sources and personal experience, thoughts, and observations of the authors. The web blog of Jeffrey Beall, University of Colorado, was greatly consulted. Jeffrey Beall is a Denver academic librarian who regularly maintains two lists: the first one, of potential, possible, or probable predatory publishers and the second one, of potential, possible, or probable predatory standalone journals. Aspects related to this topic presented by other authors have been discussed as well. Academics should bear in mind how to differentiate between trustworthy and reliable journals and predatory ones, considering: publication ethics, peer-review process, international academic standards, indexing and abstracting, preservation in digital repositories, metrics, sustainability, etc.

Avoidance response of Enchytraeus albidus in relation to carbendazim ageing

International Nuclear Information System (INIS)

Kobeticova, Klara; Hofman, Jakub; Holoubek, Ivan

2009-01-01

In this study, avoidance response of Enchytraeus albidus to LUFA 2.2 soil contaminated with pesticide carbendazim was investigated. The aim was to clarify minimal test duration and temporal changes in avoidance response due to contamination ageing. Firstly, the concentration causing 50% avoidance (EC 50 ) was determined as 7.6 mg/kg. Then, test duration needed to reach this value (ET 50 = approximately 18 h) was identified. Finally, the capability of E. albidus avoidance test to reflect the changes of pollutant bioavailability was tested. The soil was spiked with carbendazim at the EC 50 concentration 1, 14, or 28 days before the test started and avoidance effects of fresh versus aged contamination were compared. The results indicated that enchytraeids preferred soil contaminated for 28 days prior to assay where carbendazim was probably less bioavailable than in freshly spiked soil. Our results open an interesting research area of potential use of avoidance tests for contaminant bioavailability assessment. - The results of this study show that avoidance response of Enchytraeus albidus might identify changes of contaminant bioavailability

Analyzing hospitalization data: potential limitations of Poisson regression.

Science.gov (United States)

Weaver, Colin G; Ravani, Pietro; Oliver, Matthew J; Austin, Peter C; Quinn, Robert R

2015-08-01

Poisson regression is commonly used to analyze hospitalization data when outcomes are expressed as counts (e.g. number of days in hospital). However, data often violate the assumptions on which Poisson regression is based. More appropriate extensions of this model, while available, are rarely used. We compared hospitalization data between 206 patients treated with hemodialysis (HD) and 107 treated with peritoneal dialysis (PD) using Poisson regression and compared results from standard Poisson regression with those obtained using three other approaches for modeling count data: negative binomial (NB) regression, zero-inflated Poisson (ZIP) regression and zero-inflated negative binomial (ZINB) regression. We examined the appropriateness of each model and compared the results obtained with each approach. During a mean 1.9 years of follow-up, 183 of 313 patients (58%) were never hospitalized (indicating an excess of 'zeros'). The data also displayed overdispersion (variance greater than mean), violating another assumption of the Poisson model. Using four criteria, we determined that the NB and ZINB models performed best. According to these two models, patients treated with HD experienced similar hospitalization rates as those receiving PD {NB rate ratio (RR): 1.04 [bootstrapped 95% confidence interval (CI): 0.49-2.20]; ZINB summary RR: 1.21 (bootstrapped 95% CI 0.60-2.46)}. Poisson and ZIP models fit the data poorly and had much larger point estimates than the NB and ZINB models [Poisson RR: 1.93 (bootstrapped 95% CI 0.88-4.23); ZIP summary RR: 1.84 (bootstrapped 95% CI 0.88-3.84)]. We found substantially different results when modeling hospitalization data, depending on the approach used. Our results argue strongly for a sound model selection process and improved reporting around statistical methods used for modeling count data. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Animal to human translational paradigms relevant for approach avoidance conflict decision making.

Science.gov (United States)

Kirlic, Namik; Young, Jared; Aupperle, Robin L

2017-09-01

Avoidance behavior in clinical anxiety disorders is often a decision made in response to approach-avoidance conflict, resulting in a sacrifice of potential rewards to avoid potential negative affective consequences. Animal research has a long history of relying on paradigms related to approach-avoidance conflict to model anxiety-relevant behavior. This approach includes punishment-based conflict, exploratory, and social interaction tasks. There has been a recent surge of interest in the translation of paradigms from animal to human, in efforts to increase generalization of findings and support the development of more effective mental health treatments. This article briefly reviews animal tests related to approach-avoidance conflict and results from lesion and pharmacologic studies utilizing these tests. We then provide a description of translational human paradigms that have been developed to tap into related constructs, summarizing behavioral and neuroimaging findings. Similarities and differences in findings from analogous animal and human paradigms are discussed. Lastly, we highlight opportunities for future research and paradigm development that will support the clinical utility of this translational work. Copyright © 2017 Elsevier Ltd. All rights reserved.

Neurologic disorders, in-hospital deaths, and years of potential life lost in the USA, 1988-2011.

Science.gov (United States)

Rosenbaum, Benjamin P; Kelly, Michael L; Kshettry, Varun R; Weil, Robert J

2014-11-01

Premature mortality is a public health concern that can be quantified as years of potential life lost (YPLL). Studying premature mortality can help guide hospital initiatives and resource allocation. We investigated the categories of neurologic and neurosurgical conditions associated with in-hospital deaths that account for the highest YPLL and their trends over time. Using the Nationwide Inpatient Sample (NIS), we calculated YPLL for patients hospitalized in the USA from 1988 to 2011. Hospitalizations were categorized by related neurologic principal diagnoses. An estimated 2,355,673 in-hospital deaths accounted for an estimated 25,598,566 YPLL. The traumatic brain injury (TBI) category accounted for the highest annual mean YPLL at 361,748 (33.9% of total neurologic YPLL). Intracerebral hemorrhage, cerebral ischemia, subarachnoid hemorrhage, and anoxic brain damage completed the group of five diagnoses with the highest YPLL. TBI accounted for 12.1% of all inflation adjusted neurologic hospital charges and 22.4% of inflation adjusted charges among neurologic deaths. The in-hospital mortality rate has been stable or decreasing for all of these diagnoses except TBI, which rose from 5.1% in 1988 to 7.8% in 2011. Using YPLL, we provide a framework to compare the burden of premature in-hospital mortality on patients with neurologic disorders, which may prove useful for informing decisions related to allocation of health resources or research funding. Considering premature mortality alone, increased efforts should be focused on TBI, particularly in and related to the hospital setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

Science.gov (United States)

Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

2017-11-01

The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Prognostic psychosocial factors for disabling low back pain in Japanese hospital workers.

Science.gov (United States)

Yoshimoto, Takahiko; Oka, Hiroyuki; Katsuhira, Junji; Fujii, Tomoko; Masuda, Katsuhiko; Tanaka, Sakae; Matsudaira, Ko

2017-01-01

Although the occupational health field has identified psychosocial factors as risk factors for low back pain that causes disability, the association between disabling low back pain and psychosocial factors has not been examined adequately in Japanese hospital workers. Therefore, this study examined the association between low back pain, which interfered with work, and psychosocial factors in Japanese hospital workers. This cross-sectional study was conducted at a hospital in Japan. In total, 280 hospital workers were recruited from various occupational settings. Of these, 203 completed a self-administered questionnaire that included items concerning individual characteristics, severity of low back pain, fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), somatic symptoms (Somatic Symptom Scale-8), psychological distress (K6), workaholism, and work-related psychosocial factors (response rate: 72.5%). Logistic regression was used to explore risk factors associated with disabling low back pain. Of the 203 participants who completed questionnaires, 36 (17.7%) reported low back pain that interfered with their work. Multivariate analyses with individual factors and occupations adjusted for showed statistically significant associations between disabling low back pain and fear-avoidance beliefs (adjusted odds ratio [OR]: 2.619, 95% confidence interval [CI]: 1.003-6.538], somatic symptoms (OR: 4.034, 95% CI: 1.819-9.337), and interpersonal stress at work (OR: 2.619, 95% CI: 1.067-6.224). Psychosocial factors, such as fear-avoidance beliefs, somatic symptoms, and interpersonal relationships at work, were important risk factors in low back pain that interfered with work in Japanese hospital workers. With respect to occupational health, consideration of psychosocial factors is required to reduce disability related to low back pain.

A collision avoidance model for two-pedestrian groups: Considering random avoidance patterns

Science.gov (United States)

Zhou, Zhuping; Cai, Yifei; Ke, Ruimin; Yang, Jiwei

2017-06-01

Grouping is a common phenomenon in pedestrian crowds and group modeling is still an open challenging problem. When grouping pedestrians avoid each other, different patterns can be observed. Pedestrians can keep close with group members and avoid other groups in cluster. Also, they can avoid other groups separately. Considering this randomness in avoidance patterns, we propose a collision avoidance model for two-pedestrian groups. In our model, the avoidance model is proposed based on velocity obstacle method at first. Then grouping model is established using Distance constrained line (DCL), by transforming DCL into the framework of velocity obstacle, the avoidance model and grouping model are successfully put into one unified calculation structure. Within this structure, an algorithm is developed to solve the problem when solutions of the two models conflict with each other. Two groups of bidirectional pedestrian experiments are designed to verify the model. The accuracy of avoidance behavior and grouping behavior is validated in the microscopic level, while the lane formation phenomenon and fundamental diagrams is validated in the macroscopic level. The experiments results show our model is convincing and has a good expansibility to describe three or more pedestrian groups.

Knowledge Translation Strategy to Reduce the Use of Potentially Inappropriate Medications in Hospitalized Elderly Adults.

Science.gov (United States)

Cossette, Benoit; Bergeron, Josée; Ricard, Geneviève; Éthier, Jean-François; Joly-Mischlich, Thomas; Levine, Mitchell; Sene, Modou; Mallet, Louise; Lanthier, Luc; Payette, Hélène; Rodrigue, Marie-Claude; Brazeau, Serge

2016-12-01

To evaluate the effect of a knowledge translation (KT) strategy to reduce potentially inappropriate medication (PIM) use in hospitalized elderly adults. Segmented regression analysis of an interrupted time series. Teaching hospital. Individuals aged 75 and older discharged from the hospital in 2013/14 (mean age 83.3, 54.5% female). The KT strategy comprises the distribution of educational materials, presentations by geriatricians, pharmacist-physician interventions based on alerts from a computerized alert system, and comprehensive geriatric assessments. Rate of PIM use (number of patient-days with use of at least one PIM/number of patient-days of hospitalization for individuals aged ≥75). For 8,622 patients with 14,071 admissions, a total of 145,061 patient-days were analyzed. One or more PIMs were prescribed on 28,776 (19.8%) patient-days; a higher rate was found for individuals aged 75 to 84 (24.0%) than for those aged 85 and older (14.4%) (P patient-days with at least one PIM was observed immediately after the intervention. A KT strategy resulted in decreased use of PIM in elderly adults in the hospital. Additional interventions will be implemented to maintain or further reduce PIM use. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

The impact of avoidant personality disorder on psychosocial impairment is substantial.

Science.gov (United States)

Wilberg, Theresa; Karterud, Sigmund; Pedersen, Geir; Urnes, Øyvind

2009-01-01

Few studies have compared the psychosocial problems associated with different types of personality disorders (PDs). The aim of this study was to investigate the functional impairment and symptomatic distress associated with six PD diagnoses coded in DSM-IV: paranoid, borderline, avoidant, dependent, obsessive-compulsive PD and PD not otherwise specified, as well as a condition of non-psychotic symptom disorders with no PD. The study included 1023 patients from eight day treatment units specialized in the treatment of PDs. Eighty-one per cent had one or more PD diagnoses. At admission to day treatment, the patients were evaluated with respect to global functioning, symptomatic and interpersonal distress, education, quality of life, social support, legal problems and previous psychotic episodes and psychiatric hospitalizations. There were few differences in global functioning or symptomatic and interpersonal distress between patients with a single PD diagnosis. Avoidant PD and borderline PD was the diagnoses that contributed most to dysfunction in most variables when taking into account the presences of several co-occurrent PD diagnoses and axis I disorders. The psychosocial problems associated with avoidant and borderline PD were partly domain specific. The study indicates that avoidant PD is associated with severe dysfunction and subjective distress, at a level comparable to that of borderline PD. Avoidant PD deserves more attention, both with respect to the specific psychopathology and dynamics underlying the disorder and the development of treatment approaches.

Nurses' intention to resign and avoidance of emergency department violence: A moderated mediation model.

Science.gov (United States)

Li, Yu-Fang; Chao, Minston; Shih, Chih-Ting

2017-10-10

Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

Science.gov (United States)

Sulo, Suela; Feldstein, Josh; Partridge, Jamie; Schwander, Bjoern; Sriram, Krishnan; Summerfelt, Wm Thomas

2017-07-01

Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay. To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention. The reduction in readmission rate and length of stay for 1269 patients enrolled in the quality improvement program (between October 13, 2014, and April 2, 2015) were compared with the pre-quality improvement program baseline and validation cohorts (4611 patients vs 1319 patients, respectively) to calculate potential cost-savings as well as to inform the design of the budget impact model. Readmission rate and length-of-stay reductions were calculated by determining the change from baseline to post-quality improvement program as well as the difference between the validation cohort and the post-quality improvement program, respectively. As a result of improved health outcomes for the treated patients, the nutrition-focused quality improvement program led to a reduction in 30-day hospital readmissions and length of stay. The avoided hospital readmissions and reduced number of days in the hospital for the patients in the quality improvement program resulted in cost-savings of $1,902,933 versus the pre-quality improvement program baseline cohort, and $4,896,758 versus the pre-quality improvement program in the

Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study

Directory of Open Access Journals (Sweden)

Kaufman Samuel R

2008-11-01

Full Text Available Abstract Background Many hospitalizations for residents of skilled nursing facilities are potentially avoidable. Factors that could prevent hospitalization for urinary tract infection (UTI were investigated, with focus on patient mobility. Methods A retrospective cohort study was conducted using 2003–2004 data from the Centers for Medicare and Medicaid Services. The study included 408,192 residents of 4267 skilled nursing facilities in California, Florida, Michigan, New York, and Texas. The patients were followed over time, from admission to the skilled nursing facility to discharge or, for those who were not discharged, for 1 year. Cox proportional hazards regression was conducted with hospitalization for UTI as the outcome. Results The ability to walk was associated with a 69% lower rate of hospitalization for UTI. Maintaining or improving walking ability over time reduced the risk of hospitalization for UTI by 39% to 76% for patients with various conditions. For residents with severe mobility problems, such as being in a wheelchair or having a missing limb, maintaining or improving mobility (in bed or when transferring reduced the risk of hospitalization for UTI by 38% to 80%. Other potentially modifiable predictors included a physician visit at the time of admission to the skilled nursing facility (Hazard Ratio (HR, 0.68, use of an indwelling urinary catheter (HR, 2.78, infection with Clostridium difficile or an antibiotic-resistant microorganism (HR, 1.20, and use of 10 or more medications (HR, 1.31. Patient characteristics associated with hospitalization for UTI were advancing age, being Hispanic or African-American, and having diabetes mellitus, renal failure, Parkinson's disease, dementia, or stroke. Conclusion Maintaining or improving mobility (walking, transferring between positions, or moving in bed was associated with a lower risk of hospitalization for UTI. A physician visit at the time of admission to the skilled nursing facility

Avoidance of Ag nanoparticles by earthworms, Eisenia fetida

DEFF Research Database (Denmark)

Mariyadas, Jennifer; Mónica, Amorim; Scott-Fordsmand, Janeck James

2013-01-01

Earthworms are key sentinel organisms playing an important role in improving the soil structure. Here we tested the avoidance behaviour of earthworms, Eisenia fetida to silver nanoparticles (Ag NPs). Silver nanoparticles are widely used in a range of consumer products mainly as antibacterial agents....... The avoidance behaviour could not be explained by the release of silver ions in the soil-solution. Although, Ag-ions release (if any) may still have had an influence on behaviour. The present results suggests that the earthworms perceive the presence of actual nanoparticles in the soil. Our results suggest that...... and thus causes potential risk to the environment once these particles are released into the environment [1]. In our tests, we were able to show that the earthworms avoided commercially fabricated silver nanoparticles in a dose and time dependent manner. The earthworms were exposed to 3 nanoparticles: NM...

Overview of physician-hospital ventures.

Science.gov (United States)

Cohn, Kenneth H; Allyn, Thomas R; Rosenfield, Robert H; Schwartz, Richard

2005-01-01

An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

Occupational Exposure to Antineoplastic Drugs: Identification of Job Categories Potentially Exposed throughout the Hospital Medication System

Directory of Open Access Journals (Sweden)

Chun-Yip Hon

2011-09-01

Conclusion: We found drug contamination on select surfaces at every stage of the medication system, which indicates the existence of an exposure potential throughout the facility. Our results suggest that a broader range of workers are potentially exposed than has been previously examined. These results will allow us to develop a more inclusive exposure assessment encompassing all healthcare workers that are at risk throughout the hospital medication system.

The ins and outs of managing avoidance diets for food allergies.

Science.gov (United States)

Shaker, Marcus; Venter, Carina

2016-08-01

Food allergic reactions have become more prevalent and management of food allergies requires dietary avoidance of triggers that may place children at nutritional risk. Immunoglobulin E and non-immunoglobulin E-mediated food allergies lead to dietary avoidance. Although some children outgrow food allergies or become tolerant to cooked/baked versions of the allergen, many do not. Multiple food avoidance increases the risk for inadequate nutrient intake, including protein, calcium, vitamin D, and others. Multidisciplinary management of patients requires careful attention to growth, particularly height, and nutrition. Although attention to accurate diagnosis of food allergy is key, understanding nutritional risks of children with food allergies can lead to opportunities to address potential deficiencies resulting from food allergen avoidance.

The 'unnecessary' use of emergency departments by older people: findings from hospital data, hospital staff and older people.

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Faulkner, Debbie; Law, Julia

2015-11-01

Increasing demands are being placed on emergency departments in Australia and there is a view that older Australians are more likely than other age groups to attend for non-urgent conditions. The objective of this paper is to compare and contrast administrative data with the views of hospital staff and older people with regard to their presentation at two emergency departments in metropolitan Adelaide and how this aligns with the Australian Institute of Health and Welfare definition of 'potentially avoidable general practitioner-type presentations'. The study used three sources of data from two emergency departments: hospital data for the financial year 2010-11 for patients aged 65 years and over and identified as triage category four or five; three focus groups with medical, nursing and allied staff from these two hospitals; and interviews with 58 older people who presented at the two emergency departments over a two-week period. The hospital administrative data provided a very limited insight into why older people attended the emergency department, other than the medical diagnosis. Professional staff identified individual determinants, societal determinants and the health services system as explanations. Older people attended the emergency department for a range of reasons that may not necessarily reflect the opinions of health professionals. For many older people the emergency department was an appropriate place to attend considering their condition, though some presentations could be circumvented with appropriate and increased services in the community. However, as many older people suffer comorbidities, careful consideration needs to be given as to the best possible practices to achieve this.

UAV formation control design with obstacle avoidance in dynamic three-dimensional environment.

Science.gov (United States)

Chang, Kai; Xia, Yuanqing; Huang, Kaoli

2016-01-01

This paper considers the artificial potential field method combined with rotational vectors for a general problem of multi-unmanned aerial vehicle (UAV) systems tracking a moving target in dynamic three-dimensional environment. An attractive potential field is generated between the leader and the target. It drives the leader to track the target based on the relative position of them. The other UAVs in the formation are controlled to follow the leader by the attractive control force. The repulsive force affects among the UAVs to avoid collisions and distribute the UAVs evenly on the spherical surface whose center is the leader-UAV. Specific orders or positions of the UAVs are not required. The trajectories of avoidance obstacle can be obtained through two kinds of potential field with rotation vectors. Every UAV can choose the optimal trajectory to avoid the obstacle and reconfigure the formation after passing the obstacle. Simulations study on UAV are presented to demonstrate the effectiveness of proposed method.

Constipation in children: avoiding hospital admissions by the use of a specialist community nurse.

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Bartle, David; Finlay, Fiona; Atherton, Fiona

2003-01-01

To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead. A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period. Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights. The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.

Estimating potential infection transmission routes in hospital wards using wearable proximity sensors.

Directory of Open Access Journals (Sweden)

Philippe Vanhems

Full Text Available BACKGROUND: Contacts between patients, patients and health care workers (HCWs and among HCWs represent one of the important routes of transmission of hospital-acquired infections (HAI. A detailed description and quantification of contacts in hospitals provides key information for HAIs epidemiology and for the design and validation of control measures. METHODS AND FINDINGS: We used wearable sensors to detect close-range interactions ("contacts" between individuals in the geriatric unit of a university hospital. Contact events were measured with a spatial resolution of about 1.5 meters and a temporal resolution of 20 seconds. The study included 46 HCWs and 29 patients and lasted for 4 days and 4 nights. 14,037 contacts were recorded overall, 94.1% of which during daytime. The number and duration of contacts varied between mornings, afternoons and nights, and contact matrices describing the mixing patterns between HCW and patients were built for each time period. Contact patterns were qualitatively similar from one day to the next. 38% of the contacts occurred between pairs of HCWs and 6 HCWs accounted for 42% of all the contacts including at least one patient, suggesting a population of individuals who could potentially act as super-spreaders. CONCLUSIONS: Wearable sensors represent a novel tool for the measurement of contact patterns in hospitals. The collected data can provide information on important aspects that impact the spreading patterns of infectious diseases, such as the strong heterogeneity of contact numbers and durations across individuals, the variability in the number of contacts during a day, and the fraction of repeated contacts across days. This variability is however associated with a marked statistical stability of contact and mixing patterns across days. Our results highlight the need for such measurement efforts in order to correctly inform mathematical models of HAIs and use them to inform the design and evaluation of

The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients : A Nested Case Control Study

NARCIS (Netherlands)

van der Stelt, C. A K; Vermeulen Windsant-van den Tweel, A. M A; Egberts, A. C G; van den Bemt, P. M L A; Leendertse, A. J.; Hermens, W. A J J; van Marum, R. J.; Derijks, H. J.

2016-01-01

Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study

NARCIS (Netherlands)

van der Stelt, C.A.K.; Vermeulen Windsant-van den Tweel, A.M.A.; Egberts, A.C.G.|info:eu-repo/dai/nl/162850050; van den Bemt, P.M.L.A.|info:eu-repo/dai/nl/151330689; Leendertse, A.J.; Hermens, W.A.J.J.; van Marum, R.J.; Derijks, Jeroen|info:eu-repo/dai/nl/304840505

2016-01-01

Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

Experiential avoidance mediates the link between maternal attachment style and theory of mind.

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Vanwoerden, Salome; Kalpakci, Allison H; Sharp, Carla

2015-02-01

Theoretical and empirical models suggest a relation between attachment style and theory of mind (ToM) in childhood and adulthood; however, this link has not been evaluated to the same extent in adolescence. Additionally, these models typically fail to consider mechanisms by which attachment style affects ToM abilities. The present study sought to test a mediational model in which experiential avoidance mediates the relation between maternal attachment style and ToM. A sample of 282 adolescents (Mage=15.42years, SD=1.44, 62.8% female) was recruited from an inpatient psychiatric hospital. Findings revealed that maternal attachment style in females was related to ToM, through experiential avoidance. Specifically, those with a disorganized maternal attachment were most likely to engage in experiential avoidant cognitive and emotional strategies, which in turn related to lower levels of ToM ability. Implications and areas for future research are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

Avoidance of Novelty Contributes to the Uncanny Valley

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Kyoshiro Sasaki

2017-10-01

Full Text Available A hypothesis suggests that objects with a high degree of visual similarity to real humans trigger negative impressions (i.e., the uncanny valley. Previous studies have suggested that difficulty in object categorization elicits negative emotional reactions to enable the avoidance of potential threats. The present study further investigated this categorization-difficulty hypothesis. In an experiment, observers categorized morphed images of photographs and human doll faces as “photograph” or “doll” and evaluated the perceived eeriness of the images. Additionally, we asked the observers to answer questionnaires on behavioral inhibition systems (BIS. The results indicated that individual differences in the BIS score were associated with enhanced eeriness in the objects with a specific human likeness. These findings suggest that the tendency to avoid a potentially threatening novel experience contributes to promoting the perceived eeriness of objects with some degree of visual similarity to real humans.

Avoiding revenue loss due to 'lesser of' contract clauses.

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Stodolak, Frederick; Gutierrez, Henry

2014-08-01

Finance managers seeking to avoid lost revenue attributable to lesser-of-charge-or-fixed-fee (lesser-of) clauses in their contracts should: Identify payer contracts that contain lesser-of clauses. Prepare lesser-of lost-revenue reports for non-bundled and bundled rates. For claims with covered charges below the bundled rate, identify service codes associated with the greatest proportion of total gross revenue and determine new, higher charge levels for those codes. Establish an approach for setting charges for non-bundled fee schedules to address lost-revenue-related issues. Incorporate changes into overall strategic or hospital zero-based pricing modeling and parameters.

Higher threat avoidance costs reduce avoidance behaviour which in turn promotes fear extinction in humans.

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Rattel, Julina A; Miedl, Stephan F; Blechert, Jens; Wilhelm, Frank H

2017-09-01

Theoretical models specifying the underlying mechanisms of the development and maintenance of anxiety and related disorders state that fear responses acquired through classical Pavlovian conditioning are maintained by repeated avoidance behaviour; thus, it is assumed that avoidance prevents fear extinction. The present study investigated behavioural avoidance decisions as a function of avoidance costs in a naturalistic fear conditioning paradigm. Ecologically valid avoidance costs - manipulated between participant groups - were represented via time-delays during a detour in a gamified computer task. After differential acquisitions of shock-expectancy to a predictive conditioned stimulus (CS+), participants underwent extinction where they could either take a risky shortcut, while anticipating shock signaled by the CS+, or choose a costly avoidance option (lengthy detour); thus, they were faced with an approach-avoidance conflict. Groups with higher avoidance costs (longer detours) showed lower proportions of avoiders. Avoiders gave heightened shock-expectancy ratings post-extinction, demonstrating 'protecting from extinction', i.e. failure to extinguish. Moreover, there was an indirect effect of avoidance costs on protection from extinction through avoidance behaviour. No moderating role of trait-anxiety was found. Theoretical implications of avoidance behaviour are discussed, considering the involvement of instrumental learning in the maintenance of fear responses. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Transient Dopamine Signal Represents Avoidance Value and Causally Influences the Demand to Avoid

Science.gov (United States)

Pultorak, Katherine J.; Schelp, Scott A.; Isaacs, Dominic P.; Krzystyniak, Gregory

2018-01-01

Abstract While an extensive literature supports the notion that mesocorticolimbic dopamine plays a role in negative reinforcement, recent evidence suggests that dopamine exclusively encodes the value of positive reinforcement. In the present study, we employed a behavioral economics approach to investigate whether dopamine plays a role in the valuation of negative reinforcement. Using rats as subjects, we first applied fast-scan cyclic voltammetry (FSCV) to determine that dopamine concentration decreases with the number of lever presses required to avoid electrical footshock (i.e., the economic price of avoidance). Analysis of the rate of decay of avoidance demand curves, which depict an inverse relationship between avoidance and increasing price, allows for inference of the worth an animal places on avoidance outcomes. Rapidly decaying demand curves indicate increased price sensitivity, or low worth placed on avoidance outcomes, while slow rates of decay indicate reduced price sensitivity, or greater worth placed on avoidance outcomes. We therefore used optogenetics to assess how inducing dopamine release causally modifies the demand to avoid electrical footshock in an economic setting. Increasing release at an avoidance predictive cue made animals more sensitive to price, consistent with a negative reward prediction error (i.e., the animal perceives they received a worse outcome than expected). Increasing release at avoidance made animals less sensitive to price, consistent with a positive reward prediction error (i.e., the animal perceives they received a better outcome than expected). These data demonstrate that transient dopamine release events represent the value of avoidance outcomes and can predictably modify the demand to avoid. PMID:29766047

Influence of hospitalization on potentially inappropriate prescribing ...

African Journals Online (AJOL)

risk of physical falls in elderly people being the most common for pre- and ... Improving the knowledge of hospital practitioners regarding geriatric pharmacotherapy ..... “Antiplatelet therapy with a documented history of coronary, cerebral or.

A Crowd Avoidance Method Using Circular Avoidance Path for Robust Person Following

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Kohei Morishita

2017-01-01

Full Text Available A life-support service robot must avoid both static and dynamic obstacles for working in a real environment. Here, a static obstacle means an obstacle that does not move, and a dynamic obstacle is the one that moves. Assuming the robot is following a target person, we discuss how the robot avoids a crowd through which the target person passes and arrives at the target position. The purpose of this paper is to propose a crowd avoidance method that makes a robot to be able to avoid both static and dynamic obstacles. The method uses the surface points of the obstacles to form an avoidance region, and the robot moves along the edge of the region. We conducted experiments assuming various situations such that the robot was blocked, there was a wide gap in the crowd, or a person in the crowd yielded for the robot to pass through. As an experimental result, it was confirmed the robot could avoid the crowd even when the obstacles were aligned in an “inverted wedge” shape.

[Flexibility and safety in hospitals].

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Fara, G M; Barni, M

2011-01-01

The paper explains the reasons according to which the newly-planned hospitals must adopt the concept of advanced flexibility (structural, technological, organizational, diagnostic and therapeutic), in order to avoid the risk of being already obsolete at the moment of their opening, and this due to the fact that too much time elapses in this Country between the moment of planning a new hospital and the moment of the start of its activity. Flexibility is needed at different levels: at low or medium levels for what concerns administrative spaces and also patient rooms (except, in this latter case, when differential intensity of care is adopted); at advanced levelfor what concerns diagnostic and therapeutic areas, which must be rapidly adaptable to new solutions offered by advances in technology and organization. From a different standpoint, flexibility applies also to the fact that hospital must increasingly become a node of a large net including territorial health services: the latter devoted to take care of chronicity, while hospitals should concentrate on acute pathology. Of course the territory surrounding the hospital, through its outpatient service and consultories, is in charge also for first level diagnosy and therapy, leaving the hospital to more sophisticated activities.

Liability for wrongful terminations: are hospitals at risk?

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Hames, D S

1991-01-01

This article examines the extent to which the three principal exceptions to the common-law doctrine of employment-at-will--namely the public policy, implied contract, and good faith and fair dealing exceptions--have been recognized in hospital termination cases. State supreme court and appellate court cases are analyzed to illustrate the type of conduct that precipitated wrongful termination claims against hospitals during the 1980s, how the courts disposed of these claims, and the rationale underlying their decisions. Suggestions, based on these and related cases, for avoiding or at least minimizing liability for wrongfully terminating hospital employees, are presented.

Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study.

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So, Cynthia; Pierluissi, Edgar

2012-04-01

To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults. Qualitative study using the framework theory. Public hospital general medical wards. Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103. Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes. For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise. Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

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

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Sahawneh, Laith Rasmi

The increasing demand to integrate unmanned aircraft systems (UAS) into the national airspace is motivated by the rapid growth of the UAS industry, especially small UAS weighing less than 55 pounds. Their use however has been limited by the Federal Aviation Administration regulations due to collision risk they pose, safety and regulatory concerns. Therefore, before civil aviation authorities can approve routine UAS flight operations, UAS must be equipped with sense-and-avoid technology comparable to the see-and-avoid requirements for manned aircraft. The sense-and-avoid problem includes several important aspects including regulatory and system-level requirements, design specifications and performance standards, intruder detecting and tracking, collision risk assessment, and finally path planning and collision avoidance. In this dissertation, our primary focus is on developing an collision detection, risk assessment and avoidance framework that is computationally affordable and suitable to run on-board small UAS. To begin with, we address the minimum sensing range for the sense-and-avoid (SAA) system. We present an approximate close form analytical solution to compute the minimum sensing range to safely avoid an imminent collision. The approach is then demonstrated using a radar sensor prototype that achieves the required minimum sensing range. In the area of collision risk assessment and collision prediction, we present two approaches to estimate the collision risk of an encounter scenario. The first is a deterministic approach similar to those been developed for Traffic Alert and Collision Avoidance (TCAS) in manned aviation. We extend the approach to account for uncertainties of state estimates by deriving an analytic expression to propagate the error variance using Taylor series approximation. To address unanticipated intruders maneuvers, we propose an innovative probabilistic approach to quantify likely intruder trajectories and estimate the probability of

Harm avoidance and depression, anxiety, insomnia, and migraine in fifth-year medical students in Taiwan

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Chen CY

2018-05-01

Full Text Available Ching-Yen Chen,1–3 Nan-Wen Yu,2–4 Tien-Hao Huang,4 Wei-Shin Wang,4 Ji-Tseng Fang2,3,5 1Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Medical Education Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 4Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taiwan; 5Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan Purpose: During medical school training, increased stress, depression, and anxiety are common. Certain personality traits, particularly harm avoidance (HA, may increase the risk of psychopathological disorders, insomnia, and migraine among medical students. This study evaluated the role HA may play on levels of stress, depression, anxiety, and insomnia among Taiwanese medical students starting their fifth and final year of medical school.Patients and methods: A series of self-report questionnaires were used to measure the severity of anxiety, depression, and insomnia, as well as somatic symptoms, particularly migraine headache, among 143 Taiwanese fifth-year medical students (94 males and 49 females. Most had normal or mild levels of anxiety, depression, insomnia, and migraine.Results: HA personality trait was significantly associated with depression (all P ≤ 0.001 after adjusting for other factors. HA was not significantly associated with anxiety, insomnia, or migraine headache days.Conclusion: HA personality trait was significantly associated with depression among fifth-year medical students in Taiwan. Keywords: anxiety, depression, harm avoidance, psychological stress, sleep initiation and maintenance disorders, migraine, students, medical

Returns to Scale in the Production of Hospital Services

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Berry, Ralph E.

1967-01-01

The primary purpose of this article is to investigate whether or not economies of scale exist in the production of hospital services. In previous studies the results have implied the existence of economies of scale, but the question has not been satisfactorily resolved. The factor most responsible for clouding the issue is the overwhelming prevalence of product differences in the outputs of hospitals. In this study a method which avoids the problem of product differentiation is developed. The analysis strongly supports the conclusion that hospital services are produced subject to economies of scale. PMID:6054380

Intranet usage and potential in acute care hospitals in the United States: survey-2000.

Science.gov (United States)

Hatcher, M

2001-12-01

This paper provides the results of the Survey-2000 measuring Intranet and its potential in health care. The survey measured the levels of Internet and Intranet existence and usage in acute care hospitals. Business-to-business electronic commerce and electronic commerce for customers were measured. Since the Intranet was not studied in survey-1997, no comparisons could be made. Therefore the results were presented and discussed. The Intranet data were compared with the Internet data and statistically significant differences were presented and analyzed. This information will assist hospitals to plan Internet and Intranet technology. This is the third of three articles based upon the results of the Survey-2000. Readers are referred to prior articles by the author, which discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2) The second article based upon the survey results discusses distribution of Internet usage and rating of Internet usage applied to specific applications. Homepages, advertising, and electronic commerce are discussed from an Internet perspective.

[Myths about organ donation on health personnel, potential recipients and relatives of potential donors in a peruvian hospital: a qualitative study].

Science.gov (United States)

Gómez-Rázuri, Katherine; Ballena-López, José; León-Jiménez, Franco

2016-03-01

To explore the myths regarding organ donation at a national hospital in Lambayeque, Peru during 2014. A qualitative-phenomenological study was performed using 24 unstructured in-depht interview of health personnel, potential recipients and relatives of potential donors. Sampling was intentional opinion-based, completed by theoretical saturation in each group. An interview guide was used, which was assessed by five experts, and data triangulation was performed. Twenty-three interviewees (95,8%) reported a favorable attitude towards organ donation. On their National Identification Document, thirteen (54,2%) had marked "no" for donation. The myths were: age or illness can preclude donation; that the recipient may experience the donor's behaviours and lives in it; brain death is undestood as the immobility of the body and a reversible state; religions do not accept organ donation because it affects physical integrity and resurrection; and that there are preferences on the organ donor waiting list and that organ trafficking taxes place. Myths explored in this study involved religious, socio-cultural, psychological and ethical misperceptions. The apparent lack of knowledge of the brain death diagnosis is the starting point of the donation process. Therefore, the presence of a hospital coordinator, the role of spiritual leaders and the correct information provided by media would be key parts to dispell these myths.

Avoiding humiliations in the clinical encounter.

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Malterud, Kirsti; Hollnagel, Hanne

2007-06-01

To explore potentials for avoiding humiliations in clinical encounters, especially those that are unintended and unrecognized by the doctor. Furthermore, to examine theoretical foundations of degrading behaviour and identify some concepts that can be used to understand such behaviour in the cultural context of medicine. Finally, these concepts are used to build a model for the clinician in order to prevent humiliation of the patient. Empirical studies document experiences of humiliation among patients when they see their doctor. Philosophical and sociological analysis can be used to explain the dynamics of unintended degrading behaviour between human beings. Skjervheim, Vetlesen, and Bauman have identified the role of objectivism, distantiation, and indifference in the dynamics of evil acts, pointing to the rules of the cultural system, rather than accusing the individual of bad behaviour. Examining the professional role of the doctor, parallel traits embedded in the medical culture are demonstrated. According to Vetlesen, emotional awareness is necessary for moral perception, which again is necessary for moral performance. A better balance between emotions and rationality is needed to avoid humiliations in the clinical encounter. The Awareness Model is presented as a strategy for clinical practice and education, emphasizing the role of the doctor's own emotions. Potentials and pitfalls are discussed.

Traffic jam driving with NMV avoidance

Science.gov (United States)

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

2012-08-01

In recent years, the development of advanced driver assistance systems (ADAS) - mainly based on lidar and cameras - has considerably improved the safety of driving in urban environments. These systems provide warning signals for the driver in the case that any unexpected traffic circumstance is detected. The next step is to develop systems capable not only of warning the driver but also of taking over control of the car to avoid a potential collision. In the present communication, a system capable of autonomously avoiding collisions in traffic jam situations is presented. First, a perception system was developed for urban situations—in which not only vehicles have to be considered, but also pedestrians and other non-motor-vehicles (NMV). It comprises a differential global positioning system (DGPS) and wireless communication for vehicle detection, and an ultrasound sensor for NMV detection. Then, the vehicle's actuators - brake and throttle pedals - were modified to permit autonomous control. Finally, a fuzzy logic controller was implemented capable of analyzing the information provided by the perception system and of sending control commands to the vehicle's actuators so as to avoid accidents. The feasibility of the integrated system was tested by mounting it in a commercial vehicle, with the results being encouraging.

Why radiologists lose their hospital contracts: is your contract secure?

Science.gov (United States)

Muroff, Lawrence R

2010-03-01

Previously, a hospital contract meant tenure for the incumbent group of radiologists; however, those days are long gone. Exclusive contracts have morphed into exclusive contracts with carve-outs. Turf erosion has become a fact of life for radiology practices. Now radiologists are losing their hospital contracts in record numbers. Group size, though helpful for a variety of reasons, does not ensure that a practice will be secure in its hospital setting. The reasons that groups lose their hospital contracts are varied, and in this paper, the author discusses the most common ones. Suggestions to help practices avoid this unfortunate fate are presented.

The role of social cognition in parasite and pathogen avoidance.

Science.gov (United States)

Kavaliers, Martin; Choleris, Elena

2018-07-19

The acquisition and use of social information are integral to social behaviour and parasite/pathogen avoidance. This involves social cognition which encompasses mechanisms for acquiring, processing, retaining and acting on social information. Social cognition entails the acquisition of social information about others (i.e. social recognition) and from others (i.e. social learning). Social cognition involves assessing other individuals and their infection status and the pathogen and parasite threat they pose and deciding about when and how to interact with them. Social cognition provides a framework for examining pathogen and parasite avoidance behaviours and their associated neurobiological mechanisms. Here, we briefly consider the relationships between social cognition and olfactory-mediated pathogen and parasite avoidance behaviours. We briefly discuss aspects of (i) social recognition of actual and potentially infected individuals and the impact of parasite/pathogen threat on mate and social partner choice; (ii) the roles of 'out-groups' (strangers, unfamiliar individuals) and 'in-groups' (familiar individuals) in the expression of parasite/pathogen avoidance behaviours; (iii) individual and social learning, i.e. the utilization of the pathogen recognition and avoidance responses of others; and (iv) the neurobiological mechanisms, in particular the roles of the nonapeptide, oxytocin and steroid hormones (oestrogens) associated with social cognition and parasite/pathogen avoidance.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'. © 2018 The Author(s).

Avoiding boredom: Caudate and insula activity reflects boredom-elicited purchase bias.

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Dal Mas, Dennis E; Wittmann, Bianca C

2017-07-01

People show a strong tendency to avoid boring situations, but the neural systems mediating this behavioural bias are yet unknown. We used functional magnetic resonance imaging (fMRI) to investigate how the anticipation of a boring task influences decisions to purchase entertainment. Participants accepted higher prices to avoid boredom compared to control tasks, and individual differences in boredom experience predicted the increase in price. This behavioural bias was associated with higher activity in the caudate nucleus during music purchases driven by boredom avoidance. Insula activation was increased during performance of the boring task and subsequently associated with individual differences in boredom-related decision making. These results identify a mechanism that drives decisions to avoid boring situations and potentially underlies consumer decisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Video‑assisted thoracic surgery in a Nigerian teaching hospital ...

African Journals Online (AJOL)

2015-05-20

May 20, 2015 ... minimally invasive surgery of the chest where a thoracotomy is avoided, access .... 6 patients (24%), spontaneous pneumothorax in. 5 patients (20%) ... involves less surgical trauma and results in a reduction in hospital stay.[1].

Stimulus conflict triggers behavioral avoidance.

Science.gov (United States)

Dignath, David; Eder, Andreas B

2015-12-01

According to a recent extension of the conflict-monitoring theory, conflict between two competing response tendencies is registered as an aversive event and triggers a motivation to avoid the source of conflict. In the present study, we tested this assumption. Over five experiments, we examined whether conflict is associated with an avoidance motivation and whether stimulus conflict or response conflict triggers an avoidance tendency. Participants first performed a color Stroop task. In a subsequent motivation test, participants responded to Stroop stimuli with approach- and avoidance-related lever movements. These results showed that Stroop-conflict stimuli increased the frequency of avoidance responses in a free-choice motivation test, and also increased the speed of avoidance relative to approach responses in a forced-choice test. High and low proportions of response conflict in the Stroop task had no effect on avoidance in the motivation test. Avoidance of conflict was, however, obtained even with new conflict stimuli that had not been presented before in a Stroop task, and when the Stroop task was replaced with an unrelated filler task. Taken together, these results suggest that stimulus conflict is sufficient to trigger avoidance.

Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems

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Glenn A. Melnick PhD

2016-06-01

Full Text Available A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113% than prices paid to all other California hospitals (70%. Prices were similar in both groups at the start of the period (approximately $9200 per admission. By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country.

Influence of hospitalization on potentially inappropriate prescribing ...

African Journals Online (AJOL)

Methods: This was a prospective observational study conducted in the multidisciplinary medical and surgical units ... Having a PIM at discharge was associated with the number of discharge medications and the history of .... assess the impact of hospitalization on PIPs in .... Central Nervous System and Psychotropic Drugs.

Key conclusions from AVOID Work Stream One

Science.gov (United States)

Warren, Rachel

2010-05-01

AVOID work stream (WS1)one has produced emission scenarios that simulate potential future global emission pathways for greenhouse gases during the 21st century. The study explored the influence of three key features of such pathways: (1) the year in which emissions peak globally, (2) the rate of emission reduction, and (3) the minimum level to which emissions are eventually reduced. It examined the resultant climate change, climate change impacts and economic implications using computer simulations. Avoided impacts, carbon taxes and GDP change increase throughout the 21st century in the models. AVOID-WS1 showed that in the absence of climate policy it is very likely that global mean temperatures would exceed 3 degrees and there are evens chances that the temperature would rise by 4 degrees relative to pre-industrial times. Scenarios that peak emissions in 2016 were more effective at constraining temperatures to below 3 degrees than those that peaked in 2030: one ‘2016' scenario achieved a probability of 45% of avoiding breaching of a 2 degree threshold. Scenarios peaking in 2030 were inconsistent with constraining temperatures to below 2 degrees. Correspondingly, scenarios that peak in 2030 are more effective at avoiding climate impacts than scenarios that peak in 2016, for all sectors that we studied. Hence the date at which emissions peak is more important than the rate of subsequent emissions reduction in determining the avoided impacts. Avoided impacts increase with time, being negligible in the 2030s, significant by the 2050s and large by the 2080s. Finally, the choice of GCM influences the magnitude of the avoided impacts strongly, so that the uncertainties in our estimates of avoided impacts for each scenario are larger than the difference between the scenarios. Our economic analysis is based on models which differ greatly in the assumptions that they make, but generally show that the date at which emissions peak is a stronger driver of induced GDP changes

An Examination of Avoided Costs in Utah

Energy Technology Data Exchange (ETDEWEB)

Bolinger, Mark; Wiser, Ryan

2005-01-07

The Utah Wind Working Group (UWWG) believes there are currently opportunities to encourage wind power development in the state by seeking changes to the avoided cost tariff paid to qualifying facilities (QFs). These opportunities have arisen as a result of a recent renegotiation of Pacificorp's Schedule 37 tariff for wind QFs under 3 MW, as well as an ongoing examination of Pacificorp's Schedule 38 tariff for wind QFs larger than 3 MW. It is expected that decisions made regarding Schedule 38 will also impact Schedule 37. Through the Laboratory Technical Assistance Program (Lab TAP), the UWWG has requested (through the Utah Energy Office) that LBNL provide technical assistance in determining whether an alternative method of calculating avoided costs that has been officially adopted in Idaho would lead to higher QF payments in Utah, and to discuss the pros and cons of this method relative to the methodology recently adopted under Schedule 37 in Utah. To accomplish this scope of work, I begin by summarizing the current method of calculating avoided costs in Utah (per Schedule 37) and Idaho (the ''surrogate avoided resource'' or SAR method). I then compare the two methods both qualitatively and quantitatively. Next I present Pacificorp's four main objections to the use of the SAR method, and discuss the reasonableness of each objection. Finally, I conclude with a few other potential considerations that might add value to wind QFs in Utah.

Negative emotions and emotional eating: the mediating role of experiential avoidance.

Science.gov (United States)

Litwin, Rachel; Goldbacher, Edie M; Cardaciotto, LeeAnn; Gambrel, Laura Eubanks

2017-03-01

Emotional eating is a risk factor for eating pathology across the life- and weight-span. Research demonstrates that negative emotions are a precipitant of emotional eating, particularly among female college students. However, the underlying factors that explain this relationship are unclear. Experiential avoidance, a propensity toward being unwilling to remain in contact with aversive private experiences, may explain the association between negative emotions and emotional eating. The purpose of this study was to examine whether experiential avoidance would mediate the association between negative emotions and emotional eating. A sample of 132 women (17.4 % African American, 59.8 % White) completed measures of mood, experiential avoidance and emotional eating. Bias-corrected bootstrapping mediational analyses were conducted. Experiential avoidance mediated the relationship between negative emotions and emotional eating b = -0.21, 95 % BC CI [-0.43, -0.07]. The indirect effect through experiential avoidance accounted for 9 % of the variance, which represents a medium effect (k 2  = 0.09, 95 % BC CI [0.03, 0.18]). Results suggest that experiential avoidance is important for understanding the relationship between negative emotions and emotional eating and may inform potential strategies for prevention and treatment.

Workplace Violence and Abuse Against Nurses in Hospitals in Iran

Directory of Open Access Journals (Sweden)

Mahnaz Shoghi, MSN

2008-09-01

Conclusion: The findings showed a noticeable trend of a rising number of assaults against nurses. The findings of this study may help hospital staff and nurses to avoid, reduce and control violence and abuse.

Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population.

Science.gov (United States)

Brameld, Kate; Spilsbury, Katrina; Rosenwax, Lorna; Murray, Kevin; Semmens, James

2017-06-01

Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. Retrospective cohort study. The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.

Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality.

Science.gov (United States)

Friedman, Bernard; Berdahl, Terceira; Simpson, Lisa A; McCormick, Marie C; Owens, Pamela L; Andrews, Roxanne; Romano, Patrick S

2011-01-01

The aim of this study was to describe selected trends in hospital inpatient care for children between 2000 and 2007. Analysis was conducted of administrative data from annual nationwide databases of hospital discharges from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project, along with survey data from a nationally representative random sample of children from the Medical Expenditure Panel Survey. Hospital utilization rates and expenses, risk-adjusted rates of potentially avoidable hospitalization, and safety indicators in the hospital are calculated and tracked with established and downloadable software. The rate of hospital discharges for children aged 15 to 17 years declined significantly, mainly due to fewer maternity-related discharges. The leading principal conditions by age group were similar to the report for 1995 to 2000; however, the rate of admissions for skin infections doubled to 9 per 10,000. Hospital cost per discharge increased by an annual average of 4.5% per year compared with 2.6% annual growth in the gross domestic product deflator. Medicaid is increasingly important relative to private insurance as a payer for hospital care for children. The rate of potentially preventable hospitalizations for both acute and chronic conditions declined substantially (18%, adjusted for age and gender). Several measures of patient safety improved--the rates of postoperative sepsis, iatrogenic pneumothorax, and selected infections due to medical care declined by 14.2%, 17.8%, and 23.5%, respectively. However, the rate of accidental punctures and lacerations and the rate of decubitus ulcer increased by 25.6% and 34.5%, respectively. The trends in safety indicators varied somewhat by age group, income quartile of zip codes, insurance, region, and type of location without a consistent pattern. Although teenage pregnancy rates were declining, there was a worsening trend in skin infections. The latter may eventually be impacted by

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

Science.gov (United States)

Reb, Jochen; Connolly, Terry

2009-01-01

Decision makers can become trapped by "myopic regret avoidance" in which rejecting feedback to avoid short-term "outcome regret" (regret associated with counterfactual outcome comparisons) leads to reduced learning and greater long-term regret over continuing poor decisions. In a series of laboratory experiments involving repeated choices among…

Method for Collision Avoidance Motion Coordination of Multiple Mobile Robots Using Central Observation

Energy Technology Data Exchange (ETDEWEB)

Ko, N.Y.; Seo, D.J. [Chosun University, Kwangju (Korea)

2003-04-01

This paper presents a new method driving multiple robots to their goal position without collision. Each robot adjusts its motion based on the information on the goal locations, velocity, and position of the robot and the velocity and position of the other robots. To consider the movement of the robots in a work area, we adopt the concept of avoidability measure. The avoidability measure figures the degree of how easily a robot can avoid other robots considering the following factors: the distance from the robot to the other robots, velocity of the robot and the other robots. To implement the concept in moving robot avoidance, relative distance between the robots is derived. Our method combines the relative distance with an artificial potential field method. The proposed method is simulated for several cases. The results show that the proposed method steers robots to open space anticipating the approach of other robots. In contrast, the usual potential field method sometimes fails preventing collision or causes hasty motion, because it initiates avoidance motion later than the proposed method. The proposed method can be used to move robots in a robot soccer team to their appropriate position without collision as fast as possible. (author). 21 refs., 10 figs., 13 tabs.

Identifying compensatory driving behavior among older adults using the situational avoidance questionnaire.

Science.gov (United States)

Davis, Jessica J; Conlon, Elizabeth G

2017-12-01

Driving self-regulation is considered a means through which older drivers can compensate for perceived declines in driving skill or more general feelings of discomfort on the road. One form of driving self-regulation is situational avoidance, the purposeful avoidance of situations perceived as challenging or potentially hazardous. This study aimed to validate the Situational Avoidance Questionnaire (SAQ, Davis, Conlon, Ownsworth, & Morrissey, 2016) and identify the point on the scale at which drivers practicing compensatory avoidance behavior could be distinguished from those whose driving is unrestricted, or who are avoiding situations for other, non-compensatory reasons (e.g., time or convenience). Seventy-nine Australian drivers (M age =71.48, SD=7.16, range: 55 to 86years) completed the SAQ and were classified as a compensatory-restricted or a non-restricted driver based on a semi-structured interview designed to assess the motivations underlying avoidance behavior reported on the SAQ. Using receiver-operator characteristic (ROC) analysis, the SAQ was found to have high diagnostic accuracy (sensitivity: 85%, specificity: 82%) in correctly classifying the driver groups. Group comparisons confirmed that compensatory-restricted drivers were self-regulating their driving behavior to reduce the perceived demands of the driving task. This group had, on average, slower hazard perception reaction times, and reported greater difficulty with driving, more discomfort when driving due to difficulty with hazard perception skills, and greater changes in cognition over the past five years. The SAQ is a psychometrically sound measure of situational avoidance for drivers in baby boomer and older adult generations. Use of validated measures of driving self-regulation that distinguish between compensatory and non-compensatory behavior, such as the SAQ, will advance our understanding of the driving self-regulation construct and its potential safety benefits for older road users

Burnout and stress amongst interns in Irish hospitals: contributing factors and potential solutions.

Science.gov (United States)

Hannan, E; Breslin, N; Doherty, E; McGreal, M; Moneley, D; Offiah, G

2018-05-01

The transition from medical school to internship can be daunting for newly qualified doctors. High rates of stress and burnout have been reported, with negative impacts on patient care and physician wellbeing. We surveyed interns in our hospital group to evaluate rates of stress and burnout, as well as identify the causative factors and propose potential solutions to these. A hundred and one interns working in four different hospitals over a 2-year period were invited to participate in an anonymous survey. The survey collected basic demographic details and surveyed aspects of mental health using the burnout scale, Maslach Burnout Inventory (MBI) and the stress scale and 12-item General Health Questionnaire (GHQ-12). Interns were also asked to rate a variety of workplace factors on a Likert scale based on the degree of stress caused. Finally, they were surveyed on their awareness of support services available to them. Our results showed that 37% of interns met the criteria for psychological distress, high levels of emotional exhaustion, high depersonalisation and a low sense of personal accomplishment were reported in 55.4, 51.5 and 41.6%, respectively. Inadequate preparation for practice, financial worries, poor role definition and sleep deprivation were reported as significant stressors. Most were unaware of available support services and expressed interest in leaving Ireland after internship. Burnout and stress are significant problems amongst doctors in Irish hospitals. Ensuring better preparation for clinical practice and awareness of support services is vital to tackle this issue.

Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth

Directory of Open Access Journals (Sweden)

Norris ML

2016-01-01

Full Text Available Mark L Norris,1 Wendy J Spettigue,2 Debra K Katzman3 1Division of Adolescent Medicine, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 2Department of Psychiatry, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada; 3Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada Abstract: Avoidant/restrictive food intake disorder (ARFID is a new eating disorder diagnosis that was introduced in the Diagnostic and Statistical Manual of Mental Disorders (DSM fifth edition. The fourth edition of the DSM had failed to adequately capture a cohort of children, adolescents, and adults who are unable to meet appropriate nutritional and/or energy needs, for reasons other than drive for thinness, leading to significant medical and/or psychological sequelae. With the introduction of ARFID, researchers are now starting to better understand the presentation, clinical characteristics, and complexities of this disorder. This article outlines the diagnostic criteria for ARFID with specific focus on children and youth. A case example of a patient with ARFID, factors that differentiate ARFID from picky eating, and the estimated prevalence in pediatric populations are discussed, as well as clinical and treatment challenges that impact health care providers providing treatment for patients. Keywords: avoidant/restrictive food intake disorder, ARFID, eating disorder, picky eating, prevalence, treatment

Pediatric Fear-Avoidance Model of Chronic Pain: Foundation, Application and Future Directions

Directory of Open Access Journals (Sweden)

Gordon JG Asmundson

2012-01-01

Full Text Available The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child/adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child/adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.

Real-Time Autonomous Obstacle Avoidance for Low-Altitude Fixed-Wing Aircraft

Science.gov (United States)

Owlia, Shahboddin

The GeoSurv II is an Unmanned Aerial Vehicle (UAV) being developed by Carleton University and Sander Geophysics. This thesis is in support of the GeoSurv II project. The objective of the GeoSurv II project is to create a fully autonomous UAV capable of performing geophysical surveys. In order to achieve this level of autonomy, the UAV, which due to the nature of its surveys flies at low altitude, must be able to avoid potential obstacles such as trees, powerlines, telecommunication towers, etc. Developing a method to avoid these obstacles is the objective of this thesis. The literature is rich in methods for trajectory planning and mid-air collision avoidance with other aircraft. In contrast, in this thesis, a method for avoiding static obstacles that are not known a priori is developed. The potential flow theory and panel method are borrowed from fluid mechanics and are employed to generate evasive maneuvers when obstacles are encountered. By means of appropriate modelling of obstacles, the aircraft's constraints are taken into account such that the evasive maneuvers are feasible for the UAV. Moreover, the method is developed with consideration of the limitations of obstacle detection in GeoSurv II. Due to the unavailability of the GeoSurv II aircraft, and the lack of a complete model for GeoSurv II, the method developed is implemented on the non-linear model of the Aerosonde UAV. The Aerosonde model is then subjected to various obstacle scenarios and it is seen that the UAV successfully avoids the obstacles.

Potential Role of Staphylococcus cohnii in a Hospital Environment

OpenAIRE

Szewczyk, Eligia M.; Nowak, Tomasz; Cieślikowski, Tomasz; Róźalska, Magorzata

2011-01-01

We have analysed the isolates of Staphylococcus cohnii found in the intensive care unit of a pediatric teaching hospital: in the environment, 159 isolates; on the skin of hospitalized premature infants, 26; and on the skin of ward personnel, 49. Sixteen phenotypic features were used to characterize the isolates at metabolic, biologic and antibiotic resistance level. All selected attributes were treated as equivalent, and numerical analysis of all isolates was performed on this basis. Each iso...

Behavioral and neural correlates of loss aversion and risk avoidance in adolescents and adults.

Science.gov (United States)

Barkley-Levenson, Emily E; Van Leijenhorst, Linda; Galván, Adriana

2013-01-01

Individuals are frequently faced with risky decisions involving the potential for both gain and loss. Exploring the role of both potential gains and potential losses in predicting risk taking is critical to understanding how adolescents and adults make the choice to engage in or avoid a real-life risk. This study aimed to examine the impact of potential losses as well as gains on adolescent decisions during risky choice in a laboratory task. Adolescent (n=18) and adult (n=16) participants underwent functional magnetic resonance imaging (fMRI) during a mixed gambles task, and completed questionnaires measuring real-world risk-taking behaviors. While potential loss had a significantly greater effect on choice than potential gain in both adolescents and adults and there were no behavioral group differences on the task, adolescents recruited significantly more frontostriatal circuitry than adults when choosing to reject a gamble. During risk-seeking behavior, adolescent activation in medial prefrontal cortex (mPFC) was negatively correlated with self-reported likelihood of risk taking. During risk-avoidant behavior, mPFC activation of in adults was negatively correlated with self-reported benefits of risk-taking. Taken together, these findings reflect different neural patterns during risk-taking and risk-avoidant behaviors in adolescents and adults. Copyright © 2012 Elsevier Ltd. All rights reserved.

Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse.

Science.gov (United States)

Schwab, C; Korb-Savoldelli, V; Escudie, J B; Fernandez, C; Durieux, P; Saint-Jean, O; Sabatier, B

2018-06-01

Hospital readmission within 30 days of patient discharge has become a standard to judge the quality of hospitalizations. It is estimated that 14% of the elderly, people over 75 years old or those over 65 with comorbidities, are at risk of readmission, of which 23% are avoidable. It may be possible to identify elderly patients at risk of readmission and implement steps to reduce avoidable readmissions. The aim of this study was to identify iatrogenic risk factors for readmission. The secondary objective was to evaluate the rate of drug-related readmissions (DRRs) among all readmissions and compare it to the rate of readmissions for other reasons. We conducted a retrospective, matched, case-control study to identify non-demographic risk factors for avoidable readmission, specifically DRRs. The study included patients hospitalized between 1 September 2014 and 31 October 2015 in an 800-bed university hospital. We included patients aged 75 and over. Cases consisted of patients readmitted to the emergency department within 30 days of initial discharge. Controls did not return to the emergency department within 30 days. Cases and controls were matched on sex and age because they are known as readmissions risk factors. After comparison of the mean or percentage between cases and controls for each variable, we conducted a conditional logistic regression. The risk factors identified were an emergency admission at the index hospitalization, returning home after discharge, a history of unplanned readmissions and prescription of nervous system drugs. Otherwise, 11.4% of the readmissions were DRRs, of which 30% were caused by an overdose of antihypertensive. The number of drugs at readmission was higher, and potentially inappropriate medications were more widely prescribed for DRRs than for readmissions for other reasons. In this matched case-control retrospective study, after controlling for gender and age, we identified the typical profile of elderly patients at risk of

Factors Associated with Potential Food-Drug Interaction in Hospitalized Patients: A Cross-Sectional Study in Northeast Iran

Directory of Open Access Journals (Sweden)

Mostafa Abdollahi

2018-04-01

Full Text Available Background: The minimization of adverse food-drug interactions will improve patient care by optimizing the therapeutic effects and maintaining proper nutritional status. Aim: The aim of the present study was to find the main factors that may place the hospitalized patients at risk of potential food-drug interactions. Method: This cross-sectional, descriptive study was conducted on 400 inpatients admitted to the Department of Internal Medicine of a teaching hospital in Mashhad, Northeast Iran, within 20 March 2013 to 20 April 2013. The potential food-drug interactions were evaluated for 19 commonly prescribed medications. The main factors (e.g., age, gender, education level, number of medications, and duration of the disease that may place the patients at risk of potential food-drug interactions were analyzed for each patient. Results: Out of the 19 commonly prescribed medications, 17 drugs (89% were not properly used with respect to meal. Furthermore, 14 commonly prescribed drugs were found to have a high frequency (≥50% of potential food-drug interactions. Most of the patients (n=359, 89.8% consumed their medicines at inappropriate time with respect to meals. The results of a multiple logistic regression after adjustment for confounders revealed that the age [β=0.005, CI: 0.0-0.01; P=033], number of medications [β=0.1, CI: 0.083-0.117; P

Review of successful hospital readmission reduction strategies and the role of health information exchange.

Science.gov (United States)

Kash, Bita A; Baek, Juha; Davis, Elise; Champagne-Langabeer, Tiffany; Langabeer, James R

2017-08-01

The United States has invested substantially in technologies that enable health information exchange (HIE), which in turn can be deployed to reduce avoidable hospital readmission rates in many communities. With avoidable hospital readmissions as the primary focus, this study profiles successful hospital readmission rate reduction initiatives that integrate HIE as a strategy. We hypothesized that the use of HIE is associated with decreased hospital readmissions beyond other observed population health benefits. Results of this systematic review are used to describe and profile successful readmission reduction programs that integrate HIE as a tool. A systematic review of literature provided an understanding of the use of HIE as a strategy to reduce hospital readmission rates. We conducted a review of 4,862 citations written in English about readmission reduction strategies from January 2006 to September 2016 in the MEDLINE-PubMed database. Of these, 106 studies reported 30-day readmission rates as an outcome and only 13 articles reported using HIE. Only a very small number (12%) of hospitals incorporated HIE as a primary tool for evidence-based readmission reduction initiatives. Information exchange between providers has been suggested to play a key role in reducing avoidable readmission rates, yet there is not currently evidence supporting current HIE-enabled readmission initiatives. Most successful readmission reduction programs demonstrate collaboration with primary care providers to augment transitions of care to existing care management functions without additional staff while using effective information exchange capabilities. This research confirms there is very little integration of HIE into health systems readmissions initiatives. There is a great opportunity to achieve population health targets using the HIE infrastructure. Hospitals should consider partnering with primary care clinics to implement multifaceted transitions of care programs to significantly

Flocking Control of Multiple Mobile Agents with the Rules of Avoiding Collision

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Hongtao Zhou

2015-01-01

Full Text Available This paper investigates the flocking and the coordinative control problems of multiple mobile agents with the rules of avoiding collision. We propose a set of control laws using hysteresis in adding new links and applying new potential function to guarantee that the fragmentation of the network can be avoided, under which all agents approach a common velocity vector, and asymptotically converge to a fixed value of interagent distances and collisions between agents can be avoided throughout the motion. Furthermore, we extend the flocking algorithm to solve the flocking situation of the group with a virtual leader agent. The laws can make all agents asymptotically approach the virtual leader and collisions can be avoided between agents in the motion evolution. Finally, some numerical simulations are showed to illustrate the theoretical results.

Cigarette tax avoidance and evasion.

Science.gov (United States)

Stehr, Mark

2005-03-01

Variation in state cigarette taxes provides incentives for tax avoidance through smuggling, legal border crossing to low tax jurisdictions, or Internet purchasing. When taxes rise, tax paid sales of cigarettes will decline both because consumption will decrease and because tax avoidance will increase. The key innovation of this paper is to compare cigarette sales data to cigarette consumption data from the Behavioral Risk Factor Surveillance System (BRFSS). I show that after subtracting percent changes in consumption, residual percent changes in sales are associated with state cigarette tax changes implying the existence of tax avoidance. I estimate that the tax avoidance response to tax changes is at least twice the consumption response and that tax avoidance accounted for up to 9.6% of sales between 1985 and 2001. Because of the increase in tax avoidance, tax paid sales data understate the level of smoking and overstate the drop in smoking. I also find that the level of legal border crossing was very low relative to other forms of tax avoidance. If states have strong preferences for smoking control, they must pair high cigarette taxes with effective policies to curb smuggling and other forms of tax avoidance or employ alternative policies such as counter-advertising and smoking restrictions.

Cost and benefit estimates of partially-automated vehicle collision avoidance technologies.

Science.gov (United States)

Harper, Corey D; Hendrickson, Chris T; Samaras, Constantine

2016-10-01

Many light-duty vehicle crashes occur due to human error and distracted driving. Partially-automated crash avoidance features offer the potential to reduce the frequency and severity of vehicle crashes that occur due to distracted driving and/or human error by assisting in maintaining control of the vehicle or issuing alerts if a potentially dangerous situation is detected. This paper evaluates the benefits and costs of fleet-wide deployment of blind spot monitoring, lane departure warning, and forward collision warning crash avoidance systems within the US light-duty vehicle fleet. The three crash avoidance technologies could collectively prevent or reduce the severity of as many as 1.3 million U.S. crashes a year including 133,000 injury crashes and 10,100 fatal crashes. For this paper we made two estimates of potential benefits in the United States: (1) the upper bound fleet-wide technology diffusion benefits by assuming all relevant crashes are avoided and (2) the lower bound fleet-wide benefits of the three technologies based on observed insurance data. The latter represents a lower bound as technology is improved over time and cost reduced with scale economies and technology improvement. All three technologies could collectively provide a lower bound annual benefit of about $18 billion if equipped on all light-duty vehicles. With 2015 pricing of safety options, the total annual costs to equip all light-duty vehicles with the three technologies would be about $13 billion, resulting in an annual net benefit of about $4 billion or a $20 per vehicle net benefit. By assuming all relevant crashes are avoided, the total upper bound annual net benefit from all three technologies combined is about $202 billion or an $861 per vehicle net benefit, at current technology costs. The technologies we are exploring in this paper represent an early form of vehicle automation and a positive net benefit suggests the fleet-wide adoption of these technologies would be beneficial

Outpatient waiting time in Jos University Teaching Hospital ...

African Journals Online (AJOL)

Problem Long waiting time for services has been identified as a reason people avoid presenting to for care in African countries. Design Examination of causes for long outpatient waiting time and the effect of measures to reduce waiting time. Setting Outpatient department of the Jos University Teaching Hospital.

Applicability of refractometry for fast routine checking of hospital preparations.

Science.gov (United States)

Hendrickx, Stijn; Verón, Aurora Monteagudo; Van Schepdael, Ann; Adams, Erwin

2016-04-30

Quality control of hospital pharmacy formulations is of the utmost importance to ensure constant quality and to avoid potential mistakes before administration to the patient. In this study we investigated the applicability of refractometry as a fast, inexpensive and easy-to-use quality control measurement. Refractive indices (RI) of a multitude of different hospital formulations with varying concentrations of active compound were measured. The samples consisted of a number of binary aqueous solutions (one compound in water), complex aqueous solutions (multiple compounds in water or in a constant matrix), two suspensions and one emulsion. For all these formulations, linear regression analysis was performed, quality control limits determined and accuracy and repeatability were checked. Subsequently, actual hospital pharmacy samples were analyzed to check whether they were within the specified limits. For both binary and complex aqueous formulations, repeatability was good and a linear correlation for all samples could be observed on condition that the concentration of the active compound was sufficiently high. The refractometer was not sensitive enough for solutions of folic acid and levothyroxine, which had too low a concentration of active compound. Due to lack of homogeneity and light scattering, emulsions and suspensions do not seem suitable for quality control by refractometry. A mathematical equation was generated to predict the refractive index of an aqueous solution containing clonidine HCl as active compound. Values calculated from the equation were compared with measured values and deviations of all samples were found to be lower than 1.3%. In order to use refractometry in a hospital pharmacy for quality control of multicomponent samples, additional intermediate measurements would be required, to overcome the fact that refractometry is not compound specific. In conclusion, we found that refractometry could potentially be useful for daily, fast quality

Spatial Analysis of Potentially Preventable Pneumonia and Asthma Hospitalizations for Children in the Texas Coastal Bend Area

Science.gov (United States)

Lin, Na

Pneumonia and asthma, two common Ambulatory Care Sensitive Conditions (ACSCs), were two top reasons for the admission of children to the hospitals and emergency rooms in the United States in 2011. Pneumonia and asthma are potentially preventable if the child's environment is properly managed. Underlying vulnerabilities such as low socioeconomic status (SES) and proximity to air pollution play an important role in ACSCs hospitalization. Pneumonia and asthma are two common reasons for hospitalizations among children and missed school days in Texas Coastal Bend Area. This thesis examines the relationships between neighborhood socioeconomic characteristics, meteorological conditions and children ACSCs hospitalization, including pneumonia and asthma among children age 0-17 in this area. Hospital discharge data from 2007 to 2009 based on Zip Code Tabulation Area (ZCTA) were examined along with American Community Survey (ACS) data, air pollution data from Environmental Protection Agency (EPA) and temperature data from National Climatic Data Center (NCDC). Hotspot and Local Moran's I analyses were applied to identify the concentrations of the illnesses. Two regressions (OLS and GWR) were applied to identify factors that contribute the most to ACSCs hospitalization. Pearson's correlation was calculated to examine the relationship between meteorological condition and child hospitalization for asthma and pneumonia. A human subject survey was conducted to examine the relationships between neighborhood environment and children asthma cases. The main finding was that children from families with health insurance, children from single father families and children from poor families were more likely to visit hospital for ACSCs and pneumonia care. "Hispanic families" and especially "Hispanic families with father but no mother" also contributed most to child hospitalization for ACSCs and pneumonia, suggesting that family preventative health care education is needed for Hispanic

Potential drug interactions in intensive care patients at a teaching hospital Interacciones medicamentosas potenciales en pacientes de una unidad de terapia intensiva de un hospital universitario Interações medicamentosas potenciais em pacientes de unidade de terapia intensiva de um hospital universitário

Directory of Open Access Journals (Sweden)

Rhanna Emanuela Fontenele Lima

2009-04-01

Full Text Available This study assessed potential drugs interactions in intensive care patients at a university hospital in Ceará, northeast Brazil. Of 102 patients studied, 72.5% were exposed to 311 potential drug-drug interactions; 64% of them were females aged 60 years or more and hospital stay was at least 9 days. A statistically significant association was found between number of drugs used and the occurrence of drug interactions. A total of 1,140 drugs were scheduled to be administered concomitantly; of these, 74% had potential for drug interactions. As for the classification of these events, 48.2% had a pharmacokinetic profile; 55.4% were of slow onset; 54.7% had moderate severity; and 60.6% were well-documented in the literature. The most common clinical action taken was "to monitor signs and symptoms". Nursing staff can perform 80% of preventive actions to avoid undesirable effects of drug interactions. However, nurses need to have adequate knowledge about drug action mechanisms and triggering factors associated to drug interactions.Este estudio investigó interacciones medicamentosas (IM potenciales en una Unidad de Terapia Intensiva (UTI en un hospital universitario del Ceará. De los 102 pacientes del estudio, 72,5% presentaron 311 potenciales IMs. De estos, 64% eran del sexo femenino, con edad mayor o igual a 60 años y tiempo de internación mayor o igual a nueve días. Hubo una asociación estadísticamente significativa entre el número de medicamentos y la ocurrencia de IM; 1.140 medicamentos fueron administrados durante el mismo horario, entre estos, 74% presentaron potencial para IM. En lo que se refiere a la clasificación de las IMs, 48,2% presentaron un perfil fármaco cinético, 55,4% inicio demorado, 54,7% moderada gravedad y 60,6% bien documentadas en la literatura. El manejo clínico más frecuente fue "observar señales y síntomas". Ochenta por ciento de las intervenciones para evitar los efectos indeseables de las IMs pueden ser

Assessing knowledge, performance, and efficiency for hospital waste management-a comparison of government and private hospitals in Pakistan.

Science.gov (United States)

Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma

2017-04-01

Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.

Approach/avoidance in dreams.

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

2012-03-01

The influential threat simulation theory (TST) asserts that dreaming yields adaptive advantage by providing a virtual environment in which threat-avoidance may be safely rehearsed. We have previously found the incidence of biologically threatening dreams to be around 20%, with successful threat avoidance occurring in approximately one-fifth of such dreams. TST asserts that threat avoidance is over-represented relative to other possible dream contents. To begin assessing this issue, we contrasted the incidence of 'avoidance' dreams with that of their opposite: 'approach' dreams. Because TST states that the threat-avoidance function is only fully activated in ecologically valid (biologically threatening) contexts, we also performed this contrast for populations living in both high- and low-threat environments. We find that 'approach' dreams are significantly more prevalent across both contexts. We suggest these results are more consistent with the view that dreaming is generated by reward-seeking systems than by fear-conditioning systems, although reward-seeking is clearly not the only factor determining the content of dreams. Copyright © 2011 Elsevier Inc. All rights reserved.

Brain death organ donation potential and life support therapy limitation in neurocritical patients.

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Bodí, M A; Pont, T; Sandiumenge, A; Oliver, E; Gener, J; Badía, M; Mestre, J; Muñoz, E; Esquirol, X; Llauradó, M; Twose, J; Quintana, S

2015-01-01

To analyze the profile, incidence of life support therapy limitation (LSTL) and donation potential in neurocritical patients. A multicenter prospective study was carried out. Nine hospitals authorized for organ harvesting for transplantation. All patients consecutively admitted to the hospital with GCS < 8 during a 6-month period were followed-up until discharge or day 30 of hospital stay. Demographic data, cause of coma, clinical status upon admission and outcome were analyzed. LSTL, brain death (BD) and organ donation incidence were recorded. A total of 549 patients were included, with a mean age of 59.0 ± 14.5 years. The cause of coma was cerebral hemorrhage in 27.0% of the cases.LSTL was applied in 176 patients (32.1%). In 78 cases LSTL consisted of avoiding ICU admission. Age, the presence of contraindications, and specific causes of coma were associated to LSTL. A total of 58.1% of the patients died (n=319). One-hundred and thirty-three developed BD (24.2%), and 56.4% of these became organ donors (n=75). The presence of edema and mid-line shift on the CT scan, and transplant coordinator evaluation were associated to BD. LSTL was associated to a no-BD outcome. Early LSTL (first 4 days) was applied in 9 patients under 80 years of age, with no medical contraindications for donation and a GCS ≤ 4 who finally died in asystole. LSTL is a frequent practice in neurocritical patients. In almost one-half of the cases, LSTL consisted of avoiding admission to the ICU, and on several occasions the donation potential was not evaluated by the transplant coordinator. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Healthcare avoidance: a critical review.

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Byrne, Sharon K

2008-01-01

The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

Small UAV Automatic Ground Collision Avoidance System Design Considerations and Flight Test Results

Science.gov (United States)

Sorokowski, Paul; Skoog, Mark; Burrows, Scott; Thomas, SaraKatie

2015-01-01

The National Aeronautics and Space Administration (NASA) Armstrong Flight Research Center Small Unmanned Aerial Vehicle (SUAV) Automatic Ground Collision Avoidance System (Auto GCAS) project demonstrated several important collision avoidance technologies. First, the SUAV Auto GCAS design included capabilities to take advantage of terrain avoidance maneuvers flying turns to either side as well as straight over terrain. Second, the design also included innovative digital elevation model (DEM) scanning methods. The combination of multi-trajectory options and new scanning methods demonstrated the ability to reduce the nuisance potential of the SUAV while maintaining robust terrain avoidance. Third, the Auto GCAS algorithms were hosted on the processor inside a smartphone, providing a lightweight hardware configuration for use in either the ground control station or on board the test aircraft. Finally, compression of DEM data for the entire Earth and successful hosting of that data on the smartphone was demonstrated. The SUAV Auto GCAS project demonstrated that together these methods and technologies have the potential to dramatically reduce the number of controlled flight into terrain mishaps across a wide range of aviation platforms with similar capabilities including UAVs, general aviation aircraft, helicopters, and model aircraft.

Predictable and avoidable: What’s next?

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Ivo Pezzuto

2014-09-01

Full Text Available The author of this paper (Dr. Ivo Pezzuto has been one of the first authors to write back in 2008 about the alleged "subprime mortgage loans fraud" which has triggered the 2008 financial crisis, in combination with multiple other complex, highly interrelated, and concurrent factors. The author has been also one of the first authors to report in that same working paper of 2008 (available on SSRN and titled "Miraculous Financial Engineering or Toxic Finance? The Genesis of the U.S. Subprime Mortgage Loans Crisis and its Consequences on the Global Financial Markets and Real Economy" the high probability of a Eurozone debt crisis, due to a number of unsolved structural macroeconomic problems, the lack of a single crisis resolution scheme, current account imbalances, and in some countries, housing bubbles/high private debt. In the book published in 2013 and titled "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", Dr. Ivo Pezzuto has exposed the root causes of the financial crisis in order to enables readers to understand that the crisis we have seen was predictable and should have been avoidable, and that a recurrence can be avoided, if lessons are learned and the right action taken. Almost one year after the publication of the book "Predictable and Avoidable: Repairing Economic Dislocation and Preventing the Recurrence of Crisis", the author has decided to write this working paper to explore what happened in the meantime to the financial markets and to the financial regulation implementation. Most of all, the author with this working paper aims to provide an updated analysis as strategist and scenario analyst on the topics addressed in the book "Predictable and Avoidable" based on a forward-looking perspective and on potential "tail risk" scenarios. The topics reported in this paper relate to financial crises; Government policy; financial regulation; corporate governance; credit risk management

Identifying patient fear-avoidance beliefs by physical therapists managing patients with low back pain.

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Calley, Darren Q; Jackson, Steven; Collins, Heather; George, Steven Z

2010-12-01

. Therapists' ratings of perceived patient fear-avoidance were not associated with self-reported fear-avoidance scores, showing a potential disconnect between therapist judgments and commonly used fear-avoidance measures. Instead, therapist ratings had small but statistically significant correlations with pain catastrophizing and disability, findings that may support therapists' inability to discriminate fear-avoidance from these other factors. The 2-item screening questions based on fear of physical activity and harm showed potential to identify elevated FABQ physical activity scores. Differential diagnosis, level 2b.

Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

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Binit N Jhaveri

2014-01-01

Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

Reactive Collision Avoidance Algorithm

Science.gov (United States)

Scharf, Daniel; Acikmese, Behcet; Ploen, Scott; Hadaegh, Fred

2010-01-01

The reactive collision avoidance (RCA) algorithm allows a spacecraft to find a fuel-optimal trajectory for avoiding an arbitrary number of colliding spacecraft in real time while accounting for acceleration limits. In addition to spacecraft, the technology can be used for vehicles that can accelerate in any direction, such as helicopters and submersibles. In contrast to existing, passive algorithms that simultaneously design trajectories for a cluster of vehicles working to achieve a common goal, RCA is implemented onboard spacecraft only when an imminent collision is detected, and then plans a collision avoidance maneuver for only that host vehicle, thus preventing a collision in an off-nominal situation for which passive algorithms cannot. An example scenario for such a situation might be when a spacecraft in the cluster is approaching another one, but enters safe mode and begins to drift. Functionally, the RCA detects colliding spacecraft, plans an evasion trajectory by solving the Evasion Trajectory Problem (ETP), and then recovers after the collision is avoided. A direct optimization approach was used to develop the algorithm so it can run in real time. In this innovation, a parameterized class of avoidance trajectories is specified, and then the optimal trajectory is found by searching over the parameters. The class of trajectories is selected as bang-off-bang as motivated by optimal control theory. That is, an avoiding spacecraft first applies full acceleration in a constant direction, then coasts, and finally applies full acceleration to stop. The parameter optimization problem can be solved offline and stored as a look-up table of values. Using a look-up table allows the algorithm to run in real time. Given a colliding spacecraft, the properties of the collision geometry serve as indices of the look-up table that gives the optimal trajectory. For multiple colliding spacecraft, the set of trajectories that avoid all spacecraft is rapidly searched on

Daytime avoidance of chemosensory alarm cues by adult sea lamprey (Petromyzon marinus)

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Di Rocco, Richard; Belanger, Cowan; Imre, István; Brown, Grant; Johnson, Nicholas S.

2014-01-01

Sea lamprey (Petromyzon marinus) avoid damage-released and predator chemosensory cues at night, but their response to these cues during the day is unknown. Here, we explored (i) whether sea lamprey avoid these cues during the day and (ii) the effect of water temperature on the avoidance of chemosensory alarm cues in two diurnal laboratory experiments. We hypothesized that daytime activity would be temperature-dependent and that only sea lamprey vulnerable to predation (i.e., not hiding) would behaviourally respond to chemosensory alarm cues. Ten groups of ten sea lamprey were exposed to one of a variety of potential chemosensory cues. The experiments were conducted over a range of temperatures to quantify the effect of temperature on avoidance behaviour. Consistent with our hypothesis, a higher proportion of animals were active during daytime as water temperature increased. Moving sea lamprey showed an avoidance response to 2-phenylethylamine (a compound found in mammalian urine) and human saliva once water temperatures had risen to mean (±SD) = 13.7 (±1.4) °C. Resting and hiding sea lamprey did not show an avoidance response to any of the experimental stimuli.

How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2014-07-01

Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual

Women with multiple chemical sensitivity have increased harm avoidance and reduced 5-HT(1A receptor binding potential in the anterior cingulate and amygdala.

Directory of Open Access Journals (Sweden)

Lena Hillert

Full Text Available Multiple chemical sensitivity (MCS is a common condition, characterized by somatic distress upon exposure to odors. As in other idiopathic environmental intolerances, the underlying mechanisms are unknown. Contrary to the expectations it was recently found that persons with MCS activate the odor-processing brain regions less than controls, while their activation of the anterior cingulate cortex (ACC is increased. The present follow-up study was designed to test the hypotheses that MCS subjects have increased harm avoidance and deviations in the serotonin system, which could render them intolerant to environmental odors. Twelve MCS and 11 control subjects, age 22-44, all working or studying females, were included in a PET study where 5-HT(1A receptor binding potential (BP was assessed after bolus injection of [(11C]WAY100635. Psychological profiles were assessed by the Temperament and Character Inventory and the Swedish universities Scales of Personality. All MCS and 12 control subjects were also tested for emotional startle modulation in an acoustic startle test. MCS subjects exhibited significantly increased harm avoidance, and anxiety compared to controls. They also had a reduced 5-HT(1A receptor BP in amygdala (p = 0.029, ACC (p = 0.005 (planned comparisons, significance level 0.05, and insular cortex (p = 0.003; significance level p<0.005 with Bonferroni correction, and showed an inverse correlation between degree of anxiety and the BP in the amygdala (planned comparison. No group by emotional category difference was found in the startle test. Increased harm avoidance and the observed changes in the 5-HT(1A receptor BP in the regions processing harm avoidance provides a plausible pathophysiological ground for the symptoms described in MCS, and yields valuable information for our general understanding of idiopathic environmental intolerances.

Changing patterns in deforestation avoidance by different protection types in the Brazilian Amazon.

Science.gov (United States)

Jusys, Tomas

2018-01-01

This study quantifies how much deforestation was avoided due to legal protection in Legal Amazon in strictly protected areas, sustainable use areas, and indigenous lands. Only regions that are protected de jure (i.e., where deforestation is avoided due to effective laws rather than remoteness) were considered, so that the potential of legal protection could be better assessed. This is a cross-sectional approach, which allows comparisons in terms of avoided deforestation among the different types of protection in the same period. This study covers three different periods. Regions protected de jure were sampled by estimating a threshold distance at which deforestation starts to diminish and retaining all pixels up to that distance, and deforestation that has been avoided due to legal protection was estimated by matching. Indigenous lands avoided the highest percentage of deforestation during the 2001-2004 and 2005-2008 periods, followed by those under strict protection and sustainable use areas, in respective order. Shifting patterns in deforestation avoidance are clearly noticeable for the 2009-2014 period when 1) strictly protected areas outperformed indigenous lands in terms of the percentage of saved forests, 2) some protected regions began to attract deforestation instead of avoiding it, and 3) sustainable use areas, on average, did not avoid deforestation.

Smoking-Specific Experiential Avoidance is Indirectly Associated with Trait Worry and Smoking Processes among Treatment-Seeking Smokers.

Science.gov (United States)

Farris, Samantha G; Zvolensky, Michael J; Norton, Peter J; Hogan, Julianna; Smith, Angela H; Talkovsky, Alexander M; Garey, Lorra; Schmidt, Norman B

2016-01-01

Limited work has examined worry, or apprehensive anticipation about future negative events, in terms of smoking. One potential explanatory factor is the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (smoking-specific experiential avoidance). Participants (n = 465) were treatment-seeking daily smokers. Cross-sectional (pre-treatment) self-report data were utilized to assess trait worry, smoking-specific experiential avoidance, and four smoking criterion variables: nicotine dependence, motivational aspects of quitting, perceived barriers to smoking cessation, and severity of problematic symptoms reported in past quit attempts. Trait worry was significantly associated with greater levels of nicotine dependence, motivation to quit smoking, perceived barriers for smoking cessation, and more severe problems while quitting in the past; associations occurred indirectly through higher levels of smoking-specific experiential avoidance. Findings provide initial support for the potential role of smoking-specific experiential avoidance in explaining the association between trait worry and a variety of smoking processes.

Heavy cannabis use and attentional avoidance of anxiety-related stimuli

Directory of Open Access Journals (Sweden)

T.D.W. Wilcockson

2016-06-01

Conclusions: The findings suggest a difference in processing of emotional information in relation to neutral information between groups. It would appear that cannabis users avoid anxiety provoking stimuli. Such behaviour could potentially have motivational properties that could lead to exacerbating anxiety disorder-type behaviour.

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

Science.gov (United States)

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

2016-10-01

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

Open source challenges for hospital information system (HIS in developing countries: a pilot project in Mali

Directory of Open Access Journals (Sweden)

Chaacho Saad

2010-04-01

here to avoid several potential pitfalls specific to the context of Africa. Our future work will target the full integration of the billing module in Mediboard and an expanded implementation throughout the hospital.

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

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András Láng

2012-11-01

Full Text Available A new scale measuring patient-therapist attachment avoidance was developed. Attachment Avoidance in Therapy Scale is a new measure based on the Bartholomew model of adult attachment (Bartholomew & Horowitz, 1991 and the Experience in Close Relationships Scale (Brennan, Clark, & Shaver, 1998 to measure patients’ attachment avoidance towards therapists. With 112 patient-therapist dyads participating in the study, validation of a preliminary scale – measuring both attachment anxiety and attachment avoidance in therapy – took place using therapists’ evaluations of patients’ relational behavior and patients’ self-reports about their attitude toward psychotherapy. Analysis of the data revealed six underlying scales. Results showed all six scales to be reliable. Validation of scales measuring attachment anxiety failed. The importance of Attachment Avoidance in Therapy Scale and its subscales is discussed.

Hospital disinfection: efficacy and safety issues.

Science.gov (United States)

Dettenkofer, Markus; Block, Colin

2005-08-01

To review recent publications relevant to hospital disinfection (and cleaning) including the reprocessing of medical instruments. The key question as to whether the use of disinfectants on environmental surfaces rather than cleaning with detergents only reduces nosocomial infection rates still awaits conclusive studies. New disinfectants, mainly peroxygen compounds, show good sporicidal properties and will probably replace more problematical substances such as chlorine-releasing agents. The safe reprocessing of medical devices requires a well-coordinated approach, starting with proper cleaning. New methods and substances show promising activity for preventing the transmission of prions. Different aspects of virus inactivation have been studied, and the transmissibility, e.g. of norovirus, shows the need for sound data on how different disinfectant classes perform. Biofilms or other forms of surface-adherent organisms pose an extraordinary challenge to decontamination. Although resistance to biocides is generally not judged to be as critical as antibiotic resistance, scientific data support the need for proper use, i.e. the avoidance of widespread application, especially in low concentrations and in consumer products. Chemical disinfection of heat-sensitive instruments and targeted disinfection of environmental surfaces are established components of hospital infection control. To avoid danger to staff, patients and the environment, prudent use as well as established safety precautions are required. New technologies and products should be evaluated with sound methods. As emerging resistant pathogens will challenge healthcare facilities in the future even more than at present, there is a need for well-designed studies addressing the role of disinfection in hospital infection control.

Distributed learning: Developing a predictive model based on data from multiple hospitals without data leaving the hospital - A real life proof of concept.

Science.gov (United States)

Jochems, Arthur; Deist, Timo M; van Soest, Johan; Eble, Michael; Bulens, Paul; Coucke, Philippe; Dries, Wim; Lambin, Philippe; Dekker, Andre

2016-12-01

One of the major hurdles in enabling personalized medicine is obtaining sufficient patient data to feed into predictive models. Combining data originating from multiple hospitals is difficult because of ethical, legal, political, and administrative barriers associated with data sharing. In order to avoid these issues, a distributed learning approach can be used. Distributed learning is defined as learning from data without the data leaving the hospital. Clinical data from 287 lung cancer patients, treated with curative intent with chemoradiation (CRT) or radiotherapy (RT) alone were collected from and stored in 5 different medical institutes (123 patients at MAASTRO (Netherlands, Dutch), 24 at Jessa (Belgium, Dutch), 34 at Liege (Belgium, Dutch and French), 48 at Aachen (Germany, German) and 58 at Eindhoven (Netherlands, Dutch)). A Bayesian network model is adapted for distributed learning (watch the animation: http://youtu.be/nQpqMIuHyOk). The model predicts dyspnea, which is a common side effect after radiotherapy treatment of lung cancer. We show that it is possible to use the distributed learning approach to train a Bayesian network model on patient data originating from multiple hospitals without these data leaving the individual hospital. The AUC of the model is 0.61 (95%CI, 0.51-0.70) on a 5-fold cross-validation and ranges from 0.59 to 0.71 on external validation sets. Distributed learning can allow the learning of predictive models on data originating from multiple hospitals while avoiding many of the data sharing barriers. Furthermore, the distributed learning approach can be used to extract and employ knowledge from routine patient data from multiple hospitals while being compliant to the various national and European privacy laws. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

Eating avoidance disorder and Wernicke-Korsakoff syndrome following gastric bypass: an under-diagnosed association.

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Fandiño, Julia N; Benchimol, Alexander K; Fandiño, Leila N; Barroso, Fernando L; Coutinho, Walmir F; Appolinário, José C

2005-09-01

Wernicke-Korsakoff syndrome (WKS) and disordered eating behavior have been reported separately after bariatric surgery. We report a patient who following a bariatric operation developed WKS associated with a disturbed eating behavior without vomiting. This morbidly obese man developed an intense fear of gaining weight in the postoperative period and engaged in an extreme form of "food avoidance behavior". 2 months postoperatively after severe weight loss, he was hospitalized with disorientation and an amnesic syndrome. He was discharged 2 months later with stable weight and regular eating habits. Despite this, at the last follow-up visit 2 years postoperatively, he still had a residual partial amnesic syndrome. The surgical team must be aware of peculiar forms of pathological eating that may appear after bariatric surgery; the emergence of an eating avoidance disorder may be associated with the development of WKS.

Contribution of renal impairment to potentially preventable medication-related hospital admissions

NARCIS (Netherlands)

A.J. Leendertse (Anne); E.A. van Dijk (Elisabeth); P.A. de Smet (Peter); T.C.G. Egberts (Toine); P.M.L.A. van den Bemt (Patricia)

2012-01-01

textabstractBackground: Medication errors and renal impairment contribute to severe adverse drug events, which may lead to hospital admission. Objective: To determine whether medication errors and renal impairment contribute to hospital admission and examine these errors for strategies to prevent

Smoke-free hospital site conversations: how nurses can initiate change.

Science.gov (United States)

Mackereth, Peter; Finchett, Charlotte; Holt, Melody

2016-11-24

Smoking tobacco continues to be the world's most preventable cause of death and disability with over six trillion cigarettes sold each year. Patients, visitors and health professionals who smoke on hospital sites present a challenge to the effectiveness of public health messages. Health professionals who ignore 'No smoking' hospital/clinic signage, and avoid smoking-cessation activity, help to sustain the perception that smoking is tolerated. Case studies, with a focus on lung cancer and chronic obstructive pulmonary disease (COPD), are used to illustrate how nurses can 'seed' the idea of hospitals becoming smoke-free, provide brief interventions and support patients, carers and colleagues to make that change.

Summary of avoidable cancers in the Nordic countries

DEFF Research Database (Denmark)

Olsen, J H; Andersen, A; Dreyer, L

1997-01-01

An overview is given of the most important known causes of cancer in the five Nordic countries and the resulting number of cancers that are potentially avoidable. The main causes include active and passive smoking, alcohol consumption, exposure to asbestos and other occupational carcinogens, solar...... and ionizing radiation, obesity, human papillomavirus infection in the female genital tract and infection with Helicobacter pylori. The organs most commonly affected are those of the respiratory system, the upper digestive tract and stomach, skin, the lower urinary tract and the uterine cervix. Annually, more...... than 18,000 cancers in men and 11,000 in women in the Nordic populations could be avoided by eliminating exposure to known carcinogens which is equivalent to 33% and 20% of all cancers arising in men and women, respectively, around the year 2000. Smoking habits account for a little more than half...

Avoidable mortality among First Nations adults in Canada: A cohort analysis.

Science.gov (United States)

Park, Jungwee; Tjepkema, Michael; Goedhuis, Neil; Pennock, Jennifer

2015-08-01

Avoidable mortality is a measure of deaths that potentially could have been averted through effective prevention practices, public health policies, and/or provision of timely and adequate health care. This longitudinal analysis compares avoidable mortality among First Nations and non-Aboriginal adults. Data are from the 1991-to-2006 Canadian Census Mortality and Cancer Follow-up Study. A 15% sample of 1991 Census respondents aged 25 or older was linked to 16 years of mortality data. This study examines avoidable mortality among 61,220 First Nations and 2,510,285 non-Aboriginal people aged 25 to 74. During the 1991-to-2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal adults. The age-standardized avoidable mortality rate (ASMR) per 100,000 person-years at risk for First Nations men was 679.2 versus 337.6 for non-Aboriginal men (rate ratio = 2.01). For women, ASMRs were lower, but the gap was wider. The ASMR for First Nations women was 453.2, compared with 183.5 for non-Aboriginal women (rate ratio = 2.47). Disparities were greater at younger ages. Diabetes, alcohol and drug use disorders, and unintentional injuries were the main contributors to excess avoidable deaths among First Nations adults. Education and income accounted for a substantial share of the disparities. The results highlight the gap in avoidable mortality between First Nations and non-Aboriginal adults due to specific causes of death and the association with socioeconomic factors.

Measuring situational avoidance in older drivers: An application of Rasch analysis.

Science.gov (United States)

Davis, Jessica; Conlon, Elizabeth; Ownsworth, Tamara; Morrissey, Shirley

2016-02-01

Situational avoidance is a form of driving self-regulation at the strategic level of driving behaviour. It has typically been defined as the purposeful avoidance of driving situations perceived as challenging or potentially hazardous. To date, assessment of the psychometric properties of existing scales that measure situational avoidance has been sparse. This study examined the contribution of Rasch analysis to the situational avoidance construct. Three hundred and ninety-nine Australian drivers (M=66.75, SD=10.14, range: 48-91 years) completed the Situational Avoidance Questionnaire (SAQ). Following removal of the item Parallel Parking, the scale conformed to a Rasch model, showing good person separation, sufficient reliability, little disordering of thresholds, and no evidence of differential item functioning by age or gender. The residuals were independent supporting the assumption of unidimensionality and in conforming to a Rasch model, SAQ items were found to be hierarchical or cumulative. Increased avoidance was associated with factors known to be related to driving self-regulation more broadly, including older age, female gender, reduced driving space and frequency, reporting a change in driving in the past five years and poorer indices of health (i.e., self-rated mood, vision and cognitive function). Overall, these results support the use of the SAQ as a psychometrically sound measure of situational avoidance. Application of Rasch analysis to this area of research advances understanding of the driving self-regulation construct and its practice by drivers in baby boomer and older adult generations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Causes of Adult Blindness at Ecwa Eye Hospital, Kano

African Journals Online (AJOL)

user

accounting for 94 (42.3%), 28 (12.6%) and 19 (8.7%) of the unilaterally blind cases. Conclusion: Avoidable causes of blindness were predominant at. ECWA Eye Hospital, Kano. Concerted efforts at increasing cataract surgical volume, awareness and early treatment of glaucoma as well as education on prevention and early.

The Study of Cooperative Obstacle Avoidance Method for MWSN Based on Flocking Control

Directory of Open Access Journals (Sweden)

Zuo Chen

2014-01-01

Full Text Available Compared with the space fixed feature of traditional wireless sensor network (WSN, mobile WSN has better robustness and adaptability in unknown environment, so that it is always applied in the research of target tracking. In order to reach the target, the nodes group should find a self-adaptive method to avoid the obstacles together in their moving directions. Previous methods, which were based on flocking control model, realized the strategy of obstacle avoidance by means of potential field. However, these may sometimes lead the nodes group to fall into a restricted area like a trap and never get out of it. Based on traditional flocking control model, this paper introduced a new cooperative obstacle avoidance model combined with improved SA obstacle avoidance algorithm. It defined the tangent line of the intersection of node’s velocity line and the edge of obstacle as the steering direction. Furthermore, the cooperative obstacle avoidance model was also improved in avoiding complex obstacles. When nodes group encounters mobile obstacles, nodes will predict movement path based on the spatial location and velocity of obstacle. And when nodes group enters concave obstacles, nodes will temporarily ignore the gravity of the target and search path along the edge of the concave obstacles. Simulation results showed that cooperative obstacle avoidance model has significant improvement on average speed and time efficiency in avoiding obstacle compared with the traditional flocking control model. It is more suitable for obstacle avoidance in complex environment.

The study of cooperative obstacle avoidance method for MWSN based on flocking control.

Science.gov (United States)

Chen, Zuo; Ding, Lei; Chen, Kai; Li, Renfa

2014-01-01

Compared with the space fixed feature of traditional wireless sensor network (WSN), mobile WSN has better robustness and adaptability in unknown environment, so that it is always applied in the research of target tracking. In order to reach the target, the nodes group should find a self-adaptive method to avoid the obstacles together in their moving directions. Previous methods, which were based on flocking control model, realized the strategy of obstacle avoidance by means of potential field. However, these may sometimes lead the nodes group to fall into a restricted area like a trap and never get out of it. Based on traditional flocking control model, this paper introduced a new cooperative obstacle avoidance model combined with improved SA obstacle avoidance algorithm. It defined the tangent line of the intersection of node's velocity line and the edge of obstacle as the steering direction. Furthermore, the cooperative obstacle avoidance model was also improved in avoiding complex obstacles. When nodes group encounters mobile obstacles, nodes will predict movement path based on the spatial location and velocity of obstacle. And when nodes group enters concave obstacles, nodes will temporarily ignore the gravity of the target and search path along the edge of the concave obstacles. Simulation results showed that cooperative obstacle avoidance model has significant improvement on average speed and time efficiency in avoiding obstacle compared with the traditional flocking control model. It is more suitable for obstacle avoidance in complex environment.

Ranking Hospitals Based on Colon Surgery and Abdominal Hysterectomy Surgical Site Infection Outcomes: Impact of Limiting Surveillance to the Operative Hospital.

Science.gov (United States)

Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Kleinman, Ken; Huang, Susan S

2018-03-16

Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at non-operative hospitals are included. We utilized data from a California statewide hospital registry to assess for evidence of SSI following colon surgery or abdominal hysterectomies performed 3/1/2011-11/30/2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Among 60,059 colon surgeries at 285 hospitals and 64,918 abdominal hysterectomies at 270 hospitals, 5,921 (9.9%) colon surgeries and 1,481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following surgery. 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSI would have been missed by operative hospital surveillance alone. The proportion of individual hospital's SSI detected during hospitalizations at other hospitals varied widely. Including non-operative hospital SSI resulted in improved relative ranking of 11 (3.9%) colon surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI under-estimation, leading to inaccurate assignment or avoidance of financial penalties for approximately one in eleven to sixteen hospitals.

How Teachers Can Avoid Being Sued: Law and American Education.

Science.gov (United States)

Greene, Jim

This paper explores what teachers can do to avoid potential lawsuits. Section 1 describes different types of laws for public and private schools. Section 2 discusses tort liability. Section 3 presents legal principles that apply to educators (in loco parents, intentional torts, strict liability, negligence, foreseeability, assigned duties,…

Avoiding spurious submovement decompositions: a globally optimal algorithm

International Nuclear Information System (INIS)

Rohrer, Brandon Robinson; Hogan, Neville

2003-01-01

Evidence for the existence of discrete submovements underlying continuous human movement has motivated many attempts to extract them. Although they produce visually convincing results, all of the methodologies that have been employed are prone to produce spurious decompositions. Examples of potential failures are given. A branch-and-bound algorithm for submovement extraction, capable of global nonlinear minimization (and hence capable of avoiding spurious decompositions), is developed and demonstrated.

Optimization of decision making to avoid stochastically predicted air traffic conflicts

Directory of Open Access Journals (Sweden)

В.М. Васильєв

2005-01-01

Full Text Available  The method of decision-making optimization on planning an aircraft trajectory to avoid potential conflict with restricted minimal level of separation standard is proposed. Evaluation and monitoring the conflict probability are made using the probabilistic composite method.

Inbreeding avoidance influences the viability of reintroduced populations of African wild dogs (Lycaon pictus.

Directory of Open Access Journals (Sweden)

Penny A Becker

Full Text Available The conservation of many fragmented and small populations of endangered African wild dogs (Lycaon pictus relies on understanding the natural processes affecting genetic diversity, demographics, and future viability. We used extensive behavioural, life-history, and genetic data from reintroduced African wild dogs in South Africa to (1 test for inbreeding avoidance via mate selection and (2 model the potential consequences of avoidance on population persistence. Results suggested that wild dogs avoided mating with kin. Inbreeding was rare in natal packs, after reproductive vacancies, and between sibling cohorts (observed on 0.8%, 12.5%, and 3.8% of occasions, respectively. Only one of the six (16.7% breeding pairs confirmed as third-order (or closer kin consisted of animals that were familiar with each other, while no other paired individuals had any prior association. Computer-simulated populations allowed to experience inbreeding had only a 1.6% probability of extinction within 100 years, whereas all populations avoiding incestuous matings became extinct due to the absence of unrelated mates. Populations that avoided mating with first-order relatives became extinct after 63 years compared with persistence of 37 and 19 years for those also prevented from second-order and third-order matings, respectively. Although stronger inbreeding avoidance maintains significantly more genetic variation, our results demonstrate the potentially severe demographic impacts of reduced numbers of suitable mates on the future viability of small, isolated wild dog populations. The rapid rate of population decline suggests that extinction may occur before inbreeding depression is observed.

Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

Directory of Open Access Journals (Sweden)

Lauren Lapointe-Shaw

Full Text Available Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices.We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class.The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge.In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.

How do nonprofit hospitals manage earnings?

Science.gov (United States)

Leone, Andrew J; Van Horn, R Lawrence

2005-07-01

We hypothesize that, unlike for-profit firms, nonprofit hospitals have incentives to manage earnings to a range just above zero. We consider two ways managers can achieve this. They can adjust discretionary spending [Hoerger, T.J., 1991. 'Profit' variability in for-profit and not-for-profit hospitals. Journal of Health Economics 10, 259-289.] and/or they can adjust accounting accruals using the flexibility inherent in Generally Accepted Accounting Principles (GAAP). To test our hypothesis we use regressions as well as tests of the distribution of earnings by Burgstahler and Dichev [Burgstahler, D., Dichev, I., 1997. Earnings management to avoid earnings decreases and losses. Journal of Accounting and Economics 24, 99-126.] on a sample of 1,204 hospitals and 8,179 hospital-year observations. Our tests support the use of discretionary spending and accounting accrual management. Like Hoerger (1991), we find evidence that nonprofit hospitals adjust discretionary spending to manage earnings. However, we also find significant use of discretionary accruals (e.g., adjustments to the third-party-allowance, and allowance for doubtful accounts) to meet earnings objectives. These findings have two important implications. First, the previous evidence by Hoerger that nonprofit hospitals show less variation in income may at least partly be explained by an accounting phenomenon. Second, our findings provide guidance to users of these financial statements in predicting the direction of likely bias in reported earnings.

Modification of CO2 avoidance behaviour in Drosophila by inhibitory odorants.

Science.gov (United States)

Turner, Stephanie Lynn; Ray, Anandasankar

2009-09-10

The fruitfly Drosophila melanogaster exhibits a robust and innate olfactory-based avoidance behaviour to CO(2), a component of odour emitted from stressed flies. Specialized neurons in the antenna and a dedicated neuronal circuit in the higher olfactory system mediate CO(2) detection and avoidance. However, fruitflies need to overcome this avoidance response in some environments that contain CO(2) such as ripening fruits and fermenting yeast, which are essential food sources. Very little is known about the molecular and neuronal basis of this unique, context-dependent modification of innate olfactory avoidance behaviour. Here we identify a new class of odorants present in food that directly inhibit CO(2)-sensitive neurons in the antenna. Using an in vivo expression system we establish that the odorants act on the Gr21a/Gr63a CO(2) receptor. The presence of these odorants significantly and specifically reduces CO(2)-mediated avoidance behaviour, as well as avoidance mediated by 'Drosophila stress odour'. We propose a model in which behavioural avoidance to CO(2) is directly influenced by inhibitory interactions of the novel odours with CO(2) receptors. Furthermore, we observe differences in the temporal dynamics of inhibition: the effect of one of these odorants lasts several minutes beyond the initial exposure. Notably, animals that have been briefly pre-exposed to this odorant do not respond to the CO(2) avoidance cue even after the odorant is no longer present. We also show that related odorants are effective inhibitors of the CO(2) response in Culex mosquitoes that transmit West Nile fever and filariasis. Our findings have broader implications in highlighting the important role of inhibitory odorants in olfactory coding, and in their potential to disrupt CO(2)-mediated host-seeking behaviour in disease-carrying insects like mosquitoes.

LightForce: An Update on Orbital Collision Avoidance Using Photon Pressure

Science.gov (United States)

Stupl, Jan; Mason, James; De Vries, Willem; Smith, Craig; Levit, Creon; Marshall, William; Salas, Alberto Guillen; Pertica, Alexander; Olivier, Scot; Ting, Wang

2012-01-01

We present an update on our research on collision avoidance using photon-pressure induced by ground-based lasers. In the past, we have shown the general feasibility of employing small orbit perturbations, induced by photon pressure from ground-based laser illumination, for collision avoidance in space. Possible applications would be protecting space assets from impacts with debris and stabilizing the orbital debris environment. Focusing on collision avoidance rather than de-orbit, the scheme avoids some of the security and liability implications of active debris removal, and requires less sophisticated hardware than laser ablation. In earlier research we concluded that one ground based system consisting of a 10 kW class laser, directed by a 1.5 m telescope with adaptive optics, could avoid a significant fraction of debris-debris collisions in low Earth orbit. This paper describes our recent efforts, which include refining our original analysis, employing higher fidelity simulations and performing experimental tracking tests. We investigate the efficacy of one or more laser ground stations for debris-debris collision avoidance and satellite protection using simulations to investigate multiple case studies. The approach includes modeling of laser beam propagation through the atmosphere, the debris environment (including actual trajectories and physical parameters), laser facility operations, and simulations of the resulting photon pressure. We also present the results of experimental laser debris tracking tests. These tests track potential targets of a first technical demonstration and quantify the achievable tracking performance.

The Citadel cannot hold: technologies go outside the hospital, patients and doctors too.

Science.gov (United States)

Stoeckle, J D

1995-01-01

Use of the acute hospital has markedly decreased over the past four decades for various reasons: the decentralization of diagnostic treatment technologies to out-of-hospital sites; the clinical substitutions of quick diagnostic testing of the ambulatory patient for the longer diagnostic testing of the hospitalized patient; the diminished use of hospital bed rest and the expanded use of exercise for treatment; the corporate organization of hospital work that emphasizes efficiency; and the group practice organization of generalists and specialists that avoids hospital use for the diagnosis of complex disorders in ambulatory patients. A smaller domain for hospital bed care and renewed attention to chronic disease and prevention in the community diminish the hold of the acute hospital on care. The evolution of more collaborative, decentralized arrangements promises to be a positive development for community care.

The application of hospitality elements in hospitals.

Science.gov (United States)

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

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

Determinants of Aggressive Tax Avoidance

OpenAIRE

Herbert, Tanja

2015-01-01

This thesis consists of three essays examining determinants of aggressive tax avoidance. The first essay “Measuring the Aggressive Part of International Tax Avoidance”, co-authored with Prof. Dr. Michael Overesch, proposes a new measure that isolates the additional or even aggressive part in international tax avoidance and analyzes the determinants of aggressive tax avoidance of multinational enterprises. The second essay “Capital Injections and Aggressive Tax Planning - Can Banks Have It All...

The potential economic value of screening hospital admissions for Clostridium difficile.

Science.gov (United States)

Bartsch, S M; Curry, S R; Harrison, L H; Lee, B Y

2012-11-01

Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53-272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system.

Life-cycle environmental and economic impacts of energy-crop fuel-chains: an integrated assessment of potential GHG avoidance in Ireland

International Nuclear Information System (INIS)

Styles, David; Jones, Michael B.

2008-01-01

This paper combines life-cycle analyses and economic analyses for Miscanthus and willow heat and electricity fuel-chains in Ireland. Displaced agricultural land-uses and conventional fuels were considered in fuel-chain permutations. Avoided greenhouse gas (GHG) emissions ranged from 7.7 to 35.2 t CO 2 eq. ha -1 a -1 . Most fuel-chain permutations exhibited positive discounted financial returns, despite losses for particular entities at a farm-gate processed-biomass price of Euro 100 t -1 dry-matter. Attributing a value of Euro 10 t -1 CO 2 eq. to avoided GHG emissions, but subtracting financial returns associated with displaced fuel supplies, resulted in discounted annual national economic benefits (DANEBs) ranging from -457 to 1887 Euro ha -1 a -1 . Extrapolating a plausible combination of fuel-chains up to a national indicative scenario resulted in GHG emission avoidance of 3.56 Mt CO 2 eq. a -1 (5.2% of national emissions), a DANEB of 167 M Euro , and required 4.6% of national agricultural land area. As cost-effective national GHG avoidance options, Miscanthus and willow fuel-chains are robust to variation in yields and CO 2 price, and appear to represent an efficient land-use option (e.g. compared with liquid biofuel production). Policies promoting utilisation of these energy-crops could avoid unnecessary, and environmentally questionable, future purchase of carbon credits, as currently required for national Kyoto compliance

Measuring LEED–NC applicability in design for hospitality

Directory of Open Access Journals (Sweden)

Teresa Marie Cracknell

2015-12-01

Full Text Available Mounting awareness of climate change in recent years has led the construction industry to initiate new approaches toward sustainable building design, yet stakeholders in hospitality development still hesitate to build green. This reluctance is due to perceived high guest expectations of comfort levels and amenity access among these properties. Research was conducted to determine precisely which green building innovations present the most significant barriers to incorporating sustainability into design for hospitality. Average LEED credit implementation rates among 28 existing LEED hotel projects were calculated and compared with average credits employed among common commercial building projects. 15 of those projects’ designers also offered survey opinions on which sustainable innovations were most commonly avoided in their approaches for hospitality. The results indicate that certain credits do experience decreased popularity among hospitality projects, yet guest comfort was not the only barrier identified. Cost of implementation and local applicability affected by climate and local bylaws were also found as major role players in the selection of credits specific to hospitality design. Conclusions are presented according to the data and recommendations made to support further growth and success in future applications of LEED sustainable design in hospitality.

Avoidable waste management costs

International Nuclear Information System (INIS)

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

1995-01-01

This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP

Avoidable waste management costs

Energy Technology Data Exchange (ETDEWEB)

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

1995-01-01

This report describes the activity based costing method used to acquire variable (volume dependent or avoidable) waste management cost data for routine operations at Department of Energy (DOE) facilities. Waste volumes from environmental restoration, facility stabilization activities, and legacy waste were specifically excluded from this effort. A core team consisting of Idaho National Engineering Laboratory, Los Alamos National Laboratory, Rocky Flats Environmental Technology Site, and Oak Ridge Reservation developed and piloted the methodology, which can be used to determine avoidable waste management costs. The method developed to gather information was based on activity based costing, which is a common industrial engineering technique. Sites submitted separate flow diagrams that showed the progression of work from activity to activity for each waste type or treatability group. Each activity on a flow diagram was described in a narrative, which detailed the scope of the activity. Labor and material costs based on a unit quantity of waste being processed were then summed to generate a total cost for that flow diagram. Cross-complex values were calculated by determining a weighted average for each waste type or treatability group based on the volume generated. This study will provide DOE and contractors with a better understanding of waste management processes and their associated costs. Other potential benefits include providing cost data for sites to perform consistent cost/benefit analysis of waste minimization and pollution prevention (WMIN/PP) options identified during pollution prevention opportunity assessments and providing a means for prioritizing and allocating limited resources for WMIN/PP.

Avoidant/Restrictive Food Intake Disorder

Science.gov (United States)

... Eating Disorder Bulimia Nervosa Pica Rumination Disorder Avoidant/restrictive food intake disorder is characterized by eating very little food and/or avoiding eating certain foods. People with this disorder eat ...

Exclusive contracts in the hospital setting: a two-edged sword, part 1: legal issues.

Science.gov (United States)

Portman, Robert M

2007-05-01

Hospitals routinely enter into contracts with radiology groups for the right to be the exclusive provider of radiology services at the facility in exchange for the group agreeing to provide and manage all aspects of that service within the hospital. These "exclusive contracts" generally result in the radiology department and associated equipment being closed off to physicians who are not part of the contracting group. Exclusive contracts are generally considered to be good for physicians who have them and bad for those excluded by them. In fact, while exclusive contracts offer obvious benefits to the physicians who receive them and obvious disadvantages for those who are excluded, they also present pitfalls for physicians in the chosen group. Part I of this article discusses the legal issues raised by exclusive contracts. Although these agreements appear to be anti-competitive, most courts have rejected antitrust challenges to exclusive contracts. Excluded physicians have had much greater success in attacking exclusive contracting arrangements on breach of contract and procedural/due process grounds. Exclusive contracting arrangements can also raise concerns under the Medicare-Medicaid anti-kickback statute if the contracting physicians are required to pay consideration or accept less than fair market value compensation in exchange for exclusive contracts. These agreements can also raise issues under the Stark II physician self-referral law if the contracting physicians are in a position to refer Medicare or Medicaid patients to the hospital. Part II of this article will discuss the advantages and disadvantages of exclusive contracts for physicians covered and not covered by such contracts, as well as strategies for avoiding them or minimizing their potential adverse impact. It also will discuss specific provisions of exclusive contracts that should be included or avoided.

Potential barriers to the application of multi-factor portfolio analysis in public hospitals: evidence from a pilot study in the Netherlands.

Science.gov (United States)

Pavlova, Milena; Tsiachristas, Apostolos; Vermaeten, Gerhard; Groot, Wim

2009-01-01

Portfolio analysis is a business management tool that can assist health care managers to develop new organizational strategies. The application of portfolio analysis to US hospital settings has been frequently reported. In Europe however, the application of this technique has received little attention, especially concerning public hospitals. Therefore, this paper examines the peculiarities of portfolio analysis and its applicability to the strategic management of European public hospitals. The analysis is based on a pilot application of a multi-factor portfolio analysis in a Dutch university hospital. The nature of portfolio analysis and the steps in a multi-factor portfolio analysis are reviewed along with the characteristics of the research setting. Based on these data, a multi-factor portfolio model is developed and operationalized. The portfolio model is applied in a pilot investigation to analyze the market attractiveness and hospital strengths with regard to the provision of three orthopedic services: knee surgery, hip surgery, and arthroscopy. The pilot portfolio analysis is discussed to draw conclusions about potential barriers to the overall adoption of portfolio analysis in the management of a public hospital. Copyright (c) 2008 John Wiley & Sons, Ltd.

Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits.

Science.gov (United States)

Gardiner, Sharon J; Metcalf, Sarah Cl; Chin, Paul Kl; Doogue, Matthew P; Dalton, Simon C; Chambers, Stephen T

2018-04-13

To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.

Obstacle-avoiding robot with IR and PIR motion sensors

Science.gov (United States)

Ismail, R.; Omar, Z.; Suaibun, S.

2016-10-01

Obstacle avoiding robot was designed, constructed and programmed which may be potentially used for educational and research purposes. The developed robot will move in a particular direction once the infrared (IR) and the PIR passive infrared (PIR) sensors sense a signal while avoiding the obstacles in its path. The robot can also perform desired tasks in unstructured environments without continuous human guidance. The hardware was integrated in one application board as embedded system design. The software was developed using C++ and compiled by Arduino IDE 1.6.5. The main objective of this project is to provide simple guidelines to the polytechnic students and beginners who are interested in this type of research. It is hoped that this robot could benefit students who wish to carry out research on IR and PIR sensors.

Hospital waste management in Lebanon

International Nuclear Information System (INIS)

Chaker, Alissar

1999-01-01

Hospital wastes comprises approximately 80% domestic waste components, also known as non-risk waste and 20% hazardous or risk waste. The 20% of the hospital waste stream or the risk waste (also known as infectious, medical, clinical wastes) comprises components which could be potentially contaminated with infections, chemical or radioactive agents. Therefore, it should be handled and disposed of in such a manner as to minimize potential human exposure and cross-contamination. Hospital risk waste and be subdivided into seven general categories as follows: infections, anatomical/pathological, chemical, pharmaceutical, radioactive waste, sharps and pressurised containers. These waste categories are generated by many types of health care establishments, including hospitals, clinics, infirmaries.... The document presents also tables of number of hospitals and estimated bed number in different regions in Lebanon; estimated hospital risk and non-risk waste generation per tonnes per day for the years 1998 until 2010 and finally sensitivity analysis of estimated generation of hospital risk waste in Lebanon per tonnes per day for the years 1998 until 2010. The management, treatment and disposal of hospital risk waste constitute important environmental and public safety issues. It is recognised that there is alack of infrastructure for the safe and environmentally acceptable disposal of hospital waste in Lebanon

Vigilance-avoidance and disengagement are differentially associated with fear and avoidant behaviors in social anxiety.

Science.gov (United States)

Evans, Travis C; Walukevich, Katherine A; Britton, Jennifer C

2016-07-15

Individuals with Social Anxiety Disorder (SAD) often exhibit preferential attention for social threat, demonstrating abnormal orientation to threat (i.e., vigilance-avoidance) and/or difficulty disengaging from threat. However, no research has compared the relationship between attention indices (i.e., vigilance-avoidance, difficulty disengaging from threat) and characteristic features of the disorder such as fear during social situations (social fear) and avoidant behaviors (social avoidance). To address this issue, seventy adults (19.29±1.47 years, 33 females) were separated into low (n=37) or high (n=33) socially anxious groups using clinical cutoff scores on the Social Interaction Anxiety Scale (SIAS). Participants in both groups completed a dot-probe task with congruent, incongruent, and neutral trials to obtain measures of vigilance-avoidance and difficulty disengaging. Using linear regression, we examined the associations each attention index shared with self-reported social fear and social avoidance. Exclusively in the high anxious group, greater vigilance towards threat was associated with higher self-reported social fear, but not with social avoidance. However, difficulty disengaging was not associated with either social measure. In the low anxiety group, no relationships between attention indices and either social measure emerged. Future research with clinical samples is necessary to replicate and extend these findings. The small sample size studied may have limited our ability to detect other smaller effects. Indices of attention bias may contribute differently to the etiology and maintenance of SAD, which offers important implications for novel treatments that target attention. Copyright © 2016 Elsevier B.V. All rights reserved.

Requiring both avoidance and emotional numbing in DSM-V PTSD: will it help?

Science.gov (United States)

Forbes, David; Fletcher, Susan; Lockwood, Emma; O'Donnell, Meaghan; Creamer, Mark; Bryant, Richard A; McFarlane, Alexander; Silove, Derrick

2011-05-01

The proposed DSM-V criteria for posttraumatic stress disorder (PTSD) specifically require both active avoidance and emotional numbing symptoms for a diagnosis. In DSM-IV, since both are included in the same cluster, active avoidance is not essential. Numbing symptoms overlap with depression, which may result in spurious comorbidity or overdiagnosis of PTSD. This paper investigated the impact of requiring both active avoidance and emotional numbing on the rates of PTSD diagnosis and comorbidity with depression. We investigated PTSD and depression in 835 traumatic injury survivors at 3 and 12 months post-injury. We used the DSM-IV criteria but explored the potential impact of DSM-IV and DSM-V approaches to avoidance and numbing using comparison of proportion analyses. The DSM-V requirement of both active avoidance and emotional numbing resulted in significant reductions in PTSD caseness compared with DSM-IV of 22% and 26% respectively at 3 and 12 months posttrauma. By 12 months, the rates of comorbid PTSD in those with depression were significantly lower (44% vs. 34%) using the new criteria, primarily due to the lack of avoidance symptoms. These preliminary data suggest that requiring both active avoidance and numbing as separate clusters offers a useful refinement of the PTSD diagnosis. Requiring active avoidance may help to define the unique aspects of PTSD and reduce spurious diagnoses of PTSD in those with depression. Copyright © 2010. Published by Elsevier B.V.

Conflict Avoidance in a University Context

Science.gov (United States)

Barsky, Allan E.; Wood, Lorinda

2005-01-01

This ethnographic study explores patterns of conflict avoidance among university students, professors, administrators and staff. Analysis of their narratives of conflict avoidance suggests that avoidance can be beneficial in some circumstances, depending upon personality issues, cost?benefit analysis, power imbalance, type of work, length of…

Predator avoidance in extremophile fish.

Science.gov (United States)

Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin

2013-02-06

Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii) females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre) and the adjacent sulfidic surface creek (El Azufre), we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve) and wild-caught (i.e., predator-experienced) individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1) that predator avoidance is still functional in extremophile Poecilia spp. and (2) that predator recognition and avoidance reactions have a strong genetic basis.

Predator Avoidance in Extremophile Fish

Science.gov (United States)

Bierbach, David; Schulte, Matthias; Herrmann, Nina; Zimmer, Claudia; Arias-Rodriguez, Lenin; Indy, Jeane Rimber; Riesch, Rüdiger; Plath, Martin

2013-01-01

Extreme habitats are often characterized by reduced predation pressures, thus representing refuges for the inhabiting species. The present study was designed to investigate predator avoidance of extremophile populations of Poecilia mexicana and P. sulphuraria that either live in hydrogen sulfide-rich (sulfidic) springs or cave habitats, both of which are known to have impoverished piscine predator regimes. Focal fishes that inhabited sulfidic springs showed slightly weaker avoidance reactions when presented with several naturally occurring predatory cichlids, but strongest differences to populations from non-sulfidic habitats were found in a decreased shoaling tendency with non-predatory swordtail (Xiphophorus hellerii) females. When comparing avoidance reactions between P. mexicana from a sulfidic cave (Cueva del Azufre) and the adjacent sulfidic surface creek (El Azufre), we found only slight differences in predator avoidance, but surface fish reacted much more strongly to the non-predatory cichlid Vieja bifasciata. Our third experiment was designed to disentangle learned from innate effects of predator recognition. We compared laboratory-reared (i.e., predator-naïve) and wild-caught (i.e., predator-experienced) individuals of P. mexicana from a non-sulfidic river and found no differences in their reaction towards the presented predators. Overall, our results indicate (1) that predator avoidance is still functional in extremophile Poecilia spp. and (2) that predator recognition and avoidance reactions have a strong genetic basis. PMID:25371337

The Global Attack on Tax Avoidance

OpenAIRE

Franck, Gustav Grønborg; Runchel, Daniel Theis; Mac, Martin Tuannhien; Ahmed, Jahanzeeb; Bang, Lars Seneca

2015-01-01

The issue of tax avoidance has been subject for recommended regulations by the G20 countries in collaboration with OECD. We examine the usefulness of market failure theory to explain the economic and political issues of tax avoidance. We test our hypothesis using theory through a deductive approach incorporating content analysis to find convergence(s) between tax avoidance methods identified and the efforts of the G20 BEPS action plan to respond to those methods. The issue of tax avoidance...

The success of 6-hour hospital discharge on patients having vaginal repair operations using a new conscious sedation technique.

Science.gov (United States)

Hill, N; Gupta, A; Zakaryan, A; Morey, R

2011-01-01

Anterior and posterior repair are standard surgical techniques for treatment of vaginal prolapse. These procedures are performed traditionally under general anaesthetic or spinal anaesthetic and usually require overnight admission in the hospital. We describe our case series of 40 patients who underwent anterior (18/40), posterior (20/40) or combined repair (2/40) under local anaesthetic and conscious sedation (Remifentanyl). The majority (35/40) were performed in the day-case surgery unit and 95% patients were discharged within 6 hours of the operation, with no complications. All the patients were satisfied with the anaesthetic technique. We concluded that our technique of vaginal repair avoids the risk of general and spinal anaesthetic. The majority of operations can be performed as day cases with good patient satisfaction and without increasing risks to the patients. This technique has potential significant financial saving for the hospitals.

Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.

Science.gov (United States)

Costanzo, Maria Rosa; Negoianu, Daniel; Jaski, Brian E; Bart, Bradley A; Heywood, James T; Anand, Inder S; Smelser, James M; Kaneshige, Alan M; Chomsky, Don B; Adler, Eric D; Haas, Garrie J; Watts, James A; Nabut, Jose L; Schollmeyer, Michael P; Fonarow, Gregg C

2016-02-01

The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD). Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes. The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF. A total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar. Compared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial's untimely termination, additional AUF investigation is warranted. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Hospital law: the changing scene.

Science.gov (United States)

Hirsh, H L

1978-01-01

The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the

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

Science.gov (United States)

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

2017-09-01

Avoidant/restrictive food intake disorder (ARFID) is a recently named condition to classify patients who present with restricted nutritional intake without body image distortion or fear of weight gain. We sought to compare treatment outcomes of patients with ARFID in a family-centered partial hospital program (PHP) to those with other eating disorders (ED). A retrospective chart review of 130 patients 7-17 years of age admitted to the program from 2008 to 2012 was performed. Intake and discharge data included: length of stay; percentage median body mass index (%MBMI); and scores on the Children's Eating Attitudes Test (ChEAT) and Revised Children's Manifest Anxiety Scale (RCMAS). Between and within group effects were measured for intake and discharge data. Patients with ARFID spent significantly fewer weeks in program than those with anorexia nervosa (AN) and experienced a similar increase in %MBMI as patients with AN and other specified/unspecified feeding and eating disorders. All patients exhibited significant improvements in psychopathology over the course of treatment as measured by scores on the ChEAT and RCMAS. Our findings suggest that patients with ARFID can be successfully treated in the same PHP as patients with other ED, with comparable improvements in weight and psychopathology over a shorter time period. Results are limited to patients with ARFID who exhibit an acute onset of severe food restriction. Future research should incorporate measures relevant to the diagnosis of ARFID and explore how patients with different ARFID subtypes may respond to various treatments. © 2017 Wiley Periodicals, Inc.

Major Differences in Advanced Life Support Training Strategies Among Danish Hospitals - A Nationwide Study

DEFF Research Database (Denmark)

Glerup Lauridsen, Kasper; Mygind-Klausen, Troels; Stærk, Mathilde

2017-01-01

Introduction: Advanced life support (ALS) training may increase survival from in-hospital cardiac arrest. Efficient ALS training includes practice of both technical and non-technical skills in a realistic setting with frequent retraining to avoid decay in ALS skills. ALS training strategies among...... hospitals are currently unknown. This study aimed to investigate ALS training strategies in Danish hospitals.Methods: We included all public, somatic hospitals in Denmark with a cardiac arrest team (n=46). Online questionnaires were distributed to resuscitation officers in each hospital. Questionnaires...... inquired information on: A) Course duration and retraining interval, B) Training methods and setting, C) Scenario training and practicing non-technical skills.Results: In total, 44 hospitals replied (response rate: 96%). ALS training was conducted in 43 hospitals (98%). Median (range) ALS course duration...

Avoidance tests with Folsomia candida for the assessment of copper contamination in agricultural soils

International Nuclear Information System (INIS)

Boiteau, G.; Lynch, D.H.; MacKinley, P.

2011-01-01

The feasibility of assessing copper accumulation in agricultural soils using avoidance tests with a Canadian strain of Folsomia candida was investigated under laboratory conditions. The avoidance response to nominal copper sulfate concentrations of 0, 200, 800, 1600 and 3200 mg kg -1 in OECD soil was inconsistent between trials with the standard plastic cup or a modified Petri dish method requiring less soil. However, combined results from three Petri dish trials decreased variability and provided a 75% avoidance level, close to the 80% criterion proposed for avoidance tests. A Copper avoidance EC 50s of 18 mg kg -1 was obtained using the Petri dish method whether tests were conducted with or without light. While Petri dish tests have potential as a cheap tool to distinguish metal contaminated soils from uncontaminated soils they would be unsuitable for tracking or quantifying changes in metal concentrations. throughout remediation. Advantages and limitations of the method have been presented. - Research highlights: → Avoidance cup test using Folsomia candida detects Cu independently of concentration. → Improved avoidance Petri dish test detects Cu in soil in function of concentration. → Cu voidance tests had similar EC50 values whether conducted with or without light. → Combining Cu avoidance test trials in OECD soil reduced the variability of results. - Improved avoidance tests having an EC 50 value similar to the background Cu concentration in uncontaminated agricultural soils can distinguish Cu contaminated and Cu free OECD soil.

Unravelling the potential mechanisms behind hospitalization-associated disability in older patients : the hospital-associated disability and impact on daily Life (Hospital-ADL) cohort study protocol

NARCIS (Netherlands)

Reichardt, Lucienne A.; Aarden, Jesse J.; van Seben, Rosanne; van der Schaaf, Marike; Engelbert, Raoul H.H.; Bosch, Jos A.; Buurman, Bianca M.

2016-01-01

BACKGROUND: Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the

Unravelling the potential mechanisms behind hospitalization-associated disability in older patients : The Hospital-Associated Disability and impact on daily Life (Hospital-ADL) cohort study protocol

NARCIS (Netherlands)

Reichardt, L.A.; Aarden, J.J.; van Seben, R.; van der Schaaf, M.; Engelbert, R.H.H.; Bosch, J.A.; Buurman, B.M.

2016-01-01

BACKGROUND: Over 30 % of older patients experience hospitalization-associated disability (HAD) (i.e., loss of independence in Activities of Daily Living (ADLs)) after an acute hospitalization. Despite its high prevalence, the mechanisms that underlie HAD remain elusive. This paper describes the

Earthworm avoidance of silver nanomaterials over time

DEFF Research Database (Denmark)

Mariyadas, Jennifer; Amorim, Mónica J B; Jensen, John

2018-01-01

Avoidance behaviour offers a highly relevant information as it reveals the ability to avoid (or not) possible toxic compounds in the field, hence it provides information on reasons for the presence/absence in the field. The earthworm Eisenia fetida was used to study avoidance behaviour to four si...... exposure durations and showed a continuous higher avoidance with time (based on EC50 values). The AgNMs avoidance was in the order NM300Ksoil solution fraction that correlated with EC50 across materials....

Terrestrial avoidance behaviour tests as screening tool to assess soil contamination

International Nuclear Information System (INIS)

Loureiro, Susana; Soares, Amadeu M.V.M.; Nogueira, Antonio J.A.

2005-01-01

To assess soil quality and risk assessment, bioassays can be useful tools to gauge the potential toxicity of contaminants focusing on their bioavailable fraction. A rapid and sublethal avoidance behaviour test was used as a screening tool with the earthworm Eisenia andrei and the isopod Porcellionides pruinosus, where organisms were exposed during 48 h to several chemicals (lindane, dimethoate and copper sulphate, for isopods and carbendazim, benomyl, dimethoate and copper sulphate for earthworms). Both species were also exposed to soils from an abandoned mine. For all bioassays a statistical approach was used to derive EC 50 values. Isopods and earthworms were able to perceive the presence of toxic compounds and escaping from contaminated to clean soil. Furthermore the behaviour parameter was equally or more sensitive then other sublethal parameters (e.g. reproduction or growth), expressing the advantages of Avoidance Behaviour Tests as screening tools in ERA. - Avoidance Behaviour Tests with earthworms and isopods can be used as screening tools in the evaluation of soil contamination

Obstacle avoidance in persons with rheumatoid arthritis walking on a treadmill.

NARCIS (Netherlands)

Smulders, E.; Schreven, C.; Lankveld, W.G.J.M. van; Duysens, J.E.J.; Weerdesteijn, V.G.M.

2009-01-01

OBJECTIVE:Patients with rheumatoid arthritis (RA) are at increased risk of falling. In healthy elderly persons with a history of falling, a reduced ability to avoid obstacles while walking has been shown to relate to increased fall risk. The aim of this study was to determine whether this potential

Towards the collaborative hospital - harnessing the potential of enabling care processes and structures

DEFF Research Database (Denmark)

Prætorious, Thim; Hasle, Peter; Edwards, Kasper

2015-01-01

Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept for the collaborat......Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept...... of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...

Hospital diversification strategy.

Science.gov (United States)

Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Activation of β-adrenoceptor facilitates active avoidance learning through enhancement of glutamate levels in the hippocampal dentate gyrus.

Science.gov (United States)

Lv, Jing; Feng, Hao; Chen, Ling; Wang, Wei-Yao; Yue, Xue-Ling; Jin, Qing-Hua

2017-10-18

Long-term potentiation (LTP) is widely accepted as the best studied model for neurophysiological mechanisms that could underlie learning and memory formation. Despite a number of studies indicating that β-adrenoceptors in the hippocampal dentate gyrus (DG) is involved in the modulation of learning and memory as well as LTP, few studies have used glutamate release as a visual indicator in awake animals to explore the role of β-adrenoceptors in learning-dependent LTP. Therefore, in the present study, the effects of propranolol (an antagonist of β-adrenoceptor) and isoproterenol (an agonist of β-adrenoceptor) on extracellular concentrations of glutamate and amplitudes of field excitatory postsynaptic potential were measured in the DG region during active avoidance learning in freely moving conscious rats. In the control group, the glutamate level in the DG was significantly increased during the acquisition of active avoidance behavior and returned to basal level following extinction training. In propranolol group, antagonism of β-adrenoceptors in the DG significantly reduced the change in glutamate level, and the acquisition of the active avoidance behavior was significantly inhibited. In contrast, the change in glutamate level was significantly enhanced by isoproterenol, and the acquisition of the active avoidance behavior was significantly accelerated. Furthermore, in all groups, the changes in glutamate level were accompanied by corresponding changes in field excitatory postsynaptic potential amplitude and active avoidance behavior. Our results suggest that activation of β-adrenoceptors in the hippocampal DG facilitates active avoidance learning by modulations of glutamate level and synaptic efficiency in rats.

Benefits negotiation: three Swedish hospitals pursuit of potential electronic health record benefits.

Science.gov (United States)

Jeansson, John S

2013-01-01

At the very heart of Swedish healthcare digitalisation are large investments in electronic health records (EHRs). These integrated information systems (ISs) carry promises of great benefits and value for organisations. However, realising IS benefits and value has, in general, proven to be a challenging task, and as organisations strive to formalise their realisation efforts a misconception of rationality threatens to emerge. This misconception manifests itself when the formality of analysis threatens to underrate the impact of social processes in deciding which potential benefits to pursue. This paper suggests that these decisions are the result of a social process of negotiation. The purpose of this paper is to observe three benefits analysis projects of three Swedish hospitals to better understand the character and management of proposed benefits negotiations. Findings depict several different categories of benefits negotiations, as well as key factors to consider during the benefits negotiation process.

ITI-signals and prelimbic cortex facilitate avoidance acquisition and reduce avoidance latencies, respectively, in male WKY rats

Directory of Open Access Journals (Sweden)

Kevin D Beck

2014-11-01

Full Text Available As a model of anxiety disorder vulnerability, male Wistar-Kyoto (WKY rats acquire lever-press avoidance behavior more readily than outbred Sprague Dawley rats, and their acquisition is enhanced by the presence of a discrete signal presented during the inter-trial intervals (ITIs, suggesting it is perceived as a safety signal. A series of experiments were conducted to determine if this is the case. Additional experiments investigated if the avoidance facilitation relies upon processing through medial prefrontal cortex (mPFC. The results suggest that the ITI-signal facilitates acquisition during the early stages of the avoidance acquisition process, when the rats are initially acquiring escape behavior and then transitioning to avoidance behavior. Post-avoidance introduction of the visual ITI-signal into other associative learning tasks failed to confirm that the visual stimulus had acquired the properties of a conditioned inhibitor. Shortening the signal from the entirety of the 3 min ITI to only the first 5 s of the 3 min ITI slowed acquisition during the first 4 sessions, suggesting the flashing light is not functioning as a feedback signal. The prelimbic (PL cortex showed greater activation during the period of training when the transition from escape responding to avoidance responding occurs. Only combined PL+infralimbic cortex lesions modestly slowed avoidance acquisition, but PL cortex lesions slowed avoidance response latencies. Thus, the flashing light ITI-signal is not likely perceived as a safety signal nor is it serving as a feedback signal. The functional role of the PL cortex appears to be to increase the drive towards responding to the threat of the warning signal. Hence, avoidance susceptibility displayed by male WKY rats may be driven, in part, both by external stimuli (ITI signal as well as by enhanced threat recognition to the warning signal via the PL cortex.

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.

Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

Science.gov (United States)

Ahn, Henry; Singh, Jeffrey; Nathens, Avery; MacDonald, Russell D.; Travers, Andrew; Tallon, John; Fehlings, Michael G.

2011-01-01

Abstract An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients

Collision avoidance in robotic environments

International Nuclear Information System (INIS)

Kreifeldt, J.G.

1984-01-01

A generalized approach to the problem of collision avoidance in robotic environments is presented. This approach transforms the three dimensional but dynamic real-world changing geometric space of the robot in its environment into a multidimensional but static space such that any possible geometric arrangement of the robotic space becomes a point in hyperspace. Major advantages of this approach include clarification of and potential solution to the basic problem of finding optimized, collision free movements from an initial to a final configuration. A major disadvantage of the approach is related to computational and data storage problems. However these latter are technically solvable while the clarification of the control and guidance problem gained through the transformational approach and its general elucidation power remain prime conceptual tools for the problem of robot design and operation

Integration of Weather Avoidance and Traffic Separation

Science.gov (United States)

Consiglio, Maria C.; Chamberlain, James P.; Wilson, Sara R.

2011-01-01

This paper describes a dynamic convective weather avoidance concept that compensates for weather motion uncertainties; the integration of this weather avoidance concept into a prototype 4-D trajectory-based Airborne Separation Assurance System (ASAS) application; and test results from a batch (non-piloted) simulation of the integrated application with high traffic densities and a dynamic convective weather model. The weather model can simulate a number of pseudo-random hazardous weather patterns, such as slow- or fast-moving cells and opening or closing weather gaps, and also allows for modeling of onboard weather radar limitations in range and azimuth. The weather avoidance concept employs nested "core" and "avoid" polygons around convective weather cells, and the simulations assess the effectiveness of various avoid polygon sizes in the presence of different weather patterns, using traffic scenarios representing approximately two times the current traffic density in en-route airspace. Results from the simulation experiment show that the weather avoidance concept is effective over a wide range of weather patterns and cell speeds. Avoid polygons that are only 2-3 miles larger than their core polygons are sufficient to account for weather uncertainties in almost all cases, and traffic separation performance does not appear to degrade with the addition of weather polygon avoidance. Additional "lessons learned" from the batch simulation study are discussed in the paper, along with insights for improving the weather avoidance concept. Introduction

Avoided intersections of nodal lines

International Nuclear Information System (INIS)

Monastra, Alejandro G; Smilansky, Uzy; Gnutzmann, Sven

2003-01-01

We consider real eigenfunctions of the Schroedinger operator in 2D. The nodal lines of separable systems form a regular grid, and the number of nodal crossings equals the number of nodal domains. In contrast, for wavefunctions of non-integrable systems nodal intersections are rare, and for random waves, the expected number of intersections in any finite area vanishes. However, nodal lines display characteristic avoided crossings which we study in this work. We define a measure for the avoidance range and compute its distribution for the random wave ensemble. We show that the avoidance range distribution of wavefunctions of chaotic systems follows the expected random wave distributions, whereas for wavefunctions of classically integrable but quantum non-separable systems, the distribution is quite different. Thus, the study of the avoidance distribution provides more support to the conjecture that nodal structures of chaotic systems are reproduced by the predictions of the random wave ensemble

Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways.

Science.gov (United States)

Walsh, Bronagh; Lattimer, Valerie; Wintrup, Julie; Brailsford, Sally

2015-06-01

There is debate worldwide about the best way to manage increased healthcare demand within ageing populations, particularly rising rates of unplanned and avoidable hospital admissions. To understand health and social care professionals' perspectives on barriers to admission avoidance throughout the admissions journey, in particular: the causes of avoidable admissions in older people; drivers of admission and barriers to use of admission avoidance strategies; and improvements to reduce unnecessary admissions. A qualitative framework analysis of interview data from a System dynamics (SD) modelling study. Semi-structured interviews were conducted with twenty health and social care professionals with experience of older people's admissions. The interviews were used to build understanding of factors facilitating or hindering admission avoidance across the admissions system. Data were analysed using framework analysis. Three overarching themes emerged: understanding the needs of the patient group; understanding the whole system; and systemwide access to expertise in care of older people. There were diverse views on the underlying reasons for avoidable admissions and recognition of the need for whole-system approaches to service redesign. Participants recommended system redesign that recognises the specific needs of older people, but there was no consensus on underlying patient needs or specific service developments. Access to expertise in management of older and frailer patients was seen as a barrier to admission avoidance throughout the system. Providing access to expertise and leadership in care of frail older people across the admissions system presents a challenge for service managers and nurse educators but is seen as a prerequisite for effective admission avoidance. System redesign to meet the needs of frail older people requires agreement on causes of avoidable admission and underlying patient needs. © 2014 John Wiley & Sons Ltd.

Shut your eyes and think of something else: self-esteem and avoidance when dealing with counter-attitudinal information

NARCIS (Netherlands)

Wiersema, D.V.; van Harreveld, F.; van der Pligt, J.

2012-01-01

Two studies investigated the hypothesis that people with low self-esteem are more inclined to avoid information that is incongruent with value-relevant attitudes than people with higher levels of self-esteem. In Study 1 participants had the opportunity to postpone and potentially avoid reading a

Drug-drug Interactions of Statins Potentially Leading to Muscle-Related Side Effects in Hospitalized Patients.

Science.gov (United States)

Bucsa, Camelia; Farcas, Andreea; Leucuta, D; Mogosan, Cristina; Bojita, M; Dumitrascu, D L

2015-01-01

The associations of drugs that may interact with the statins resulting in elevated serum concentration of the statins are an important risk factor for statin induced muscle disorders. We aimed to determine the prevalence of these associations in all hospitalized patients that had been prescribed statins before/during hospitalization and to find out how often they are associated with muscle-related side effects. This prospective, non-interventional study performed in two internal medicine departments included patients with statin therapy before/during hospitalization. Data on each patient demographic characteristics, co-morbidities and treatment was collected from medical charts and interviews. We evaluated patients' therapy for the targeted associations using Thomson Micromedex Drug Interactions checker and we ranked the identified drug-drug interactions (DDIs) accordingly. Each patient with statin treatment before admission was additionally interviewed in order to identify muscular symptoms. In 109 patients on statin treatment we found 35 potential (p) DDIs of statins in 30 (27.5%) patients, most of which were in the therapy before admission (27 pDDIs). The pDDIs were moderate (20 pDDIs) and major (15 pDDIs). Of the total number of pDDIs, 24 were targeting the muscular system. The drugs most frequently involved in the statins' pDDIs were amiodarone and fenofibrate. Two of the patients with pDDIs reported muscle pain, both having additional risk factors for statin induced muscular effects. The prevalence of statins' pDDIs was high in our study, mostly in the therapy before admission, with only a small number of pDDIs resulting in clinical outcome.

Smoking during pregnancy and hospitalization of the child

DEFF Research Database (Denmark)

Wisborg, Kirsten; Henriksen, Tine Brink; Obel, Carsten

1999-01-01

with children whose mothers did not smoke during pregnancy, children with mothers who smoked 1 to 14 cigarettes per day had no increased risk of being hospitalized (relative risk: 1.1; 95% confidence interval: 0.8-1.5), whereas children whose mothers smoked 15 or more cigarettes per day had twice as high a risk...... of the child persisted after adjustment for postpartum smoking habits and a number of socio-demographic and lifestyle factors. CONCLUSIONS: Smoking 15 or more cigarettes per day during pregnancy influenced the health of the children, and several points indicated that the effect of in utero exposure...... was independent of postpartum smoking habits. If all pregnant women smoking 15 or more cigarettes per day stopped smoking, approximately 5% of all admissions to hospitals before 8 months of age could be avoided. smoking during pregnancy, hospitalization of children. Udgivelsesdato: 1999-Oct...

Conflict Avoidance and University Management.

Science.gov (United States)

Tagliacozzo, Daisy M.

The conditions that intensify conflict avoidance by the central administration in making strategic decisions, and the consequences of such avoidance for the management of college affairs, are discussed. The implication of an emerging decision-making style for adapting the organization to changing environments is also considered. Some of the…

A predictive analytics approach to reducing 30-day avoidable readmissions among patients with heart failure, acute myocardial infarction, pneumonia, or COPD.

Science.gov (United States)

Shams, Issac; Ajorlou, Saeede; Yang, Kai

2015-03-01

Hospital readmission has become a critical metric of quality and cost of healthcare. Medicare anticipates that nearly $17 billion is paid out on the 20 % of patients who are readmitted within 30 days of discharge. Although several interventions such as transition care management have been practiced in recent years, the effectiveness and sustainability depends on how well they can identify patients at high risk of rehospitalization. Based on the literature, most current risk prediction models fail to reach an acceptable accuracy level; none of them considers patient's history of readmission and impacts of patient attribute changes over time; and they often do not discriminate between planned and unnecessary readmissions. Tackling such drawbacks, we develop a new readmission metric based on administrative data that can identify potentially avoidable readmissions from all other types of readmission. We further propose a tree-based classification method to estimate the predicted probability of readmission that can directly incorporate patient's history of readmission and risk factors changes over time. The proposed methods are validated with 2011-12 Veterans Health Administration data from inpatients hospitalized for heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease in the State of Michigan. Results shows improved discrimination power compared to the literature (c-statistics >80 %) and good calibration.

Avoiding the Conflict: Metacognitive Awareness Drives the Selection of Low-Demand Contexts

NARCIS (Netherlands)

Desender, K.; Buc Calderon, C.; Van Opstal, F.; Van den Bussche, E.

2017-01-01

Previous research attempted to explain how humans strategically adapt behavior in order to achieve successful task performance. Recently, it has been suggested that 1 potential strategy is to avoid tasks that are too demanding. Here, we report 3 experiments that investigate the empirically neglected

Interspecialty communication supported by health information technology associated with lower hospitalization rates for ambulatory care-sensitive conditions.

Science.gov (United States)

O'Malley, Ann S; Reschovsky, James D; Saiontz-Martinez, Cynthia

2015-01-01

Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for "ambulatory care-sensitive conditions" (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care-sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change's Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care-sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians' practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care-sensitive hospitalizations for one or more of these 4 conditions. Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the

Causes of mortality and associated modifiable health care factors for children (< 5-years admitted at Onandjokwe Hospital, Namibia

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Johnface F. Mdala

2015-06-01

Full Text Available Introduction: Many countries, especially those from sub-Saharan Africa, are unlikely to reach the Millennium Development Goal for under-5 mortality reduction by 2015. This study aimed to identify the causes of mortality and associated modifiable health care factors for under-5year-old children admitted to Onandjokwe Hospital, Namibia. Method: A descriptive retrospective review of the medical records of all children under fiveyears who died in the hospital for the period of 12 months during 2013, using two differentstructured questionnaires targeting perinatal deaths and post-perinatal deaths respectively. Results: The top five causes of 125 perinatal deaths were prematurity 22 (17.6%, birth asphyxia 19 (15.2%, congenital anomalies 16 (12.8%, unknown 13 (10.4% and abruptio placenta 11 (8.8%. The top five causes of 60 post-perinatal deaths were bacterial pneumonia 21 (35%, gastroenteritis 12 (20%, severe malnutrition 6 (10%, septicaemia 6 (10%, and tuberculosis 4 (6.7%. Sixty-nine (55% perinatal deaths and 42 (70% post-perinatal deaths were potentially avoidable. The modifiable factors were: late presentation to a health care facility, antenatal clinics not screening for danger signs, long distance referral, district hospitals not providing emergency obstetric care, poor monitoring of labour and admitted children in the wards, lack of screening for malnutrition, failure to repeat an HIV test in pregnant women in the third trimesteror during breastfeeding, and a lack of review of the urgent results of critically ill children. Conclusion: A significant number of deaths in children under 5-years of age could be avoided by paying attention to the modifiable factors identified in this study.

Reconstruction of fingertip injuries: surgical tips and avoiding complications.

Science.gov (United States)

Panattoni, Joao B; De Ona, Ignacio Roger; Ahmed, Mohammed M

2015-05-01

The fingertip is the most commonly injured part of the hand. When replantation of a fingertip amputation is not possible, flap reconstruction may be necessary for a functional and aesthetically pleasing outcome. This paper reviews commonly utilized reconstruction techniques with a focus on technical tricks and potential complications and how to avoid them, with illustrative cases. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

HIV-Related Stigma, Shame, and Avoidant Coping: Risk Factors for Internalizing Symptoms Among Youth Living with HIV?

Science.gov (United States)

Bennett, David S; Hersh, Jill; Herres, Joanna; Foster, Jill

2016-08-01

Youth living with HIV (YLH) are at elevated risk of internalizing symptoms, although there is substantial individual variability in adjustment. We examined perceived HIV-related stigma, shame-proneness, and avoidant coping as risk factors of internalizing symptoms among YLH. Participants (N = 88; ages 12-24) completed self-report measures of these potential risk factors and three domains of internalizing symptoms (depressive, anxiety, and PTSD) during a regularly scheduled HIV clinic visit. Hierarchical regressions were conducted for each internalizing symptoms domain, examining the effects of age, gender, and maternal education (step 1), HIV-related stigma (step 2), shame- and guilt-proneness (step 3), and avoidant coping (step 4). HIV-related stigma, shame-proneness, and avoidant coping were each correlated with greater depressive, anxiety, and PTSD symptoms. Specificity was observed in that shame-proneness, but not guilt-proneness, was associated with greater internalizing symptoms. In multivariable analyses, HIV-related stigma and shame-proneness were each related to greater depressive and PTSD symptoms. Controlling for the effects of HIV-related stigma and shame-proneness, avoidant coping was associated with PTSD symptoms. The current findings highlight the potential importance of HIV-related stigma, shame, and avoidant coping on the adjustment of YLH, as interventions addressing these risk factors could lead to decreased internalizing symptoms among YLH.

Population avoidance in aimpoint selection

International Nuclear Information System (INIS)

Andre, C.G.

1978-01-01

In most past studies of the effectiveness of tactical nuclear weapons vs the amount of collateral damage produced (civilian casualties), civilians have been congregated into idealized shaped towns and cities, and criteria for city avoidance were usually formulated in terms relating to a town's population. This treatment was sufficient in those studies where weapon yields were so large that great numbers of civilians were almost always placed at risk. As further studies developed, demonstrating that real progress could be made in reducing the numbers of civilians potentially placed at risk in tactical nuclear warfare situations, the inadequacies of the present treatment became obvious. The need existed for a more detailed description of the distribution of civilians. The method described determines the number of civilians at risk for a weapon under consideration being detonated at a given point and displays a symbol relating to the numbers at risk on a map or a transparency that overlays a 1:50,000 map of the region. Thus, a weapons planner making the selection of aimpoints for inflicting the necessary military damage required has the means to reduce potential civilian casualties by properly choosing the weapon and aimpoints

Tax Avoidance, Welfare Transfers, and Asset Prices

OpenAIRE

Denis Gorea

2013-01-01

Does tax avoidance have any implications for financial markets? This paper quantifies the general equilibrium implications of tax avoidance by setting up an incomplete markets production economy model in which households pay capital gains taxes and have access to tax avoidance technologies provided by financial institutions. I find that changes in the level of tax avoidance have disproportionate effects on different groups of agents and generally benefit the old, wealthy and high income house...

Integrating new practices: a qualitative study of how hospital innovations become routine.

Science.gov (United States)

Brewster, Amanda L; Curry, Leslie A; Cherlin, Emily J; Talbert-Slagle, Kristina; Horwitz, Leora I; Bradley, Elizabeth H

2015-12-05

Hospital quality improvement efforts absorb substantial time and resources, but many innovations fail to integrate into organizational routines, undermining the potential to sustain the new practices. Despite a well-developed literature on the initial implementation of new practices, we have limited knowledge about the mechanisms by which integration occurs. We conducted a qualitative study using a purposive sample of hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, a collaborative to reduce hospital readmissions that encouraged members to adopt new practices. We selected hospitals where risk-standardized readmission rates (RSRR) had improved (n = 7) or deteriorated (n = 3) over the course of the first 2 years of the STAAR initiative (2010-2011 to 2011-2012) and interviewed a range of staff at each site (90 total). We recruited hospitals until reaching theoretical saturation. The constant comparative method was used to conduct coding and identification of key themes. When innovations were successfully integrated, participants consistently reported that a small number of key staff held the innovation in place for as long as a year while more permanent integrating mechanisms began to work. Depending on characteristics of the innovation, one of three categories of integrating mechanisms eventually took over the role of holding new practices in place. Innovations that proved intrinsically rewarding to the staff, by making their jobs easier or more gratifying, became integrated through shifts in attitudes and norms over time. Innovations for which the staff did not perceive benefits to themselves were integrated through revised performance standards if the innovation involved complex tasks and through automation if the innovation involved simple tasks. Hospitals have an opportunity to promote the integration of new practices by planning for the extended effort required to hold a new practice in place while

Is There a Relationship Between Value-Based Purchasing and Hospital Profitability? An Exploratory Study of Missouri Hospitals.

Science.gov (United States)

Turner, Jason S; Broom, Kevin D; Counte, Michael A

2015-01-01

Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program.

Changing implicit attitudes toward smoking: results from a web-based approach-avoidance practice intervention.

Science.gov (United States)

Macy, Jonathan T; Chassin, Laurie; Presson, Clark C; Sherman, Jeffrey W

2015-02-01

Implicit attitudes have been shown to predict smoking behaviors. Therefore, an important goal is the development of interventions to change these attitudes. This study assessed the effects of a web-based intervention on implicit attitudes toward smoking and receptivity to smoking-related information. Smokers (N = 284) were recruited to a two-session web-based study. In the first session, baseline data were collected. Session two contained the intervention, which consisted of assignment to the experimental or control version of an approach-avoidance task and assignment to an anti-smoking or control public service announcement (PSA), and post-intervention measures. Among smokers with less education and with plans to quit, implicit attitudes were more negative for those who completed the approach-avoidance task. Smokers with more education who viewed the anti-smoking PSA and completed the approach-avoidance task spent more time reading smoking-related information. An approach-avoidance task is a potentially feasible strategy for changing implicit attitudes toward smoking and increasing receptivity to smoking-related information.

The effect of pyrazine odor on avoidance learning and memory in wild robins Erithacus rubecula

Directory of Open Access Journals (Sweden)

Emma C. SIDDALL, Nicola M. MARPLES

2011-04-01

Full Text Available Toxic insects advertise their defended state to potential predators using warning displays. Frequently these displays use cues through more than one sensory modality, and combine color, smell and sound to produce a multimodal warning display. Signalling through more than one sensory pathway may enhance the rate of avoidance learning, and the memorability of the learned avoidance. A common insect warning odor, pyrazine, has previously been shown to increase the rate of learned avoidance of unpalatable yellow prey by domestic chicks (Gallus gallus domesticus, and the odor also improved memory of this learned avoidance. However, to date no research has examined this response to pyrazine odor using wild birds under natural conditions. This study used wild robins (Erithacus rubecula to investigate whether wild birds avoided yellow baits that smelled of pyrazine more strongly than those presented with no odor. The results provide some evidence that pyrazine odor does increase the level of protection an aposematic insect gains from a wild avian predator, but that the effect of pyrazine on learned avoidance was much weaker than was found with domestic chicks [Current Zoology 57 (2: 208–214, 2011].

Landslide disaster avoidance: learning from Leyte

Science.gov (United States)

Davies, T. R.

2006-12-01

On 17 February 2006 a gigantic rockslide triggered a debris avalanche that overran the barangay Guinsaugon, St. Bernard in Southern Leyte Province, Philippines, burying 154 victims, with 990 missing including 246 school children. Even with satellite imagery, GIS-based landslide susceptibility modelling and real-time meteorological and seismic data analysis, scientific prediction of every potentially fatal landslide is not possible in most parts of the world. This is particular the case in steep, unstable, densely-populated country in which heavy rain is common. So how can further events of this type be prevented from turning into disasters? A number of precursory phenomena were noted by local inhabitants at Guinsaugon: a crack around the slope that failed was noticed in May 2005; coconut trees near the northern foot of the landslide scarp began to lean increasingly in the down-slope direction in December 2005; a slope around the northern edge of the 17 February 2006 landslide scarp failed on December 17, 2005; in the 9 days prior to the rockslide, 640 mm of rain fell; 450 mm in a 3-day period. Such phenomena are commonly reported by local inhabitants before large landslides (e.g. Elm, Mayunmarca, and many others). In many cases, therefore, it is in principle possible for local people to avoid the consequences of the landslide if they know enough to act appropriately in response to the precursory phenomena. For this possibility to be realized, appropriate information must be provided to and assimilated by the local population. Useful ways of achieving this include pamphlets, video, TV and radio programs and visits from civil defence personnel. The information must be properly presented; scientific language will be ineffective. A communication pyramid, leading from government agencies to local leaders, can facilitate the rapid availability of the information to all potentially susceptible communities. If science can determine those areas not vulnerable to landslide

Hazard avoidance via descent images for safe landing

Science.gov (United States)

Yan, Ruicheng; Cao, Zhiguo; Zhu, Lei; Fang, Zhiwen

2013-10-01

In planetary or lunar landing missions, hazard avoidance is critical for landing safety. Therefore, it is very important to correctly detect hazards and effectively find a safe landing area during the last stage of descent. In this paper, we propose a passive sensing based HDA (hazard detection and avoidance) approach via descent images to lower the landing risk. In hazard detection stage, a statistical probability model on the basis of the hazard similarity is adopted to evaluate the image and detect hazardous areas, so that a binary hazard image can be generated. Afterwards, a safety coefficient, which jointly utilized the proportion of hazards in the local region and the inside hazard distribution, is proposed to find potential regions with less hazards in the binary hazard image. By using the safety coefficient in a coarse-to-fine procedure and combining it with the local ISD (intensity standard deviation) measure, the safe landing area is determined. The algorithm is evaluated and verified with many simulated descent downward looking images rendered from lunar orbital satellite images.

Inadequate Nutritional Status of Hospitalized Cancer Patients

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Ali Alkan

2017-03-01

Full Text Available Objective: In oncology practice, nutrition and also metabolic activity are essential to support the nutritional status and prevent malignant cachexia. It is important to evaluate the patients and plan the maneuvers at the start of the therapy. The primary objective of the study is to define the nutritional status of hospitalized patients and the factors affecting it in order to define the most susceptible patients and maneuvers for better nutritional support. Methods: Patients hospitalized in oncology clinic for therapy were evaluated for food intake and nutritional status through structured interviews. The clinical properties, medical therapies, elements of nutritional support were noted and predictors of inadequate nutritional status (INS were analyzed. Results: Four hundred twenty three patients, between 16-82 years old (median: 52 were evaluated. Nearly half of the patients (185, 43% reported a better appetite at home than in hospital and declared that hospitalization is an important cause of loss of appetite (140/185, 75.6%. Presence of nausea/vomiting (N/V, depression, age less than 65 and use of non-steroidal anti-inflammatory drugs (NSAIDs were associated with increased risk of INS in hospitalized cancer patients. On the contrary, steroid medication showed a positive impact on nutritional status of cancer patients. Conclusion: N/V, younger age, presence of depression and NSAIDs medication were associated with INS in hospitalized cancer patients. Clinicians should pay more attention to this group of patients. In addition, unnecessary hospitalizations and medications that may disturb oral intake must be avoided. Corticosteroids are important tools for managing anorexia and INS.

HOSPITALIZATIONS DUE TO RESPIRATORY PROBLEMS DURING DIWALI FESTIVAL IN A TERTIARY CARE HOSPITAL IN SOUTH INDIA

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Raghu

2016-02-01

Full Text Available BACKGROUND The burning of firecrackers during Diwali festival produces an adverse respiratory outcome. However, there are no published articles on the impact of fireworks on hospital admission due to acute respiratory issues, hospital stay, and respiratory mortality during Diwali in India. MATERIALS AND METHODS This was a prospective, open label, observational study. It was conducted in patients admitted to the pulmonary emergency unit with respiratory symptoms 15 days before and after Diwali. It was conducted after the approval of ethics committee and written informed consent. RESULTS The number of admissions post-Diwali were significantly more compared to pre-Diwali from both rural and urban locations (p<0.001. The mean duration of hospital stay was significantly less pre-Diwali (7.59±0.74 days compared to post-Diwali (9.46±0.44 days. Also, significantly increased number of patients required ventilator support post Diwali. CONCLUSION The findings from the present study validate the deterioration of respiratory health during Diwali festival in India. There should be more awareness campaigns about the harmful effects of fire-crackers. Patients suffering from respiratory problems should be advised to avoid heavy exposure to fireworks

Præhospital ultralyd

DEFF Research Database (Denmark)

Rognås, Leif Kåre; Christensen, Erika Frischknecht; Sloth, Erik

2009-01-01

Danish anaesthesiologists use ultrasound (US) to examine and treat acutely ill or traumatized patients in the emergency room, operating theatre and intensive care unit. They are also involved in pre-hospital care where US may theoretically be beneficial for both diagnostic and therapeutic purpose....... The literature concerning the potential use of emergency US in the pre-hospital setting is evaluated. Evidence from both Europe and the USA indicates that pre-hospital US improves diagnosis and visitation of acutely ill or traumatized patients. Udgivelsesdato: 2009-Aug-31...

Simulation of Pedestrian Behavior in the Collision-Avoidance Process considering Their Moving Preferences

Directory of Open Access Journals (Sweden)

Zhilu Yuan

2017-01-01

Full Text Available Walking habits can affect the self-organizing movement in pedestrian flow. In China, pedestrians prefer to walk along the right-hand side in the collision-avoidance process, and the same is true for the left-hand preference that is followed in several countries. Through experiments with pedestrian flow, we find that the relative position between pedestrians can affect their moving preferences. We propose a kind of collision-avoidance force based on the social force model, which considers the predictions of potential conflict and the relative position between pedestrians. In the simulation, we use the improved model to explore the effect of moving preference on the collision-avoidance process and self-organizing pedestrian movement. We conclude that the improved model can bring the simulation closer to reality and that moving preference is conducive to the self-adjustment of counterflow.

A New Paradigm for Evaluating Avoidance/Escape Motivation.

Science.gov (United States)

Tsutsui-Kimura, Iku; Bouchekioua, Youcef; Mimura, Masaru; Tanaka, Kenji F

2017-07-01

Organisms have evolved to approach pleasurable opportunities and to avoid or escape from aversive experiences. These 2 distinct motivations are referred to as approach and avoidance/escape motivations and are both considered vital for survival. Despite several recent advances in understanding the neurobiology of motivation, most studies addressed approach but not avoidance/escape motivation. Here we develop a new experimental paradigm to quantify avoidance/escape motivation and examine the pharmacological validity. We set up an avoidance variable ratio 5 task in which mice were required to press a lever for variable times to avoid an upcoming aversive stimulus (foot shock) or to escape the ongoing aversive event if they failed to avoid it. We i.p. injected ketamine (0, 1, or 5 mg/kg) or buspirone (0, 5, or 10 mg/kg) 20 or 30 minutes before the behavioral task to see if ketamine enhanced avoidance/escape behavior and buspirone diminished it as previously reported. We found that the performance on the avoidance variable ratio 5 task was sensitive to the intensity of the aversive stimulus. Treatment with ketamine increased while that with buspirone decreased the probability of avoidance from an aversive stimulus in the variable ratio 5 task, being consistent with previous reports. Our new paradigm will prove useful for quantifying avoidance/escape motivation and will contribute to a more comprehensive understanding of motivation. © The Author 2017. Published by Oxford University Press on behalf of CINP.

Recurrent, robust and scalable patterns underlie human approach and avoidance.

Directory of Open Access Journals (Sweden)

Byoung Woo Kim

2010-05-01

Full Text Available Approach and avoidance behavior provide a means for assessing the rewarding or aversive value of stimuli, and can be quantified by a keypress procedure whereby subjects work to increase (approach, decrease (avoid, or do nothing about time of exposure to a rewarding/aversive stimulus. To investigate whether approach/avoidance behavior might be governed by quantitative principles that meet engineering criteria for lawfulness and that encode known features of reward/aversion function, we evaluated whether keypress responses toward pictures with potential motivational value produced any regular patterns, such as a trade-off between approach and avoidance, or recurrent lawful patterns as observed with prospect theory.Three sets of experiments employed this task with beautiful face images, a standardized set of affective photographs, and pictures of food during controlled states of hunger and satiety. An iterative modeling approach to data identified multiple law-like patterns, based on variables grounded in the individual. These patterns were consistent across stimulus types, robust to noise, describable by a simple power law, and scalable between individuals and groups. Patterns included: (i a preference trade-off counterbalancing approach and avoidance, (ii a value function linking preference intensity to uncertainty about preference, and (iii a saturation function linking preference intensity to its standard deviation, thereby setting limits to both.These law-like patterns were compatible with critical features of prospect theory, the matching law, and alliesthesia. Furthermore, they appeared consistent with both mean-variance and expected utility approaches to the assessment of risk. Ordering of responses across categories of stimuli demonstrated three properties thought to be relevant for preference-based choice, suggesting these patterns might be grouped together as a relative preference theory. Since variables in these patterns have been

Posture as index for approach-avoidance behavior.

Directory of Open Access Journals (Sweden)

Anita Eerland

Full Text Available Approach and avoidance are two behavioral responses that make people tend to approach positive and avoid negative situations. This study examines whether postural behavior is influenced by the affective state of pictures. While standing on the Wii™ Balance Board, participants viewed pleasant, neutral, and unpleasant pictures (passively viewing phase. Then they had to move their body to the left or the right (lateral movement phase to make the next picture appear. We recorded movements in the anterior-posterior direction to examine approach and avoidant behavior. During passively viewing, people approached pleasant pictures. They avoided unpleasant ones while they made a lateral movement. These findings provide support for the idea that we tend to approach positive and avoid negative situations.

Hospital reforms in France under a Socialist government.

Science.gov (United States)

De Pouvourville, G

1986-01-01

French health care faced the dual crises of rising costs and excess physicians. No government, whether left or right, could avoid focusing reform on the extensive public hospital system. Many differences introduced by the Socialists after 1981 were rhetorical and relational--matters of "democratization" of governance and "control" of physicians. Paradoxically, the two major structural reforms, "departmentalization" and "global budgeting," were extensions of actions begun under preceding governments. Neither has come to fruition yet.

Detection of Potential Drug-Drug Interactions for Outpatients across Hospitals

Directory of Open Access Journals (Sweden)

Yu-Ting Yeh

2014-01-01

Full Text Available The National Health Insurance Administration (NHIA has adopted smart cards (or NHI-IC cards as health cards to carry patients’ medication histories across hospitals in Taiwan. The aims of this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI checking based on a patient’s medication history stored in his/her NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operation on NHI-IC cards. Based on analysis of the transaction tracking log from 1 August to 31 October 2007, physicians read patients’ NHI-IC cards in 71.01% (8,246 of patient visits; 33.02% (2,723 of the card reads showed at least one medicine currently being taken by the patient, 82.94% of which were prescribed during the last visit. Among 10,036 issued prescriptions, seven prescriptions (0.09% contained at least one drug item that might interact with the currently-taken medicines stored in NHI-IC cards and triggered pop-up alerts. This study showed that the capacity of an NHI-IC card is adequate to support DDI checking across hospitals. Thus, the enhanced computerized physician order entry (CPOE system can support better DDI checking when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.

Detection of potential drug-drug interactions for outpatients across hospitals.

Science.gov (United States)

Yeh, Yu-Ting; Hsu, Min-Hui; Chen, Chien-Yuan; Lo, Yu-Sheng; Liu, Chien-Tsai

2014-01-27

The National Health Insurance Administration (NHIA) has adopted smart cards (or NHI-IC cards) as health cards to carry patients' medication histories across hospitals in Taiwan. The aims of this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient's medication history stored in his/her NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operation on NHI-IC cards. Based on analysis of the transaction tracking log from 1 August to 31 October 2007, physicians read patients' NHI-IC cards in 71.01% (8,246) of patient visits; 33.02% (2,723) of the card reads showed at least one medicine currently being taken by the patient, 82.94% of which were prescribed during the last visit. Among 10,036 issued prescriptions, seven prescriptions (0.09%) contained at least one drug item that might interact with the currently-taken medicines stored in NHI-IC cards and triggered pop-up alerts. This study showed that the capacity of an NHI-IC card is adequate to support DDI checking across hospitals. Thus, the enhanced computerized physician order entry (CPOE) system can support better DDI checking when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.

Nitric oxide facilitates active avoidance learning via enhancement of glutamate levels in the hippocampal dentate gyrus.

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Wang, Shi; Pan, De-Xi; Wang, Dan; Wan, Peng; Qiu, De-Lai; Jin, Qing-Hua

2014-09-01

The hippocampus is a key structure for learning and memory in mammals, and long-term potentiation (LTP) is an important cellular mechanism responsible for learning and memory. Despite a number of studies indicating that nitric oxide (NO) is involved in the formation and maintenance of LTP as a retrograde messenger, few studies have used neurotransmitter release as a visual indicator in awake animals to explore the role of NO in learning-dependent long-term enhancement of synaptic efficiency. Therefore, in the present study, the effects of l-NMMA (a NO synthase inhibitor) and SNP (a NO donor) on extracellular glutamate (Glu) concentrations and amplitudes of field excitatory postsynaptic potential (fEPSP) were measured in the hippocampal dentate gyrus (DG) region during the acquisition and extinction of active-avoidance behavior in freely-moving conscious rats. In the control group, the extracellular concentration of Glu in the DG was significantly increased during the acquisition of active-avoidance behavior and gradually returned to baseline levels following extinction training. In the experimental group, the change in Glu concentration was significantly reduced by local microinjection of l-NMMA, as was the acquisition of the active-avoidance behavior. In contrast, the change in Glu concentration was significantly enhanced by SNP, and the acquisition of the active-avoidance behavior was significantly accelerated. Furthermore, in all groups, the changes in extracellular Glu were accompanied by corresponding changes in fEPSP amplitude and active-avoidance behavior. Our results suggest that NO in the hippocampal DG facilitates active avoidance learning via enhancements of glutamate levels and synaptic efficiency in rats. Copyright © 2014 Elsevier B.V. All rights reserved.

Collision Avoidance for Airport Traffic Concept Evaluation

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Jones, Denise R.; Prinzel, Lawrence J., III; Otero, Sharon D.; Barker, Glover D.

2009-01-01

An initial Collision Avoidance for Airport Traffic (CAAT) concept for the Terminal Maneuvering Area (TMA) was evaluated in a simulation study at the National Aeronautics and Space Administration (NASA) Langley Research Center. CAAT is being designed to enhance surface situation awareness and provide cockpit alerts of potential conflicts during runway, taxi, and low altitude air-to-air operations. The purpose of the study was to evaluate the initial concept for an aircraft-based method of conflict detection and resolution (CD&R) in the TMA focusing on conflict detection algorithms and alerting display concepts. This paper gives an overview of the CD&R concept, simulation study, and test results.

Work-related well-being of South African hospital pharmacists

Directory of Open Access Journals (Sweden)

Sebastiaan Rothmann

2011-06-01

Research purpose: The objective of this study was to investigate whether job stress and coping strategies could predict the work-related well-being (burnout and work engagement of hospital pharmacists in South Africa. Motivation for the study: Information about the work-related well-being and coping strategies of hospital pharmacists could be used to plan individual and organisational interventions which can be used to retain them and to manage their well-being and performance. Research design, approach and method: A survey design was used. A stratified random sample (N = 187 of pharmacists in South African hospitals was studied. The Maslach Burnout Inventory – Human Services Survey, Utrecht Work Engagement Scale, Pharmacist Stress Inventory and the COPE questionnaire were administered. Main findings: The results showed that job related stress and three coping strategies (approach coping, avoidant coping, and turning to religion predicted burnout and work engagement of South African hospital pharmacists. Practical implications: Job stressors that are in the main responsible for the unfavourable work environment and that lead to the development of burnout amongst hospital pharmacists should be addressed. It is also important to enhance the coping capabilities of the hospital pharmacists. Contribution/value-add: The findings of this study provide insight into the factors impacting on the work-related well-being of hospital pharmacists in South Africa.

Drug-Avoidance Self-Efficacy Among Exclusive Cannabis Users vs. Other Drug Users Visiting the Emergency Department.

Science.gov (United States)

Clingan, Sarah E; Woodruff, Susan I

2017-07-29

Medical care in the emergency department (ED) is a growing and complex area of outpatient care, with about 256 visits made to EDs every minute in 2013. Studies report that, compared to people who do not use drugs, people who use illicit drugs are more likely to use the ED for their medical care. Self-efficacy has been shown to be a predictor of abstinence or reduced use among drug-using individuals. The current study describes drug avoidance self-efficacy among exclusive cannabis-using individuals and other drug-using individuals who use the ED for any reason. Participants were 693 adult patients visiting the trauma units and EDs of two large urban "safety net" hospitals (i.e., providing care to low-income, uninsured, and vulnerable population) in Southern California who reported using illicit drugs in the past 30 days. For people who use only cannabis, higher drug-avoidance self-efficacy was associated with older age, lower drug involvement scores, lower drug severity scores, and higher readiness to change use. For people who use other drugs, higher drug avoidance self-efficacy scores was associated with lower drug severity scores, lower psychiatric severity scores, higher medical severity scores, and higher readiness to change use. This study identified several factors (some common, some unique) related to higher drug-avoidance self-efficacy for both groups. Results may be important when designing intervention protocols for use in the ED.

Energy dissipation by submarine obstacles during landslide impact on reservoir - potentially avoiding catastrophic dam collapse

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Kafle, Jeevan; Kattel, Parameshwari; Mergili, Martin; Fischer, Jan-Thomas; Tuladhar, Bhadra Man; Pudasaini, Shiva P.

2017-04-01

Dense geophysical mass flows such as landslides, debris flows and debris avalanches may generate super tsunami waves as they impact water bodies such as the sea, hydraulic reservoirs or mountain lakes. Here, we apply a comprehensive and general two-phase, physical-mathematical mass flow model (Pudasaini, 2012) that consists of non-linear and hyperbolic-parabolic partial differential equations for mass and momentum balances, and present novel, high-resolution simulation results for two-phase flows, as a mixture of solid grains and viscous fluid, impacting fluid reservoirs with obstacles. The simulations demonstrate that due to the presence of different obstacles in the water body, the intense flow-obstacle-interaction dramatically reduces the flow momentum resulting in the rapid energy dissipation around the obstacles. With the increase of obstacle height overtopping decreases but, the deflection and capturing (holding) of solid mass increases. In addition, the submarine solid mass is captured by the multiple obstacles and the moving mass decreases both in amount and speed as each obstacle causes the flow to deflect into two streams and also captures a portion of it. This results in distinct tsunami and submarine flow dynamics with multiple surface water and submarine debris waves. This novel approach can be implemented in open source GIS modelling framework r.avaflow, and be applied in hazard mitigation, prevention and relevant engineering or environmental tasks. This might be in particular for process chains, such as debris impacts in lakes and subsequent overtopping. So, as the complex flow-obstacle-interactions strongly and simultaneously dissipate huge energy at impact such installations potentially avoid great threat against the integrity of the dam. References: Pudasaini, S. P. (2012): A general two-phase debris flow model. J. Geophys. Res. 117, F03010, doi: 10.1029/ 2011JF002186.

Herpes–Zoster Infection in a Tertiary Hospital in Brazil

Science.gov (United States)

Antoniolli, Luciana; Azambuja, Aline; Rodrigues, Camila; Borges, Rafael; Goldani, Luciano

2017-01-01

Abstract Background herpes zoster (HZ) is a common infection with potential complications requiring hospital care, especially for patients with multiple comorbities. However, there is little information on HZ from hospital registries. Methods we searched for hospital-based records of B02 code (ICD-10) between March 2000 and January 2017 at Hospital de Clínicas de Porto Alegre, a tertiary, university hospital in south Brazil. To avoid misclassifications, we considered clinical evaluation for the diagnosis of cutaneous HZ and postherpetic neuralgia (PHN), ophthalmological evaluation for ophthalmic HZ and the combination of clinical, radiologic and cerebrospinal fluid analysis for HZ meningo-encephalitis (ME). We analyzed conditions associated with immune dysregulation, complications, length of hospital stay, and mortality. Chi-square test and Kaplan-Meier estimator were used for statistical analyses. P < 0.05 was considered statistically significant. Results there were 847 records for this period, of which 801 were confirmed according to our criteria and included in the analysis. Most patients were women (n = 448; 60%), with an average of 48.8 years, standard deviation of 22.2. There were more diagnoses in the inpatients group (74.4%), and fewer in the emergency room (22.4%) and outpatient (3.3%). The median length of hospital stay was 7 days (2-10, P25-P75) when HZ was the main reason for admission. Most patients presented cutaneous HZ (n = 743, 92.8%). There were fewer cases of PHN (6.1%), ophthalmic HZ (7.6%) and ME (4.1%). Seventy percent had some kind of immune dysregulation; more frequently AIDS (31%), use of immunosuppressive agents (18.7%) and malignant disease (16.2%). We followed the subjects for a median of 28.2 (2.8-77.5) months. During this period, there were 105 (13.1%) deaths. Five were related to HZ ME. The 30-day overall mortality rate was 1.5%. There was no statistical difference in cumulative survival (graph 1, P = 0.05) or incidence of

What you want to avoid is what you see: Social avoidance motivation affects the interpretation of emotional faces

OpenAIRE

Nikitin, Jana; Freund, Alexandra M

2015-01-01

This study investigated the effects of habitual social approach and avoidance motivation on the classification of facial expressions of different visual clarity. Participants (N = 78) categorized partially masked emotional faces expressing either anger or happiness as positive or negative. Participants generally tended to interpret the facial expressions in a positive way. This positivity effect was reduced when persons were highly avoidance motivated. Social avoidance motivation predicted fe...

Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.

Science.gov (United States)

Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B

2015-06-01

To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

Reduction in Memory Specificity Following an Approach/Avoidance Scrambled Sentences Task Relates to Cognitive Avoidant Coping

Science.gov (United States)

Debeer, Elise; Raes, Filip; Williams, J. Mark G.; Hermans, Dirk

2013-01-01

"Overgeneral autobiographical memory" (OGM) refers to the tendency to retrieve less specific personal memories. According to the functional avoidance hypothesis, OGM might act as a cognitive strategy to avoid emotionally distressing details of negative memories. In the present study, we investigated the effect of an experimentally…

The impact of non-IPA HMOs on the number of hospitals and hospital capacity.

Science.gov (United States)

Chernew, M

1995-01-01

Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.

[Labor law issues in hospitals by structural changes and changes in hospital ownership].

Science.gov (United States)

Meyer, Peter

2003-11-01

The present article deals with the potential impact of structural changes and changes in hospital control or ownership on the employment contracts of the physicians concerned. While taking the applicable jurisdiction into consideration, the author examines the options of assigning new responsibilities or decreasing compensation opportunities, amending or even terminating employment contracts, outsourcing hospital-related services, or allowing physicians in the future to provide these services at their own risk. Furthermore, the article outlines the change in employer in various "change of control" scenarios such as in the case of hospital privatisation.

Audit and account billing process in a private general hospital: a case study

Directory of Open Access Journals (Sweden)

Raquel Silva Bicalho Zunta

2017-12-01

Full Text Available Our study aimed to map, describe and, validate the audit, account billing and billing reports processes in a large, private general hospital.  An exploratory, descriptive, case report study. We conducted non-participatory observation moments in Internal Audit Sectors and  Billing Reports from the hospital, aiming to map the processes which were the study objects. The data obtained was validated by internal and external audit specialists in hospital bills. The described and illustrated processes in three flow-charts favor professionals to rationalize their activities and the time spent in hospital billing, avoiding or minimizing the occurrence of flaws and, generating more effective financial results. The mapping, the description and the audit validation process and billing and, the billing reports propitiated more visibility and legitimacy to actions developed by auditor nurses.

Hospital operations management: improving organizational efficiency.

Science.gov (United States)

2013-08-01

Reducing operational inefficiencies represents one of the most promising sources of potential savings in hospitals today. Health Forum convened a panel of hospital executives and industry experts to discuss the daunting challenges and big opportunities that lie ahead.

The costs of avoiding environmental impacts from shale-gas surface infrastructure.

Science.gov (United States)

Milt, Austin W; Gagnolet, Tamara D; Armsworth, Paul R

2016-12-01

Growing energy demand has increased the need to manage conflicts between energy production and the environment. As an example, shale-gas extraction requires substantial surface infrastructure, which fragments habitats, erodes soils, degrades freshwater systems, and displaces rare species. Strategic planning of shale-gas infrastructure can reduce trade-offs between economic and environmental objectives, but the specific nature of these trade-offs is not known. We estimated the cost of avoiding impacts from land-use change on forests, wetlands, rare species, and streams from shale-energy development within leaseholds. We created software for optimally siting shale-gas surface infrastructure to minimize its environmental impacts at reasonable construction cost. We visually assessed sites before infrastructure optimization to test whether such inspection could be used to predict whether impacts could be avoided at the site. On average, up to 38% of aggregate environmental impacts of infrastructure could be avoided for 20% greater development costs by spatially optimizing infrastructure. However, we found trade-offs between environmental impacts and costs among sites. In visual inspections, we often distinguished between sites that could be developed to avoid impacts at relatively low cost (29%) and those that could not (20%). Reductions in a metric of aggregate environmental impact could be largely attributed to potential displacement of rare species, sedimentation, and forest fragmentation. Planners and regulators can estimate and use heterogeneous trade-offs among development sites to create industry-wide improvements in environmental performance and do so at reasonable costs by, for example, leveraging low-cost avoidance of impacts at some sites to offset others. This could require substantial effort, but the results and software we provide can facilitate the process. © 2016 Society for Conservation Biology.

Association between quality domains and health care spending across physician networks

Science.gov (United States)

Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

2018-01-01

One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

Predictors of distress in hospital physicians: protective and vulnerability factors

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Fermín Martínez-Zaragoza

2014-05-01

Full Text Available This study investigates the relationship between protective and vulnerability factors affecting health (distréss in medical staff. Participants were 127 doctors from four public hospitals, who were administered the Occupational Stress in Health Professionals Inventory, the Ways of Coping Questionnaire, the Maslach Burnout Inventory, the Symptom Check-list-90 Revised Questionnaire, and the Flow Trait Scale-2. Following the methodology of Partial Least Squares modeling (PLS, an explanation is given for distréss in hospital physicians, where the avoidance coping strategy produces distréss directly (β = .296 and indirectly (β = .139 th rough its influence on the increase of burnout (β = .314, which in turn is increased by occupational stress (β = .209. Professional flow, measured by professional efficacy and flow, acts as a good protector against distréss (β = -.133, partly compensating the effects of the variables which have an increasing impact on an individual's distréss (GoF = .983. To sum up, when trying to predict a physician's distréss, four key elements should be considered: avoidance coping and its indirect effect through burnout on distréss; the burnout construct itself and professional flow.

Cost-Effectiveness Analysis of an Automated Medication System Implemented in a Danish Hospital Setting.

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Risør, Bettina Wulff; Lisby, Marianne; Sørensen, Jan

To evaluate the cost-effectiveness of an automated medication system (AMS) implemented in a Danish hospital setting. An economic evaluation was performed alongside a controlled before-and-after effectiveness study with one control ward and one intervention ward. The primary outcome measure was the number of errors in the medication administration process observed prospectively before and after implementation. To determine the difference in proportion of errors after implementation of the AMS, logistic regression was applied with the presence of error(s) as the dependent variable. Time, group, and interaction between time and group were the independent variables. The cost analysis used the hospital perspective with a short-term incremental costing approach. The total 6-month costs with and without the AMS were calculated as well as the incremental costs. The number of avoided administration errors was related to the incremental costs to obtain the cost-effectiveness ratio expressed as the cost per avoided administration error. The AMS resulted in a statistically significant reduction in the proportion of errors in the intervention ward compared with the control ward. The cost analysis showed that the AMS increased the ward's 6-month cost by €16,843. The cost-effectiveness ratio was estimated at €2.01 per avoided administration error, €2.91 per avoided procedural error, and €19.38 per avoided clinical error. The AMS was effective in reducing errors in the medication administration process at a higher overall cost. The cost-effectiveness analysis showed that the AMS was associated with affordable cost-effectiveness rates. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Avoidance symptoms and delayed verbal memory are associated with post-traumatic stress symptoms in female victims of sexual violence.

Science.gov (United States)

Shin, Kyoung Min; Chang, Hyoung Yoon; Cho, Sun-Mi; Kim, Nam Hee; Kim, Kyoung Ah; Chung, Young Ki

2015-09-15

Victimization by sexual violence is strongly associated with the development of posttraumatic stress disorder (PTSD). While several psychological and cognitive factors are known to be associated with PTSD prognosis, multivariable analysis is scarce. This study examined factors affecting the severity of PTSD symptoms in early stage of traumatic experience of sexual violence, including initial post-traumatic symptoms and cognitive characteristics. Participants were recruited from the center for women and children victims of violence in a university hospital. Thirty-four sexual assault victims were assessed at the baseline and the second visit one to five months after the baseline. At the baseline, an array of posttraumatic symptoms and cognitive functions were measured: at follow-up, PTSD symptoms were determined by Clinician Administered PTSD Scale. Stepwise multiple regression showed that avoidance symptoms (β = 0.551, P PTSD symptoms one to five month later. The regression model, factoring in avoidance and delayed verbal memory, showed a 34.9% explanatory power regarding the PTSD symptom severity. This study suggests that avoidance symptoms and verbal memory at the early stage of trauma are associated with later PTSD symptoms. It is also suggested that early intervention targeting avoidance symptoms may be beneficial in decreasing PTSD symptoms. Copyright © 2015 Elsevier B.V. All rights reserved.

Who participates in tax avoidance?

OpenAIRE

Alstadsæter, Annette; Jacob, Martin

2013-01-01

This paper analyzes the sources of heterogeneity in legal tax avoidance strategies across individuals. Three conditions are required for a taxpayer to participate in tax avoidance: incentive, access, and awareness. Using rich Swedish administrative panel data with a unique link between corporate and individual tax returns, we analyze individual participation in legal tax planning around the 2006 Swedish tax reform. Our results suggest that closely held corporations are utilized to facilitate ...

The Impact of Medicaid Disproportionate Share Hospital Payment on Provision of Hospital Uncompensated Care

Science.gov (United States)

Hsieh, Hui-Min; Bazzoli, Gloria J.

2012-01-01

This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response was inelastic in value. Policy makers need to continue to monitor how UC changes as sources of support for indigent care change with the Patient Protection and Affordable Care Act (PPACA). PMID:23230705

Optimal Placement of Cerebral Oximeter Monitors to Avoid the Frontal Sinus as Determined by Computed Tomography.

Science.gov (United States)

Gregory, Alexander J; Hatem, Muhammed A; Yee, Kevin; Grocott, Hilary P

2016-01-01

To determine the optimal location to place cerebral oximeter optodes to avoid the frontal sinus, using the orbit of the skull as a landmark. Retrospective observational study. Academic hospital. Fifty adult patients with previously acquired computed tomography angiography scans of the head. The distance between the superior orbit of the skull and the most superior edge of the frontal sinus was measured using imaging software. The mean (SD) frontal sinus height was 16.4 (7.2) mm. There was a nonsignificant trend toward larger frontal sinus height in men compared with women (p = 0.12). Age, height, and body surface area did not correlate with frontal sinus height. Head circumference was positively correlated (r = 0.32; p = 0.03) to frontal sinus height, with a low level of predictability based on linear regression (R(2) = 0.10; p = 0.02). Placing cerebral oximeter optodes>3 cm from the superior rim of the orbit will avoid the frontal sinus in>98% of patients. Predicting the frontal sinus height based on common patient variables is difficult. Additional studies are required to evaluate the recommended height in pediatric populations and patients of various ethnic backgrounds. The clinical relevance of avoiding the frontal sinus also needs to be further elucidated. Copyright © 2016 Elsevier Inc. All rights reserved.

Communication Avoiding and Overlapping for Numerical Linear Algebra

Science.gov (United States)

2012-05-08

future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve scalability by reducing...linear algebra problems to future exascale systems, communication cost must be avoided or overlapped. Communication-avoiding 2.5D algorithms improve...will continue to grow relative to the cost of computation. With exascale computing as the long-term goal, the community needs to develop techniques

Estrogenic involvement in social learning, social recognition and pathogen avoidance.

Science.gov (United States)

Choleris, Elena; Clipperton-Allen, Amy E; Phan, Anna; Valsecchi, Paola; Kavaliers, Martin

2012-04-01

Sociality comes with specific cognitive skills that allow the proper processing of information about others (social recognition), as well as of information originating from others (social learning). Because sociality and social interactions can also facilitate the spread of infection among individuals the ability to recognize and avoid pathogen threat is also essential. We review here various studies primarily from the rodent literature supporting estrogenic involvement in the regulation of social recognition, social learning (socially acquired food preferences and mate choice copying) and the recognition and avoidance of infected and potentially infected individuals. We consider both genomic and rapid estrogenic effects involving estrogen receptors α and β, and G-protein coupled estrogen receptor 1, along with their interactions with neuropeptide systems in the processing of social stimuli and the regulation and expression of these various socially relevant behaviors. Copyright © 2012 Elsevier Inc. All rights reserved.

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

Science.gov (United States)

Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

2013-02-01

During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Science.gov (United States)

Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

Risk Factors of Prolonged Hospitalization in Patients with Hyperemesis Gravidarum

Directory of Open Access Journals (Sweden)

Hasan Onur Topcu

2015-03-01

Conclusion: Number of vomiting per day and maternal serum TSH levels could help physicians to estimate the risk of prolonged hospitalization; however further investigations are needed in large population studies. Identifying the high risk patients is important both for prevention of HEG and beginning appropriate antiemetic treatment to avoid complications to reduce the economic costs. [Cukurova Med J 2015; 40(1.000: 113-118

Hospital-based school for children with chronic illness in Taiwan.

Science.gov (United States)

Chen, Der-Fang; Tsai, Tsuen-Chiuan; Su, Yu-Tsun; Lin, Chi-Wei

2015-10-01

To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children. Copyright © 2014. Published by Elsevier B.V.

Engaging Math-Avoidant College Students

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M. Paul Latiolais

2009-07-01

Full Text Available This paper is an informal, personal account of how we, as two college teachers, became interested in math anxiety, decided to explore it amongst students at our institution in order to inform our teaching, and became convinced that the massive problem is math avoidance. We tried discussion groups, but few students attended, although those that did made useful suggestions. Thus informed, we designed an innovative course, Confronting College Mathematics as a Humanities course with the possibility of credit toward the math requirement, but it was undersubscribed in its first offering and had to be canceled. How can we get college students who avoid math to break through the barrier of math avoidance? We have now begun to explore a new approach: Second Life, where students can engage math—and quantitative literacy—virtually, and anonymously.

Whole-arm obstacle avoidance system conceptual design

International Nuclear Information System (INIS)

Wintenberg, A.L.; Butler, P.L.; Babcock, S.M.; Ericson, M.N.; Britton, C.L. Jr.

1993-04-01

Whole-arm obstacle avoidance is needed for a variety of robotic applications in the Environmental Restoration and Waste Management (ER ampersand WM) Program. Typical industrial applications of robotics involve well-defined workspaces, allowing a predetermined knowledge of collision-free paths for manipulator motion. In the unstructured or poorly defined hazardous environments of the ER ampersand WM Program, the potential for significant problems resulting from collisions between manipulators and the environment in which they are utilized is great. The conceptual design for a sensing system that will provide protection against such collisions is described herein. The whole-arm obstacle avoidance system consists of a set of sensor ''bracelets,'' which cover the surface area of the manipulator links to the maximum extent practical, and a host processor. The host processor accepts commands from the robot control system, controls the operation of the sensors, manipulates data received from the bracelets, and makes the data available to the manipulator control system. The bracelets consist of a subset of the sensors, associated sensor interface electronics, and a bracelet interface. Redundant communications links between the host processor and the bracelets are provided, allowing single-point failure protection. The system allows reporting of 8-bit data from up to 1000 sensors at a minimum of 50 Hz. While the initial prototype implementation of the system utilizes capacitance proximity sensor, the system concept allows multiple types of sensors. These sensors are uniquely addressable, allowing remote calibration, thresholding at the bracelet, and correlation of a sensor measurement with the associated sensor and its location on the manipulator. Variable resolution allows high-speed, single-bit sensing as well as lower-speed higher-resolution sensing, which is necessary for sensor calibration and potentially useful in control

Design and Performance Evaluation of Underwater Data Dissemination Strategies using Interference Avoidance and Network Coding

DEFF Research Database (Denmark)

Palacios, Raul; Heide, Janus; Fitzek, Frank

2012-01-01

constraints and achieve efficient data transmission under water. Network Coding can exploit the broadcast channel to send different information to several receivers simultaneously. With Interference Avoidance the long propagation delay can be used to communicate in full-duplex mode. Alone and combined...... these concepts could increase channel utilisation as well as improve energy efficiency of the network nodes. The main goal is to investigate the potential benefits of new strategies for data dissemination over a string topology scenario. Comprehensive simulations prove the feasibility of Interference Avoidance...

Performance Analysis of an Integrated Heat Pump with Air-Conditioning System for the Existing Hospital Building Application

Directory of Open Access Journals (Sweden)

Chen-Yu Chiang

2017-03-01

Full Text Available In this study, a complete evaluation procedure of energy-saving and efficiency improvement for a large-scale hospital retrofit project has been established and successfully validated in Taiwan. The retrofit scheme, in integrating the alternative hot water system, namely, a water source heat pump (WSHP, with the existing HVAC (Heating, Ventilating, and Air-Conditioning system, enables the capability to meet the cooling and hot water demand simultaneously with a larger safety margin as well as saving energy. In addition, it has been found that the integrated system provides a new source for cooling which can be utilized as a system redundancy in avoiding system shutdown. This is very useful when considering in specific areas in the hospital, such as intensive care unit, or operation rooms, where cooling should not be interrupted on any occasion. In this study, it is validated that the coefficient of performance (COP of the newly added WSHP system, under heating and cooling mode, is 3.62 and 2.62, respectively. The recorded annual cost reduction by this integrated system is $102,564, with a payback of 1.2 years. The hospital after retrofit has been operating safer, with more redundancy, and more energy-efficient which warrants tremendous potential for implementation in the industry.

Avoiding the Flu

Science.gov (United States)

... of this page please turn Javascript on. Feature: Flu Avoiding the Flu Past Issues / Fall 2009 Table of Contents Children ... should still get the 2009 H1N1 vaccine. H1N1 Flu: Who Should Be Vaccinated First The Centers for ...

[Microbiological verification of a self control plan for a hospital food service].

Science.gov (United States)

Torre, I; Pennino, F; Crispino, M

2006-01-01

During the past years, it has been an increment of food related infectious diseases. In order to avoid micro biological food contamination, adherence to good manufacturing is required through control measures of food safety practices. Updated national and European regulations underline the need to apply the HACCP system, overcoming the old concept of sample control on the end user product. This work shows results of microbiological controls made along the whole productive chain. Measurements are made using biomolecular techniques (PFGE) in order to assess the management of the micro biological risk of the self control plan applied to a hospital food service of Naples. The use of the PFGE applied on some micro-organisms gram negative potentially pathogen, underlines the circulation, continued in time, of these micro-organisms within the cooking area. In addition, cross contamination between several matrixes of samples has been detected.

Hospital medicine (Part 2): what would improve acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

CEO Power, Corporate Tax Avoidance and Tax Aggressiveness

OpenAIRE

GATOT SOEPRIYANTO

2017-01-01

My thesis investigates the association between CEO power, corporate tax avoidance and tax aggressiveness, using two organizational theory perspectives: self-interest and stewardship. I find that a powerful CEO engages in less corporate tax avoidance activities, which lends credence to the risk minimization motive of the stewardship perspective. My findings on the association between CEO power and tax aggressiveness show that powerful CEOs avoid risky tax avoidance strategies that expose a fir...

Exposure to antineoplastic drugs outside the hospital environment.

Science.gov (United States)

Meijster, T; Fransman, W; Veldhof, R; Kromhout, H

2006-10-01

The objectives were (i) to identify occupational populations outside hospitals working with antineoplastic drugs, (ii) to determine the size of the populations 'at risk', (iii) to identify major determinants and routes of exposure outside hospitals and (iv) to estimate exposure levels and frequencies relative to levels found in hospitals. The survey consisted of two phases; (i) identification of activities with potential exposure to antineoplastic drugs by literature review, interviews, questionnaires and workplace visits, (ii) exploratory measurements of exposure and surface contamination in selected sectors. Eight sectors were identified with potential exposure to antineoplastic drugs: pharmaceutical industry, pharmacies, universities, veterinary medicine, nursing homes, home care, laundry facilities, and waste treatment. Four sectors were of primary concern: veterinary medicine, home care, nursing homes and industrial laundries. The populations potentially exposed in these sectors vary considerably (from several tens to thousands of workers), as do their levels of exposure. Exposure measurements collected in the veterinary medicine sector showed that workers are indeed exposed to antineoplastic drugs and, in some cases (on gloves after administration), levels were 15 times higher than levels measured during administration in hospitals. Workers sorting contaminated hospital laundry in industrial laundry facilities were exposed to antineoplastic drugs through inhalation. For the home care and nursing homes sectors the highest exposure levels were found when cleaning toilets and washing treated patients. These two sectors are expected to have the largest exposed population (5,000-10,000 individuals). This study has resulted in a comprehensive overview of populations with potential exposure to antineoplastic drugs. Exposure levels can potentially be high compared with the hospital environment, because exposure routes are complex and awareness of the hazard (and

Investigating the obstacles and difficulties of using the potentials of medical tourism in Shiraz hospitals

Directory of Open Access Journals (Sweden)

Alireza Mooghali

2018-01-01

Full Text Available Introduction: The tourism industry is one of the greatest professions in the world and the governments have considered it as an important activity to achieve their macroeconomics objectives. One of the branches of this industry is medical tourism. Considering the importance of this issue, this study investigated the obstacles and problems of medical tourism with an adaptive approach between public and private hospitals. Method: This study was cross-sectional, descriptive and analytical. In this study, two tools of checklists and questionnaires in three areas of financial infrastructure, skilled manpower and facilities were used to collect the data. The study population included all senior hospital executives (chairman, manager, matron, the receptionist, clinical supervisor of 14 private hospitals and six governmental hospitals in Shiraz that admit tourists. Results: A total number of 94 subjects participated in the study, of whom 54 (57% were female and 38 (43% were male with a mean age of 47 years and 22.5 years of work experience. The results of the checklist showed that seven private hospitals (50% and four public hospitals (67% had lack of infrastructure. There are significant differences in the number of medical tourists’ admission between private and public hospitals (P=0.001. The results did not show a significant difference between the views of senior executives in private and public hospitals on the effects of these three infrastructures, human resources, financial facilities and equipment on more tourists’ attraction (P=0.077 and P=0.416 and P=0.355. Conclusion: According to the results, admitting foreign patients more frequently occurs in private hospitals due to the presence of famous physicians. It seems that with proper collaboration of some organizations and establishment of health tourism office in these hospitals, including Cultural Heritage and Handicrafts and Tourism, Shiraz University of Medical Sciences and the Governor

The challenges for scientists in avoiding plagiarism.

Science.gov (United States)

Fisher, E R; Partin, K M

2014-01-01

Although it might seem to be a simple task for scientists to avoid plagiarism and thereby an allegation of research misconduct, assessment of trainees in the Responsible Conduct of Research and recent findings from the National Science Foundation Office of Inspector General regarding plagiarism suggests otherwise. Our experiences at a land-grant academic institution in assisting researchers in avoiding plagiarism are described. We provide evidence from a university-wide multi-disciplinary course that understanding how to avoid plagiarism in scientific writing is more difficult than it might appear, and that a failure to learn the rules of appropriate citation may cause dire consequences. We suggest that new strategies to provide training in avoiding plagiarism are required.

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

Directory of Open Access Journals (Sweden)

Liang Ji

2001-05-01

Full Text Available Abstract Background Evidence-based obstetric care is widely promoted in developing countries, but the success of implementation is not known. Using selected childbirth care procedures in four hospitals in Shanghai, we compared practice against evidence-based information, and explored user and provider views about each procedure. Methods Observational study. Using the Cochrane Library, we identified six procedures that should be avoided as routine and two that should be encouraged. Procedure rate determined by exit interviews with women, verified using hospital notes. Views of women and providers explored with in depth interviews. The study sites were three hospitals in Shanghai and one in neighbouring province of Jiangsu. 150 women at each centre for procedure rate, and 48 in-depth interviews with women and providers. Results Vaginal births were 50% (303/599 of the total. Of the six practices where evidence suggests they should be avoided as routine, three were performed with rates above 70%: pubic shaving (3 hospitals, rectal examination (3 hospitals, and episiotomy (3 hospitals. Most women delivered lying down, pain relief was rarely given, and only in the urban district hospital did women routinely have a companion. Most women wanted support or companionship during labour and to be given pain relief; but current practice is insufficient to meet women's needs. Conclusion Obstetric practice is not following best available evidence in the hospitals studied. There is a need to adjust hospital policy to support the use of interventions proven to be of benefit to women during childbirth, and develop approaches that ensure clinical practice changes.

Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study.

Science.gov (United States)

Challener, Douglas; Marcelin, Jasmine; Visscher, Sue; Baddour, Larry

2017-12-01

Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined. Hospital admissions were analyzed retrospectively using standardized cost analysis within several relevant categories. Thirty-four patients had an average hospital length of stay of 4.7 days. The median total inpatient cost was $7,341. The median cost per day was $2,087, with 49% due to room and board. Antibiotics administered for treatment of NLEC contributed a median cost of $75 per day of hospitalization, and laboratory and imaging test costs were $73 and $44, respectively, per day of hospitalization. Hospitalizations for NLEC can be costly and prolonged with room and board accounting for much of the cost. Therefore, newer management strategies should seek to reduce hospital length of stay and/or avoid inpatient admission to reduce cost.

Reducing Hospital Readmissions Through Preferred Networks Of Skilled Nursing Facilities.

Science.gov (United States)

McHugh, John P; Foster, Andrew; Mor, Vincent; Shield, Renée R; Trivedi, Amal N; Wetle, Terrie; Zinn, Jacqueline S; Tyler, Denise A

2017-09-01

Establishing preferred provider networks of skilled nursing facilities (SNFs) is one approach hospital administrators are using to reduce excess thirty-day readmissions and avoid Medicare penalties or to reduce beneficiaries' costs as part of value-based payment models. However, hospitals are also required to provide patients at discharge with a list of Medicare-eligible providers and cannot explicitly restrict patient choice. This requirement complicates the development of a SNF network. Furthermore, there is little evidence about the effectiveness of network development in reducing readmission rates. We used a concurrent mixed-methods approach, combining Medicare claims data for the period 2009-13 with qualitative data gathered from interviews during site visits to hospitals in eight US markets in March-October 2015, to examine changes in rehospitalization rates and differences in practices between hospitals that did and did not develop formal SNF networks. Four hospitals had developed formal SNF networks as part of their care management efforts. These hospitals saw a relative reduction from 2009 to 2013 in readmission rates for patients discharged to SNFs that was 4.5 percentage points greater than the reduction for hospitals without formal networks. Interviews revealed that those with networks expanded existing relationships with SNFs, effectively managed patient data, and exercised a looser interpretation of patient choice. Project HOPE—The People-to-People Health Foundation, Inc.

Avoidable cancers in the Nordic countries-The impact of alcohol consumption.

Science.gov (United States)

Andersson, Therese M-L; Engholm, Gerda; Pukkala, Eero; Stenbeck, Magnus; Tryggvadottir, Laufey; Storm, Hans; Weiderpass, Elisabete

2018-05-05

Alcohol consumption is an important and preventable cause of cancer. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to alcohol and estimate the potential for cancer prevention by changes in alcohol consumption. Using the Prevent macro-simulation model, the number of cancer cases in the Nordic countries over a 30-year period (2016-2045) was modelled for six sites, under different scenarios of changing alcohol consumption, and compared to the projected number of cases if constant alcohol consumption prevailed. The studied sites were colorectal, post-menopausal breast, oral cavity and pharynx, liver, larynx as well as oesophageal squamous cell carcinoma. The alcohol consumption was based on the categories of non-drinkers/occasional drinkers, light drinkers (12.5 and ≤ 50 g/day) and heavy drinkers (>50 g/day). About 83,000 cancer cases could be avoided in the Nordic countries in a 30-year period if alcohol consumption was entirely eliminated, which is 5.5% of the expected number of cases for the six alcohol-related cancer types. With a 50% reduction in the proportion with moderate alcohol consumption by year 2025, 21,500 cancer cases could be avoided. The number of avoidable cases was highest for post-menopausal breast and colorectal cancer, but the percentage was highest for oesophageal squamous cell carcinoma. The results from this study can be used to understand the potential impact and significance of primary prevention programmes targeted towards reducing the alcohol consumption in the Nordic countries. Copyright © 2018 Elsevier Ltd. All rights reserved.

Relative valuation of alternative methods of tax avoidance

OpenAIRE

Inger, Kerry Katharine

2012-01-01

This paper examines the relative valuation of alternative methods of tax avoidance. Prior studies find that firm value is positively associated with overall measures of tax avoidance; I extend this research by providing evidence that investors distinguish between methods of tax reduction in their valuation of tax avoidance. The impact of tax avoidance on firm value is a function of tax risk, permanence of tax savings, tax planning costs, implicit taxes and contrasts in disclosures of tax re...

Neural substrates of approach-avoidance conflict decision-making

Science.gov (United States)

Aupperle, Robin L.; Melrose, Andrew J.; Francisco, Alex; Paulus, Martin P.; Stein, Murray B.

2014-01-01

Animal approach-avoidance conflict paradigms have been used extensively to operationalize anxiety, quantify the effects of anxiolytic agents, and probe the neural basis of fear and anxiety. Results from human neuroimaging studies support that a frontal-striatal-amygdala neural circuitry is important for approach-avoidance learning. However, the neural basis of decision-making is much less clear in this context. Thus, we combined a recently developed human approach-avoidance paradigm with functional magnetic resonance imaging (fMRI) to identify neural substrates underlying approach-avoidance conflict decision-making. Fifteen healthy adults completed the approach-avoidance conflict (AAC) paradigm during fMRI. Analyses of variance were used to compare conflict to non-conflict (avoid-threat and approach-reward) conditions and to compare level of reward points offered during the decision phase. Trial-by-trial amplitude modulation analyses were used to delineate brain areas underlying decision-making in the context of approach/avoidance behavior. Conflict trials as compared to the non-conflict trials elicited greater activation within bilateral anterior cingulate cortex (ACC), anterior insula, and caudate, as well as right dorsolateral prefrontal cortex. Right caudate and lateral PFC activation was modulated by level of reward offered. Individuals who showed greater caudate activation exhibited less approach behavior. On a trial-by-trial basis, greater right lateral PFC activation related to less approach behavior. Taken together, results suggest that the degree of activation within prefrontal-striatal-insula circuitry determines the degree of approach versus avoidance decision-making. Moreover, the degree of caudate and lateral PFC activation is related to individual differences in approach-avoidance decision-making. Therefore, the AAC paradigm is ideally suited to probe anxiety-related processing differences during approach-avoidance decision-making. PMID:25224633

The Natural Hospital Environment: a Socio-Technical-Material perspective.

Science.gov (United States)

Fernando, Juanita; Dawson, Linda

2014-02-01

This paper introduces two concepts into analyses of information security and hospital-based information systems-- a Socio-Technical-Material theoretical framework and the Natural Hospital Environment. The research is grounded in a review of pertinent literature with previously published Australian (Victoria) case study data to analyse the way clinicians work with privacy and security in their work. The analysis was sorted into thematic categories, providing the basis for the Natural Hospital Environment and Socio-Technical-Material framework theories discussed here. Natural Hospital Environments feature inadequate yet pervasive computer use, aural privacy shortcomings, shared workspace, meagre budgets, complex regulation that hinders training outcomes and out-dated infrastructure and are highly interruptive. Working collaboratively in many cases, participants found ways to avoid or misuse security tools, such as passwords or screensavers for patient care. Workgroup infrastructure was old, architecturally limited, haphazard in some instances, and was less useful than paper handover sheets to ensure the quality of patient care outcomes. Despite valiant efforts by some participants, they were unable to control factors influencing the privacy of patient health information in public hospital settings. Future improvements to hospital-based organisational frameworks for e-health can only be made when there is an improved understanding of the Socio-Technical-Material theoretical framework and Natural Hospital Environment contexts. Aspects within control of clinicians and administrators can be addressed directly although some others are beyond their control. An understanding and acknowledgement of these issues will benefit the management and planning of improved and secure hospital settings. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

DNA elasticity: topology of self-avoidance

International Nuclear Information System (INIS)

Samuel, Joseph; Sinha, Supurna; Ghosh, Abhijit

2006-01-01

We present a theoretical treatment of DNA stretching and twisting experiments, in which we discuss global topological subtleties of self-avoiding ribbons and provide an underlying justification for the worm-like rod chain (WLRC) model proposed by Bouchiat and Mezard. Some theoretical points regarding the WLRC model are clarified: the 'local writhe formula' and the use of an adjustable cut-off parameter to 'regularize' the model. Our treatment brings out the precise relation between the worm-like chain (WLC), the paraxial worm-like chain (PWLC) and the WLRC models. We describe the phenomenon of 'topological untwisting' and the resulting collapse of link sectors in the WLC model and note that this leads to a free energy profile periodic in the applied link. This periodicity disappears when one takes into account the topology of self-avoidance or at large stretch forces (paraxial limit). We note that the difficult non-local notion of self-avoidance can be replaced (in an approximation) by the simpler local notion of 'south avoidance'. This gives an explanation for the efficacy of the approach of Bouchiat and Mezard in explaining the 'hat curves' using the WLRC model, which is a south avoiding model. We propose a new class of experiments to probe the continuous transition between the periodic and aperiodic behaviour of the free energy

Recurrent, Robust and Scalable Patterns Underlie Human Approach and Avoidance

Science.gov (United States)

Kennedy, David N.; Lehár, Joseph; Lee, Myung Joo; Blood, Anne J.; Lee, Sang; Perlis, Roy H.; Smoller, Jordan W.; Morris, Robert; Fava, Maurizio

2010-01-01

Background Approach and avoidance behavior provide a means for assessing the rewarding or aversive value of stimuli, and can be quantified by a keypress procedure whereby subjects work to increase (approach), decrease (avoid), or do nothing about time of exposure to a rewarding/aversive stimulus. To investigate whether approach/avoidance behavior might be governed by quantitative principles that meet engineering criteria for lawfulness and that encode known features of reward/aversion function, we evaluated whether keypress responses toward pictures with potential motivational value produced any regular patterns, such as a trade-off between approach and avoidance, or recurrent lawful patterns as observed with prospect theory. Methodology/Principal Findings Three sets of experiments employed this task with beautiful face images, a standardized set of affective photographs, and pictures of food during controlled states of hunger and satiety. An iterative modeling approach to data identified multiple law-like patterns, based on variables grounded in the individual. These patterns were consistent across stimulus types, robust to noise, describable by a simple power law, and scalable between individuals and groups. Patterns included: (i) a preference trade-off counterbalancing approach and avoidance, (ii) a value function linking preference intensity to uncertainty about preference, and (iii) a saturation function linking preference intensity to its standard deviation, thereby setting limits to both. Conclusions/Significance These law-like patterns were compatible with critical features of prospect theory, the matching law, and alliesthesia. Furthermore, they appeared consistent with both mean-variance and expected utility approaches to the assessment of risk. Ordering of responses across categories of stimuli demonstrated three properties thought to be relevant for preference-based choice, suggesting these patterns might be grouped together as a relative preference

ADVERTISING AVOIDANCE PADA IKLAN DI MEDIA TELEVISI

Directory of Open Access Journals (Sweden)

Indah Dwi Pratama

2016-01-01

Full Text Available One factor that can interfere with the absorption rate of viewers on television advertisement is advertising avoidance which shows the difference between the number of viewers who watch advertisement programs and the number of viewers who watch television programs. The factors that affect advertising avoidance include the demography of the viewers (gender, age, area of residence, and social economic status, or SES, advertising attributes (the television stations, order of ads, genre of the program, and advertising sector, and competition (DayPart. The study attempted to measure the level of advertising avoidance in Indonesia and its relation to various factors that influence it by using the secondary data generated by Nielsen Audience Measurement Indonesia through Television Audience Measurement (TAM. The methods utilized consisted of the t-test independent sample, one way ANOVA, Tukey, Kruskal Wallis, and Dunn Bonferoni. The result showed that the level of advertising avoidance in Indonesia reached by 23%, with relatively similar results to the other studies in various countries. The hypothesis test results also showed a significant relationship between the advertising avoidance and demographic variables, advertising attributes, and competitions affecting this avoidance. On one hand, the findings of the study are expected to be useful for the advertisers to plan their advertisements on television so that they become more effective and efficient. On the other hand, television stations can utilize these findings as a development strategy to expand their audience segmentation and to accommodate the needs of the advertisers more optimally.Keywords: advertising avoidance, television advertisement, TAM, ANOVA, Tukey

Injury-related fear-avoidance and symptoms of posttraumatic stress in parents of children with burns.

Science.gov (United States)

Willebrand, M; Sveen, J

2016-03-01

Parents of children with burns experience a range of psychological reactions and symptoms, and parents' health is known to impact children's health. So far, there is little research into potential mechanisms that maintain parents' symptoms. The aim was to investigate parental injury-related fear-avoidance, and its associations with injury severity and health measures. Parents (n=107) of children aged 0.4-18 years that sustained burns 0.1-9.0 years previously completed questionnaires on fear-avoidance, posttraumatic stress, and health of the child. Analyses showed that the average level of fear-avoidance was low and positively associated with measures of injury severity and parents' symptoms of posttraumatic stress, and negatively associated with parents' ratings of their child's health. In two separate multiple regressions with parents' symptoms of PTSD and the child's health as dependent variables, fear-avoidance made the largest contribution in both models while injury severity was non-significant. Results were not related to comorbid conditions of the child, scarring, or parent-related socio-demographic variables. In summary, injury-related fear-avoidance is more likely among parents whose children sustain more severe burns. In turn, fear-avoidance contributes significantly to parents' symptoms of PTSD and to poorer health ratings regarding the child, irrespective of injury severity or child comorbidity. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Nurses' medication administration practices at two Singaporean acute care hospitals.

Science.gov (United States)

Choo, Janet; Johnston, Linda; Manias, Elizabeth

2013-03-01

This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design. © 2013 Wiley Publishing Asia Pty Ltd.

Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia.

Science.gov (United States)

Nuti, Sudhakar V; Qin, Li; Rumsfeld, John S; Ross, Joseph S; Masoudi, Frederick A; Normand, Sharon-Lise T; Murugiah, Karthik; Bernheim, Susannah M; Suter, Lisa G; Krumholz, Harlan M

2016-02-09

Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital. For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed. We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and

Sensor-based whole-arm obstacle avoidance for unstructured environments

International Nuclear Information System (INIS)

Wintenberg, AL.; Butler, P.L.; Babcock, S.M.; Ericson, M.N.; Britton, C.L. Jr.; Hamel, W.R.

1992-01-01

Whole-arm obstacle avoidance is needed for a variety of robotic applications in the Environmental Restoration and Waste Management (ER ampersand WM) Program. Typical industrial applications of robotics involve well-defined work spaces, allowing a predetermined knowledge of collision-free paths for manipulator motion. In the unstructured or poorly defined hazardous environments of the ER ampersand WM program, the potential for significant problems resulting from collisions between manipulators and the environment in which they are utilized is great. A sensing system under development, which will provide protection against such collisions, is described in this paper

Comparison of potentially preventable hospitalizations related to diabetes among Native Hawaiian, Chinese, Filipino, and Japanese elderly compared with whites, Hawai'i, December 2006-December 2010.

Science.gov (United States)

Sentell, Tetine L; Ahn, Hyeong Jun; Juarez, Deborah T; Tseng, Chien-Wen; Chen, John J; Salvail, Florentina R; Miyamura, Jill; Mau, Marjorie L M

2013-07-25

Approximately 25% of individuals aged 65 years or older in the United States have diabetes mellitus. Diabetes rates in this age group are higher for Asian American and Pacific Islanders (AA/PI) than for whites. We examined racial/ethnic differences in diabetes-related potentially preventable hospitalizations (DRPH) among people aged 65 years or older for Japanese, Chinese, Filipinos, Native Hawaiians, and whites. Discharge data for hospitalizations in Hawai'i for people aged 65 years or older from December 2006 through December 2010 were compared. Annual rates of DRPH by patient were calculated for each racial/ethnic group by sex. Rate ratios (RRs) were calculated relative to whites. Multivariable models controlling for insurer, comorbidity, diabetes prevalence, age, and residence location provided final adjusted rates and RRs. A total of 1,815 DRPH were seen from 1,515 unique individuals. Unadjusted RRs for DRPH by patient were greater than 1 in all AA/PI study groups compared with whites, but were highest among Native Hawaiians and Filipinos [corrected]. In fully adjusted models accounting for higher diabetes prevalence in AA/PI groups, Native Hawaiian (adjusted rate ratio [aRR] = 1.59), Filipino (aRR = 2.26), and Japanese (aRR = 1.86) men retained significantly higher rates of diabetes-related potentially preventable hospitalizations than whites, as did Filipino women (aRR = 1.61). Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older have a higher risk than whites for DRPH. Health care providers and public health programs for elderly patients should consider effective programs to reduce potentially preventable hospitalizations among Native Hawaiian, Filipino, and Japanese men and Filipino women aged 65 years or older.

Introducing the Date and Acquaintance Rape Avoidance Scale.

Science.gov (United States)

Resendez, Josephine R; Hughes, Jamie S

2016-01-01

We present the Date and Acquaintance Rape Avoidance Scale (DARAS). The DARAS is a measure of a woman's behaviors used to avoid date and acquaintance rape. Three factor structures were possible. The DARAS may have measured several factors related to alcohol and drug use, self-defense, and date behaviors; 2 factors related to behaviors to avoid acquaintance versus date rape; or a single factor that represented general vigilance. The data revealed a highly reliable, 63 item single factor that was correlated with stranger rape avoidance, rejection of rape myths, hostile sexist beliefs about men, and benevolent sexist beliefs about women. The creation of the DARAS adds to the growing body of research on rape avoidance. The DARAS is key to understanding the behaviors women employ to avoid date rape. Rather than placing the responsibility for rape on the victim, the DARAS was developed as a theoretical and applied tool that can be used to improve theory and construct rape education and prevention programs.

Joint-venture proposals strengthen hospital-physician relationship.

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Rovinsky, M

2000-12-01

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

A Computerized Hospital Patient Information Management System

Science.gov (United States)

Wig, Eldon D.

1982-01-01

The information processing needs of a hospital are many, with varying degrees of complexity. The prime concern in providing an integrated hospital information management system lies in the ability to process the data relating to the single entity for which every hospital functions - the patient. This paper examines the PRIMIS computer system developed to accommodate hospital needs with respect to a central patient registry, inpatients (i.e., Admission/Transfer/Discharge), and out-patients. Finally, the potential for expansion to permit the incorporation of more hospital functions within PRIMIS is examined.

Social Epistemology and Its Politically Correct Words: Avoiding Absolutism, Relativism, Consensualism, and Vulgar Pragmatism

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Price, Leigh

2005-01-01

Where social epistemology has been applied in environmental education research, certain words have come to be associated with it, such as, "social," "contextualized," "strategic," "political," "pragmatic," "democratic," and "participatory." In this paper, I first suggest interpretations of these words that potentially avoid absolutism, relativism,…

Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

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McHugh, Matthew D; Berez, Julie; Small, Dylan S

2013-10-01

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

PENGARUH CORPORATE GOVERNANCE TERHADAP TAX AVOIDANCE

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Nuralifmida Ayu Annisa

2012-05-01

Full Text Available This study aims to find out how the influence of the corporate governance of tax avoidanceactivity in companies listed on Indonesia Stock Exchange in 2008. The samples are publiclytraded company listed on the Indonesia Stock Exchange in 2008 as many as 200 companies. Thisstudy uses data analysis and regression analysis of the elements of corporate governance and taxavoidance. The results of this study show that the elements of corporate governance that consist ofaudit quality and audit committee significantly influence the activity of tax avoidance as measuredusing proxy book tax gap. Other results show that the tax avoidance activity as measured withproxy book tax gap are not affected significantly by institutional ownership and board ofcommissioners. Limitation of this study is not to use each type of industries as control variable socan’t identify the direct effect from type of industry on tax avoidance. Another limitation of thisstudy is use corporate governance’s proxy separately, so it can’t capture the full effect ofcorporate governance. Keywords:corporate governance, ownership structure, board of commissioners, audit committee,tax avoidance, book tax gap.

Harm avoidance and disability in old age.

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Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A

2006-01-01

The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

How change management can prevent the failure of information systems implementation among Malaysian government hospitals?

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ChePa, Noraziah; Jasin, Noorhayati Md; Bakar, Nur Azzah Abu

2017-10-01

Fail to prevent or control challenges of Information System (IS) implementation have led to the failure of its implementation. Successful implementation of IS has been a challenging task to any organization including government hospitals. Government has invested a big amount of money on information system (IS) projects to improve service delivery in healthcare. However, several of them failed to be implemented successfully due to several factors. This article proposes a prevention model which incorporated Change Management (CM) concepts to avoid the failure of IS implementation, hence ensuring the success of it. Challenges of IS implementation in government hospitals have been discovered. Extensive literature review and deep interview approaches were employed to discover these challenges. A prevention model has been designed to cater the challenges. The model caters three main phases of implementation; pre-implementation, during implementation, and post-implementation by adopting CM practices of Lewin's, Kotter's and Prosci's CM model. Six elements of CM comprising thirteen sub-elements adopted from the three CM models have been used to handle CFFs of Human and Support issues; guiding team, resistance avoidance, IS adoption, enforcement, monitoring, and IS sustainability. Successful practice of the proposed mapping is expected to prevent CFFs to occur, hence ensuring a successful implementation of IS in the hospitals. The proposed model has been presented and successfully evaluated by the domain experts from the selected hospitals. The proposed model is believed to be beneficial for top management, IT practitioners and medical practitioners in preventing IS implementation failure among government hospitals towards ensuring the success implementation.

The technical-economic potential of thermal energy saving in hospitals; El potencial tecnico-economico de ahorro de energia termica en hospitales

Energy Technology Data Exchange (ETDEWEB)

Herrera, A. [Universidad Nacional Autonoma de Mexico (Mexico); Islas, J [Universidad Nacional Autonoma de Mexico, Mexico, D.F. (Mexico); Arriola, A. [Instituto de Investigaciones Electricas, Cuernavaca, Morelos (Mexico)

2001-07-01

The hospitals are important consumers of energy. At the General Hospital of Zone (HGZ) N of the IMSS in Aguscalientes (HGZ N . IMSS Ags.), the diesel oil is the main fuel that is used to satisfy the requirements of thermal energy of the hospital. According to the data collected by this author, this fuel represented in 2001, 75% of its total energy consumption and the 67.9% of its total costs in energy that ascended to $396.131 (December 2001 Dollars) Since this last amount represents an important percentage of the total expenses of the hospital (29.367 million dollars) it is important to determine the technical-economic possibilities of thermal energy saving of the hospital. The HGZ N 1 IMSS Ags. is located in a ampler conglomerate where the IMSS units are located, such as, the regional laundry, the sport unit, the center of social security, the familiar medicine unit N 1 and the hospital. Nevertheless departing from the installation of the electrical systems and the provision of steam and hot water to the hospital, the electrical and thermal fluids of all this facilities are distributed. Due to this situation, in this work we will refer to the global consumption of the IMSS of Aguascalientes development where the hospital is the main consumer of thermal energy. In the present work we will calculate the technical-economic potential of thermal energy saving in the development of the IMSS through the thermodynamic technique of folding point or pinch technique. [Spanish] Los hospitales son importantes consumidores de energia. En el Hospital General de Zona N del IMSS en Aguscalientes (HGZ N - IMSS Ags.), el diesel es el principal combustible que se usa para satisfacer los requerimientos de energia termica del hospital. Segun los datos obtenidos por el autor anterior, este combustible represento en 2001 el 75% de su consumo total energetico y el 67.9% de sus costos totales en energeticos que ascendieron a $396,131 (dolares de diciembre de 2001). Dado que esta ultima

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

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Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip

2017-03-01

There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

Between two beds: inappropriately delayed discharges from hospitals.

Science.gov (United States)

Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

2013-12-01

Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

Dopamine modulation of avoidance behavior in Caenorhabditis elegans requires the NMDA receptor NMR-1.

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Melvin Baidya

Full Text Available The nematode C. elegans utilizes a relatively simple neural circuit to mediate avoidance responses to noxious stimuli such as the volatile odorant octanol. This avoidance behavior is modulated by dopamine. cat-2 mutant animals that are deficient in dopamine biosynthesis have an increased response latency to octanol compared to wild type animals, and this defect can be fully restored with the application of exogenous dopamine. Because this avoidance behavior is mediated by glutamatergic signaling between sensory neurons and premotor interneurons, we investigated the genetic interactions between dopaminergic signaling and ionotropic glutamate receptors. cat-2 mutant animals lacking either the GLR-1 or GLR-2 AMPA/kainate receptors displayed an increased response latency to octanol, which could be restored via exogenous dopamine. However, whereas cat-2 mutant animals lacking the NMR-1 NMDA receptor had increased response latency to octanol they were insensitive to exogenous dopamine. Mutants that lacked both AMPA/kainate and NMDA receptors were also insensitive to exogenous dopamine. Our results indicate that dopamine modulation of octanol avoidance requires NMR-1, consistent with NMR-1 as a potential downstream signaling target for dopamine.

Cultural Humility and Hospital Safety Culture.

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Hook, Joshua N; Boan, David; Davis, Don E; Aten, Jamie D; Ruiz, John M; Maryon, Thomas

2016-12-01

Hospital safety culture is an integral part of providing high quality care for patients, as well as promoting a safe and healthy environment for healthcare workers. In this article, we explore the extent to which cultural humility, which involves openness to cultural diverse individuals and groups, is related to hospital safety culture. A sample of 2011 hospital employees from four hospitals completed measures of organizational cultural humility and hospital safety culture. Higher perceptions of organizational cultural humility were associated with higher levels of general perceptions of hospital safety, as well as more positive ratings on non-punitive response to error (i.e., mistakes of staff are not held against them), handoffs and transitions, and organizational learning. The cultural humility of one's organization may be an important factor to help improve hospital safety culture. We conclude by discussing potential directions for future research.

A case study of hospital operations management.

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Cheng, T C

1987-12-01

This paper discusses a study to investigate various operations management problems in a newly opened, modern regional hospital in Hong Kong. The findings of the study reveal that there exist in the hospital a number of current and potential problem areas. Recommendations for solving these problems are suggested with a view to improving the overall operational efficiency and effectiveness of the hospital.

Quantitative tools for addressing hospital readmissions

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Lagoe Ronald J

2012-11-01

Full Text Available Abstract Background Increased interest in health care cost containment is focusing attention on reduction of hospital readmissions. Major payors have already developed financial penalties for providers that generate excess readmissions. This subject has benefitted from the development of resources such as the Potentially Preventable Readmissions software. This process has encouraged hospitals to renew efforts to improve these outcomes. The aim of this study was to describe quantitative tools such as definitions, risk estimation, and tracking of patients for reducing hospital readmissions. Findings This study employed the Potentially Preventable Readmissions software to develop quantitative tools for addressing hospital readmissions. These tools included two definitions of readmissions that support identification and management of patients. They also included analytical approaches for estimation of the risk of readmission for individual patients by age, discharge status of the initial admission, and severity of illness. They also included patient specific spreadsheets for tracking of target populations and for evaluation of the impact of interventions. Conclusions The study demonstrated that quantitative tools including the development of definitions of readmissions, estimation of the risk of readmission, and patient specific spreadsheets could contribute to the improvement of patient outcomes in hospitals.

THE ABILITY OF FAST-GROWING TRANSGENIC AFRICAN CATFISH (Clarias gariepinus ON PREDATOR AVOIDANCE

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Huria Marnis

2016-12-01

Full Text Available Research Institute for Fish Breeding has produced transgenic African catfish (Clarias gariepinus containing stripped catfish growth hormone gene (PccBA-PhGH with growth 19.86% faster than that of non-transgenic fish. This fish has high potential to be released and utilized for fish farming sector to increase national production. However, there is not yet information about environmental risk of this fish. One of the major fitness traits determining potential environmental risk is predator avoidance. This study aimed to determine the predator avoidance ability of transgenic African catfish in an experimental laboratory condition. In this study, thirty five individuals each of transgenic and non-transgenic with body weight of about 0.1 ± 0.019 g were communally stocked in 60 cm x 40 cm x 40 cm aquarium with limited feeding frequency (ad libitum twice a day. One day after the fish were stocked, the predators were added to each aquarium. The non-transgenic and transgenic with body weight of 1.0 ± 0.024 g were stocked as predators as many as five individual in each aquarium. After approximately two weeks of predation, all remaining fish were collected for transgenic verification by PCR method. Genomic DNA was isolated from fin tissue of individually survivors. The results of this study showed that the transgenic fish had worse predator avoidance and lower cannibal than non-transgenic (P0.05 in limited food. The transgenic fish may have lower fitness than non-transgenic.

The billing process at a teaching hospital specialized in cardiology and pulmonology

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Gabriela Favaro Faria Guerrer

2014-09-01

Full Text Available The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences between patient charts and the patient’s hospital bill. doi: 10.5216/ree.v16i3.23487.

Neuromorphic UAS Collision Avoidance

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National Aeronautics and Space Administration — Collision avoidance for unmanned aerial systems (UAS) traveling at high relative speeds is a challenging task. It requires both the detection of a possible collision...

The effect of chronic stimulation of serotonin receptor type 7 on recognition, passive avoidance memory, hippocampal long-term potentiation, and neuronal apoptosis in the amyloid β protein treated rat.

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Shahidi, Siamak; Asl, Sara Soleimani; Komaki, Alireza; Hashemi-Firouzi, Nasrin

2018-05-01

Alzheimer's disease (AD) is a neurodegenerative disorder characterized by memory impairment, neuronal death, and synaptic loss in the hippocampus. Long-term potentiation (LTP), a type of synaptic plasticity, occurs during learning and memory. Serotonin receptor type 7 (5-HTR7) activation is suggested as a possible therapeutic target for AD. The aim of the present study was to examine the effects of chronic treatment with the 5-HTR7 agonist, AS19, on cognitive function, memory, hippocampal plasticity, amyloid beta (Aβ) plaque accumulation, and apoptosis in an adult rat model of AD. AD was induced in rats using Aβ (single 1 μg/μL intracerebroventricular (icv) injection during surgery). The following experimental groups were included: control, sham-operated, Aβ + saline (1 μL icv for 30 days), and Aβ + AS19 (1 μg/μL icv for 30 days) groups. The animals were tested for cognition and memory performance using the novel object recognition and passive avoidance tests, respectively. Next, anesthetized rats were placed in a stereotaxic apparatus for electrode implantation, and field potentials were recorded in the hippocampal dentate gyrus. Lastly, brains were removed and Aβ plaques and neuronal apoptosis were evaluated using Congo red staining and TUNEL assay, respectively. Administration of AS19 in the Aβ rats increased the discrimination index of the novel object recognition test. Furthermore, AS19 treatment decreased time spent in the dark compartment during the passive avoidance test. AS19 also enhanced both the population spike (PS) amplitude and the field excitatory postsynaptic potential (fEPSP) slope evoked potentials of the LTP components. Aβ plaques and neuronal apoptosis were decreased in the AS19-treated Aβ rats. These results indicate that chronic treatment with a 5-HTR7 agonist can prevent Aβ-related impairments in cognition and memory performance by alleviating Aβ plaque accumulation and neuronal apoptosis, hence improving neuronal

Conducting qualitative research within Clinical Trials Units: avoiding potential pitfalls.

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Cooper, Cindy; O'Cathain, Alicia; Hind, Danny; Adamson, Joy; Lawton, Julia; Baird, Wendy

2014-07-01

The value of using qualitative research within or alongside randomised controlled trials (RCTs) is becoming more widely accepted. Qualitative research may be conducted concurrently with pilot or full RCTs to understand the feasibility and acceptability of the interventions being tested, or to improve trial conduct. Clinical Trials Units (CTUs) in the United Kingdom (UK) manage large numbers of RCTs and, increasingly, manage the qualitative research or collaborate with qualitative researchers external to the CTU. CTUs are beginning to explicitly manage the process, for example, through the use of standard operating procedures for designing and implementing qualitative research with trials. We reviewed the experiences of two UK Clinical Research Collaboration (UKCRC) registered CTUs of conducting qualitative research concurrently with RCTs. Drawing on experiences gained from 15 studies, we identify the potential for the qualitative research to undermine the successful completion or scientific integrity of RCTs. We show that potential problems can arise from feedback of interim or final qualitative findings to members of the trial team or beyond, in particular reporting qualitative findings whilst the trial is on-going. The problems include: We make recommendations for improving the management of qualitative research within CTUs. Copyright © 2014. Published by Elsevier Inc.

Lack of behavioural evidence for kin avoidance in mate choice in a hymenopteran parasitoid (Hymenoptera: Braconidae).

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Bourdais, D; Hance, T

2009-05-01

Mechanisms for inbreeding avoidance should be prevalent in insects that reproduce by arrhenotokous haplodiploidy because of the higher potential production of unviable diploid males in inbred matings. Few studies have focused on mating strategies in insect parasitoids and even less on kinship relationships during mate choice. In this study we tested avoidance of kin as mate in the parasitic wasp Aphidius matricariae (Hymenoptera: Braconidae) using an ethological approach. Key mating parameters, such as male wing fanning, latent period before genitalia contact and duration of copulation were measured. No evidence for kin avoidance in mate choice in both A. matricariae males and females was observed in our behaviour (no choice or choice tests) tests. This lack of ethological sib mating avoidance could be due to different factors such as sex determination rule different than the single locus complementary sex determination, making lower the proportion of diploid males in case of sib matings and thus its negative consequence. The existence of other inbreeding avoidance strategies and mechanisms that reduce the probability of 2 receptive relatives meeting in nature may be common, for example, inbred mating may be rare through differential dispersal, delayed maturation, or protandry.

Medical tourism private hospitals: focus India.

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Brotman, Billie Ann

2010-01-01

This article examines demand factors for sophisticated medical treatments offered by private hospitals operating in India. Three types of medical tourism exist: Outbound, Inbound, and Intrabound. Increased profitability and positive growth trends by private hospital chains can be attributed to rising domestic income levels within India. Not all of the chains examined were financially solvent. Some of the hospital groups in this sample that advertised directly to potential Inbound medical tourists appear to be experiencing negative cash flows.

[Comparative evaluation of maternity hospitals in Auvergne: from planning to contracting].

Science.gov (United States)

Gerbaud, L; Biolay, S; Venet, M; Pomey, M P; Belgacem, B; Jacquetin, B; Glanddier, P Y

1998-01-01

Two reforms of public hospitals have been launched by the French government in 1991 and 1996 aimed at lowering costs and increasing the quality of services and ultimately the safety of patients. As concerns maternity hospitals, several new rules have been imposed upon. For example, those who performed less than 300 births a year should be closed. The basic idea was to concentrate technical resources and human skills in middle-size and important hospitals for saving money, and simultaneously, raising the safety level for mothers and babies. However, negative adverse effects fastly appeared: to avoid closure, some small maternity homes tried to convince future mothers not to go to well-equipped hospitals, even if their cases appeared complex and their health at risk. An experience of partnership between maternity hospitals (care providers), the Sickness Insurance Fund (the financing body) and the Administration was carried out in the Auvergne region. It was based on the observation of a large number of indicators concerning the activity of hospitals, the size and quality of their equipment, the satisfaction of their patients ... etc ... for designing the rights and duties of each partner. Instead of planning from the summit, a process of mutually-agreed contract was established.

Early Implementation of THAM for ICP Control: Therapeutic Hypothermia Avoidance and Reduction in Hypertonics/Hyperosmotics

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F. A. Zeiler

2014-01-01

Full Text Available Background. Tromethamine (THAM has been demonstrated to reduce intracranial pressure (ICP. Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH and 2 with traumatic brain injury (TBI receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted.

Smart Textiles in Humanistic Hospital Design

DEFF Research Database (Denmark)

Mogensen, Jeppe Emil; Fisker, Anna Marie; Poulsen, Søren Bolvig

2013-01-01

in Future Hospitals”, stating the overall hypothesis that textiles in hospital interiors possess an unexploited architectural potential in relation to the humanistic visions of healing architecture. Concerned with the operational challenge of unfolding the visionary design principle, we suggest to re......With the construction of new hospitals, the design principle healing architecture is introduced, representing the humanistic vision of improving hospitalised patients’ healing process, supported by stimulating architecture. In this regard, we address focus on the potential influence of the design...... principle, discussing how healing architecture may contribute in making the future hospital institutions more responsive to human needs. The main purpose of this paper is thus to present a review of healing architecture, by considering some of the challenges in the operational use of the design principle...

Smart Textiles in Humanistic Hospital Design

DEFF Research Database (Denmark)

Mogensen, Jeppe; Fisker, Anna Marie; Poulsen, Søren Bolvig

2014-01-01

of some of the stakeholders involved in the design process? Relating to the Danish scene of hospital design, we introduce the research project “Smart Textiles in Future Hospitals”, stating the overall hypothesis that textiles in hospital interiors possess an unexploited architectural potential in relation......Hospitalised patients’ healing process, supported by stimulating architecture. In this regard, we address focus on the potential influence of the design principle, discussing how healing architecture may contribute in making the future hospital institutions more responsive to human needs. The main...... purpose of this paper is thus to present a review of healing architecture, by considering some of the challenges in the operational use of the design principle. Associated with the methodology of evidence-based design (EBD), we in this regard question, if these challenges derive from conflicting paradigms...

Therapeutic follow-up in hospitalization: social inclusion, recovery of citizenship and respect for individuality

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Regina Célia Fiorati

2008-01-01

Full Text Available This study was carried out in a psychiatric crisis hospitalization unit, with the aim of drawing up a proposal for implementing therapeutic follow-up as part of the therapeutic program at this unit. The concept of therapeutic follow-up was envisaged as an important resource to be included in psychosocial rehabilitation projects, with the following goals: linking users with extra-hospital services, avoiding re-hospitalization and achieving inclusion in social networks. The study consisted of an exploratory-descriptive case study with a qualitative approach to data. Participant observation and a field diary were the techniques used for gathering and recording data. The difficulties experienced were correlated with the spheres of social networks, family, institutional relationships and society. The results included heeding the patient's and the family's suffering and including users in social networks, extra-hospital services and community organizations.

Functional textiles in hospital interiors

DEFF Research Database (Denmark)

Mogensen, Jeppe

This PhD thesis explores the possibilities and design qualities of using functional textiles in the interior of hospital environments, and is the result of a three years collaboration between Aalborg University, Department of Civil Engineering, and VIA University College, VIA Design. The project...... that the physical environments affect the patients’ level of stress and influence their process of recovery and healing. However, although research in this field of hospital design has increased substantially in recent years, knowledge on the use of new materials and textiles in hospital interiors is still rather...... limited. Concerned with the design potentials of using textiles in hospital interiors, the purpose of the PhD project has been to explore the possibilities and design qualities of using these materials in hospital design. Relating to both technical and aesthetic aspects of using functional textiles...

Food Waste Avoidance Actions in Food Retailing

DEFF Research Database (Denmark)

Kulikovskaja, Viktorija; Aschemann-Witzel, Jessica

2017-01-01

Food waste occurs throughout the entire food supply chain, from production to consumption of food in households. Retailers are in a unique position to contribute to food waste avoidance, not only by minimizing the amount of waste in their distribution channels but also by influencing consumer...... attitudes and behaviors. This explorative study aims to identify which food waste avoidance actions are conducted by retailers in Denmark, to which extent, and how they vary across food categories and supermarket chain. Based on an analysis of secondary and empirical data collected via observations...... at retail stores, the authors identify 22 food waste avoidance actions in Danish retail. The results provide new insights into food waste avoidance in retail. Based on the findings, suggestions for further research directions are developed that should serve to identify the most efficient customer targeted...

Obstacle detection and avoiding of quadcopter

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Wang, Dizhong; Lin, Jiajian

2017-10-01

Recent years, the flight control technology over quadcopter has been boosted vigorously and acquired the comprehensive application in a variety of industries. However, it is prominent for there to be problems existed in the stable and secure flight with the development of its autonomous flight. Through comparing with the characteristics of ultrasonic ranging and laser Time-of-Flight(abbreviated to ToF) distance as well as vision measurement and its related sensors, the obstacle detection and identification sensors need to be installed in order to effectively enhance the safety flying for aircraft, which is essential for avoiding the dangers around the surroundings. That the major sensors applied to objects perception at present are distance measuring instruments which based on the principle and application of non-contact detection technology . Prior to acknowledging the general principles of flight and obstacle avoiding, the aerodynamics modeling of the quadcopter and its object detection means has been initially determined on this paper. Based on such premise, this article emphasized on describing and analyzing the research on obstacle avoiding technology and its application status, and making an expectation for the trend of its development after analyzing the primary existing problems concerning its accuracy object avoidance.

Ecology: avoidance of disease by social lobsters.

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Behringer, Donald C; Butler, Mark J; Shields, Jeffrey D

2006-05-25

Transmissible pathogens are the bane of social animals, so they have evolved behaviours to decrease the probability of infection. There is no record, however, of social animals avoiding diseased individuals of their own species in the wild. Here we show how healthy, normally gregarious Caribbean spiny lobsters (Panulirus argus) avoid conspecifics that are infected with a lethal virus. Early detection and avoidance of infected, though not yet infectious, individuals by healthy lobsters confers a selective advantage and highlights the importance of host behaviour in disease transmission among natural populations.

Inhibition of NKCC1 attenuated hippocampal LTP formation and inhibitory avoidance in rat.

Directory of Open Access Journals (Sweden)

Meng Chang Ko

Full Text Available The loop diuretic bumetanide (Bumex is thought to have antiepileptic properties via modulate GABAA mediated signaling through their antagonism of cation-chloride cotransporters. Given that loop diuretics may act as antiepileptic drugs that modulate GABAergic signaling, we sought to investigate whether they also affect hippocampal function. The current study was performed to evaluate the possible role of NKCC1 on the hippocampal function. Brain slice extracellular recording, inhibitory avoidance, and western blot were applied in this study. Results showed that hippocampal Long-term potentiation was attenuated by suprafusion of NKCC1 inhibitor bumetanide, in a dose dependent manner. Sequent experiment result showed that Intravenous injection of bumetanide (15.2 mg/kg 30 min prior to the training session blocked inhibitory avoidance learning significantly. Subsequent control experiment's results excluded the possible non-specific effect of bumetanide on avoidance learning. We also found the phosphorylation of hippocampal MAPK was attenuated after bumetanide administration. These results suggested that hippocampal NKCC1 may via MAPK signaling cascade to possess its function.

Potential loss of revenue due to errors in clinical coding during the implementation of the Malaysia diagnosis related group (MY-DRG®) Casemix system in a teaching hospital in Malaysia.

Science.gov (United States)

Zafirah, S A; Nur, Amrizal Muhammad; Puteh, Sharifa Ezat Wan; Aljunid, Syed Mohamed

2018-01-25

The accuracy of clinical coding is crucial in the assignment of Diagnosis Related Groups (DRGs) codes, especially if the hospital is using Casemix System as a tool for resource allocations and efficiency monitoring. The aim of this study was to estimate the potential loss of income due to an error in clinical coding during the implementation of the Malaysia Diagnosis Related Group (MY-DRG ® ) Casemix System in a teaching hospital in Malaysia. Four hundred and sixty-four (464) coded medical records were selected, re-examined and re-coded by an independent senior coder (ISC). This ISC re-examined and re-coded the error code that was originally entered by the hospital coders. The pre- and post-coding results were compared, and if there was any disagreement, the codes by the ISC were considered the accurate codes. The cases were then re-grouped using a MY-DRG ® grouper to assess and compare the changes in the DRG assignment and the hospital tariff assignment. The outcomes were then verified by a casemix expert. Coding errors were found in 89.4% (415/424) of the selected patient medical records. Coding errors in secondary diagnoses were the highest, at 81.3% (377/464), followed by secondary procedures at 58.2% (270/464), principal procedures of 50.9% (236/464) and primary diagnoses at 49.8% (231/464), respectively. The coding errors resulted in the assignment of different MY-DRG ® codes in 74.0% (307/415) of the cases. From this result, 52.1% (160/307) of the cases had a lower assigned hospital tariff. In total, the potential loss of income due to changes in the assignment of the MY-DRG ® code was RM654,303.91. The quality of coding is a crucial aspect in implementing casemix systems. Intensive re-training and the close monitoring of coder performance in the hospital should be performed to prevent the potential loss of hospital income.

Avoiding student infection during a Middle East respiratory syndrome (MERS) outbreak: a single medical school experience.

Science.gov (United States)

Park, Seung Won; Jang, Hye Won; Choe, Yon Ho; Lee, Kyung Soo; Ahn, Yong Chan; Chung, Myung Jin; Lee, Kyu-Sung; Lee, Kyunghoon; Han, Taehee

2016-06-01

In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges. Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease. The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students. Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.

Interactions medicative and consequents interventions pharmaceutics in the unity of intensive therapy in a private hospital in Macapa, Amapa

Directory of Open Access Journals (Sweden)

Uriel Davi de Almeida e Silva

2018-05-01

Full Text Available Introduction: Patients admitted to Intensive Care Units (ICU are submitted to multiple drug treatments, considering the severity of their problems. Drug interaction is defined as an event caused by the modification of the effect or use of a drug in the body. The evaluation of potential drug interactions can help the multiprofessional team to promote a quality treatment, avoiding harmful interactions, reducing the length of hospitalization and consequently reducing costs. Objective: To evaluate the main drug interactions observed in the ICUs of a private hospital in the city of Macapá, Brazil, through the analysis of the prescriptions and the consequent interventions adopted in order to minimize their risks. Method: Prescriptions of patients admitted to the ICU were evaluated for the presence of potential drug interactions and their respective classification according to their risk and mechanism. A brief bibliographic study about the main interactions was carried out in order to highlight its mechanism and the measures adopted by the multidisciplinary team. Results: We observed that the majority of the interactions, both in the adult ICU and in the neonatal ICU, were considered of moderate risk. Pharmacokinetic interactions were more common in the adult ICU, while pharmacodynamics predominated in the neonatal intensive care unit. Management during the administration of medications was the most appropriate intervention for most cases of drug interactions. Conclusions: Monitoring of potential interactions in critically ill patients seeks to ensure patient safety in order to reduce the potential risks to which they are exposed.

Præhospital behandling af svært tilskadekomne patienter med fokus på damage control-kirurgi

DEFF Research Database (Denmark)

Sørensen, Anne Marie; Larsen, Claus Falck; Steinmetz, Jacob

2011-01-01

The majority of patients undergoing damage control surgery initially receive prehospital treatment. Bleeding causes 40% of trauma deaths, half of which happen in the prehospital setting. Future research and improved treatment before hospital admission should focus on control of the bleeding, avoi......, avoidance of hypothermia, minimising the time to definitive surgery, and a restrictive and goal directed therapy with regard to the intake of fluids. On occasion, lifesaving procedures could be performed during transport to the hospital....

[Treatment of eating disorders during hospitalization: presentation of a hospital intensive care program in pediatric age].

Science.gov (United States)

D'Argenio, L; Zaccagnino, M; Donati, C; Perini, A; Fazzi, E

2013-04-01

The aim of this study was to present a hospital intensive care program for patients affected by a severe eating disorders, with a significant loss of weight (BMI110 bpm or inability to sustain core body temperature), abnormal laboratory data, especially electrolyte imbalance and refusal to take food and fluids. In our study we reported 2 year follow-up of 16 patients treated with the hospital intensive care program between 2007 and 2008 in our department. The proposed program was proved an efficient method in a critical phase of the alimentary behavior disorders. It was possible for all the patients to avoid alternative feeding techniques (enteral or parenteral) and to obtain a correct alimentation with a satisfactory improvement of clinical conditions. Eight patients (50%) fully recovered. 5 patients (31.25%) had a significant improvement reaching a BMI>18.5 and one of them had a regular menstrual cycle, too. However in this group of patients a strict modality to alimentation and concern about weight and physical appearance remain. In 3 patients (18.5%) the BMI is still low and amenorrhea persists. The hospital intensive care program, inspired by the cognitive-behavioral model, through a food rehabilitation and a psychotherapeutic and psychoeducational help, lets the patients and their family understand and modify the dysfunctional patterns, experimenting a right modality to approach alimentation, with a satisfactory improvement in clinical conditions.

Threat to Freedom and the Detrimental Effect of Avoidance Goal Frames: Reactance as a Mediating Variable

Science.gov (United States)

Niesta Kayser, Daniela; Graupmann, Verena; Fryer, James W.; Frey, Dieter

2016-01-01

Two experiments examined how individuals respond to a restriction presented within an approach versus an avoidance frame. In Study 1, working on a problem-solving task, participants were initially free to choose their strategy, but for a second task were told to change their strategy. The message to change was embedded in either an approach or avoidance frame. When confronted with an avoidance compared to an approach frame, the participants’ reactance toward the request was greater and, in turn, led to impaired performance. The role of reactance as a response to threat to freedom was explicitly examined in Study 2, in which participants evaluated a potential change in policy affecting their program of study herein explicitly varying whether a restriction was present or absent and whether the message was embedded in an approach versus avoidance frame. When communicated with an avoidance frame and as a restriction, participants showed the highest resistance in terms of reactance, message agreement and evaluation of the communicator. The difference in agreement with the change was mediated by reactance only when a restriction was present. Overall, avoidance goal frames were associated with more resistance to change on different levels of experience (reactance, performance, and person perception). Reactance mediated the effect of goal frame on other outcomes only when a restriction was present. PMID:27242572

An inquiry - aesthetics of art in hospitals.

Science.gov (United States)

Gates, Jillian

2008-09-01

Historically, art has served a significant purpose within hospital waiting rooms. However, in recent times we have experienced cuts in funding and less interest in improving the aesthetic of art displayed in Australian hospitals. This article briefly discusses the history of art in hospitals and explores a methodology for researching the preference of Australian patients today. Potentially, Australians waiting in hospitals and medical clinics could benefit from art works that reflect their preferences; this may help to ease the pain, anxiety, and boredom of waiting.

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

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Dai, Ying-Xiu; Chen, Tzeng-Ji; Lin, Ming-Hwai

2017-01-01

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ 2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ 2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

Prevalence of Allergy to Natural Rubber Latex and Potential Cross Reacting Food in Operation Room Staff in Shiraz Hospitals -2006

OpenAIRE

H Nabavizade; R Amin

2007-01-01

Introduction & Objective: Allergic reactions to natural rubber latex have increased during past 10 years especially among health care workers and patients with high exposure to latex allergens. Allergic reaction to latex is related to many diseases like occupational asthma. This study was performed to determine the prevalence of allergy to natural rubber latex and potential cross reacting food in operation room staff in Shiraz hospitals. Materials & Methods: In this cross-sectional descr...

Sensor-based whole-arm obstacle avoidance for unstructured environments

International Nuclear Information System (INIS)

Wintenberg, A.L.; Butler, P.L.; Babcock, S.M.; Ericson, M.N.; Armstrong, G.A.; Britton, C.L. Jr.; Hamel, W.R.

1992-01-01

Whole-arm obstacle avoidance is needed for a variety of robotic applications in the Environmental Restoration and Waste Management (ER ampersand WM) Program. Typical industrial applications of robotics involve well-defined workspaces, allowing a predetermined knowledge of collision-free paths for manipulator motion. However, many hazardous environments are unstructured or poorly defined, providing a significant potential for collisions between manipulators and the environment. In order to allow applications of robotics in such situations, a sensing system is under development which will provide protection against collisions. Specifics of this system including system architecture and projected implementation are described

Automatic guidance and control laws for helicopter obstacle avoidance

Science.gov (United States)

Cheng, Victor H. L.; Lam, T.

1992-01-01

The authors describe the implementation of a full-function guidance and control system for automatic obstacle avoidance in helicopter nap-of-the-earth (NOE) flight. The guidance function assumes that the helicopter is sufficiently responsive so that the flight path can be readily adjusted at NOE speeds. The controller, basically an autopilot for following the derived flight path, was implemented with parameter values to control a generic helicopter model used in the simulation. Evaluation of the guidance and control system with a 3-dimensional graphical helicopter simulation suggests that the guidance has the potential for providing good and meaningful flight trajectories.

Posture as index for approach-avoidance behavior

NARCIS (Netherlands)

Eerland, A.; Guadalupe, Tulio; Franken, Ingmar; Zwaan, Rolf

2012-01-01

Approach and avoidance are two behavioral responses that make people tend to approach positive and avoid negative situations. This study examines whether postural behavior is influenced by the affective state of pictures. While standing on the Wii™ Balance Board, participants viewed pleasant,

Posture as index for Approach-Avoidance behavior

NARCIS (Netherlands)

A. Eerland (Anita); T. Guadalupe (Tulio); I.H.A. Franken (Ingmar); R.A. Zwaan (Rolf)

2012-01-01

textabstractApproach and avoidance are two behavioral responses that make people tend to approach positive and avoid negative situations. This study examines whether postural behavior is influenced by the affective state of pictures. While standing on the Wii™ Balance Board, participants viewed

Potential drug-drug interactions in a Brazilian teaching hospital: age-related differences?

Directory of Open Access Journals (Sweden)

Daniela Oliveira Melo

2016-07-01

Full Text Available This study proposes to measure frequency and to characterize the profile of potential drug interactions (pDDI in a general medicine ward of a teaching hospital. Data about identification and clinical status of patients were extracted from medical records between March to August 2006. The occurrence of pDDI was analyzed using the database monographs Micromedex® DrugReax® System. From 5,336 prescriptions with two or more drugs, 3,097 (58.0% contained pDDI. The frequency of major and well document pDDI was 26.5%. Among 647 patients, 432 (66.8% were exposed to at least one pDDI and 283 (43.7% to major pDDI. The multivariate analysis identified that factors related to higher rates of major pDDI were the same age (p< 0.0001, length of stay (p< 0.0001, prevalence of hypertension [OR=3.42 (p< 0.0001] and diabetes mellitus [OR=2.1 (p< 0.0001], cardiovascular diseases (p< 0.0001 and the number of prescribed drugs (Spearman’s correlation=0.640622, p< 0.0001. Between major pDDI, the main risk was hemorrhage (50.3%, the most frequent major pDDI involved combination of anticoagulants and antiplatelet drugs. Among moderate pDDI, 3,866 (90.8% involved medicines for the treatment of chronic non-communicable diseases, mainly hypertension. In HU-USP, the profile of pDDI was similar among adults and elderly (the most frequent pDDI and major pDDI were same, the difference was only the frequency in either group. The efforts of the clinical pharmacists should be directed to elderly patients with cardiovascular compromise, mainly in use of anticoagulants and antiplatelet drugs. Furthermore, hospital managers should increase the integration between levels of health care to promote safety patient after discharge.Keywords: Drug interactions. Aged. Internal Medicine. Hospitals, University. RESUMOInterações medicamentosas potenciais em um hospital escolar brasileiro: diferenças relacionadas à idade?O estudo tem por objetivo descrever o perfil de intera

[Hospitality for elderly patients in the emergency department].

Science.gov (United States)

Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas

2015-12-09

Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective.

Quantifying the Benefit of Early Climate Change Mitigation in Avoiding Biodiversity Loss

Science.gov (United States)

Warren, R.; Vanderwal, J.; Price, J.; Welbergen, J.; Atkinson, I. M.; Ramirez-Villegas, J.; Osborn, T.; Shoo, L.; Jarvis, A.; Williams, S.; Lowe, J. A.

2014-12-01

Quantitative simulations of the global-scale benefits of climate change mitigation in avoiding biodiversity loss are presented. Previous studies have projected widespread global and regional impacts of climate change on biodiversity. However, these have focused on analysis of business-as-usual scenarios, with no explicit mitigation policy included. This study finds that early, stringent mitigation would avoid a large proportion of the impacts of climate change induced biodiversity loss projected for the 2080s. Furthermore, despite the large number of studies addressing extinction risks in particular species groups, few studies have explored the issue of potential range loss in common and widespread species. Our study is a comprehensive global scale analysis of 48,786 common and widespread species. We show that without climate change mitigation, 57+/-6% of the plants and 34+/-7% of the animals studied are likely to lose over 50% of their present climatic range by the 2080s. This estimate incorporates realistic, taxon-specific dispersal rates. With stringent mitigation, in which emissions peak in 2016 and are reduced by 5% annually thereafter, these losses are reduced by 60%. Furthermore, with stringent mitigation, global temperature rises more slowly, allowing an additional three decades for biodiversity to adapt to a temperature rise of 2C above pre-industrial levels. The work also shows that even with mitigation not all the impacts can now be avoided, and ecosystems and biodiversity generally has a very limited capacity to adapt. Delay in mitigation substantially reduces the percentage of impacts that can be avoided, for example if emissions do not peak until 2030, the percentage of losses that can be avoided declines to 40%. Since even small declines in common and widespread species can disrupt ecosystem function and services, these results indicate that without mitigation, globally widespread losses in ecosystem service provision are to be expected.

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

Directory of Open Access Journals (Sweden)

Maarten C Eisma

Full Text Available Rumination is a risk factor in adjustment to bereavement. It is associated with and predicts psychopathology after loss. Yet, the function of rumination in bereavement remains unclear. In the past, researchers often assumed rumination to be a maladaptive confrontation process. However, based on cognitive avoidance theories of worry in generalised anxiety disorder (GAD and rumination after post-traumatic stress disorder (PTSD, others have suggested that rumination may serve to avoid painful aspects of the loss, thereby contributing to complicated grief. To examine if rumination is linked with loss avoidance, an eye-tracking study was conducted with 54 bereaved individuals (27 high and 27 low ruminators. On 24 trials, participants looked for 10 seconds at a picture of the deceased and a picture of a stranger, randomly combined with negative, neutral or loss-related words. High ruminators were expected to show initial vigilance followed by subsequent disengagement for loss stimuli (i.e., picture deceased with a loss word in the first 1500 ms. Additionally, we expected high ruminators to avoid these loss stimuli and to show attentional preference for non-loss-related negative stimuli (i.e., picture stranger with a negative word on longer exposure durations (1500-10000 ms. Contrary to expectations, we found no evidence for an effect of rumination on vigilance and disengagement of loss stimuli in the first 1500 ms. However, in the 1500-10000 ms interval, high ruminators showed shorter gaze times for loss stimuli and longer gaze times for negative (and neutral non-loss-related stimuli, even when controlling for depression and complicated grief symptom levels. Effects of rumination on average fixation times mirrored these findings. This suggests that rumination and loss avoidance are closely associated. A potential clinical implication is that rumination and grief complications after bereavement may be reduced through the use of exposure and acceptance

A Compact Magnetic Field-Based Obstacle Detection and Avoidance System for Miniature Spherical Robots

Directory of Open Access Journals (Sweden)

Fang Wu

2017-05-01

Full Text Available Due to their efficient locomotion and natural tolerance to hazardous environments, spherical robots have wide applications in security surveillance, exploration of unknown territory and emergency response. Numerous studies have been conducted on the driving mechanism, motion planning and trajectory tracking methods of spherical robots, yet very limited studies have been conducted regarding the obstacle avoidance capability of spherical robots. Most of the existing spherical robots rely on the “hit and run” technique, which has been argued to be a reasonable strategy because spherical robots have an inherent ability to recover from collisions. Without protruding components, they will not become stuck and can simply roll back after running into bstacles. However, for small scale spherical robots that contain sensitive surveillance sensors and cannot afford to utilize heavy protective shells, the absence of obstacle avoidance solutions would leave the robot at the mercy of potentially dangerous obstacles. In this paper, a compact magnetic field-based obstacle detection and avoidance system has been developed for miniature spherical robots. It utilizes a passive magnetic field so that the system is both compact and power efficient. The proposed system can detect not only the presence, but also the approaching direction of a ferromagnetic obstacle, therefore, an intelligent avoidance behavior can be generated by adapting the trajectory tracking method with the detection information. Design optimization is conducted to enhance the obstacle detection performance and detailed avoidance strategies are devised. Experimental results are also presented for validation purposes.

Banking deregulation and corporate tax avoidance

Directory of Open Access Journals (Sweden)

Bill B. Francis

2017-06-01

Full Text Available We investigate whether tax avoidance substitutes for external financing. We exploit interstate banking deregulation as a quasi-external shock to examine whether firms engage in less tax avoidance after banking deregulation, because of cheaper and easier access to credit from banks. We find no empirical evidence to support this substitutive relation, even for firms with higher financial constraints or firms with higher external financing dependence.

A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol

Science.gov (United States)

Garber, Andrea K.; Michihata, Nobuaki; Hetnal, Katherine; Shafer, Mary-Ann; Moscicki, Anna-Barbara

2015-01-01

Purpose Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol. Methods Adolescents aged 13.1–20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day. Results Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission. Conclusions Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome. PMID:22188830

Use of closed systems in the Hospital Pharmacy

Directory of Open Access Journals (Sweden)

María Forte Pérez-Minayo

2016-03-01

Full Text Available Objective: In the setting of the increasing use of closed systems for reconstitution and preparation of these drugs, we intend to analyze the correct use of these systems in the Hospital Pharmacy, with the objective to minimize the risks of exposure not only for those professionals directly involved, but also for all the staff in the unit, taking also into account efficiency criteria. Method: Since some systems protect against aerosol formation but not from vapours, we decided to review which cytostatics should be prepared using an awl with an air inlet valve, in order to implement a new working procedure. We reviewed the formulations available in our hospital, with the following criteria: method of administration, excipients, and potential hazard for the staff handling them. We measured the diameters of the vials. We selected drugs with Level 1 Risk and also those including alcohol-based excipients, which could generate vapours. Outcomes: Out of the 66 reviewed formulations, we concluded that 11 drugs should be reconstituted with this type of awl: busulfan, cabazitaxel, carmustine, cyclophosphamide, eribulin, etoposide, fotemustine, melphalan, paclitaxel, temsirolimus and thiotepa; these represented an 18% of the total volume of formulations. Conclusions: The selection of healthcare products must be done at the Hospital Pharmacy, because the use of a system with an air valve inlet only for those drugs selected led to an outcome of savings and a more efficient use of materials. In our experience, we confirmed that the use of the needle could only be avoided when the awl could adapt to the different formulations of cytostatics, and this is only possible when different types of awls are available. Besides, connections were only really closed when a single awl was used for each vial. The change in working methodology when handling these drugs, as a result of this study, will allow us to start different studies about environmental contamination as a

Self-avoiding polygons and walks in slits

International Nuclear Information System (INIS)

Alvarez, J; Whittington, S G; Rensburg, E J Janse van; Soteros, C E

2008-01-01

A polymer in a confined geometry may be modeled by a self-avoiding walk or a self-avoiding polygon confined between two parallel walls. In two dimensions, this model involves self-avoiding walks or self-avoiding polygons in the square lattice between two parallel confining lines. Interactions of the polymer with the confining walls are introduced by energy terms associated with edges in the walk or polygon which are at or near the confining lines. We use transfer-matrix methods to investigate the forces between the walk or polygon and the confining lines, as well as to investigate the effects of the confining slit's width and of the energy terms on the thermodynamic properties of the walks or polygons in several models. The phase diagram found for the self-avoiding walk models is qualitatively similar to the phase diagram of a directed walk model confined between two parallel lines, as was previously conjectured. However, the phase diagram of one of our polygon models is found to be significantly different and we present numerical data to support this. For that particular model we prove that, for any finite values of the energy terms, there are an infinite number of slit widths where a polygon will induce a steric repulsion between the confining lines

Identifying potentially eligible subjects for research: paper-based logs versus the hospital administrative database.

Science.gov (United States)

Magee, L A; Massey, K; von Dadelszen, P; Fazio, M; Payne, B; Liston, R

2011-12-01

The Canadian Perinatal Network (CPN) is a national database focused on threatened very pre-term birth. Women with one or more conditions most commonly associated with very pre-term birth are included if admitted to a participating tertiary perinatal unit at 22 weeks and 0 days to 28 weeks and 6 days. At BC Women's Hospital and Health Centre, we compared traditional paper-based ward logs and a search of the Canadian Institute for Health Information (CIHI) electronic database of inpatient discharges to identify patients. The study identified 244 women potentially eligible for inclusion in the CPN admitted between April and December 2007. Of the 155 eligible women entered into the CPN database, each method identified a similar number of unique records (142 and 147) not ascertained by the other: 10 (6.4%) by CIHI search and 5 (3.2%) by ward log review. However, CIHI search achieved these results after reviewing fewer records (206 vs. 223) in less time (0.67 vs. 13.6 hours for ward logs). Either method is appropriate for identification of potential research subjects using gestational age criteria. Although electronic methods are less time-consuming, they cannot be performed until after the patient is discharged and records and charts are reviewed. Each method's advantages and disadvantages will dictate use for a specific project.

Avoidance and tolerance to avian herbivores in aquatic plants

NARCIS (Netherlands)

Hidding, A.

2009-01-01

Tolerance and avoidance are the two contrasting strategies that plants may adopt to cope with herbivores. Tolerance traits define the degree to which communities remain unaffected by herbivory. Trade-offs between herbivore avoidance and competitive strength and between avoidance and colonization

Obstacle avoidance test using a sensor-based autonomous robotic system

International Nuclear Information System (INIS)

Fujii, Yoshio; Suzuki, Katsuo

1998-12-01

From a viewpoint of reducing personnel radiation exposure of plant staffs working in the high radiation area of nuclear facilities, it is often said to be necessary to develop remote robotic systems, which have great potential of performing various tasks in nuclear facilities. Hence, we developed an advanced remote robotic system, consisting of redundant manipulator and environment-sensing systems, which can be applied to complicated handling tasks under unstructured environment. In the robotic system, various types of sensors for environment-sensing are mounted on the redundant manipulator and sensor-based autonomous capabilities are incorporated. This report describes the results of autonomous obstacle avoidance test which was carried out as follows: manipulating valves at the rear-side of wall, through a narrow window of the wall, with the redundant manipulator mounted on an x-axis driving mechanism. From this test, it is confirmed that the developed robotic system can autonomously achieve handling tasks in limited space as avoiding obstacles, which is supposed to be difficult by a non-redundant manipulator. (author)

Effects of traumatic experiences on obsessive-compulsive and internalizing symptoms: The role of avoidance and mindfulness.

Science.gov (United States)

Kroska, Emily B; Miller, Michelle L; Roche, Anne I; Kroska, Sydney K; O'Hara, Michael W

2018-01-01

Trauma exposure is associated with adverse psychological outcomes including anxiety, depression, and obsessive-compulsive (OC) symptoms. Adolescence is increasingly recognized as a period of vulnerability for the onset of these types of psychological symptoms. The current study explored the mediating roles of experiential avoidance and mindfulness processes in the association between retrospective reports of childhood trauma and current internalizing and OC symptoms in adolescents. A group of at-risk adolescents (N = 51) and a group of college students (N = 400) reported on childhood trauma, experiential avoidance, mindfulness, anxiety, depressive, and OC symptoms. Mediation analyses were performed to examine the mechanistic roles of avoidance and mindfulness in the association between trauma and internalizing and OC-specific symptoms. In the group of at-risk adolescents, experiential avoidance and mindfulness both significantly mediated the association between childhood trauma and OC symptoms. In the college student sample, experiential avoidance mediated the association between trauma and OC symptoms. Experiential avoidance, as well as the observe, act with awareness, and nonjudgmental facets of mindfulness all significantly mediated the association between trauma and internalizing symptoms. The group of at-risk adolescents was small, and the college student group was demographically homogeneous. All data was self-report and cross-sectional. The current study demonstrated that experiential avoidance and mindfulness processes may be the mechanisms through which the association between trauma and obsessive-compulsive and trauma and internalizing symptoms exist in adolescents. These findings provide potential targets for clinical intervention to improve outcomes for adolescents who have experienced trauma. Copyright © 2017 Elsevier B.V. All rights reserved.

A Hybrid Architecture for Vision-Based Obstacle Avoidance

Directory of Open Access Journals (Sweden)

Mehmet Serdar Güzel

2013-01-01

Full Text Available This paper proposes a new obstacle avoidance method using a single monocular vision camera as the only sensor which is called as Hybrid Architecture. This architecture integrates a high performance appearance-based obstacle detection method into an optical flow-based navigation system. The hybrid architecture was designed and implemented to run both methods simultaneously and is able to combine the results of each method using a novel arbitration mechanism. The proposed strategy successfully fused two different vision-based obstacle avoidance methods using this arbitration mechanism in order to permit a safer obstacle avoidance system. Accordingly, to establish the adequacy of the design of the obstacle avoidance system, a series of experiments were conducted. The results demonstrate the characteristics of the proposed architecture, and the results prove that its performance is somewhat better than the conventional optical flow-based architecture. Especially, the robot employing Hybrid Architecture avoids lateral obstacles in a more smooth and robust manner than when using the conventional optical flow-based technique.

28 CFR 552.23 - Confrontation avoidance procedures.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Confrontation avoidance procedures. 552... MANAGEMENT CUSTODY Use of Force and Application of Restraints on Inmates § 552.23 Confrontation avoidance... information about the inmate and the immediate situation. Based on their assessment of that information, they...

A survey of blood conservation methods in clinical practice in some urban south-eastern government hospitals in Nigeria.

Science.gov (United States)

Amucheazi, A O; Ajuzeiogu, V O; Ezike, H A; Odiakosa, M C; Nwoke, O M; Onyia, E

2011-01-01

GENERAL OBJECTIVE: To assess the practice of blood conservation. To determine the methods of blood conservation in use, to assess the lower limit for hemoglobin for elective procedures, to determine transfusion trigger point in practice, to find out limitations in practice and ways to improve clinical practice. This was conducted in February 2009. Self-administered questionnaires were distributed among the surgeons and anesthetists in practice at the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, Ebonyi State University Teaching Hospital and National Orthopaedic Hospital, Enugu. The data gathered was analyzed using the SPSS software. : Of participants who agreed to fill the questionnaires, more than 50% were males. The most prevalent specialty was general surgery (24.2%), followed by orthopedics (22.6%), obstetrics and gynecology (20.7%), and anesthesia (17.7%). The lowest hemoglobin limit before the patient was allowed into the theatre for elective procedures was 10 g/dl while individual transfusion trigger points ranged from hemoglobin of 6 to 10 g/dl. Majority of the doctors would avoid homologous blood transfusion in order to avoid transfusion-related diseases and reaction. Regarding knowledge of blood conservation methods and means of avoiding homologous blood, the use of diathermy was highest (12.33%), followed by preoperative blood donation (11.87%), use of hematinics (10.96%), and tourniquet 10.5%. Also, in practice, diathermy was the most frequently used (18.69%), followed by preoperative blood donation (16.16%), use of tourniquet (15.15%), while the Ovadje cell saver was least with 0.01%. Suggestions from respondents on the ways of limiting transfusion-related problems included optimization of patients (24.5%), improvement of standard of living (17.7%), and personnel training (13.3%). There is an agreement with the global trend geared toward minimizing the use of homologous blood by doctors in these hospitals. However

Universality of collapsing two-dimensional self-avoiding trails

International Nuclear Information System (INIS)

Foster, D P

2009-01-01

Results of a numerically exact transfer matrix calculation for the model of interacting self-avoiding trails are presented. The results lead to the conclusion that at the collapse transition, self-avoiding trails are in the same universality class as the O(n = 0) model of Bloete and Nienhuis (or vertex-interacting self-avoiding walk), which has thermal exponent ν = 12/23, contrary to previous conjectures. (fast track communication)

Tax avoidance with cross-border hybrid instruments

DEFF Research Database (Denmark)

Johannesen, Niels

2014-01-01

in the other country with a cross-border hybrid instrument. We then investigate why countries tend to allow the use of hybrid instruments for tax avoidance and show that even if effective anti-avoidance rules are available, there exists a global policy equilibrium in which no country uses such rules......The rules demarcating debt and equity for tax purposes differ between countries, hence the possibility that a hybrid financial instrument is treated as equity in one country and debt in another. This may create a scope for tax avoidance by allowing firms that invest in foreign countries to combine...... tax deductible interest expenses in the host country and tax favored dividend income in the home country. In this paper, we first develop a formal model of hybrid instruments and show that, for a given pair of countries, firms in at least one country and sometimes in both can avoid taxes on investment...

An analysis of the recording of tobacco use among inpatients in Irish hospitals.

LENUS (Irish Health Repository)

Sheridan, A

2014-10-01

Smoking is the largest avoidable cause of premature mortality in the world. Hospital admission is an opportunity to identify and help smokers quit. This study aimed to determine the level of recording of tobacco use (current and past) in Irish hospitals. Information on inpatient discharges with a tobacco use diagnosis was extracted from HIPE. In 2011, a quarter (n=84, 679) of discharges had a recording of tobacco use, which were more common among males (29% (n=50,161) male v. 20% (n=30,162) female), among medical patients (29% (n=54,375) medical v. 20% (n=30,162) other) and was highest among those aged 55-59 years (30.6%; n=7,885). SLAN 2007 reported that 48% of adults had smoked at some point in their lives. This study would suggest an under- reporting of tobacco use among hospital inpatients. Efforts should be made to record smoking status at hospital admission, and to improve the quality of the HIPE coding of tobacco use.

Excise Tax Avoidance: The Case of State Cigarette Taxes

Science.gov (United States)

DeCicca, Philip; Kenkel, Donald; Liu, Feng

2013-01-01

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower-tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20 percent smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. PMID:24140760

Excise tax avoidance: the case of state cigarette taxes.

Science.gov (United States)

DeCicca, Philip; Kenkel, Donald; Liu, Feng

2013-12-01

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes. Copyright © 2013 Elsevier B.V. All rights reserved.

Cross-sectional study on prevalence, causes and avoidable causes of visual impairment in Maori children.

Science.gov (United States)

Chong, Cheefoong; Dai, Shuan

2013-08-02

To provide information and comparison pertaining to visual impairment of Maori children with other children in New Zealand in particular: prevalence of blindness, causes of visual impairment, and avoidable causes of visual impairment. Retrospective data collection utilising the WHO/PBL eye examination record for children with blindness and low vision at Blind and Low Vision Education Network New Zealand (BLENNZ), Homai. Individuals not of Maori ethnicity or over the age of 16 were excluded from the study. 106 blind and 64 low-vision Maori children were studied. The main cause of blindness in Maori children is cortical visual impairment. Twenty-eight percent of causes of blindness in this population are potentially avoidable with non-accidental injury as the main cause. The prevalence of blindness and low vision in children amounts to 0.05% and 0.03%, respectively. The prevalence and causes of childhood blindness are comparable to the other ethnic groups in New Zealand. The main difference lies in avoidable causes of blindness, which appeared to be much higher in the Maori population. The leading cause of avoidable blindness in Maori children is caused by non-accidental injuries.

Interest of a drug and therapeutics committee for the operation of a hospital in a developing country: Dapaong, Togo.