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Sample records for reported healthcare utilization

  1. Self-report of healthcare utilization among community-dwelling older persons: a prospective cohort study.

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    Marlies T van Dalen

    Full Text Available BACKGROUND: Self-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies. OBJECTIVE: To analyze older adults' self-report of healthcare utilization compared to data obtained from the general practitioners' (GP electronic medical record (EMR and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up. METHODS: A prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office. RESULTS: Overall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72-80, 55.8% had no disabilities in (instrumental activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were substantial for 'hospitalizations' and 'GP home visits' at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58-0.68. Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05. Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001 and 18.9% had 2 or more hospital admissions (p<0.001 versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01 versus 18.6 of the participants who completed the study. CONCLUSIONS: Self-report of hospitalizations and GP home visits in a broadly 'healthy' community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will

  2. A systematic review of the psychometric properties of self-report research utilization measures used in healthcare

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    Squires Janet E

    2011-07-01

    Full Text Available Abstract Background In healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization. Objectives The objectives of this systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity of these measures. Methods We conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the Standards for Educational and Psychological Testing. Results Of 42,770 titles screened, 97 original studies (108 articles were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies and healthcare decision makers (5 studies. No studies reported data on acceptability of the measures. Reliability was reported in 32 (33% of the studies, representing 13 of the 60 measures. Internal consistency (Cronbach's Alpha reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearson's r coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6 reported evidence from any three (out of four possible Standards validity sources (which, in the case of single item

  3. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  4. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  5. Healthcare. State Report

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    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

  6. Healthcare Cost and Utilization Project (HCUP)

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    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  7. FACTORS ASSOCIATED WITH HEALTHCARE UTILIZATION AMONG ARAB IMMIGRANTS AND REFUGEES

    Science.gov (United States)

    2015-01-01

    Background Arab migrants are exposed to pre- and post migration stressors that increase their risk for health problems. However, little is known regarding healthcare utilization rates or factors associated with healthcare utilization among Arab immigrants and refugees. Methods 590 participants were interviewed 1 year post-migration to the United States Factors associated with healthcare utilization including stress coping mechanisms were examined using binary logistic regressions. Results Compared to national healthcare utilization data, immigrants had significantly lower and refugees had significantly higher rates. Being a refugee, married, and having health insurance were significantly associated with medical service utilization. None of the immigrants in this study had utilized psychological services. Among refugees, the use of medications and having strategies for dealing with stress were inversely associated with utilization of psychological services. Discussion (Conclusion) Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than immigrants. PMID:25331684

  8. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

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    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  9. The moderation effect of personality on healthcare utilization in Chinese people living with HIV.

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    Yu, Nancy Xiaonan; Mols, Floortje; Stewart, Sunita M; Zhang, Jianxin

    2017-06-01

    There is evidence that Type D personality can predict impaired quality of life and health status in various chronic conditions. The evidence is conflicting as to whether Type D is associated with increased healthcare services, and no study has reported on the healthcare utilization of people living with HIV (PLWH) who have a Type D personality. This study investigated the impact of Type D personality on healthcare utilization in a sample of Chinese PLWH and examined physical and emotional symptoms as possible mechanisms of healthcare utilization. This was a cross-sectional study of 199 PLWH in rural China. Participants completed a survey on physical symptoms, emotional symptoms, healthcare utilization, and Type D personality. Those PLWH with a Type D personality reported more physical and emotional symptoms and healthcare utilization than patients without this personality. Among PLWH who had a Type D personality, physical symptoms had a direct effect on healthcare utilization, and emotional symptoms did not significantly mediate this association. However, among PLWH without a Type D personality, emotional symptoms significantly mediated the effects of physical symptoms on healthcare utilization. PLWH with a Type D personality reported more healthcare utilization, which was attributed to their high physical symptoms rather than their emotional symptoms. These findings suggest that PLWH with a Type D personality might be bothered by intensified emotional symptoms, which might be too severe to be associated with physical symptoms and healthcare utilization. New prospective studies should focus on the pattern of healthcare utilization among patients with a Type D personality and their intensified physical and emotional symptoms.

  10. Does the distribution of healthcare utilization match needs in Africa?

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    Bonfrer, Igna; van de Poel, Ellen; Grimm, Michael; Van Doorslaer, Eddy

    2014-10-01

    An equitable distribution of healthcare use, distributed according to people's needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

  11. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

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    U.S. Department of Health & Human Services — 2001 to 2013. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  12. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  13. Measuring equity in disability and healthcare utilization in Afghanistan.

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    Trani, Jean-Francois; Barbou-des-Courieres, Cecile

    2012-01-01

    This paper analyses equity in health and healthcare utilization in Afghanistan based on a representative national household survey. Equitable access is a cornerstone of the Afghan health policy. We measured socioeconomic-related equity in access to public health care, using disability--because people with disabilities are poorer and more likely to use health care--and a concentration index (CI) and its decomposition. The socioeconomic-related equity in healthcare utilization was measured using a probit model and compared with an OLS model providing the horizontal inequity index (HI). We found a low rate of healthcare facilities utilization (25%). Disabled persons are using more healthcare facilities and have higher medical expenses. Disability is more frequently associated with older age, unemployed heads of household and lower education. The Cl of disability is 0.0221 indicating a pro-rich distribution of health. This pro-rich effect is higher in small households (CI decreases with size of the household, -0.0048) and safe (0.0059) areas. The CI of healthcare utilization is -0.0159 indicating a slightly pro-poor distribution of healthcare utilization but, overall, there is no difference in healthcare utilization by wealth status. Our study does not show major socioeconomic related inequity in disability and healthcare utilization in Afghanistan. This is due to the extreme and pervasive poverty found in Afghanistan. The absence of inequity in health access is explained by the uniform poverty of the population and the difficulty of accessing BPHS facilities (a basic package of health services), despite alarming health indicators.

  14. Healthcare utilization among Hispanic immigrants with diabetes: investigating the effect of US documentation status.

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    Do, Elizabeth K; Matsuyama, Robin K

    2014-04-01

    Previous studies have not examined whether documentation status has an effect on healthcare utilization among US Hispanic immigrants with diabetes. A secondary analysis was conducted using data from the Pew Hispanic Center and Robert Johnson Wood Foundation's 2007 Hispanic Healthcare Survey. Hispanic immigrants diagnosed with diabetes were included in analyses. The association between documentation status and healthcare utilization was assessed using logistic regressions. Of N = 577 Hispanic immigrants with diabetes, 80 % were documented immigrants and 81% reported having visited a healthcare provider in the last 6 months. Adjusting for confounders, those who were undocumented faced higher odds of having seen a healthcare provider more than 6 months ago or never when compared to those who were documented (OR = 1.79; 95% CI 1.01, 3.14). Unique opportunities in addressing healthcare disparities can be found in focusing on the Hispanic immigrant population living with diabetes.

  15. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

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    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  16. Health Literacy Impact on National Healthcare Utilization and Expenditure

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    Rafia Rasu

    2015-11-01

    Full Text Available Background Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL on healthcare utilization and healthcare expenditure. Methods Database analysis used Medical Expenditure Panel Survey (MEPS from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL. HLS ranged from 0-500. Health literacy level (HLL and categorized in 2 groups: Below basic or basic (HLS <226 and above basic (HLS ≥226. Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI. A Pvalue of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA®11.0 statistical software. Results The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%. Caucasian were the predominant racial ethnic group (83% and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P < .05. The extrapolated national

  17. Determinants of elevated healthcare utilization in patients with COPD

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    Bernhard-Scharf Barbara J

    2011-01-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients. Results Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p Conclusion Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

  18. Healthcare utilization of patients accessing an African national treatment program

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    Wood Robin

    2007-06-01

    Full Text Available Abstract Background The roll-out of antiretroviral therapy (ART in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. Methods This paper describes healthcare utilization from program entry by treatment-naïve patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count Results 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO, excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes. Conclusion Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates.

  19. Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.

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    Winetrobe, H; Rice, E; Rhoades, H; Milburn, N

    2016-03-01

    Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions.

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    Hamadah, Abdurrahman M; Beaulieu, Lynn M; Wilson, John W; Aksamit, Timothy R; Gregoire, James R; Williams, Amy W; Dillon, John J; Albright, Robert C; Onuigbo, Macaulay; Iyer, Venkateshwaran K; Hickson, LaTonya J

    2016-01-01

    The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. © 2016 S. Karger AG, Basel.

  1. Mindfulness, health symptoms and healthcare utilization: Active facets and possible affective mediators.

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    Consedine, Nathan S; Butler, Haley F

    2014-01-01

    Prior work has linked mindfulness with superior physical and psychological health outcomes. However, studies to date have infrequently tested the unique contributions of individual mindfulness facets, inadequately tested links between facets and healthcare utilization, and have not tested whether depression or anxiety may influence these links. In the current report, 40 young, middle aged and older adults (N = 121) completed measures of dispositional mindfulness, health, healthcare utilization and depression/anxiety. As expected, global trait mindfulness did not predict outcomes while individual mindfulness facets predicted both objective and subjective health as well as healthcare utilization. Across models, observe scores - the tendency to attend to thoughts, sensations and feelings - predicted poorer, and non-reactivity scores better, outcomes even when controlling for demographic and health confounds. Depressed and anxious emotion reduced some but not all mindfulness-health links. Results are discussed in terms of the mechanisms by which greater mindfulness may facilitate better health and health behaviour.

  2. Experience on healthcare utilization in seven administrative regions of Tanzania.

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    Kayombo, Edmund J; Uiso, Febronia C; Mahunnah, Rogasian L A

    2012-01-27

    Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM) and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.

  3. Experience on healthcare utilization in seven administrative regions of Tanzania

    Directory of Open Access Journals (Sweden)

    Kayombo Edmund J

    2012-01-01

    Full Text Available Abstract Health care utilization in many developing countries, Tanzania included, is mainly through the use of traditional medicine (TRM and its practitioners despite the presence of the conventional medicine. This article presents findings on the study that aimed to get an experience of health care utilization from both urban and rural areas of seven administrative regions in Tanzania. A total of 33 health facility managers were interviewed on health care provision and availability of supplies including drugs, in their respective areas. The findings revealed that the health facilities were overburden with higher population to serve than it was planned. Consequently essential drugs and other health supplies were available only in the first two weeks of the month. Conventional health practitioners considered traditional health practitioners to be more competent in mental health management, and overall, they were considered to handle more HIV/AIDS cases knowingly or unknowingly due to shear need of healthcare by this group. In general conventional health practitioners were positive towards traditional medicine utilization; and some of them admitted using traditional medicines. Traditional medicines like other medical health systems worldwide have side effects and some contentious ethical issues that need serious consideration and policy direction. Since many people will continue using traditional/alternative medicine, there is an urgent need to collaborate with traditional/alternative health practitioners through the institutionalization of basic training including hygiene in order to improved healthcare in the community and attain the Millennium Development Goals by 2015.

  4. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's

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    Kuo Tzu-Chun

    2008-05-01

    Full Text Available Abstract Background Alzheimer's disease (AD is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER visits and inpatient admissions. Methods Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan® Medicare Supplemental and Coordination of Benefits (COB Database were examined: 1 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs, a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. Results Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324. Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p Conclusion Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.

  5. Utility measurement in healthcare: the things I never got to.

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    Torrance, George W

    2006-01-01

    The present article provides a brief historical background on the development of utility measurement and cost-utility analysis in healthcare. It then outlines a number of research ideas in this field that the author never got to. The first idea is extremely fundamental. Why is health economics the only application of economics that does not use the discipline of economics? And, more importantly, what discipline should it use? Research ideas are discussed to investigate precisely the underlying theory and axiom systems of both Paretian welfare economics and the decision-theoretical utility approach. Can the two approaches be integrated or modified in some appropriate way so that they better reflect the needs of the health field? The investigation is described both for the individual and societal levels. Constructing a 'Robinson Crusoe' society of only a few individuals with different health needs, preferences and willingness to pay is suggested as a method for gaining insight into the problem. The second idea concerns the interval property of utilities and, therefore, QALYs. It specifically concerns the important requirement that changes of equal magnitude anywhere on the utility scale, or alternatively on the QALY scale, should be equally desirable. Unfortunately, one of the original restrictions on utility theory states that such comparisons are not permitted by the theory. It is shown, in an important new finding, that while this restriction applies in a world of certainty, it does not in a world of uncertainty, such as healthcare. Further research is suggested to investigate this property under both certainty and uncertainty. Other research ideas that are described include: the development of a precise axiomatic basis for the time trade-off method; the investigation of chaining as a method of preference measurement with the standard gamble or time trade-off; the development and training of a representative panel of the general public to improve the completeness

  6. Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents.

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    Tsai, Meng-Che; Lin, Sheng-Hsiang; Chou, Yen-Yin; Lin, Shio-Jean

    2014-02-01

    There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12–18 years in 2010.We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences.We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907 students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting. Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate.

  7. Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

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    Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

    2017-05-12

    Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2017

  8. Predictors of healthcare utilization among older Mexican Americans.

    Science.gov (United States)

    Al Snih, Soham; Markides, Kyriakos S; Ray, Laura A; Freeman, Jean L; Ostir, Glenn V; Goodwin, James S

    2006-01-01

    To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. A two-year prospective cohort study. Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. After two years of follow-up, predisposing and enabling factors accounted for diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

  9. The relationship between mental healthcare utilization and criminal behaviors among internal medicine outpatients.

    Science.gov (United States)

    Sansone, Randy A; Lam, Charlene; Wiederman, Michael W

    2011-06-01

    According to the scant empirical literature, largely in studies of offenders, there appears to be a general but diffuse relationship between various psychiatric disorders and criminal behavior. In this study, we examined mental healthcare utilization, a general measure of psychiatric dysfunction, in relationship to a history of criminal behavior in a sample of internal medicine outpatients. In a consecutive sample of 376 internal medicine outpatients being seen predominantly by resident providers, we examined the relationship between 27 illegal behaviors (charges, not convictions) as delineated by the Federal Bureau of Investigation's crime cataloguing schema and four items related to mental healthcare utilization (i.e., ever been seen by a psychiatrist, ever been hospitalized in a psychiatric hospital, ever been in counseling, ever been on medication for your "nerves"). Twenty-two percent of the sample reported a history of having been charged with at least one criminal behavior. With the exception of ever having been on "nerve" medication, the remaining mental-healthcare-utilization variables demonstrated statistically significant relationships with the number of illegal behaviors reported. However, overall correlations were relatively weak. Using both a sample and methodology that is unique to the current literature, we found relationships between past mental health treatment and history of criminal behavior.

  10. Understanding health-care access and utilization disparities among Latino children in the United States.

    Science.gov (United States)

    Langellier, Brent A; Chen, Jie; Vargas-Bustamante, Arturo; Inkelas, Moira; Ortega, Alexander N

    2016-06-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., income) and (2) those attributable to differences in group-specific regression coefficients that measure the health-care 'return' Latino, White, and Black children receive on these characteristics. In the United States, Latino children are less likely than Whites to have a usual source of care, receive at least one preventive care visit, and visit a doctor, and are more likely to have delayed care. The return on sociodemographic characteristics explains 20-30% of the disparity between Latino and White children in the usual source of care, delayed care, and doctor visits and 40-50% of the disparity between Latinos and Blacks in emergency department use and preventive care. Much of the health-care disadvantage experienced by Latino children would persist if Latinos had the sociodemographic characteristics as Whites and Blacks.

  11. Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.

    Science.gov (United States)

    Panzner, Ursula; Pak, Gi Deok; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Baker, Stephen; Bjerregaard-Andersen, Morten; Crump, John A; Deerin, Jessica; Cruz Espinoza, Ligia Maria; Gasmelseed, Nagla; Heriniaina, Jean Noël; Hertz, Julian T; Im, Justin; von Kalckreuth, Vera; Keddy, Karen H; Lankoande, Bruno; Løfberg, Sandra; Meyer, Christian G; Oresto, Michael Munishi; Park, Jin Kyung; Park, Se Eun; Rakotozandrindrainy, Raphaël; Sarpong, Nimako; Soura, Abdramane Bassiahi; Gassama Sow, Amy; Tall, Adama; Teferi, Mekonnen; Worku, Alemayehu; Yeshitela, Biruk; Wierzba, Thomas F; Marks, Florian

    2016-03-15

    Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever. © The Author 2016. Published by Oxford University Press for the

  12. The impact of HIV-associated lipodystrophy on healthcare utilization and costs

    Directory of Open Access Journals (Sweden)

    Lee Daniel

    2008-07-01

    Full Text Available Abstract Background HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. Objective To examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients. Methods Healthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs. Results Of the 181 HIV-infected participants evaluated in the study, 92 (51% had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV

  13. Sociodemographics, Comorbidities, Healthcare Utilization and Work Productivity in Japanese Patients with Adult ADHD.

    Directory of Open Access Journals (Sweden)

    Eiji Kirino

    Full Text Available This study compared the sociodemographic characteristics, comorbidities, healthcare resource utilization, and work productivity among Japanese adults who reported being diagnosed with attention-deficit/hyperactivity disorder (ADHD to those of a non-ADHD control population.Data for this study were captured from an online survey of adults in Japan conducted by Kantar Health using consumer panels. A total of 84 survey participants reported they had received a diagnosis of ADHD from a physician. Survey responses pertaining to functional status and resource utilization from this ADHD group were compared to those from a non-ADHD control group of 100 participants. Comparisons between the ADHD and non-ADHD groups were made using chi-square tests for categorical variables and t-tests for continuous variables.Participants in the ADHD group were on average slightly younger with a higher proportion of males. ADHD respondents reported significantly more comorbid depression, sleep difficulties, headaches, and anxiety than non-ADHD controls. Over the previous 6 months, the ADHD group made more visits to healthcare providers and the emergency room, and had more hospitalizations than non-ADHD controls. The ADHD group also rated their overall health status lower than the non-ADHD control group. Respondents with ADHD reported a significantly higher degree of health-related work impairment compared to non-ADHD, with greater absenteeism and decreased work productivity. The ADHD group indicated their symptoms negatively impacted relationships, self-esteem, and regular daily activities.Japanese adults with ADHD face a substantial burden of illness, including lower overall health status, increased number of comorbidities, greater healthcare utilization, and significant health-related occupational impairment compared to those without ADHD. Additional research is needed to develop a better understanding of both the consequences and treatment approaches for Japanese

  14. The ART advantage: healthcare utilization for diabetes and hypertension in rural South Africa

    Science.gov (United States)

    Manne-Goehler, Jennifer; Montana, Livia; Gómez-Olivé, F. Xavier; Rohr, Julia; Harling, Guy; Wagner, Ryan G.; Wade, Alisha; Kabudula, Chodziwadziwa Whiteson; Geldsetzer, Pascal; Kahn, Kathleen; Tollman, Stephen; Berkman, Lisa F.; Bärnighausen, Till W.; Gaziano, Thomas A.

    2017-01-01

    Background The prevalence of diabetes and hypertension has increased in HIV-positive populations but there is limited understanding of the role that ART programs play in the delivery of services for these conditions. The aim of this study is to assess the relationship between ART use and utilization of healthcare services for diabetes and hypertension. Methods Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa is a cohort of 5,059 adults. The baseline study collects biomarker-based data on HIV, ART, diabetes and hypertension and self-reported data on healthcare utilization. We calculated differences in care utilization for diabetes and hypertension by HIV and ART status and used multivariable logistic regressions to estimate the relationship between ART use and utilization of services for these conditions, controlling for age, sex, body mass index (BMI), education and household wealth quintile. Results Mean age, BMI, hypertension and diabetes prevalence were lower in the HIV-positive population (all pART use was significantly associated with greater odds of blood pressure (aOR 1.27 95% CI 1.04–1.55) and blood sugar measurement (aOR 1.26, 95% CI 1.05–1.51), counseling regarding exercise (aOR 1.57, 95% CI 1.11–2.22), awareness of hypertension diagnosis (aOR 1.52, 95% CI 1.12–2.05) and treatment for hypertension (aOR 1.63, 95% CI 1.21–2.19). Conclusions HIV-positive patients who use ART are more likely to have received healthcare services for diabetes and hypertension. This apparent ART advantage suggests that ART programs may be a vehicle for strengthening health systems for chronic care. PMID:28696346

  15. Factors associated with patterns of plural healthcare utilization among patients taking antiretroviral therapy in rural and urban South Africa: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Moshabela Mosa

    2012-07-01

    Full Text Available Abstract Background In low-resource settings, patients’ use of multiple healthcare sources may complicate chronic care and clinical outcomes as antiretroviral therapy (ART continues to expand. However, little is known regarding patterns, drivers and consequences of using multiple healthcare sources. We therefore investigated factors associated with patterns of plural healthcare usage among patients taking ART in diverse South African settings. Methods A cross-sectional study of patients taking ART was conducted in two rural and two urban sub-districts, involving 13 accredited facilities and 1266 participants selected through systematic random sampling. Structured questionnaires were used in interviews, and participant’s clinic records were reviewed. Data collected included household assets, healthcare access dimensions (availability, affordability and acceptability, healthcare utilization and pluralism, and laboratory-based outcomes. Multiple logistic regression models were fitted to identify predictors of healthcare pluralism and associations with treatment outcomes. Prior ethical approval and informed consent were obtained. Results Nineteen percent of respondents reported use of additional healthcare providers over and above their regular ART visits in the prior month. A further 15% of respondents reported additional expenditure on self-care (e.g. special foods. Access to health insurance (Adjusted odds ratio [aOR] 6.15 and disability grants (aOR 1.35 increased plural healthcare use. However, plural healthcare users were more likely to borrow money to finance healthcare (aOR 2.68, and incur catastrophic levels of healthcare expenditure (27% than non-plural users (7%. Quality of care factors, such as perceived disrespect by staff (aOR 2.07 and lack of privacy (aOR 1.50 increased plural healthcare utilization. Plural healthcare utilization was associated with rural residence (aOR 1.97. Healthcare pluralism was not associated with missed

  16. Module Utilization Committee. Final report

    Energy Technology Data Exchange (ETDEWEB)

    None

    1984-03-01

    Photovoltaic collector modules were declared surplus to the needs of the US Department of Energy. The Module Utilization Committee was formed to make appropriate disposition of the surplus modules. The final report of that committee accounts for that disposition. The membership and activities of the committee are set forth and the results of its activities are reported.

  17. Problem alcohol use and healthcare utilization among persons with cannabis use disorder in the United States.

    Science.gov (United States)

    John, William S; Wu, Li-Tzy

    2017-09-01

    The emergency department (ED) and hospital settings represent crucial opportunities for engaging treatment for cannabis use disorder (CUD). Thus, there is a need to identify factors associated with healthcare utilization among persons with CUD to improve screening and intervention approaches. Problematic alcohol use may be a salient risk factor. Using data from the 2005-2013 National Surveys on Drug Use and Health, we determined factors, including different patterns of alcohol use, associated with past-year ED admission and inpatient hospitalization among persons aged 12 years or older meeting criteria for CUD in the past year (N=16,757). We also determined the prevalence and correlates of problem alcohol use among persons with CUD to further inform its association with healthcare utilization. Among persons with CUD, 40.15% and 10.04% reported past-year ED admission and inpatient hospitalization, respectively. Severe alcohol use disorder (AUD) (≥6 AUD symptoms), female sex, Black race, low income, major depressive episode (MDE), and other substance use disorders were associated with increased odds of healthcare utilization; current (i.e., last month) alcohol use patterns were not. Persons with CUD that were males, ages 18-25 (vs. ages 12-17), Hispanic (vs. White), and with low income, other drug use disorders, or MDE had increased odds of AUD. Findings suggest that screening and intervention efforts for improving treatment initiation or engagement for CUD may target cannabis-using women, blacks, low-income adults or those with severe AUD in the past year, another substance use disorder, or MDE. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Migrants' utilization of somatic healthcare services in Europe - a systematic review

    DEFF Research Database (Denmark)

    Nørredam, Marie Louise; Nielsen, Signe Smith; Krasnik, Allan

    2010-01-01

    Background: Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first......-generation migrants. Our study question was: ‘Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Methods: Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based...... on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. Results: The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants...

  19. Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

    Science.gov (United States)

    Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan

    2015-09-01

    Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

  20. Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh.

    Science.gov (United States)

    Siddique, Md Kaoser Bin; Islam, Sheikh Mohammed Shariful; Banik, Palash Chandra; Rawal, Lal B

    2017-08-22

    Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries. This study aimed to determine diabetes related knowledge and factors affecting utilization of healthcare services among patients with type 2 diabetes mellitus in Bangladesh. This analytical study was conducted among 318 patients with type 2 diabetes (T2DM) attending two large tertiary hospitals in Dhaka, Bangladesh between August 2014 and January 2015. Interviewer assisted semi-structured survey questionnaire was used to collect data on diabetes knowledge (measured by a validated Likert scale) and self-reported utilization of service for diabetes. Univariate and bivariate analyses were conducted to determine the factors associated with diabetes knowledge and healthcare utilization. The mean (±SD) age of participants was 52 (±10) years. Majority of the participants were females (58%) and urban residents (74%). Almost two-third (66%) of the participants had an average level of knowledge of T2DM. One-fifth (21%) of the participants had poor knowledge which was significantly associated with gender (P knowledge of diabetes which might affect the utilization of healthcare services for diabetes management. Innovations in increasing diabetes knowledge and health behavior change are recommended specially for females, those with lower education and less income.

  1. Inequalities versus Utilization: Factors Predicting Access to Healthcare in Ghana

    Directory of Open Access Journals (Sweden)

    Dominic Buer Boyetey

    2016-08-01

    Full Text Available Universal access to health care remains a significant source of inequality especially among vulnerable groups. Challenges such as lack of insurance coverage, absence of certain types of care, as well as high individual financial care cost can be blamed for the growing inequality in the healthcare sector. The concern is worrying especially when people are denied care. It is in this light that the study set to find out what factors are likely to impact the chances of access to health care, so far as the Ghana Demographic and Health Survey Data 2014 data are concerned, particularly to examine the differences in access to healthcare in connection with varying income groups, educational levels and residential locations. The study relied on the logistic regression analysis to establish that people with some level of education have greater chances of accessing health care compared with those without education. Also chances of access to health care in the sample were high for people in the lower quartile and upper quartile of the household wealth index and a local minimum for those in the middle class. It became evident also that increased number of people with NHIS or PHIS or combination of cash with NHIS or PHIS will give rise to a corresponding increment in the probability of gaining access to health care.

  2. Beyond metrics? Utilizing 'soft intelligence' for healthcare quality and safety.

    Science.gov (United States)

    Martin, Graham P; McKee, Lorna; Dixon-Woods, Mary

    2015-10-01

    Formal metrics for monitoring the quality and safety of healthcare have a valuable role, but may not, by themselves, yield full insight into the range of fallibilities in organizations. 'Soft intelligence' is usefully understood as the processes and behaviours associated with seeking and interpreting soft data-of the kind that evade easy capture, straightforward classification and simple quantification-to produce forms of knowledge that can provide the basis for intervention. With the aim of examining current and potential practice in relation to soft intelligence, we conducted and analysed 107 in-depth qualitative interviews with senior leaders, including managers and clinicians, involved in healthcare quality and safety in the English National Health Service. We found that participants were in little doubt about the value of softer forms of data, especially for their role in revealing troubling issues that might be obscured by conventional metrics. Their struggles lay in how to access softer data and turn them into a useful form of knowing. Some of the dominant approaches they used risked replicating the limitations of hard, quantitative data. They relied on processes of aggregation and triangulation that prioritised reliability, or on instrumental use of soft data to animate the metrics. The unpredictable, untameable, spontaneous quality of soft data could be lost in efforts to systematize their collection and interpretation to render them more tractable. A more challenging but potentially rewarding approach involved processes and behaviours aimed at disrupting taken-for-granted assumptions about quality, safety, and organizational performance. This approach, which explicitly values the seeking out and the hearing of multiple voices, is consistent with conceptual frameworks of organizational sensemaking and dialogical understandings of knowledge. Using soft intelligence this way can be challenging and discomfiting, but may offer a critical defence against the

  3. Attitudes to reporting medication error among differing healthcare professionals.

    Science.gov (United States)

    Sarvadikar, Ajit; Prescott, Gordon; Williams, David

    2010-08-01

    Medication error reporting is an important measure to prevent medication error incidents in a healthcare system and can serve as an important tool for improving patient safety. This study aimed to investigate attitudes of healthcare professionals (doctors, nurses, and pharmacists) in reporting medication errors. Fifty-six healthcare professionals working at a 900-bed tertiary referral hospital were surveyed. A questionnaire using two different clinical scenarios (involving oral and intravenous administration of a drug) and four questions with an ascending order of worsening patient outcome was used. A Likert scale ranging from 1 (unlikely) to 5 (likely) was used to describe the likelihood of reporting a medication error. The overall response rate was 57% (43% for doctors, 68% for nurses, and 64% for pharmacists). Results showed that doctors were unlikely to report less-serious medication errors (median value of 2 on the Likert scale). Nurses and pharmacists (median value of 5) were likely to report less-serious as well as serious medication errors despite their fears of receiving disciplinary action. All healthcare professionals were more likely to report an error as the clinical scenarios had a progressively worsening outcome for the patient. These results suggest that among healthcare professionals, there are differing attitudes to reporting medication errors. Differing approaches are therefore required to encourage medication error reporting among different healthcare professionals. Future study is required to further investigate these findings and improve reporting rates.

  4. Depression, Diabetes, and Healthcare Utilization: Results from the Korean Longitudinal Study of Aging (KLoSA)

    OpenAIRE

    Hyun Kyung Lee; Seung Hee Lee

    2014-01-01

    Abstract Background The aim of this study was to explore the relationship between diabetes and depression and investigate the effects of comorbid diabetes and depression on healthcare utilization. Methods The study sample included 10,179 Korean adults aged ≥ 45 years. The presence of diabetes was assessed by asking participants if the participants had ever been diagnosed with diabetes. Depression was measured using the 10-item Center for Epidemiological Studies—Depression scale. Healthcare ut...

  5. Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization

    Directory of Open Access Journals (Sweden)

    Classi Peter

    2012-10-01

    Full Text Available Abstract Background The objective of this study was to examine the impact of co-occurring social and emotional difficulties on missed school days and healthcare utilization among children with attention deficit/hyperactivity disorder (ADHD. Methods Data were from the 2007 U.S. National Health Interview Survey (NHIS and were based on parental proxy responses to questions in the Sample Child Core, which includes questions on demographics, health, healthcare treatment, and social and emotional status as measured by questions about depression, anxiety, and phobias, as well as items from the brief version of the Strength and Difficulties Questionnaire (SDQ. Logistic regression was used to assess the association between co-occurring social and emotional difficulties with missed school days and healthcare utilization, adjusting for demographics. Results Of the 5896 children aged 6–17 years in the 2007 NHIS, 432 (7.3% had ADHD, based on parental report. Children with ADHD and comorbid depression, anxiety, or phobias had significantly greater odds of experiencing > 2 weeks of missed school days, ≥ 6 visits to a healthcare provider (HCP, and ≥ 2 visits to the ER, compared with ADHD children without those comorbidities (OR range: 2.1 to 10.4. Significantly greater odds of missed school days, HCP visits, and ER visits were also experienced by children with ADHD who were worried, unhappy/depressed, or having emotional difficulties as assessed by the SDQ, compared with ADHD children without those difficulties (OR range: 2.2 to 4.4. Conclusions In children with ADHD, the presence of social and emotional problems resulted in greater odds of missed school days and healthcare utilization. These findings should be viewed in light of the limited nature of the parent-report measures used to assess social and emotional problems.

  6. Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

    Science.gov (United States)

    Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

    2017-01-01

    Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

  7. Determinants of Choice of Healthcare Services Utilization: Empirical Evidence from India

    Directory of Open Access Journals (Sweden)

    Dipanjan Kumar Dey

    2014-12-01

    Full Text Available Background: In order to improve the condition of the health care services in India, public healthcare services can play a very important role. However, the domination of private health care services and low utilization of public healthcare services in India is a matter of concern for the policy makers. Objective: The objective of the present study is to examine the determinants that lead an individual to choose between public and private healthcare service providers in India. Methods: For this purpose, a national level health survey data National Family Health Survey – 3 (NFHS – 3 is used. The determinants considered are age, gender, education, income, access, caste, marital status and exposure to mass media. Logistic regression analyses are carried out. Total, urban and rural samples are studied separately. Results: Findings reveal that people with increasing age, females, lower income group people, uneducated, weaker sections of society and those having access to primary public health care are more likely to utilize public healthcare services as compared to private ones in India. Conclusion: The government and policy makers should keep these findings in perspective to improve utilization of public healthcare services.

  8. Logistics research report : Framework in the healthcare industry

    OpenAIRE

    Willems, A; Hajdasinski, A.K.; Willems, J

    2009-01-01

    The research report takes the perspective of Information Logistics and investigates relating concepts like Knowledge Management, Information Systems and Context Awareness in the context of the healthcare industry. The aim of Information Logistics is to deliver the right information product, in the right format, at the right place at the right time for the right people in a customer demand driven approach. This principle is of high importance in dynamic organizations like the healthcare indust...

  9. Increased healthcare service utilizations for patients with dementia: a population-based study.

    Directory of Open Access Journals (Sweden)

    Shiu-Dong Chung

    Full Text Available BACKGROUND: The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan's National Health Insurance population-based database. METHODS: This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. RESULTS: As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001 and significantly higher outpatient costs (US$124 vs. US$16, p<0.001 than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001 and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001 than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001 and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001 than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001. CONCLUSIONS: We concluded that subjects who had received a clinical dementia diagnosis had

  10. The effect of increasing the coinsurance rate on outpatient utilization of healthcare services in South Korea.

    Science.gov (United States)

    Lee, Hyo Jung; Jang, Sung-In; Park, Eun-Cheol

    2017-02-20

    The Korean healthcare system is composed of costly and inefficient structures that fail to adequately divide the functions and roles of medical care organizations. To resolve this matter, the government reformed the cost-sharing policy in November of 2011 for the management of outpatients visiting general or tertiary hospitals with comparatively mild diseases. The purpose of the present study was to examine the impact of increasing the coinsurance rate of prescription drug costs for 52 mild diseases at general or tertiary hospitals on outpatient healthcare service utilization. The present study used health insurance claim data collected from 2010 to 2013. The study population consisted of 505,691 outpatients and was defined as those aged 20-64 years who had visited medical care organizations for the treatment of 52 diseases both before and after the program began. To examine the effect of the cost-sharing policy on outpatient healthcare service utilization (percentage of general or tertiary hospital utilization, number of outpatient visits, and outpatient medical costs), a segmented regression analysis was performed. After the policy to increase the coinsurance rate on prescription drug costs was implemented, the number of outpatient visits at general or tertiary hospitals decreased (β = -0.0114, p utilization of general or tertiary hospitals has transferred to that of clinics or hospitals due to the increased cost-sharing policy of prescription drug costs. This result indicates the cost-sharing policy, intended to change patient behaviors for healthcare service utilization, has had limited effects on rebuilding the healthcare system and the function of medical care organizations.

  11. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients

    Directory of Open Access Journals (Sweden)

    Karla Diaz

    2014-01-01

    Full Text Available Background: Obstructive sleep apnea (OSA is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA. Materials and Methods: This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA. Results: Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4% were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF, pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05. The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05. Conclusion: Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA

  12. Facility Utilization Reports -  FAA Aviation Information Utilization Reports

    Data.gov (United States)

    Department of Transportation — Provides: (1) Space management and planning, including area calculations, tracking space by organization and employee, and monitoring space utilization information....

  13. 45 CFR 650.11 - Utilization reports.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 3 2010-10-01 2010-10-01 false Utilization reports. 650.11 Section 650.11 Public... Utilization reports. Paragraph (h) of the standard Patent Rights clause set forth in § 650.4 obliges grantees “to submit on request periodic reports no more frequently than annually on the utilization of a...

  14. Workplace Ergonomic and Psychosocial Factors in Occupational Back Disorders, Healthcare Utilization, and Lost Time: Cross-Sectional and Prospective Studies

    Science.gov (United States)

    1999-03-31

    and work stress exposure) entered last . Once the multivariate logistic regression results were examined~ variables that failed to reach a minimum...terms (social problem solving, ergonomic exposure, and work stress exposure) entered last . Healthcare Utilization: The healthcare utilization outcome was... AMBLYOPIA . OTH SPEC VISUAL DISTURBANCES ACUTE CONJUNCTIVITIS. UNSPEC CONJUNCTIVITIS. UNSPEC · TRICHIASIS OF EYELID WIO ENTROPION EXOTROPIA. UNSPEC

  15. Primary care physician assistant and advance practice nurses roles: Patient healthcare utilization, unmet need, and satisfaction.

    Science.gov (United States)

    Everett, Christine M; Morgan, Perri; Jackson, George L

    2016-12-01

    Team-based care involving physician assistants (PAs) and advance practice nurses (APNs) is one strategy for improving access and quality of care. PA/APNs perform a variety of roles on primary care teams. However, limited research describes the relationship between PA/APN role and patient outcomes. We examined multiple outcomes associated with primary care PA/APN roles. In this cross-sectional survey analysis, we studied adult respondents to the 2010 Health Tracking Household Survey. Outcomes included primary care and emergency department visits, hospitalizations, unmet need, and satisfaction. PA/APN role was categorized as physician only (no PA/APN visits; reference), usual provider (PA/APN provide majority of primary care visits) or supplemental provider (physician as usual provider, PA/APN provide a subset of visits). Multivariable logistic and multinomial logistic regressions were performed. Compared to people with physician only care, patients with PA/APNs as usual providers [5-9 visits RRR=2.4 (CI 1.8-3.4), 10+ visits RRR=3.0 (CI 2.0-4.5): reference 2-4 visits] and supplemental providers had increased risk of having 5 or more primary care visits [5-9 visits RRR=1.3 (CI 1.0-1.6)]. Patients reporting PA/APN as supplemental providers had increased risk of emergency department utilization [2+ visits: RRR 1.8 (CI 1.3, 2.5)], and lower satisfaction [very dissatisfied: RRR 1.8 (CI 1.03-3.0)]. No differences were seen for hospitalizations or unmet need. Healthcare utilization patterns and satisfaction varied between adults with PA/APN in different roles, but reported unmet need did not. These findings suggest a wide range of outcomes should be considered when identifying the best PA/APN role on primary care teams. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Utility photovoltaic group: Status report

    Science.gov (United States)

    Serfass, Jeffrey A.; Hester, Stephen L.; Wills, Bethany N.

    1996-01-01

    The Utility PhotoVoltaic Group (UPVG) was formed in October of 1992 with a mission to accelerate the use of cost-effective small-scale and emerging grid-connected applications of photovoltaics for the benefit of electric utilities and their customers. The UPVG is now implementing a program to install up to 50 megawatts of photovoltaics in small-scale and grid-connected applications. This program, called TEAM-UP, is a partnership of the U.S. electric utility industry and the U.S. Department of Energy to help develop utility PV markets. TEAM-UP is a utility-directed program to significantly increase utility PV experience by promoting installations of utility PV systems. Two primary program areas are proposed for TEAM-UP: (1) Small-Scale Applications (SSA)—an initiative to aggregate utility purchases of small-scale, grid-independent applications; and (2) Grid-Connected Applications (GCA)—an initiative to identify and competitively award cost-sharing contracts for grid-connected PV systems with high market growth potential, or collective purchase programs involving multiple buyers. This paper describes these programs and outlines the schedule, the procurement status, and the results of the TEAM-UP process.

  17. Logistics research report : Framework in the healthcare industry

    NARCIS (Netherlands)

    Willems, A.; Hajdasinski, A.K.; Willems, J.

    2009-01-01

    The research report takes the perspective of Information Logistics and investigates relating concepts like Knowledge Management, Information Systems and Context Awareness in the context of the healthcare industry. The aim of Information Logistics is to deliver the right information product, in the r

  18. Logistics research report : Framework in the healthcare industry

    NARCIS (Netherlands)

    Willems, A.; Hajdasinski, A.K.; Willems, J.

    2009-01-01

    The research report takes the perspective of Information Logistics and investigates relating concepts like Knowledge Management, Information Systems and Context Awareness in the context of the healthcare industry. The aim of Information Logistics is to deliver the right information product, in the r

  19. Utilization and utility of clinical laboratory reports with graphical elements

    Directory of Open Access Journals (Sweden)

    Brian H Shirts

    2012-01-01

    Full Text Available Background: Graphical reports that contain charts, images, and tables have potential to convey information more effectively than text-based reports; however, studies have not measured how much clinicians value such features. We sought to identify factors that might influence the utilization of reports with graphical elements postulating that this is a surrogate for relative clinical utility of these graphical elements. Materials and Methods: We implemented a pilot project at ARUP laboratories to develop online enhanced laboratory test reports that contained graphical elements. We monitored on-demand clinician access to reports generated for 48 reportable tests over 22 months. We evaluated utilization of reports with graphical elements by clinicians at all institutions that use ARUP as a reference laboratory using descriptive statistics, regression, and meta-analysis tools to evaluate groups of similar test reports. Results: Median download rate by test was 8.6% with high heterogeneity in download rates between tests. Test reports with additional graphical elements were not necessarily downloaded more often than reports without these elements. Recently implemented tests and tests reporting abnormal results were associated with higher download rates (P < 0.01. Higher volume tests were associated with lower download rates (P = 0.03. Conclusions: In select cases graphical information may be clinically useful, particularly for less frequently ordered tests and in on reports of abnormal results. The utilization data presented could be used as a reference point for other laboratories planning on implementing graphical reporting. However, between-test heterogeneity was high and in many cases graphical elements may add little clinical utility, particularly if these merely reinforce information already contained in text based reports.

  20. The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings.

    Science.gov (United States)

    Black, Jed; Reaven, Nancy L; Funk, Susan E; McGaughey, Karen; Ohayon, Maurice; Guilleminault, Christian; Ruoff, Chad; Mignot, Emmanuel

    2014-05-01

    The aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States. This retrospective, observational study using data from the Truven Health Analytics MarketScan Research Databases assessed 5 years of claims data (2006-2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18 years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified. Compared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all pnarcolepsy versus controls (26.4 vs. 13.3; pnarcolepsy drugs and non-narcolepsy drugs, respectively (both pnarcolepsy compared with controls for medical services ($8346 vs. $4147; pNarcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  2. [Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class].

    Science.gov (United States)

    Aguilar-Palacio, Isabel; Carrera-Lasfuentes, Patricia; Solsona, Sofía; Sartolo, M Teresa; Rabanaque, M José

    2016-04-01

    to explore health-care utilization (primary and specialized health-care, hospitalizations, day hospital and emergency services) and overuse in elderly in Spain, considering the influence of health status, sex, social class and its temporal trend. cross sectional study in two phases. Spain. people surveyed in the National Health Surveys 2006 and 2011-12. Health status was measured using self-rated and diagnosed health (number and diagnoses). Social class was obtained from the last occupation of the main supporter (manual and non-manual workers). Logistic regression analyses were conducted adjusting by sex, age, health status, social class and year, obtaining its predictive capacity. the percentage of elderly population with health-care utilization decreased during the period analyzed. Women who belonged to the manual workers category presented the highest prevalence of low health (low self-rated health in 2006: 70.6%). Low health status was associated with a higher utilization of health-care services. Self-rated health was a better predictor of health-care utilization and overuse than diagnosed health, getting the highest predictive capacity for specialized health-care (C = 0.676). Old people from low social class used with higher frequency primary health-care and emergency services. On the other hand, specialized health-care and day hospital were more used by high social classes. inequalities in health and health-care utilization have been observed in elderly according social class. It is necessary to consider self-rated health as a health-care utilization predictor and to review our health-care services accessibility and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  3. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature.

    Science.gov (United States)

    Hanney, William J; Masaracchio, Michael; Liu, Xinliang; Kolber, Morey J

    2016-01-01

    Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence regarding the

  4. Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.

    Directory of Open Access Journals (Sweden)

    James E Stahl

    Full Text Available Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization.Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP on healthcare utilization.Retrospective controlled cohort observational study.Major US Academic Health Network.All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452, controls (n = 13149 followed for a median of 4.2 years (.85-8.4 yrs.Utilization as measured by billable encounters/year (be/yr stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate.At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001. Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group's Emergency department (ED visits decreased from 3.6 to 1.7/year (p<0.0001 and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates-Intervention group: high utilizing controls showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories.Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and

  5. A Healthcare Utilization Analysis Framework for Hot Spotting and Contextual Anomaly Detection

    Science.gov (United States)

    Hu, Jianying; Wang, Fei; Sun, Jimeng; Sorrentino, Robert; Ebadollahi, Shahram

    2012-01-01

    Patient medical records today contain vast amount of information regarding patient conditions along with treatment and procedure records. Systematic healthcare resource utilization analysis leveraging such observational data can provide critical insights to guide resource planning and improve the quality of care delivery while reducing cost. Of particular interest to providers are hot spotting: the ability to identify in a timely manner heavy users of the systems and their patterns of utilization so that targeted intervention programs can be instituted, and anomaly detection: the ability to identify anomalous utilization cases where the patients incurred levels of utilization that are unexpected given their clinical characteristics which may require corrective actions. Past work on medical utilization pattern analysis has focused on disease specific studies. We present a framework for utilization analysis that can be easily applied to any patient population. The framework includes two main components: utilization profiling and hot spotting, where we use a vector space model to represent patient utilization profiles, and apply clustering techniques to identify utilization groups within a given population and isolate high utilizers of different types; and contextual anomaly detection for utilization, where models that map patient’s clinical characteristics to the utilization level are built in order to quantify the deviation between the expected and actual utilization levels and identify anomalies. We demonstrate the effectiveness of the framework using claims data collected from a population of 7667 diabetes patients. Our analysis demonstrates the usefulness of the proposed approaches in identifying clinically meaningful instances for both hot spotting and anomaly detection. In future work we plan to incorporate additional sources of observational data including EMRs and disease registries, and develop analytics models to leverage temporal relationships among

  6. Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

    2017-05-12

    Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (P<.05). Treatment diminishes utilization, with FI of 159 during year+1 and 1.72 during year+2 (P<.05). The main causes of attendance were otolaryngological and pneumological diseases, improving after treatment. Children suffering from OSAS demand more healthcare services, at least 2 years before treatment, implying that the disease could be present years before we manage it. Therapeutic actions improve healthcare services utilization, although remain higher than for controls, which suggests OSAS sequelae or residual disease. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  7. Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype.

    Science.gov (United States)

    Goolsby Hunter, Alyssa; Rosenblatt, Lisa; Patel, Chad; Blauer-Peterson, Cori; Anduze-Faris, Beatrice

    2017-05-01

    In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored. In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics. Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity. The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs. Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients. These results suggest that liver disease progression varies by genotype and

  8. Diabetes knowledge and utilization of healthcare services among patients with type 2 diabetes mellitus in Dhaka, Bangladesh

    National Research Council Canada - National Science Library

    Md Kaoser Bin Siddique; Sheikh Mohammed Shariful Islam; Palash Chandra Banik; Lal B Rawal

    2017-01-01

    Background Diabetes is a significant global public health concern. Poor knowledge of disease and healthcare utilization is associated with worse health outcomes, leading to increasing burden of diabetes in many developing countries...

  9. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3

    Directory of Open Access Journals (Sweden)

    Aditya Singh

    2014-11-01

    Full Text Available Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap.Data and Methods. Using information from the third wave of District Level Household Survey (2007–08, we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13–19 years who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are ‘full antenatal care (ANC’, ‘safe delivery’ and ‘postnatal care within 42 days of delivery’. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care.Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother’s education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother’s education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman

  10. Healthcare Service Utilization for Practicing Physicians: A Population-Based Study.

    Directory of Open Access Journals (Sweden)

    Yu-Lung Chiu

    Full Text Available Physicians are considered to be the most informed consumers in the use of medical services since they have more information about diseases or medical technology. However, although plenty of researchers have suggested that different medical seeking behavior exists among physicians, very few empirical studies have been conducted to investigate differences in medical utilization between physicians and the general population.We explored differences in the utilization of healthcare services between physicians and the general population using a population-based dataset.A cross-sectional study.Data for this study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We included 1426 physicians and 1426 sex- and age-matched comparison subjects.We used Wilcoxon-Mann-Whitney tests to explore differences in variables of healthcare resource utilization between physicians and comparison subjects. We further used Kruskal-Wallis tests to examine differences in variables of healthcare resource utilization between physician practice location and comparison subjects.We found that physicians had significantly fewer outpatient visits (13.2 vs. 15.7, p<0.001 and significantly lower outpatient costs (US$477 vs. US$680, p<0.001 than comparison subjects. Furthermore, physicians had lower total health service costs than comparison subjects (US$643 vs. US$1066, p<0.001. This indicates that the mean total health service costs in the year 2010 was 1.66-fold greater for comparison subjects than for physicians. We also found that there were significant differences in the mean number of outpatient services (p<0.001, outpatient costs (p = 0.001, inpatients costs (p = 0.018, and total costs (p = 0.001 among office-based physicians, hospital-based physicians, and comparison subjects. Specifically, Scheffe contrast tests showed that office-based physicians had significantly more outpatient visits (19.3 vs.10.7, p<0.001 and significantly higher outpatient costs

  11. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3.

    Science.gov (United States)

    Singh, Aditya; Kumar, Abhishek; Pranjali, Pragya

    2014-01-01

    Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap. Data and Methods. Using information from the third wave of District Level Household Survey (2007-08), we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13-19 years) who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are 'full antenatal care (ANC)', 'safe delivery' and 'postnatal care within 42 days of delivery'. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care. Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother's education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother's education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman's education, full antenatal care, safe

  12. Impact of Bariatric Surgery on Healthcare Utilization and Costs among Patients with Diabetes

    Science.gov (United States)

    Bleich, Sara N.; Chang, Hsien-Yen; Lau, Bryan; Steele, Kimberly; Clark, Jeanne M.; Richards, Thomas; Weiner, Jonathan P; Wu, Albert W.; Segal, Jodi B.

    2011-01-01

    Background The effect of bariatric surgery on health care utilization and costs among individuals with type 2 diabetes remains unclear. Objective To examine healthcare utilization and costs in an insured cohort of individuals with type 2 diabetes after bariatric surgery. Research Design Cohort study derived from administrative data from 2002–2008 from 7 Blue Cross Blue Shield Plans. Subjects 7,806 individuals with type 2 diabetes who had bariatric surgery Measures Cost (inpatient, outpatient, pharmacy, other) and utilization (number of inpatient days, outpatient visits, specialist visits). Results Compared to pre-surgical costs, the ratio of hospital costs (excluding the initial surgery), among beneficiaries who had any hospital costs, was higher in years 2 through 6 of the post-surgery period and increased over time [post 1: OR = 0.58 (95% CI: 0.50, 0.67); post 6: OR = 3.43 (95% CI: 2.60, 4.53)]. In comparison to the pre-surgical period, the odds of having any healthcare costs was lower in the post-surgery period and remained relatively flat over time. Among those with hospitalizations, the adjusted ratio of inpatient days was higher after surgery [post 1: OR = 1.05 (95% CI: 0.94, 1.16); post 6: OR = 2.77 (95% CI: 1.57, 4.90)]. Among those with primary care visits, the adjusted odds ratio was lower after surgery [post 1: OR = 0.80 (95% CI: 0.78, 0.82); post 6: OR = 0.66 (95% CI: 0.57, 0.76)]. Conclusion In the six years following surgery, individuals with type 2 diabetes did not have lower healthcare costs than before surgery. PMID:22167064

  13. Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content

    Directory of Open Access Journals (Sweden)

    Krasnik Allan

    2009-11-01

    Full Text Available Abstract Background Cross-national comparable data on migrants' use of healthcare services are important to address problems in access to healthcare; to identify high risk groups for prevention efforts; and to evaluate healthcare systems comparatively. Some of the main obstacles limiting analyses of health care utilization are lack of sufficient coverage and availability of reliable and valid healthcare data which includes information allowing for identification of migrants. The objective of this paper was to reveal which registry data on healthcare utilization were available in the EU countries in which migrants can be identified; and to determine to what extent data were comparable between the EU countries. Methods A questionnaire survey on availability of healthcare utilization registries in which migrants can be identified was carried out among all national statistic agencies and other relevant national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO. The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public Health, Lazio Region, Italy within the MEHO-project; thus, the information on registries was double-checked to assure accuracy and verification. Results Available registry data on healthcare utilization which allow for identification on migrants on a national/regional basis were only reported in 11 EU countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants, five countries reported having information on both citizenship and country of birth, one reported availability of information on country of birth, and

  14. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

    DEFF Research Database (Denmark)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders

    2014-01-01

    OBJECTIVE: To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. DESIGN: Descriptive cross-sectional study using descriptive analyses including t.......30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care...... data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level...

  15. Combining communication technology utilization and organizational innovation: evidence from Canadian healthcare decision makers.

    Science.gov (United States)

    Jbilou, Jalila; Landry, Réjean; Amara, Nabil; El Adlouni, Salaheddine

    2009-08-01

    Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal's Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as

  16. British Columbia Utilities Commission 1998 annual report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-06-01

    The BC Utilities Commission is an independent regulatory agency of the provincial government that operates under the Utilities Commission Act. The Commission's main responsibility is the regulation of the energy utilities under its jurisdiction to ensure that rates charged for energy are fair, just and reasonable, and that utility operations provide safe, adequate and secure service to their clients. It approves the construction of new facilities planned by utilities and their issuance of securities. The Commission's function is quasi-judical and its Decisions and Orders may be appealed to the Court of Appeal on questions of law or jurisdiction. It participates in the review of utility and energy projects under the Environmental Assessment Act. It also reviews, evaluates, and reports on energy related matters referred to it by Cabinet. This review usually involves public hearings followed by a decision or a report and recommendations to the Lieutenant Governor in Council.

  17. British Columbia Utilities Commission 1998 annual report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-06-01

    The BC Utilities Commission is an independent regulatory agency of the provincial government that operates under the Utilities Commission Act. The Commission`s main responsibility is the regulation of the energy utilities under its jurisdiction to ensure that rates charged for energy are fair, just and reasonable, and that utility operations provide safe, adequate and secure service to their clients. It approves the construction of new facilities planned by utilities and their issuance of securities. The Commission`s function is quasi-judical and its Decisions and Orders may be appealed to the Court of Appeal on questions of law or jurisdiction. It participates in the review of utility and energy projects under the Environmental Assessment Act. It also reviews, evaluates, and reports on energy related matters referred to it by Cabinet. This review usually involves public hearings followed by a decision or a report and recommendations to the Lieutenant Governor in Council.

  18. Variations in healthcare access and utilization among Mexican immigrants: the role of documentation status.

    Science.gov (United States)

    Vargas Bustamante, Arturo; Fang, Hai; Garza, Jeremiah; Carter-Pokras, Olivia; Wallace, Steven P; Rizzo, John A; Ortega, Alexander N

    2012-02-01

    The objective of this study is to identify differences in healthcare access and utilization among Mexican immigrants by documentation status. Cross-sectional survey data are analyzed to identify differences in healthcare access and utilization across Mexican immigrant categories. Multivariable logistic regression and the Blinder-Oaxaca decomposition are used to parse out differences into observed and unobserved components. Mexican immigrants ages 18 and above who are immigrants of California households and responded to the 2007 California Health Interview Survey (2,600 documented and 1,038 undocumented immigrants). Undocumented immigrants from Mexico are 27% less likely to have a doctor visit in the previous year and 35% less likely to have a usual source of care compared to documented Mexican immigrants after controlling for confounding variables. Approximately 88% of these disparities can be attributed to predisposing, enabling and need determinants in our model. The remaining disparities are attributed to unobserved heterogeneity. This study shows that undocumented immigrants from Mexico are much less likely to have a physician visit in the previous year and a usual source of care compared to documented immigrants from Mexico. The recently approved Patient Protection and Affordable Care Act will not reduce these disparities unless undocumented immigrants are granted some form of legal status.

  19. Utilization of mathematics amongst healthcare students towards problem solving during their occupational safety health internship

    Science.gov (United States)

    Umasenan a/l Thanikasalam

    2017-05-01

    Occupational safety health is a multidisciplinary discipline concentrating on the safety, health and welfare of workers in the working place. Healthcare Students undergoing Occupational Safety Health internships are required to apply mathematical in areas such as safety legislation, safety behavior, ergonomics, chemical safety, OSH practices, industrial hygiene, risk management and safety health practices as problem solving. The aim of this paper is to investigate the level of mathematics and logic utilization from these students during their internship looking at areas of Hazard identification, Determining the population exposed to the hazard, Assessing the risk of the exposure to the hazards and Taking preventive and control. A total of 142 returning healthcare students from their Occupational Safety Health, internship were given a questionnaire to measure their perceptions towards mathematical and logic utilization. The overall results indicated a strong positive skewed result towards the use of Mathematics during their internship. The findings showed that mathematics were well delivered by the students during their internship. Mathematics could not be separated from OSH practice as a needed precision in quantifying safety, health an d welfare of workers in addition to empiricism.

  20. Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases.

    Science.gov (United States)

    Broder, M S; Neary, M P; Chang, E; Cherepanov, D; Katznelson, L

    2014-08-01

    The economic burden of acromegaly in the US has been largely unknown. We describe the prevalence of treatment patterns, complication rates, and associated healthcare utilization and costs of acromegaly in the US. Patients were identified between 1/1/2002 and 12/31/2009 in claims databases. During 1-year after each continuously-enrolled patient's first acromegaly claim, pharmacy and medical claims were used to estimate outcomes. Regression models were used to adjust outcomes. There were 2,171 acromegaly patients (mean age: 45.3 years; 49.7% female); 77.8% received the majority of their care from non-endocrinologists. Pharmacologic treatment was used by 30.8% of patients: octreotide-LAR in 18.6%, dopamine agonists in 9.8%, short-acting octreotide in 4.7%, pegvisomant in 4.1%, and lanreotide in 1.2%; 56% had biochemical monitoring. Comorbidities were common, ranging from 6.6% (colon neoplasms) to 25.6% (musculoskeletal abnormalities). Mean healthcare costs were $24,900. Adjusted analyses indicated comorbidities increased the odds of hospitalization: by 76% for musculoskeletal abnormalities; 193% for cardiovascular abnormalities; and 56% for sleep apnea (p acromegaly patients. Cardiovascular complications nearly tripled the odds of hospitalization (OR 2.93) and increased annual mean cost by $13,331. Adequate management of this disease may be able to reduce health care utilization and cost associated with these complications and with acromegaly in general.

  1. Use of surveillance data for prevention of healthcare-associated infection: risk adjustment and reporting dilemmas.

    LENUS (Irish Health Repository)

    O'Neill, Eoghan

    2009-08-01

    Healthcare-associated or nosocomial infection (HCAI) is of increasing importance to healthcare providers and the public. Surveillance is crucial but must be adjusted for risk, especially when used for interhospital comparisons or for public reporting.

  2. The effect of hyperactive bladder severity on healthcare utilization and labor productivity.

    Science.gov (United States)

    Angulo, J C; Brenes, F J; Ochayta, D; Lizarraga, I; Arumí, D; Trillo, S; Rejas, J

    2014-05-01

    To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  3. Gender differences in the utilization of health-care services among the older adult population of Spain

    Directory of Open Access Journals (Sweden)

    Banegas José

    2006-06-01

    Full Text Available Abstract Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status, need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL and enabling factors (educational level, marital status, head-of-family employment status and social network. Relative differences in the use of each service between women and men were summarized using odds ratios (OR, obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL: 1.07–1.44, received home medical visits (OR: 1.67; 95% CL: 1.34–2.10 and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79, but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45. After adjustment for HRQL, the OR was 1.03 (0.89–1.21 for visits to medical practitioners, 1.24 (0.98–1.58 for home medical visits, 0.71 (0.58–0.87 for hospitalization, and 1.14 (0.97–1.33 for intake of ≥3 medications. After adjustment for the

  4. A Survey of Obstetric Healthcare Utilization in the Rural Western Indian Himalayas.

    Science.gov (United States)

    Prochaska, Erica C; Uniyal, V P; Lanham, Michael; Heisler, Michele; Quasin, Shazia; Bisht, Monika

    2016-12-01

    Objectives To determine the socio-economic factors affecting access to antepartum, intrapartum, and postpartum healthcare in the rural Western Indian Himalayas over the past 20 years. Methods Face-to-face surveys were conducted with 197 women in Chamoli District, Uttarakhand from October 2011 to May 2012. Participants who gave birth within the past 20 years were included in the final analysis (n = 158). Stratified odds ratios and analysis of variance were calculated. Results Among women who delivered in the prior 7 years, there was a nine-fold increase (95 % CI 4-20.8) in institutionalized births compared to women who delivered 8-20 years before the study. Among women who delivered 7 years prior to the study, low income increased the risk of home delivery (OR 3.07, 95 % CI 1.15-8.54). Low caste (OR 2.79, 95 % CI 1.04-7.72) and low level of education (OR 3.93 95 % CI 1.41-11.81) decreased the use of antepartum medications (vitamins and vaccines). Remote location among all participants was a risk factor for not seeking care for obstetric morbidities (OR 0.44 95 % CI 0.2-0.95). Conclusions The incidence of institutionalized delivery has increased over the past decade in rural Uttarakhand. Income, caste, education, and remote location correlated with poor access to antepartum and intrapartum healthcare. These correlations have increased in statistical significance over the past 20 years, except for location. This indicates that the Western Himalayas face similar challenges to obstetric service utilization as the north Indian plains and that several of these inequalities in healthcare access have become more pronounced in recent years.

  5. Adverse drug reaction reports of patients and healthcare professionals-differences in reported information

    NARCIS (Netherlands)

    Rolfes, Leàn; van Hunsel, Florence; Wilkes, Sarah; Grootheest, Kees van; Puijenbroek, Eugène van

    2015-01-01

    PURPOSE: This study aims to explore the differences in reported information between adverse drug reaction (ADR) reports of patient and healthcare professionals (HCPs), and, in addition, to explore possible correlation between the reported elements of information. METHODS: This retrospective study co

  6. Health insurance benefit design and healthcare utilization in northern rural China.

    Directory of Open Access Journals (Sweden)

    Hong Wang

    Full Text Available BACKGROUND: Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. METHODS AND FINDINGS: We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. CONCLUSION: The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful

  7. A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization.

    Science.gov (United States)

    Emery, Paul; Solem, Caitlyn; Majer, Istvan; Cappelleri, Joseph C; Tarallo, Miriam

    2015-11-01

    This retrospective medical chart review aimed to provide a current, real-world overview of biologic usage in patients with rheumatoid arthritis (RA) in Germany, Spain, and the UK, and estimate clinical and healthcare utilization outcomes associated with early versus late treatment. Adults (≥18 years) with a confirmed RA diagnosis between January 2008 and December 2010, who received biologic treatment for ≥3 months and had ≥12 months of follow-up were included. Early treatment was receipt of biologic agent ≤1 year after RA diagnosis. Outcomes included 28-joint disease activity score (DAS28) reduction of ≥1.2 from biologic start and remission (DAS28 treatment, with a significant difference in Kaplan-Meier curves when indexing on time since diagnosis (p treatment.

  8. Patterns of healthcare utilization in patients with generalized anxiety disorder in general practice in Germany

    Directory of Open Access Journals (Sweden)

    Ariel Berger

    2009-06-01

    Full Text Available Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD in general practitioner (GP settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1 between October 1, 2003 and September 30, 2004 ("GAD patients". We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57], substance abuse disorders (3.91 [2.89, 5.28], and digestive system disorders (2.62 [2.36, 2.91] (all p <0.01. GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7] (both p <0.01. Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics. Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

  9. Adherence and healthcare utilization among older adults with COPD and depression.

    Science.gov (United States)

    Albrecht, Jennifer S; Khokhar, Bilal; Huang, Ting-Ying; Wei, Yu-Jung; Harris, Ilene; Moyo, Patience; Hur, Peter; Lehmann, Susan W; Netzer, Giora; Simoni-Wastila, Linda

    2017-08-01

    Adherence to chronic obstructive pulmonary disease (COPD) maintenance medications and antidepressants may reduce healthcare utilization among multimorbid individuals with COPD and depression. We quantified the independent effects of adherence to antidepressants and COPD maintenance medications on healthcare utilization among individuals co-diagnosed with COPD and depression. We conducted a retrospective cohort study using a 2006-2012 5% random sample of Medicare beneficiaries co-diagnosed with COPD and depression who had two or more prescription fills of both COPD maintenance medications and antidepressants. We measured adherence to medications using the proportion of days covered per 30-day period. The primary outcomes were all-cause emergency department (ED) visits and hospitalizations. Beneficiaries were followed over a minimum 12-month follow-up period. Of the 16,075 beneficiaries meeting inclusion criteria, 21% achieved adherence ≥80% to COPD maintenance medications and 55% achieved adherence ≥80% to antidepressants. Compared to no use and controlling for antidepressant adherence and potential confounders, higher (≥80%) levels of adherence to COPD maintenance medications were associated with decreased risk of ED visits (hazard ratio (HR) 0.79; 95% CI 0.74, 0.83) and hospitalizations (HR 0.82; 95% CI 0.78, 0.87). Similarly, higher levels (≥80%) of adherence to antidepressants resulted in decreased risk of ED visits (HR 0.74; 95% CI 0.70, 0.78) and hospitalizations (HR 0.77; 95% CI 0.73, 0.81) compared to no use. Clinicians can assist in the improved management of their multimorbid patients' health by treating depression among patients with COPD and monitoring and encouraging adherence to the regimens they prescribe. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Predictors of Health-Care Utilization Among Children 6–59 Months of Age in Zambézia Province, Mozambique

    Science.gov (United States)

    Bayham, Mary; Blevins, Meridith; Lopez, Melanie; Olupona, Omo; González-Calvo, Lazaro; Ndatimana, Elisée; Green, Ann F.; Moon, Troy D.

    2017-01-01

    Globally, approximately 5.9 million children under 5 years of age died in 2015, a reduction of over 50% since 1990. Millennium Development Goal 4 established the goal of reducing child mortality by two-thirds by 2015. Multiple countries have surpassed this goal; however, regional and within-country inequities exist. We sought to study determinants of health-care utilization among children 6–59 months of age with fever, diarrhea, and respiratory symptoms in Zambézia Province, Mozambique. We conducted a population-based cross-sectional survey of female heads of household between April and May 2014. Mobile teams conducted interviews in 262 enumeration areas, with three distinct districts being oversampled for improved precision. Descriptive statistics and logistic regression using Stata 13.1 and R 3.2.2 were used to examine factors associated with health-care utilization. A total of 2,317 children were evaluated in this study. Mothers' median age was 26 years, whereas child median age was 24 months. The proportion of children reporting fever, diarrhea, or respiratory illness in the prior 30 days was 44%, 22%, and 22%, respectively. Health-care utilization varied with 65% seeking health care for fever, compared with 57% for diarrhea and 25% for respiratory illness. In multivariable logistic regression, the characteristics most associated with health-care utilization across illnesses were delivery of last child at a facility, higher maternal education, and household ownership of a radio. The decision or ability to use health care is a multifaceted behavior swayed by societal norms, values, socioeconomics, and perceived need. Recognizing the predictors of a particular population may offer useful information to increase uptake in health-care services. PMID:27821686

  11. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  12. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review

    Science.gov (United States)

    Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  13. Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

    Science.gov (United States)

    Chung, Shiu-Dong; Liu, Shih-Ping; Li, Hsien-Chang; Lin, Herng-Ching

    2014-01-01

    This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC) and patients without using a population-based database in Taiwan. This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, phealthcare services than the controls. This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

  14. Doctor shopping by overweight and obese patients is associated with increased healthcare utilization.

    Science.gov (United States)

    Gudzune, Kimberly A; Bleich, Sara N; Richards, Thomas M; Weiner, Jonathan P; Hodges, Krista; Clark, Jeanne M

    2013-07-01

    Negative interactions with healthcare providers may lead patients to switch physicians or "doctor shop." We hypothesized that overweight and obese patients would be more likely to doctor shop, and as a result, have increased rates of emergency department (ED) visits and hospitalizations as compared to normal weight nonshoppers. We combined claims data from a health plan in one state with information from beneficiaries' health risk assessments. The primary outcome was "doctor shopping," which we defined as having outpatient claims with ≥5 different primary care physicians (PCPs) during a 24-month period. The independent variable was standard NIH categories of weight by BMI. We performed multivariate logistic regression to evaluate the association between weight categories and doctor shopping. We conducted multivariate zero-inflated negative binominal regression to evaluate the association between weight-doctor shopping categories with counts of ED visits and hospitalizations. Of the 20,726 beneficiaries, the mean BMI was 26.3 kg m(-2) (SD 5.1), mean age was 44.4 years (SD 11.1) and 53% were female. As compared to normal weight beneficiaries, overweight beneficiaries had 23% greater adjusted odds of doctor shopping (OR 1.23, 95%CI 1.04-1.46) and obese beneficiaries had 52% greater adjusted odds of doctor shopping (OR 1.52, 95%CI 1.26-1.82). As compared to normal weight non-shoppers, overweight and obese shoppers had higher rates of ED visits (IRR 1.85, 95%CI 1.37-2.45; IRR 1.83, 95%CI 1.34-2.50, respectively), which persisted during within weight group comparisons (Overweight IRR 1.50, 95%CI 1.10-2.03; Obese IRR 1.54, 95%CI 1.12-2.11). Frequently changing PCPs may impair continuity and result in increased healthcare utilization. Copyright © 2012 The Obesity Society.

  15. [Utilization of tacit knowledge by maternal healthcare providers: a systematic mapping of the literature].

    Science.gov (United States)

    Calderón Espinosa, Emmanuel; Becerril Montekio, Víctor; Alcalde Rabanal, Jacqueline; García Bello, Luis

    2016-01-01

    The search for efficient answers to strengthen maternal health care has included various sources of evidence for decision making. In this article, we present a systematic mapping of the scientific literature on the use of tacit knowledge in relation to maternal healthcare. A systematic mapping was conducted of scientific articles published in Spanish and English between 1971 and 2014 following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of 793 articles, 30 met the inclusion criteria; 60% were from high-income countries and 66.7% were focused on health professionals. We identified a predominance of qualitative methodologies (62%). Four categories regarding the use of tacit knowledge were generated: proposals to improve the organization of the maternal care system (30%) and to improve the care provided to women during the continuum of pregnancy, childbirth and postpartum (26.7%), determination of health workers' perception and skill levels (26.7%) and the interactions between tacit and explicit knowledge in clinical decision making (16.7%). This mapping shows that tacit knowledge is an emerging, innovative and versatile research approach used primarily in high-income countries and that includes interesting possibilities for its use as evidence to improve maternal healthcare, particularly in middle- and low-income countries, where it needs to be strengthened. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

  16. Report on promotion of utilization of radiation

    Energy Technology Data Exchange (ETDEWEB)

    1987-09-01

    This report presents results of studies made by the Atomic Energy Commission concerning research and development activities to be carried out in future to promote the utilization of radiation. First, the current state of radiation utilization is described, centering on practical applications, research and development activities (for practical and advanced applications), and international cooperation (with developing and advanced nations). The second part deals with activities required in future to promote practical utilization of radiation, research and development of advanced techniques, and cooperation to be offered to developing countries. Third, specific measures to be carried out for effective radiation utilization are described. For ..gamma..-rays and electron beams, which are widely in use at present, there are some economic and social problems remaining to be solved. For advanced utilization of radiation beams, further efforts should be focused on basic research on ..pi..-meson and ..mu..-particle beams and their application to canser treatment and nuclear fusion; research on monochromatic neutron beams; application of RI beams to the development of new materials and new analysis techniques, application of epithermal neutron beams to elementary radiography and CT; etc. The utilization, application and development of tracers are also described. (Nogami, K.).

  17. Utility applications program. Annual report for 1981

    Energy Technology Data Exchange (ETDEWEB)

    Doherty, T.J.; Loscutoff, W.V.

    1982-06-01

    The purpose of the Utility Applications Program is to provide information and assistance to interested utilities on central station energy storage systems. Compressed air and underground pumped hydroelectric energy storage are the primary technical focus. Smaller utilities are the primary targets of this program, as they may not have resources to track and utilize new energy conservation developments. The program, initiated during this year-long period, consists of a series of tasks integrating and supporting energy storage implementation. Program management and technical coordination activities monitor the wide range of research ongoing both under government support and in industry and provide a locus for dissemination of results. Recently completed DOE demonstration studies provide the central data base and the DOE CAES and UPH Technology Program activities provide another major resource. In addition a UPH preliminary feasibility study in coorination with Central Vermont Public Servie (CVPS), a Northeast utility, was carried out. The major program activity this period was a comprehensive technology assessment and environmental siting study, performed in coordination with the Soyland Power Cooperative in Decatur, Illinois. The reports from this work established solid siting precedents for CAES application in the US and jointly assisted the utility in assembling the required baseline information for ongoing technical and financial development of the first US compressed air energy storage facility.

  18. Understanding the Psychosocial and Environmental Factors and Barriers Affecting Utilization of Maternal Healthcare Services in Kalomo, Zambia: A Qualitative Study

    Science.gov (United States)

    Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

    2014-01-01

    This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…

  19. Understanding the Psychosocial and Environmental Factors and Barriers Affecting Utilization of Maternal Healthcare Services in Kalomo, Zambia: A Qualitative Study

    Science.gov (United States)

    Sialubanje, Cephas; Massar, Karlijn; Hamer, Davidson H.; Ruiter, Robert A. C.

    2014-01-01

    This qualitative study aimed to identify psychosocial and environmental factors contributing to low utilization of maternal healthcare services in Kalomo, Zambia. Twelve focus group discussions (n = 141) and 35 in-depth interviews were conducted in six health centre catchment areas. Focus group discussions comprised women of reproductive age…

  20. Inequity in Hospitalization Care: A Study on Utilization of Healthcare Services in West Bengal, India

    Directory of Open Access Journals (Sweden)

    Montu Bose

    2015-01-01

    Full Text Available Background Out of eight commonly agreed Millennium Development Goals (MDG, six are related to the attainment of Universal Health Coverage (UHC throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002 suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilizationto inpatient care by different socio-economic groups across regions and gender in West Bengal (WB, India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods National Sample Survey Organization (NSSO has collected information on all hospitalized cases (60th round, 2004 with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA has also been carried out. Results Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better

  1. Measuring Resource Utilization: A Systematic Review of Validated Self-Reported Questionnaires.

    Science.gov (United States)

    Leggett, Laura E; Khadaroo, Rachel G; Holroyd-Leduc, Jayna; Lorenzetti, Diane L; Hanson, Heather; Wagg, Adrian; Padwal, Raj; Clement, Fiona

    2016-03-01

    A variety of methods may be used to obtain costing data. Although administrative data are most commonly used, the data available in these datasets are often limited. An alternative method of obtaining costing is through self-reported questionnaires. Currently, there are no systematic reviews that summarize self-reported resource utilization instruments from the published literature.The aim of the study was to identify validated self-report healthcare resource use instruments and to map their attributes.A systematic review was conducted. The search identified articles using terms like "healthcare utilization" and "questionnaire." All abstracts and full texts were considered in duplicate. For inclusion, studies had to assess the validity of a self-reported resource use questionnaire, to report original data, include adult populations, and the questionnaire had to be publically available. Data such as type of resource utilization assessed by each questionnaire, and validation findings were extracted from each study.In all, 2343 unique citations were retrieved; 2297 were excluded during abstract review. Forty-six studies were reviewed in full text, and 15 studies were included in this systematic review. Six assessed resource utilization of patients with chronic conditions; 5 assessed mental health service utilization; 3 assessed resource utilization by a general population; and 1 assessed utilization in older populations. The most frequently measured resources included visits to general practitioners and inpatient stays; nonmedical resources were least frequently measured. Self-reported questionnaires on resource utilization had good agreement with administrative data, although, visits to general practitioners, outpatient days, and nurse visits had poorer agreement.Self-reported questionnaires are a valid method of collecting data on healthcare resource utilization.

  2. Toward Successful Implementation of Speech Recognition Technology: A Survey of SRT Utilization Issues in Healthcare Settings.

    Science.gov (United States)

    Clarke, Martina A; King, Joshua L; Kim, Min Soon

    2015-07-01

    To evaluate physician utilization of speech recognition technology (SRT) for medical documentation in two hospitals. A quantitative survey was used to collect data in the areas of practice, electronic equipment used for documentation, documentation created after providing care, and overall thoughts about and satisfaction with the SRT. The survey sample was from one rural and one urban facility in central Missouri. In addition, qualitative interviews were conducted with a chief medical officer and a physician champion regarding implementation issues, training, choice of SRT, and outcomes from their perspective. Seventy-one (60%) of the anticipated 125 surveys were returned. A total of 16 (23%) participants were practicing in internal medicine and 9 (13%) were practicing in family medicine. Fifty-six (79%) participants used a desktop and 14 (20%) used a laptop (2%) computer. SRT products from Nuance were the dominant SRT used by 59 participants (83%). Windows operating systems (Microsoft, Redmond, WA) was used by more than 58 (82%) of the survey respondents. With regard to user experience, 42 (59%) participants experienced spelling and grammatical errors, 15 (21%) encountered clinical inaccuracy, 9 (13%) experienced word substitution, and 4 (6%) experienced misleading medical information. This study shows critical issues of inconsistency, unreliability, and dissatisfaction in the functionality and usability of SRT. This merits further attention to improve the functionality and usability of SRT for better adoption within varying healthcare settings.

  3. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-12-01

    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  4. Quality of Life, Depression, and Healthcare Resource Utilization among Adults with Type 2 Diabetes Mellitus and Concomitant Hypertension and Obesity: A Prospective Survey

    Directory of Open Access Journals (Sweden)

    Andrew J. Green

    2012-01-01

    Full Text Available Background. This study compared quality of life, depression, and healthcare resource utilization among adults with type 2 diabetes mellitus (T2DM and comorbid hypertension (HTN and obesity with those of adults reporting T2DM alone. Methods. Respondents to the US SHIELD survey self-reported their height, weight, comorbid conditions, hospitalizations, and outpatient visits and completed the Short Form-12 (SF-12 and Patient Health Questionnaire (PHQ-9. Respondents reporting T2DM and HTN and obesity (body mass index, BMI, ≥30 kg/m2 were compared with a T2DM-alone group. Results. Respondents with T2DM, HTN, and obesity (n=1292 had significantly lower SF-12 Physical and Mental Component Summary scores (37.3 and 50.9, resp. than T2DM-alone respondents (n=349 (45.8 and 53.5, resp., P<0.0001. Mean PHQ-9 scores were significantly higher among T2DM respondents with comorbid HTN and obesity (5.0 versus 2.5, P<0.0001, indicating greater depression burden. Respondents with T2DM, HTN, and obesity had significantly more resource utilization with respect to physician visits and emergency room visits but not hospitalizations than respondents with T2DM alone (P=0.03. Conclusions. SHIELD respondents with comorbid conditions of T2DM, HTN, and obesity reported greater healthcare resource utilization, more depression symptoms, and lower quality of life than the T2DM-alone group.

  5. Type II diabetes patients in primary care: profiles of healthcare utilization obtained from observational data

    Directory of Open Access Journals (Sweden)

    van Dijk Christel E

    2013-01-01

    Full Text Available Abstract Background The high burden of diabetes for healthcare costs and their impact on quality of life and management of the disease have triggered the design and introduction of disease management programmes (DMPs in many countries. The extent to which diabetes patients vary with regard to their healthcare utilisation and costs is largely unknown and could impact on the design of DMPs. The objectives of this study are to develop profiles based on both the diabetes-related healthcare utilisation and total healthcare utilisation in primary care, to investigate which patient and disease characteristics determine ‘membership’ of each profile, and to investigate the association between these profiles. Methods Data were used from electronic medical records of 6721 known type II diabetes patients listed in 48 Dutch general practices. Latent Class Analyses were conducted to identify profiles of healthcare and regression analyses were used to analyse the characteristics of the profiles. Results For both diabetes-related healthcare utilisation and total healthcare utilisation three profiles could be distinguished: for the diabetes-related healthcare utilisation these were characterised as ‘high utilisation and frequent home visits’ (n=393, ‘low utilisation, GP only’ (n=3231 and ‘high utilisation, GP and nurse’ (n=3097. Profiles differed with respect to the patients’ age and type of medication; the oldest patients using insulin were dominant in the ‘high utilisation, GP and nurse’ profile. High total healthcare utilisation was not associated with high diabetes-related healthcare utilisation. Conclusions Healthcare utilisation of diabetes patients is heterogeneous. This challenges the development of distinguishable DMPs.

  6. Mental Healthcare Utilization in Patients Seeking Bariatric Surgery : The Role of Attachment Behavior

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Brandjes, Dees P. M.; Geenen, Rinie

    2013-01-01

    Obesity may be a factor contributing to mental health in patients seeking bariatric surgery. Whether a person uses mental healthcare may have its roots in attachment behavior. The present study (N=260) identified that attachment anxiety was associated with more mental healthcare visits (OR=1.86, 95%

  7. Lead-time reduction utilizing lean tools applied to healthcare: the inpatient pharmacy at a local hospital.

    Science.gov (United States)

    Al-Araidah, Omar; Momani, Amer; Khasawneh, Mohammad; Momani, Mohammed

    2010-01-01

    The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of > 45% in the drug dispensing cycle time.

  8. Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

    Directory of Open Access Journals (Sweden)

    Earle Craig C

    2009-12-01

    Full Text Available Abstract Background Analyses of utilization trends (cost drivers allow us to understand changes in colorectal cancer (CRC costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice, and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002. Methods Cohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371 or rectum (n = 18,619 between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC. Results CRC patients (mean age: 77.3 years; 44.9% male used more resources than controls in every category (P Conclusion Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.

  9. Healthcare Resource Utilization Associated with Burns and Necrotizing Fasciitis: A Single-Center Comparative Analysis.

    Science.gov (United States)

    Burnett, Eileen; Gawaziuk, Justin P; Shek, Kevin; Logsetty, Sarvesh

    2017-03-06

    Necrotizing fasciitis (NF) patients are increasingly managed in burn units. Although treated similarly to burns, the healthcare resource utilization (HRU) in NF appears to be greater. Accurate knowledge of the HRU is important to better allocate resources and to compare outcomes between units. The goal of this study is to provide better understanding of the HRU for NF compared with burns. A retrospective chart review of patients ≥18 years admitted to two regional tertiary referral centers with either NF or burns requiring surgery. The authors examined age, sex, %TBSA, geographic region, anatomical location, length of stay (LOS) in hospital, LOS in intensive care unit, number of operative procedures, number of packed red blood cells transfused, amputation, death, and use of free tissue transfer or skin graft. There were 210 NF and 209 burn patients. The NF cohort had a smaller TBSA (3.3 vs 10.0%), longer LOS (20 vs 14 days), and consequently a longer LOS/%TBSA (6.0 vs 1.5 days). This difference persisted after adjusting for age. More of the NF cohort (44.8%) spent ≥1 day in the intensive care unit. The NF cohort also had more procedures (median 2 vs 1), required blood (46.2 vs 16.7%), died in hospital (13.3 vs 4.3%), had an amputation (12.4 vs 4.8%), or required free tissue transfer (7.6 vs 2.9%). This study shows that NF requires substantially more HRU compared with burns. This information is important in recognizing the impact of these patients on burn units and planning for allocation of appropriate resources.

  10. Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults.

    Science.gov (United States)

    Karvelas, Deven A; Rundell, Sean D; Friedly, Janna L; Gellhorn, Alfred C; Gold, Laura S; Comstock, Bryan A; Heagerty, Patrick J; Bresnahan, Brian W; Nerenz, David R; Jarvik, Jeffrey G

    2017-03-01

    The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain. This study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain-specific health-care utilization in older adults. This is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry. We recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain. Primary outcome was total back pain-specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use. We compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables. Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72-1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17-3.03, pback pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain-specific health-care utilization compared with patients not receiving early PT. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Utilities and energy efficiency Denmark report

    Energy Technology Data Exchange (ETDEWEB)

    Olesen, G.B.; Lyck, N.C.

    1996-11-01

    The report is the Danish contribution to the project `Utilities and Energy Efficiency` produced for the European Commission by IET, Nikkel straat 15, 4823 AE Breda, The Netherlands. Information is given under the headings of existing situation and desired situation. Recommendations are also given under the headings of legislation concerning the objectives of the utilities, of government programs and targets, of organizational structure, required market dependence and internal objectives of the utilities, for regulation and standardization, and of tariff structure. Flow diagrams are presented for the Danish energy system 1990, 1993. The 1993 follow up of the energy plan `Energy 2000` points out that the goals set up at that time, first and foremost the 20% reduction in CO{sub 2} emissions in 2005 compared to the 1988 level, will not be reached without changes in policy, such as an increase in the use of renewable energy, more transparent and consistent tariff systems as a greater incentive for energy conservation, regulations on thermal insulation of houses, increase in public information activities,a new subsidy scheme to stimulate improvements of energy efficiency in buildings and regulations on energy supply to large buildings. (ARW) 55 refs.

  12. A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa

    Directory of Open Access Journals (Sweden)

    Yugbare Belemsaga Danielle

    2015-12-01

    Full Text Available Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions were those on immediate postpartum maternal care combining several intervention packages such as community mobilization and provision of services, community outreach services and health training. The integration within health facilities of mother and child clinics was shown to contribute significantly to improving the frequency of mothers’ postpartum visits.

  13. Education-related inequity in healthcare with heterogeneous reporting of health

    Science.gov (United States)

    d’Uva, Teresa Bago; Lindeboom, Maarten; O’Donnell, Owen; van Doorslaer, Eddy

    2011-01-01

    Summary Reliance on self-rated health to proxy medical need can bias estimation of education-related inequity in healthcare utilization. We correct this bias both by instrumenting self-rated health with objective health indicators and by purging self-rated health of reporting heterogeneity that is identified from health vignettes. Using data on elderly Europeans, we find that instrumenting self-rated health shifts the distribution of visits to a doctor in the direction of inequality favouring the better educated. There is a further, and typically larger, shift in the same direction when correction is made for the tendency of the better educated to rate their health more negatively. PMID:21938140

  14. Healthcare professionals' self-reported experiences and preferences related to direct healthcare professional communications : a survey conducted in the Netherlands

    NARCIS (Netherlands)

    Piening, S.; Haaijer-Ruskamp, F.M.; de Graeff, P.A.; Straus, S.M.; Mol, P.G.

    2012-01-01

    Background: In Europe, Direct Healthcare Professional Communications (DHPCs) are important tools to inform healthcare professionals of serious, new drug safety issues. However, this tool has not always been successful in effectively communicating the desired actions to healthcare professionals. Obje

  15. Healthcare Professionals' Self-Reported Experiences and Preferences Related to Direct Healthcare Professional Communications A Survey Conducted in the Netherlands

    NARCIS (Netherlands)

    Piening, Sigrid; Haaijer-Ruskamp, Flora M.; de Graeff, Pieter A.; Straus, Sabine M. J. M.; Mol, Peter G. M.

    2012-01-01

    Background: In Europe, Direct Healthcare Professional Communications (DHPCs) are important tools to inform healthcare professionals of serious, new drug safety issues. However, this tool has not always been successful in effectively communicating the desired actions to healthcare professionals. Obje

  16. Utilization of used oil. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mascetti, G.J.; White, H.M.

    1978-08-01

    This report assesses the potential impact of re-refining used automotive and industrial lubricating oils on the national petroleum consumption. The technical base for this assessment is derived from a comprehensive review of the processes utilized in re-refining used oil and those processes used to produce lube oil from crude. Both existing and recently proposed processes are considered. Additionally, an extensive review of processes described in the patent literature is provided. Re-refining processes are surveyed and evaluated. Process descriptions are provided; hardware is identified; and process energy and economic requirements are calculated. Factors affecting the profitability of a re-refining operation are discussed. Economic projections of the demand for lube oil and the ability to satisfy this demand from crude oil are made and the value of lube oil as a vital resource and the need for conservation are addressed. Other factors related to re-refining are discussed, including lube oil characteristics, degradation, lube oil quality and engine sequence testing, and legislative and institutional barriers. Finally, an energy assessment of used oil utilization is made. Two options are considered in this assessment: (1) all used oil is re-refined and recycled back to lube oil; (2) all used oil is burned to recover its heat content.

  17. 7 CFR 550.54 - Invention disclosure and utilization reporting.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Invention disclosure and utilization reporting. 550.54... Management of Agreements Reports and Records § 550.54 Invention disclosure and utilization reporting. (a) The Cooperator shall report Invention Disclosures and Utilization information electronically via i-Edison Web...

  18. 7 CFR 1030.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1030.30 Section... MARKETING AREA Order Regulating Handling Handler Reports § 1030.30 Reports of receipts and utilization. Each... cream products; (3) The utilization or disposition of all milk and milk products required to be reported...

  19. High educational attainment moderates the association between dental health-care supply and utilization in Europe.

    Science.gov (United States)

    Schulz, Maike; Kunst, Anton E; Brockmann, Hilke

    2016-02-01

    In line with the theory of supplier-induced demand, an increased physician density often goes along with a higher utilization of medical services, including dental services. This study aimed to assess whether dentist density and self-employment are related to dental care use, and whether these relationships are moderated by patients' educational attainment. We used data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) from over 20,000 respondents, 50 + yr of age, in 13 countries. We conducted multilevel logistic regressions with probability and type of dental treatment on individual education, country-specific dentist density, and dentist remuneration, and their cross-level interaction. Patients with a high educational level were more likely to report a dentist visit (OR = 2.1, 95% CI: 1.912-2.305) and to receive preventive care (OR = 1.9, 95% CI: 1.697-2.043) than those with a low educational level (reference category). Cross-level interaction effects indicated that high dentist density decreases dental care utilization differences between patients with high (OR = 0.996, 95% CI: 0.993-0.999), medium (OR = 0.995, 95% CI: 0.991-0.999), and low education levels. This was also true for prevention use (OR = 0.996, 95% CI: 0.992-0.999 for patients with a high education level, and OR = 0.996, 95% CI: 0.993-1.000 for patients with a medium education level). The findings suggest that although dentist density is positively associated with dental care utilization, patients have differing susceptibilities to dental care supply.

  20. The impact of copayments on mental healthcare utilization: a natural experiment

    NARCIS (Netherlands)

    T.R. Lambregts (Timo); R.C.J.A. van Vliet (René)

    2017-01-01

    textabstractEmpirical evidence suggests that people are fairly sensitive to cost sharing arrangements in ambulatory mental healthcare. However, pure cost sharing effects are typically hard to measure due to the presence of adverse selection effects. In this paper, we examine the impact of cost

  1. 7 CFR 1124.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1124.30 Section... MARKETING AREA Order Regulating Handling Handler Reports § 1124.30 Reports of receipts and utilization. Each... and end of the month of fluid milk products and bulk fluid cream products; (3) The utilization or...

  2. 7 CFR 1032.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1032.30 Section... AREA Order Regulating Handling Handler Reports § 1032.30 Reports of receipts and utilization. Each... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

  3. 7 CFR 1007.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1007.30 Section... AREA Order Regulating Handling Handler Reports § 1007.30 Reports of receipts and utilization. Each... beginning and end of the month of fluid milk products and bulk fluid cream products; and (9) The utilization...

  4. 7 CFR 1005.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1005.30 Section... MARKETING AREA Order Regulating Handling Handler Reports § 1005.30 Reports of receipts and utilization. Each... beginning and end of the month of fluid milk products and bulk fluid cream products; and (9) The utilization...

  5. 7 CFR 1033.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1033.30 Section... AREA Order Regulating Handling Handler Reports § 1033.30 Reports of receipts and utilization. Each... of fluid milk products and bulk fluid cream products; (3) The utilization or disposition of all milk...

  6. 7 CFR 1006.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1006.30 Section... AREA Order Regulating Handling Handler Reports § 1006.30 Reports of receipts and utilization. Each... and bulk fluid cream products; and (6) The utilization or disposition of all milk and milk products...

  7. 7 CFR 1131.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true Reports of receipts and utilization. 1131.30 Section... AREA Order Regulating Handling Handler Reports § 1131.30 Reports of receipts and utilization. Each... end of the month of fluid milk products and bulk fluid cream products; and (6) The utilization or...

  8. Reduction in Healthcare and Societal Resource Utilization Associated with Cladribine Tablets in Patients with Relapsing-Remitting Multiple Sclerosis: Analysis of Economic Data from the CLARITY Study

    DEFF Research Database (Denmark)

    Ali, Shehzad; Paracha, Noman; Cook, Stuart

    2012-01-01

    Background: Multiple sclerosis (MS) is a common, chronic, neurodegenerative condition associated with substantial healthcare and societal economic burden. Disease-modifying MS treatments have the potential to reduce health resource utilization (HRU), thereby reducing the attendant socioeconomic b...

  9. Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

    Directory of Open Access Journals (Sweden)

    Hao Zhang

    Full Text Available High drug costs due to supplier-induced demand (SID obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID; this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research

  10. PFBC Utility Demonstration Project. Annual report, 1991

    Energy Technology Data Exchange (ETDEWEB)

    1992-11-01

    This report provides a summary of activities by American Electric Power Service Corporation during the first budget period of the PFBC Utility Demonstration Project. In April 1990, AEP signed a Cooperative Agreement with the US Department of Energy to repower the Philip Sporn Plant, Units 3 & 4 in New Haven, West Virginia, with a 330 KW PFBC plant. The purpose of the program was to demonstrate and verify PFBC in a full-scale commercial plant. The technical and cost baselines of the Cooperative Agreement were based on a preliminary engineering and design and a cost estimate developed by AEP subsequent to AEP`s proposal submittal in May 1988, and prior to the signing of the Cooperative Agreement. The Statement of Work in the first budget period of the Cooperative Agreement included a task to develop a preliminary design and cost estimate for erecting a Greenfield plant and to conduct a comparison with the repowering option. The comparative assessment of the options concluded that erecting a Greenfield plant rather than repowering the existing Sporn Plant could be the technically and economically superior alternative. The Greenfield plant would have a capacity of 340 MW. The ten additional MW output is due to the ability to better match the steam cycle to the PFBC system with a new balance of plant design. In addition to this study, the conceptual design of the Sporn Repowering led to several items which warranted optimization studies with the goal to develop a more cost effective design.

  11. Light duty utility arm walkdown report

    Energy Technology Data Exchange (ETDEWEB)

    Smalley, J.L.

    1998-09-25

    This document is a report of the Light Duty Utility Arm (LDUA) drawing walkdown. The purpose of this walkdown was to validate the essential configuration of the LDUA in preparation of deploying the equipment in a Hanford waste tank. The LDUA system has, over the course of its development, caused the generation of a considerable number of design drawings. The number of drawings is estimated to be well over 1,000. A large number consist of vendor type drawings, furnished by both Pacific Northwest National Laboratory (PNNL) and SPAR Aerospace Limited (SPAR). A smaller number, approximately 200, are H-6 type drawing sheets in the Project Hanford Management Contract (PHMC) document control system. A preliminary inspection of the drawings showed that the physical configuration of the LDUA did not match the documented configuration. As a result of these findings, a scoping walkdown of 20 critical drawing sheets was performed to determine if a problem existed in configuration management of the LDUA system. The results of this activity showed that 18 of the 20 drawing sheets were found to contain errors or omissions of varying concern. Given this, Characterization Engineering determined that a walkdown of the drawings necessary and sufficient to enable safe operation and maintenance of the LDUA should be performed. A review team was assembled to perform a review of all of the drawings and determine the set which would need to be verified through an engineering walkdown. The team determined that approximately 150 H-6 type drawing sheets would need to be verified, 12 SPAR/PNNL drawing sheets would need to be verified and converted to H-6 drawings, and three to six new drawings would be created (see Appendix A). This report documents the results of that walkdown.

  12. RVUs, SGR, RUC, and Alphabet Soup: Utility of an iPad App to Teach Healthcare Economics.

    Science.gov (United States)

    Lourenco, Ana P; Baird, Grayson L; Ashkan, Mark; Slanetz, Priscilla J

    2016-07-01

    This study aimed to evaluate the effectiveness of an iPad app for teaching healthcare economics milestones. Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant survey assessment of radiology residents' knowledge of healthcare economics before and following review of the Healthcare Economics iPad app was undertaken at two residencies. Residents received an electronic link to the pre survey, answered 13 general knowledge questions, rated their knowledge of healthcare economics milestones, and reported any prior economics/business background. During the conference, residents reviewed the app on their iPads. They then received a link to the post survey. Responses were entered using REDCap and a unique yet anonymous code was used to link each resident's pre and post results. A follow-up survey was completed at 3 months using REDCap. Sixty-two of 69 (90%) residents completed the pre survey. Mean and median age was 30 years. Thirty-two of 62 (52%) were men and 30/62 (48%) were women. Twenty-nine percent (18/62) were postgraduate year (PGY) 2, 24% (15/62) PGY 3, 19% (12/62) PGY 4, 26% (16/62) PGY 5, and 1.6% (1/62) PGY 6. Thirty-four percent (21/62) reported some economics/business background. Residents' mean self-assessment of their knowledge of healthcare economics milestones was fair on the pre survey, significantly improved on the post survey, and plateaued at 3 months. Fifty-nine residents completed the post survey; 60 completed the 3-month follow-up. Residents demonstrated a significant increase in healthcare economics knowledge on post survey. At 3-month follow-up, significant decreases in gained knowledge were observed only in residents for whom the material was not integrated into the curriculum. Teaching with iPad apps offers an alternative, effective way to teach basics of healthcare economics milestones. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  13. Patients with a congenital heart defect and type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare.

    Science.gov (United States)

    Schoormans, Dounya; Mulder, Barbara Jm; van Melle, Joost P; Pieper, Els G; van Dijk, Arie Pj; Sieswerda, Gert-Jan Tj; Hulsbergen-Zwarts, Mariët S; Plokker, Thijs Hwm; Brunninkhuis, Leo Gh; Vliegen, Hubert W; Sprangers, Mirjam Ag

    2012-09-01

    Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congenital heart disease (CHD) are lacking. (1) To examine the prevalence of type D personality in CHD patients; (2) to compare type D to non-type D patients with regard to disease severity, functional status, health status and QoL; and (3) to examine the extent to which type D personality is independently related to healthcare utilization. A total of 1109 adult CHD patients were included in a questionnaire survey. Due to missing data, 302 patients were excluded. The prevalence of Type D personality was 20.4%. Type D patients reported a poorer functional status, health status and QoL than non-type D patients (p<0.05). Type D patients reported less healthcare use than non-type D patients (primary and cardiac outpatient healthcare: adjusted OR=0.56, 95% CI=0.35-0.90; inpatient healthcare: adjusted OR=0.38, 95% CI=0.17-0.83). Results of a post-hoc analysis showed a high prevalence of type D personality in patients with a poor functional status who did not consult their cardiologist. type D patients report a poorer functional status, health status and QoL, but less healthcare utilization. In clinical practice, patients should be screened for type D personality, since social inhibition may prevent them from contacting a healthcare provider in the event of symptom aggravation.

  14. The effect of outpatient dialysis global budget cap on healthcare utilization by end-stage renal disease patients.

    Science.gov (United States)

    Chang, Ray-E; Hsieh, Chi-Jeng; Myrtle, Robert C

    2011-07-01

    Controlling the cost of chronic diseases remains one of the vexing problems of developed and developing nations alike. Taiwan, faced with rapidly escalating healthcare costs associated with End Stage Renal Disease (ESRD) services utilization, imposed an outpatient dialysis global budget (ODBG) on outpatient dialysis care. This study, using a before and after study design with a comparison group, assessed the impact of this policy innovation on outpatient, inpatient and emergency room utilization. Using a difference in difference (DID) strategy and the generalized estimating equation (GEE) approach, this study found providers responded to these changes through cost reduction and revenue enhancement strategies. This study extends our understanding of provider responses to changes in reimbursement policies that target one segment of the continuum of care required by chronic disease patients.

  15. The utilization of mobile devices for telemedicine services in a South African public healthcare system.

    Science.gov (United States)

    Hartmann, André; Van Dyk, Liezl

    2014-01-01

    The purpose of this study is to develop an understanding in the use of mobile devices in administering telemedicine services within the public health care sector of South Africa. An online questionnaire was developed and distributed amongst medical officers, specialists, students and medical staff of one of the health districts of South Africa. This paper describes the design of the questionnaire as well as the most significant outcomes. Results are presented in terms of reasons why healthcare workers use mobile devices, as well as perceptions in terms of transmission security and quality of transmitted information.

  16. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

    Directory of Open Access Journals (Sweden)

    M N Hindia

    Full Text Available As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness.

  17. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

    Science.gov (United States)

    Hindia, M N; Rahman, T A; Ojukwu, H; Hanafi, E B; Fattouh, A

    2016-01-01

    As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness.

  18. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  19. Awareness and attitudes of healthcare professionals in Wuhan, China to the reporting of adverse drug reactions

    Institute of Scientific and Technical Information of China (English)

    李青; 张素敏; 陈华庭; 方世平; 于星; 刘东; 施侣元; 曾繁典

    2004-01-01

    Background A voluntary procedure for reporting adverse drug reactions (ADRs) was formally put in place in 1989. However, only a small proportion of ADR reports are actually forwarded to the national monitoring center. To identify the reasons for underreporting, the authors investigated the awareness and attitudes of healthcare professionals (doctors, nurses, and administrators) toward the ADR system in China. In addition, the authors sought to formulate approaches to improve the current ADR reporting system.Methods Structured interviews were carried out in 16 hospitals selected from 27 municipal hospitals in Wuhan, Hubei Province, China. A questionnaire survey of a stratified random sample of approximately 15% of healthcare professionals in each selected hospital was conducted during February to March 2003.Results The response rate of this survey was 85%. One thousand six hundred and fifty-three questionnaires were used in the final analysis. Only 2.7% of the healthcare professionals had a correct understanding to the definition of ADR. Eighty-nine point two percent of the healthcare professionals had encountered ADRs. Ninety-four percent of them were aware of the need to report these to the ADR monitoring center. However, only 28.5% of doctors, 22.8% of nurses, and 29.7% of administrators actually submitted a report. For the most part, they reported ADRs to the hospital pharmacy (66.0%), to other departments in the hospital (72.5%), and to the pharmaceutical industry (23.0%), rather than to the national monitoring center (2.9%) or regional monitoring center (9.5%). Severe or rare ADRs and ADRs to new products were generally perceived to be significant enough to report. Sixty-two point one percent of the healthcare professionals had encountered ADRs, yet not reported them to anybody. The major reasons for not reporting included no knowledge of the reporting procedure (71.4%), unavailability of the reporting center mailing address (67.9%), unavailability of the ADR

  20. Reporting of foodborne illness by U.S. consumers and healthcare professionals.

    Science.gov (United States)

    Arendt, Susan; Rajagopal, Lakshman; Strohbehn, Catherine; Stokes, Nathan; Meyer, Janell; Mandernach, Steven

    2013-08-19

    During 2009-2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC) (2013). However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don't report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients' consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process.

  1. Expectations for feedback in adverse drug reporting by healthcare professionals in the Netherlands

    NARCIS (Netherlands)

    Oosterhuis, Ingrid; van Hunsel, Florence P. A. M.; van Puijenbroek, Eugene P.

    2012-01-01

    Background: In 2010, the Netherlands Pharmacovigilance Centre Lareb received more than 4000 reports from healthcare professionals (HCPs). All HCPs received individual personal feedback containing information about the reported drug-adverse drug reaction (ADR) association. It is unclear what type of

  2. Reporting of Foodborne Illness by U.S. Consumers and Healthcare Professionals

    Directory of Open Access Journals (Sweden)

    Steven Mandernach

    2013-08-01

    Full Text Available During 2009–2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC (2013. However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don’t report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients’ consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process.

  3. Self-reported morbidity and health service utilization in rural Tamil Nadu, India.

    Science.gov (United States)

    Dodd, Warren; King, Nia; Humphries, Sally; Little, Matthew; Dewey, Cate

    2016-07-01

    In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability.

  4. Matching prosthetics order records in VA National Prosthetics Patient Database to healthcare utilization databases.

    Science.gov (United States)

    Smith, Mark W; Su, Pon; Phibbs, Ciaran S

    2010-01-01

    The National Prosthetics Patient Database (NPPD) is the national Department of Veterans Affairs (VA) dataset that records characteristics of individual prosthetic and assistive devices. It remains unknown how well NPPD records can be matched to encounter records for the same individuals in major VA utilization databases. We compared the count of prosthetics records in the NPPD with the count of prosthetics-related procedures for the same individuals recorded in major VA utilization databases. We then attempted to match the NPPD records to the utilization records by person and date. In general, 40% to 60% of the NPPD records could be matched to outpatient utilization records within a 14-day window around the NPPD dataset entry date. Match rates for inpatient data were lower: 10% to 16% within a 14-day window. The NPPD will be particularly important for studies of certain veteran groups, such as those with spinal cord injury or blast-related polytraumatic injury. Health services researchers should use both the NPPD and utilization databases to develop a full understanding of prosthetics use by individual patients.

  5. A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing.

    Science.gov (United States)

    Irvin, R; Wilton, L; Scott, H; Beauchamp, G; Wang, L; Betancourt, J; Lubensky, M; Wallace, J; Buchbinder, S

    2014-07-01

    In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income racial discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

  6. What to do with healthcare Incident Reporting Systems

    Directory of Open Access Journals (Sweden)

    Julius Cuong Pham

    2013-12-01

    Full Text Available Incident Reporting Systems (IRS are and will continue to be an important influence on improving patient safety. They can provide valuable insights into how and why patients can be harmed at the organizational level. However, they are not the panacea that many believe them to be. They have several limitations that should be considered. Most of these limitations stem from inherent biases of voluntary reporting systems. These limitations include: i IRS can’t be used to measure safety (error rates; ii IRS can’t be used to compare organizations; iii IRS can’t be used to measure changes over time; iv IRS generate too many reports; v IRS often don’t generate in-depth analyses or result in strong interventions to reduce risk; vi IRS are associated with costs. IRS do offer significant value; their value is found in the following: i IRS can be used to identify local system hazards; ii IRS can be used to aggregate experiences for uncommon conditions; iii IRS can be used to share lessons within and across organizations; iv IRS can be used to increase patient safety culture. Moving forward, several strategies are suggested to maximize their value: i make reporting easier; ii make reporting meaningful to the reporter; iii make the measure of success system changes, rather than events reported; iv prioritize which events to report and investigate, report and investigate them well; v convene with diverse stakeholders to enhance the value of IRS.

  7. Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content

    DEFF Research Database (Denmark)

    Nielsen, Signe Smith; Krasnik, Allan; Rosano, Aldo

    2009-01-01

    Background Cross-national comparable data on migrants’ use of healthcare services are important to address problems in access to healthcare; to identify high risk groups for prevention efforts; and to evaluate healthcare systems comparatively. Some of the main obstacles limiting analyses of health...... utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across...

  8. The use of fund accounting and the need for single fund reporting by institutional healthcare providers. Principles and Practices Board Statement No. 8. Healthcare Financial Management Association.

    Science.gov (United States)

    1986-06-01

    For many years, hospitals and other institutional healthcare providers used fund accounting as a basis for presenting their financial statements. Recently, authoritative literature has placed less emphasis on separate fund reporting. This is evidenced by the reduction of fund classifications specified in the literature. This trend seems to follow the recognition that institutional healthcare activities should be reported in a manner comparable to other businesses. The Principles and Practices Board (P&P Board) of the Healthcare Financial management Association believes that general purpose financial statements of institutional healthcare providers should be comparable to reporting by other businesses. That is, all assets, liabilities, and equity are presented in a single aggregated balance sheet without differentiation by fund. This form of presentation, referred to in this statement as single fund reporting, should be used by all institutional healthcare providers including those that are part of HMOs, universities, municipalities, and other larger entities when separate reports of the provider are issued. The P&P Board is studying other significant issues concerning the reporting of revenues and components of equity and changes therein. The conclusion in this statement can be implemented even though conclusions on these related subjects are not yet complete. The P&P Board recognizes that certain circumstances may require detailed records and reports for special purposes. This statement deals only with those general purpose financial statements on which an independent accountant's opinion is expressed.

  9. A human error taxonomy for analysing healthcare incident reports: assessing reporting culture and its effects on safety perfomance

    DEFF Research Database (Denmark)

    Itoh, Kenji; Omata, N.; Andersen, Henning Boje

    2009-01-01

    The present paper reports on a human error taxonomy system developed for healthcare risk management and on its application to evaluating safety performance and reporting culture. The taxonomy comprises dimensions for classifying errors, for performance-shaping factors, and for the maturity...

  10. Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China.

    Directory of Open Access Journals (Sweden)

    Huajie Yang

    Full Text Available BACKGROUND: Although expected to act as gate-keeping primary care providers, as community health service (CHS facilities are severely under-utilized; Chinese people in both rural and urban areas used predominantly higher-tier facilities for primary care purpose, with significant financial and outcome consequences. This study intends to explore the determinants of initial utilization of CHS among patients with major non-communicable chronic diseases (NCDs in order to understand the care-seeking behavior among urban and rural residents in South China. METHODS: A multi-stage cluster random sampling methodology was adopted to create a sample of 19,466 adults with NCDs from 7,970 urban households and 32,035 adults with NCDs from 3,860 rural households in Guangdong, China. Interviews and physical examinations were conducted in 2010 to collect data on patient characteristics, medical conditions, and awareness and utilization of healthcare. Descriptive analysis and logistic regression analysis were performed to study utilization patterns and the factors associated with the patterns. RESULTS: Prevalence of major NCDs in urban areas was significantly higher than that in rural areas (12.55% vs. 8.70%; p<0.001. Second-tier district hospitals were most preferred for initial consultation (46.05% in rural areas vs. 45.32% in urban areas; p<0.001, followed by tertiary general or specialized hospitals (28.39% in rural areas vs. 33.89% in urban areas; p<0.001. The proportion of patients who had initial use of CHS was relatively low (25.56% in rural areas vs. 20.79% in urban areas; p<0.001. Awareness of self-care and the presence of medical insurance were leading factors associated with first contact of CHS facilities in both urban and rural areas. CONCLUSION: The study suggests that CHS facilities are not often used as the first contact for patients in both rural and urban areas in south China. Much effect must be made to enhance the gatekeeper system and improve

  11. Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey.

    Science.gov (United States)

    Alameddine, Mohamad; Saleh, Shadi; Natafgi, Nabil

    2015-05-22

    Successful endorsement of quality indicators hinges on the readiness and acceptability of care providers for those measures. This paper aims to assess the readiness of care providers in the primary health-care sector in Lebanon for the implementation of quality and patient safety indicators. A cross-sectional survey methodology was utilized to gather information from 943 clinical care providers working at 123 primary health-care centres in Lebanon. The questionnaire included two sections: the first assessed four readiness dimensions (appropriateness, management support, efficacy, and personal valence) of clinical providers to use quality and safety indicators using the Readiness for Organization Change (ROC) scale, and the second section assessed the safety attitude at the primary care centre utilizing the Agency of Health Research and Quality (AHRQ) Safety Attitude Questionnaire (SAQ)-Ambulatory version. Although two thirds (66%) of respondents indicated readiness for implementation of quality and patient safety indicators in their centres, there appear to be differences by professional group. Physicians displayed the lowest scores on all readiness dimensions except for personal valence which was the lowest among nurses (60%). In contrast, allied health professionals displayed the highest scores across all readiness dimensions. Generally, respondents reflected a positive safety attitude climate in the centres. Yet, there remain a few areas of concern related to punitive culture (only 12.8% agree that staff should not be punished for reported errors/incidents), continuity of care (41.1% believe in the negative consequences of lack in continuity of care process), and resources (48.1% believe that the medical equipment they have are adequate). Providers with the highest SAQ score had 2.7, 1.7, 7 and 2.4 times the odds to report a higher readiness on the appropriateness, efficacy, management and personal valence ROC subscales, respectively (P value quality and patient

  12. Latex glove sensitivity amongst diagnostic imaging healthcare personnel: a self-reporting investigation

    Energy Technology Data Exchange (ETDEWEB)

    Healy, Jan; Brennan, Patrick C. E-mail: patrick.brennan@ucd.ie; Bowden, Julie Anne

    2003-02-01

    The use of latex gloves has risen dramatically among healthcare workers resulting in an increase in the number of workers experiencing reactions to gloves. Little evidence of reactions among Irish healthcare workers is available. The current, self-reporting study investigated the prevalence to latex gloves amongst four professional groups within three Diagnostic Imaging Departments. Prevalence is similar to that demonstrated elsewhere with 18.3% of individuals expressing latex associated symptoms. Symptoms included itching and redness of hands, dry cracked skin, soreness of eyes and upper respiratory tract complaints. These results indicate that latex hypersensitivity is a real problem amongst Irish healthcare workers. This preliminary work provides the basis of a much larger controlled study currently being planned.

  13. Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice.

    Science.gov (United States)

    Kalkan, Almina; Bodegard, Johan; Sundström, Johan; Svennblad, Bodil; Östgren, Carl Johan; Nilsson, Peter Nilsson; Johansson, Gunnar; Ekman, Mattias

    2017-04-01

    To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Patients newly initiated on insulin (n=2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. The total mean annual healthcare cost increased from €1656 per patient 2 years before insulin initiation to €3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was €13,823 in the insulin group compared to €9989 in the NIAD group. Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  14. Utility battery storage systems program report for FY 94

    Energy Technology Data Exchange (ETDEWEB)

    Butler, P.C.

    1995-03-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. The goal of this program is to assist industry in developing cost-effective battery systems as a utility resource option by 2000. Sandia is responsible for the engineering analyses, contracted development, and testing of rechargeable batteries and systems for utility energy storage applications. This report details the technical achievements realized during fiscal year 1994.

  15. Utility battery storage systems program report for FY 94

    Energy Technology Data Exchange (ETDEWEB)

    Butler, P.C.

    1995-03-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. The goal of this program is to assist industry in developing cost-effective battery systems as a utility resource option by 2000. Sandia is responsible for the engineering analyses, contracted development, and testing of rechargeable batteries and systems for utility energy storage applications. This report details the technical achievements realized during fiscal year 1994.

  16. Neonatal and pediatric healthcare worldwide: A report from UNICEF.

    Science.gov (United States)

    Guerrera, Giacomo

    2015-12-07

    The 2013 UNICEF annual report on child mortality concluded that between 1990 and 2013, the annual number of deaths among children under-5 years of age has fallen to 6.6 million (uncertainty range, 6.3 to 7.0 million), corresponding to a 48% reduction from the 12.6 million deaths in 1990 (uncertainty range, 12.4 to 12.9 million). About half of under-5 deaths occur in only five countries: India, Nigeria, Democratic Republic of the Congo, Pakistan and China. By 2050, close to 40% of all live births will take place in Sub-Saharan Africa and 37% of the world's children under age five will live in the region. Most deaths can be attributable to preventable diseases. Pneumonia, diarrhea and malaria together killed roughly 2.2 million children under age five in 2012, accounting for a third of all under-five deaths. Emerging evidence has shown that children are at greater risk of dying before age five if they are born in rural areas, poor households, or to a mother denied basic education. While under-5 mortality was consistently reduced over the past 20 years, few progresses in reducing neonatal mortality as well as maternal mortality have been done. UNICEF is a leading partner in the Global Alliance for Vaccines and Immunization (GAVI), a far-reaching public-private partnership dedicated to increasing children's access to vaccines in poor countries. Early diagnosis and appropriate low-cost therapy of maternal and neonatal diseases are the challenges of the coming years. Therefore, there is the need to promote new experimental and clinical researches and to translate results in clinical practice. Laboratory medicine is strategic for promoting and validating innovative methods for managing the most important causes of maternal, neonatal and under-5 deaths, as well as to consistently reduce the gap between bench and bedside. This may be achieved by a close cooperation between laboratory medicine and industries for the development of new diagnostic tools, especially low

  17. Utility Battery Storage Systems Program report for FY93

    Energy Technology Data Exchange (ETDEWEB)

    Butler, P.C.

    1994-02-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the US Department of Energy`s Office of Energy Management. In this capacity, Sandia is responsible for the engineering analyses, contract development, and testing of rechargeable batteries and systems for utility-energy-storage applications. This report details the technical achievements realized during fiscal year 1993.

  18. Desalination utilizing clathrate hydrates (LDRD final report).

    Energy Technology Data Exchange (ETDEWEB)

    Simmons, Blake Alexander; Bradshaw, Robert W.; Dedrick, Daniel E.; Cygan, Randall Timothy (Sandia National Laboratories, Albuquerque, NM); Greathouse, Jeffery A. (Sandia National Laboratories, Albuquerque, NM); Majzoub, Eric H. (University of Missouri, Columbia, MO)

    2008-01-01

    Advances are reported in several aspects of clathrate hydrate desalination fundamentals necessary to develop an economical means to produce municipal quantities of potable water from seawater or brackish feedstock. These aspects include the following, (1) advances in defining the most promising systems design based on new types of hydrate guest molecules, (2) selection of optimal multi-phase reactors and separation arrangements, and, (3) applicability of an inert heat exchange fluid to moderate hydrate growth, control the morphology of the solid hydrate material formed, and facilitate separation of hydrate solids from concentrated brine. The rate of R141b hydrate formation was determined and found to depend only on the degree of supercooling. The rate of R141b hydrate formation in the presence of a heat exchange fluid depended on the degree of supercooling according to the same rate equation as pure R141b with secondary dependence on salinity. Experiments demonstrated that a perfluorocarbon heat exchange fluid assisted separation of R141b hydrates from brine. Preliminary experiments using the guest species, difluoromethane, showed that hydrate formation rates were substantial at temperatures up to at least 12 C and demonstrated partial separation of water from brine. We present a detailed molecular picture of the structure and dynamics of R141b guest molecules within water cages, obtained from ab initio calculations, molecular dynamics simulations, and Raman spectroscopy. Density functional theory calculations were used to provide an energetic and molecular orbital description of R141b stability in both large and small cages in a structure II hydrate. Additionally, the hydrate of an isomer, 1,2-dichloro-1-fluoroethane, does not form at ambient conditions because of extensive overlap of electron density between guest and host. Classical molecular dynamics simulations and laboratory trials support the results for the isomer hydrate. Molecular dynamics simulations

  19. Relations and Utilities Operation monthly report, September, 1956

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, D.M.

    1956-10-24

    This document contains the September 1956 management and operations statistics of the Hanford Atomic Products Operation (HAPO) for their ``Relations and Utilities Operations.`` This is a monthly report. (BN)

  20. Health Data Recording, Reporting and Utilization Practices Among ...

    African Journals Online (AJOL)

    Health Data Recording, Reporting and Utilization Practices Among Primary ... Open Access DOWNLOAD FULL TEXT ... The study took place at the selected primary health centers located in six Local Government Areas in Enugu State Nigeria.

  1. Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients : A randomized trial

    NARCIS (Netherlands)

    Berkhof, Farida F.; van den Berg, Jan W. K.; Uil, Steven M.; Kerstjens, Huib A. M.

    2015-01-01

    Background and objectiveTelemedicine, care provided by electronic communication, may serve as an alternative or extension to traditional outpatient visits. This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease (C

  2. Utility battery storage systems. Program report for FY95

    Energy Technology Data Exchange (ETDEWEB)

    Butler, P.C.

    1996-03-01

    Sandia National Laboratories, New Mexico, conducts the Utility Battery Storage Systems Program, which is sponsored by the U.S. Department of Energy`s Office of Utility Technologies. The goal of this program is to assist industry in developing cost-effective battery systems as a utility resource option by 2000. Sandia is responsible for the engineering analyses, contracted development, and testing of rechargeable batteries and systems for utility energy storage applications. This report details the technical achievements realized during fiscal year 1995.

  3. Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data

    Science.gov (United States)

    Nikolay, Birgit; Salje, Henrik; Sturm-Ramirez, Katharine; Azziz-Baumgartner, Eduardo; Homaira, Nusrat; Iuliano, A. Danielle; Paul, Repon C.; Hossain, M. Jahangir; Cauchemez, Simon; Gurley, Emily S.

    2017-01-01

    Background The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country’s ability to meet these requirements. Methods and Findings We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals. We estimated that surveillance detected 26% (95% CI 18%–33%) of severe neurological disease cases and 18% (95% CI 16%–21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented. Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and

  4. Factors affecting costs and utilization of type 2 diabetes healthcare: a cross-sectional survey among 15 hospitals in urban China

    Directory of Open Access Journals (Sweden)

    Wang Weibing

    2010-08-01

    Full Text Available Abstract Background Type 2 Diabetes mellitus (T2DM affects persons of all ages, while also placing heavy economic burdens on national economies and healthcare systems. The study aims to investigate the determinants of direct medical cost (DMC, out-of-pocket (OOP proportion of the cost, and healthcare utilization associated with T2DM. Methods This cross-sectional study was conducted in four major cities in China. Eligible subjects were adult outpatients who received treatment at one of 15 sampled secondary or tertiary hospitals and consecutively enrolled between March 2007 and May 2007. Generalized estimating equations were used to determine impact factors associated with DMC and healthcare utilization. Results Insurance schemes and receiving insulin therapy were significantly associated with a higher annual DMC of T2DM. For each increase in number of complications, there was about 33% increase in annual DMC. Insurance schemes were significantly associated with the proportions of DMC from pocket. A 7% significantly lower proportion of DMC was paid and 23% more clinic visits (AOR = 1.232, P 2000 CNY/month paid 23% less from their pocket, compared with the lower income group. The number of complications also significantly increased the outpatient visits (AOR = 1.064, P Conclusions It implies that preventing complications through the use of more effective treatment regimens is important in order to control the healthcare expenditures of the diseases. Healthcare reform needs to be focused on the medical insurance system and redistribution of patients in hospitals of different levels.

  5. Self-reported symptoms and healthcare seeking in the general population -exploring "The Symptom Iceberg"

    DEFF Research Database (Denmark)

    Elnegaard, Sandra; Andersen, Rikke Sand; Pedersen, Anette Fischer

    2015-01-01

    BACKGROUND: Research has illustrated that the decision-making process regarding healthcare seeking for symptoms is complex and associated with a variety of factors, including gender differences. Enhanced understanding of the frequency of symptoms and the healthcare seeking behaviour in the general...... population may increase our knowledge of this complex field. The primary objective of this study was to estimate the prevalence of self-reported symptoms and the proportion of individuals reporting GP contact, in a large Danish nationwide cohort. A secondary objective was to explore gender differences in GP...... of 44 different symptoms covering a wide area of alarm symptoms and non-specific frequently occurring symptoms were selected based on extensive literature search. Further, items regarding contact to the GP were included. Data on socioeconomic factors were obtained from Statistics Denmark. RESULTS...

  6. [The social responsibility report drafting in healthcare facilities. Experiences in Fatebenefratelli's Hospitals].

    Science.gov (United States)

    Roberti, Giovanni; Franco, Claudia; Pimpinella, Giovanni; Piscioneri, Patrizia; Primavera, Angela; Bonannini, Barbara; Calvo, Manlio; Pavese, Ida; Di Palma, Mario; Fiore, Rosalia

    2013-01-01

    Medical facilities have the duty to report, in a transparent, comprehensive and integrated manner, their performance, not only in relation to the services provided directly but also in relation to the interest of the various stakeholders and the economic and social benefits for the community. The Social Report is not only a communication tool related to corporate social responsibility but also the initial basis for acquiring social legitimacy, and serves the role of "social accounting" of the activities of an organization, with respect to its mission and institutional role. In healthcare, it can contribute to achieving the fundamental objectives of the healthcare system, in the financial area (fair financing), and also in the medical (outcomes) and ethical-social areas.

  7. Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015.

    Science.gov (United States)

    Agboola, Stephen; Golas, Sara; Fischer, Nils; Nikolova-Simons, Mariana; Op den Buijs, Jorn; Schertzer, Linda; Kvedar, Joseph; Jethwani, Kamal

    2017-04-18

    Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011-2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can

  8. Utilization of dental health-care services and its barriers among the patients visiting community health centers in Nellore District, Andhra Pradesh: A cross-sectional, questionnaire study

    Directory of Open Access Journals (Sweden)

    P Nagarjuna

    2016-01-01

    Full Text Available Introduction: The primary health centers and community health centers (CHCs offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures in the remote areas. Aim: To assess the level of utilization of dental health care services and to determine barriers that prevent utilization of dental health-care services among the patients visiting CHCs in Nellore District, Andhra Pradesh. Materials and Methods: A cross-sectional study was carried out among 600 patients aged 20 years and above visiting the randomly selected 10 CHCs during May 2015 in Nellore District. A multistage sampling method was followed. The source of data was primary in nature and it was obtained through self-administered questionnaire. Data was entered and analyzed using a software program IBM SPSS Statistics version 22 (Armonk, NY: IBM Corp (P < 0.05. Results: Only 36% of patients had visited the dentist in the last 12 months. Males (54% visited dentist more frequently than females (46%. The most common reported reasons for the last dental visit were pain or a dental emergency (71%, followed by restorative treatment (17% and other reasons (12%. The most commonly reported reasons for not seeking dental care were “Not needed unless having pain” by 360 (60%, “I do not think dental diseases are very serious” by 304 (51%, “I have fear of dental procedures” by 290 (48.6%,“Lack of time” by 235 (45.6%, “Dental treatment is expensive” by 200 (33.3%, and “The dentist is at a long distance” by 158 (26.8%. Conclusions: Our findings suggest that only a small portion of population visited a dentist in previous year. Most of them believe that visiting dentist is necessary only for pain relief.

  9. Healthcare resource utilization and clinical outcomes associated with acute care and inpatient rehabilitation of stroke patients in Japan.

    Science.gov (United States)

    Murata, Kyoko; Hinotsu, Shiro; Sadamasa, Nobutake; Yoshida, Kazumichi; Yamagata, Sen; Asari, Shoji; Miyamoto, Susumu; Kawakami, Koji

    2017-02-01

    To investigate healthcare resource utilization and changes in functional status in stroke patients during hospitalization in an acute hospital and a rehabilitation hospital. Retrospective cohort study. One acute and one rehabilitation hospital in Japan. Patients who were admitted to the acute hospital due to stroke onset and then transferred to the rehabilitation hospital (n = 263, 56% male, age 70 ± 12 years). Hospitalization costs and functional independence measure (FIM) were evaluated according to stroke subtype and severity of disability at discharge from the acute hospital. Median (IQR) costs at the acute hospital were dependent on the length of stay (LOS) and implementation of neurosurgery, which resulted in higher costs in subarachnoid hemorrhage [$52 413 ($49 166-$72 606) vs $14 129 ($11 169-$19 459) in cerebral infarction; and vs $15 035 ($10 920-$21 864) in intracerebral hemorrhage]. The costs at the rehabilitation hospital were dependent on LOS, and higher in patients with moderate disability than in those with mild disability [$30 026 ($18 419-$39 911) vs $18 052 ($10 631-$24 384)], while those with severe disability spent $25 476 ($13 340-$43 032). Patients with moderate disability gained the most benefits during hospitalization in the rehabilitation hospital, with a median (IQR) total FIM gain of 16 (5-24) points, compared with a modest improvement in patients with mild (6, 2-14) or severe disability (0, 0-5). The costs for in-hospital stroke care were substantial and the improvement in functional status varied by severity of disability. Our findings would be valuable to organize efficient post-acute stroke care.

  10. Applying multivariate clustering techniques to health data: the 4 types of healthcare utilization in the Paris metropolitan area.

    Directory of Open Access Journals (Sweden)

    Thomas Lefèvre

    Full Text Available Cost containment policies and the need to satisfy patients' health needs and care expectations provide major challenges to healthcare systems. Identification of homogeneous groups in terms of healthcare utilisation could lead to a better understanding of how to adjust healthcare provision to society and patient needs.This study used data from the third wave of the SIRS cohort study, a representative, population-based, socio-epidemiological study set up in 2005 in the Paris metropolitan area, France. The data were analysed using a cross-sectional design. In 2010, 3000 individuals were interviewed in their homes. Non-conventional multivariate clustering techniques were used to determine homogeneous user groups in data. Multinomial models assessed a wide range of potential associations between user characteristics and their pattern of healthcare utilisation.We identified four distinct patterns of healthcare use. Patterns of consumption and the socio-demographic characteristics of users differed qualitatively and quantitatively between these four profiles. Extensive and intensive use by older, wealthier and unhealthier people contrasted with narrow and parsimonious use by younger, socially deprived people and immigrants. Rare, intermittent use by young healthy men contrasted with regular targeted use by healthy and wealthy women.The use of an original technique of massive multivariate analysis allowed us to characterise different types of healthcare users, both in terms of resource utilisation and socio-demographic variables. This method would merit replication in different populations and healthcare systems.

  11. Toxics Release Inventory reporting: Focus on the electric utility industry

    Energy Technology Data Exchange (ETDEWEB)

    Biden, D.; Cain, R.D.; Hoone, D.; Duncan, M.F.; O' Reilly, M.J.; Dodson, S.; Koch, L.L.; Novitsky, W.M.; Ogitis, R.S.; Farkas, S.M.

    1999-07-01

    The look of EPA's annual Toxics Release Inventory Report (TRI) is about to change. Starting in the 1998 reporting year seven new industries are required to report TRI releases. The electric utility industry will join the chemical industry and others who have reported under TRI rules for the last ten years. A major change to EPA's report will be the top ten chemical list. The TRI releases that the electric utility sector will report are of a different chemical composition than those from manufacturing. Because of the layout of the TRI database, the large quantities of utility releases will shift the public focus away from organic constituents to that of less familiar combustion by-products. The resulting shift of reported chemicals could rekindle and intensify interest in air related issues such as acid rain, global warming, and deforestation, and result in public confusion over the health and safety implications associated with releases generated by coal combustion. The nature of the electric generation marketplace will also make year-to-year and company-to-company chemical release comparisons difficult with the present framework of EPA's publication of TRI data.

  12. Algae Cultivation for Carbon Capture and Utilization Workshop Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    None

    2017-05-01

    The Algae Cultivation for Carbon Capture and Utilization Workshop Summary Report summarizes a workshop hosted by the U.S. Department of Energy's Bioenergy Technologies Office on May 23–24, 2017, in Orlando, Florida. The event gathered stakeholder input through facilitated discussions focused on innovative technologies and business strategies for growing algae on waste carbon dioxide resources.

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

    Science.gov (United States)

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

    2014-12-01

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

  14. The utility`s role in the future of PC services and the NII. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-01-01

    The paper is a report by C3 Communications (formerly CSW Communications) summarizing the experience and lessons learned during an 18 month Department of Energy Grant to evaluate how electric utilities can further the growth of the NII by developing a hybrid Internet-energy management service. In addition, the project was also expanded to include evaluation of residential gateway issues, in particular the energy management aspects of this developing area. The report is broken up into three sections, the first section focuses on the issues surrounding the start-up of a traditional ISP and provides a road map for utilities interested in this area. The second section provides an overview of the Internet energy management projects which were undertaken and the key lessons learned from each. Lastly, the third section outlines the gateway progress made during the grant and provides some of the recommendations which the work produced.

  15. Self-reported chronic diseases and health status and health service utilization - Results from a community health survey in Singapore

    Directory of Open Access Journals (Sweden)

    George Pradeep

    2012-08-01

    Full Text Available Abstract Objective To report the extent of self-reported chronic diseases, self-rated health status (SRH and healthcare utilization among residents in 1-2 room Housing Development Board (HDB apartments in Toa Payoh. Materials & methods The study population included a convenience sample of residents from 931 housing development board (HDB units residing in 1-2 room apartments in Toa Payoh. Convenience sampling was used since logistics precluded random selection. Trained research assistants carried out the survey. Results were presented as descriptive summary. Results Respondents were significantly older, 48.3% reported having one or more chronic diseases, 32% have hypertension, 16.8% have diabetes, and 7.6% have asthma. Median SRH score was seven. Hospital inpatient utilization rate were highest among Indian ethnic group, unemployed, no income, high self-rated health (SRH score, and respondents with COPD, renal failure and heart disease. Outpatient utilization rate was significantly higher among older respondents, females, and those with high SRH scores (7-10. Conclusions The findings confirming that residents living in 1-2 room HDB apartments are significantly older, with higher rates of chronic diseases, health care utilization than national average, will aid in healthcare planning to address their needs.

  16. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Science.gov (United States)

    Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

    2015-01-01

    Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  17. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Directory of Open Access Journals (Sweden)

    Oded Vered

    Full Text Available Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU. Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470. Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410. HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391. Before diagnosis (baseline, the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05, however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001. Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001. Additional elevated costs were 3.6 times higher laboratory tests (P<0.001, 2.8 times higher emergency room visits (P<0.001, 1.8 times higher medication (P<0.001 and 1.3 times higher diagnostic procedures (P<0.001. We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  18. Evaluation of health-care utilization in patients with Dravet syndrome and on adjunctive treatment with stiripentol and clobazam.

    Science.gov (United States)

    Strzelczyk, Adam; Schubert-Bast, Susanne; Reese, Jens P; Rosenow, Felix; Stephani, Ulrich; Boor, Rainer

    2014-05-01

    Dravet syndrome (DS) is a rare, severe childhood epilepsy syndrome that imposes a substantial burden on patients and their caregivers. This study evaluated health-care utilization over a 2-year period in patients with DS at an outpatient clinic of a German epilepsy center. Data on the course of epilepsy, anticonvulsant treatment, and direct costs were recorded using the electronic seizure diary Epivista and patients' files. We enrolled 13 patients with DS (6 females, mean age: 12.3±7.5 years) between 2007 and 2010 and evaluated them during a 1-year baseline. All patients had drug-resistant epilepsy and their seizures failed to improve with a mean number of 6.7±3.4 anticonvulsants. They had an overall mean seizure frequency of 102.1 seizures per year (median: 31, range: 3-538) with 43.2 GTCSs per year (median: 14, range: 0-228). We estimated the annual total direct costs at €6506±3974 (range: €1174-11,783) per patient with hospitalization (68.9% of total direct costs) as the major cost factor ahead of costs for anticonvulsants (24.0%). For the 1-year follow-up period, less severely affected patients were continued on conventional anticonvulsants (n=4) or switched to adjunctive treatment with stiripentol and clobazam (n=9). In the latter group, six patients (67%) were long-term responders, with between 25% and 100% seizure reduction with respect to either GTCSs or the overall seizure frequency. This reduction in seizure frequency was associated with a shift in the distribution of cost components towards higher medication costs and decreased hospitalization costs. The total direct costs increased by 42.7%, mainly due to the newly introduced stiripentol, with an annual cost of €6610. This study showed that direct costs of patients with DS were above the average European costs of drug-resistant epilepsy in children. Treatment with new anticonvulsants resulted in reduction of seizures and inpatient admissions.

  19. Health Service Utilization and Poor Health Reporting in Asthma Patients

    Directory of Open Access Journals (Sweden)

    Joshua G. Behr

    2016-06-01

    Full Text Available The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678. Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15 to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69 to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65 and hospitalization (OR 2.21, 95% CI 1.39–3.50, associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma

  20. ['State of the nation's healthcare 2008' annual report: technology is useful, but training comes first].

    Science.gov (United States)

    de Mol, B A J M

    2008-11-22

    The Netherlands Health Care Inspectorate's annual report on the state of the nation's healthcare in 2008 is dedicated to the use of medical technology. The subtitle of the report is 'Risks of medical technology underestimated'. Lack of education and training expose patients to an unacceptable risk of injury within both the care and the cure setting. The Inspectorate urgently recommends applying a certification system to physicians to guarantee safe and appropriate use of devices and equipment. The administration of an institution has the primary responsibility for the visible implementation of risk and safety management. Also, the medical professional must become familiar with the principles of engineering and be trained in applying a systematic approach to safety and reliability within medical technology. This annual report provides recommendations on how to incorporate biomedical engineering into medical education.

  1. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review.

    Directory of Open Access Journals (Sweden)

    Rym Boulkedid

    Full Text Available OBJECTIVE: Delphi technique is a structured process commonly used to developed healthcare quality indicators, but there is a little recommendation for researchers who wish to use it. This study aimed 1 to describe reporting of the Delphi method to develop quality indicators, 2 to discuss specific methodological skills for quality indicators selection 3 to give guidance about this practice. METHODOLOGY AND MAIN FINDING: Three electronic data bases were searched over a 30 years period (1978-2009. All articles that used the Delphi method to select quality indicators were identified. A standardized data extraction form was developed. Four domains (questionnaire preparation, expert panel, progress of the survey and Delphi results were assessed. Of 80 included studies, quality of reporting varied significantly between items (9% for year's number of experience of the experts to 98% for the type of Delphi used. Reporting of methodological aspects needed to evaluate the reliability of the survey was insufficient: only 39% (31/80 of studies reported response rates for all rounds, 60% (48/80 that feedback was given between rounds, 77% (62/80 the method used to achieve consensus and 57% (48/80 listed quality indicators selected at the end of the survey. A modified Delphi procedure was used in 49/78 (63% with a physical meeting of the panel members, usually between Delphi rounds. Median number of panel members was 17(Q1:11; Q3:31. In 40/70 (57% studies, the panel included multiple stakeholders, who were healthcare professionals in 95% (38/40 of cases. Among 75 studies describing criteria to select quality indicators, 28 (37% used validity and 17(23% feasibility. CONCLUSION: The use and reporting of the Delphi method for quality indicators selection need to be improved. We provide some guidance to the investigators to improve the using and reporting of the method in future surveys.

  2. Geothermal resource utilization: paper and cane sugar industries. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Hornburg, C.D.; Morin, O.J.

    1975-03-01

    This study was made as a specific contribution to an overall report by the United States in the area of industrial utilization of geothermal resources. This is part of an overall study in non-electrical uses of geothermal resources for a sub-committee of the North Atlantic Treaty Organization. This study was restricted to the geopressured zone along the Northern Gulf of Mexico Coast. Also, it was limited to utilizing the thermal energy of this ''geoenergy'' resource for process use in the Pulp and Paper Industry and Cane Sugar Industry. For the selected industries and resource area, this report sets forth energy requirements; identifies specific plant and sites; includes diagrams of main processes used; describes process and equipment modifications required; describes energy recovery systems; sets forth waste disposal schemes and problems; and establishes the economics involved. The scope of work included considerable data collection, analysis and documentation. Detailed technical work was done concerning existing processes and modifications to effectively utilize geothermal energy. A brief survey was made of other industries to determine which of these has a high potential for utilizing geothermal energy.

  3. Clinical characteristics and patterns of healthcare utilization in patients with painful neuropathic disorders in UK general practice: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-03-01

    Full Text Available Abstract Background Clinical characteristics and patterns of healthcare utilization in patients with painful neuropathic disorders (PNDs who are under the care of general practitioners (GPs in the UK are not well understood. Methods Using a large electronic UK database, we identified all adults (age ≥ 18 years with any GP encounters between 1 January 2006 - 31 December 2006 at which a diagnosis of PND was noted ("PND patients". An age-and gender-matched comparison group also was constituted consisting of randomly selected patients with one or more GP encounters-but no mention of PNDs-during this period. Characteristics and patterns of healthcare utilization of patients in the two groups were then examined over the one-year study period. Results The study sample consisted of 31,688 patients with mention of PNDs and an equal number of matched comparators; mean age was 56 years, and 62% were women. The prevalence of various comorbidities was higher among patients in the PND group, including digestive disorders (31% vs. 17% for comparison group, circulatory disorders (29% vs. 22%, and depression (4% vs. 3% (all p p p Conclusions Patients with PNDs under the care of GPs in the UK have relatively high levels of use of healthcare services and pain-related pharmacotherapy.

  4. A knowledge based model of electric utility operations. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-08-11

    This report consists of an appendix to provide a documentation and help capability for an analyst using the developed expert system of electric utility operations running in CLIPS. This capability is provided through a separate package running under the WINDOWS Operating System and keyed to provide displays of text, graphics and mixed text and graphics that explain and elaborate on the specific decisions being made within the knowledge based expert system.

  5. Thesis Report: Resource Utilization Provisioning in MapReduce

    OpenAIRE

    Barati, Hamidreza; Jaberi, Nasrin

    2012-01-01

    In this thesis report, we have a survey on state-of-the-art methods for modelling resource utilization of MapReduce applications regard to its configuration parameters. After implementation of one of the algorithms in literature, we tried to find that if CPU usage modelling of a MapReduce application can be used to predict CPU usage of another MapReduce application.

  6. Bariatric surgery results: reporting clinical characteristics and adverse outcomes from an integrated healthcare delivery system.

    Science.gov (United States)

    Li, Robert A; Fisher, David P; Dutta, Sanjoy; O'Brien, Rebecca M; Ackerson, Lynn M; Sorel, Michael E; Sidney, Stephen

    2015-01-01

    Limited data have been reported on bariatric surgery within a large, high-volume regional multicenter integrated healthcare delivery system. Review clinical characteristics and short- and intermediate-term outcomes and adverse events from a bariatric surgery program within an integrated healthcare delivery system. Single high-volume, multicenter regional integrated healthcare delivery system. Adult patients who underwent primary bariatric surgery during 2010-2011 were reviewed. Clinical characteristics, outcomes, and weight loss results were extracted from the electronic medical record. A total of 2399 patients were identified within the study period. The 30-day rates of clinical outcomes for Roux-en-Y gastric bypass (RYGB; n = 1313) and sleeve gastrectomy (SG; n = 1018) were 2.9% for readmission, 3.0% for major complications, .8% for reoperation, and 0% for mortality. One-year and 2-year weight loss results were as follows: percent weight loss (%WL) was 31.4 (±SD 8.5) and 34.2±12.0% for SG and 34.1±9.3 and 39.1±11.9 for RYGB; percent excess weight loss (%EBWL) was 64.2±18.0 and 69.8±23.7 for SG and 68.0±19.3 and 77.8±23.7 for RYGB; percent excess body mass index loss (%EBMIL) was 72.9±21.0 and 77.7±22.4 for SG and 76.6±22.1% and 85.6±21.6 for RYGB. Follow-up for each procedure at 1 year was 76% for SG (n = 778) and 80% for RYGB (n = 1052) and at 2 years was 65% for SG (n = 659) and 67% for RYGB (n = 875). A large regional high-volume multicenter bariatric program within an integrated healthcare delivery system can produce excellent short-term results with low rates of short- and intermediate-term adverse outcomes. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  7. Understanding Healthcare Workers Self-Reported Practices, Knowledge and Attitude about Hand Hygiene in a Medical Setting in Rural India.

    Science.gov (United States)

    Diwan, Vishal; Gustafsson, Charlotte; Rosales Klintz, Senia; Joshi, Sudhir Chandra; Joshi, Rita; Sharma, Megha; Shah, Harshada; Pathak, Ashish; Tamhankar, Ashok J; Stålsby Lundborg, Cecilia

    2016-01-01

    To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to 'always' practice hand hygiene in the selected situations varied from 40-96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers' knowledge and understanding regarding the importance of persistent practice in all situations.

  8. Report on discussions with utility engineers about superconducting generators

    Energy Technology Data Exchange (ETDEWEB)

    None

    1996-03-01

    This report relates to a series of discussions with electric utility engineers concerning the integration of high-temperature superconducting (HTS) generators into the present electric power system. The current and future interest of the utilities in the purchase and use of HTS generators is assessed. Various performance and economic factors are also considered as part of this inspection of the utility prospects for HTS generators. Integration of HTS generators into the electric utility sector is one goal of the Superconductivity Partnership Initiative (SPI). The SPI, a major part of the Department of Energy (DOE) Superconductivity Program for Electric Systems, features vertical teaming of a major industrial power apparatus manufacturers, a producer of HTS wire, and an end-user with assistance and technical support for the national laboratories. The SPI effort on HTS generators is headed by a General Electric Corporation internal team comprised of the Corporate Research Laboratories, Power Generation Engineering, and Power Systems Group. Intermagnetics General corporation, which assisted in the development of the superconducting coils, is the HTS wire and tape manufacturer. Additional technical support is provided by the national laboratories: Argonne, Los Alamos, and Oak Ridge, and the New York State Institute on Superconductivity. The end-user is represented by Niagara-Mohawk and the Electric Power Research Institute.

  9. The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases.

    Science.gov (United States)

    LaMori, Joyce C; Shoheiber, Omar; Dudash, Kellie; Crivera, Concetta; Mody, Samir H

    2014-03-01

    To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009). National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. The first, the Nationwide Inpatient Sample (NIS), provided clinical and resource use information from ∼8 million hospital stays, representing a 20% stratified sample of ∼40 million annual hospital stays in the US in 2009. The second, the State Inpatient Databases, provided 100% of inpatient data from nine states that included both patient age and linked information on multiple patient admissions within the same calendar year. For patients with repeat admissions, the LOS, primary diagnosis, and total charges between the first and subsequent admissions were evaluated. All patients≥18 years of age with at least one diagnosis of ACS, defined using the International Classification of Diseases, 9th Revision, were included (code 410.xx [except 410.x2], 411.1x and 411.8x). Variables evaluated for each discharge included demographics, cardiovascular events and procedures, LOS, discharge status, and total charges. The NIS reported 1,437,735 discharges for ACS in 2009. In this dataset, mean LOS for an initial ACS event was 5.56 days. Patients>65 years of age had the highest numbers of admissions; this group also had the most comorbidities. Approximately 40% of ACS patients with data on repeat visits had more than one admission, >70% of these within 2 months of the primary discharge. Mean charges were $71,336 for the first admission and $53,290 for the second admission. Despite a variety of new therapies to prevent ACS, it remains a common condition. Better therapies are called for if the clinical and cost burden of ACS is to be alleviated.

  10. Economic assessment of the utilization of lead-acid batteries in electric utility systems. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, A.C.; Hynds, J.A.; Nevius, D.R.; Nunan, G.A.; Sweetman, N.

    1977-04-01

    Specific applications in which lead--acid batteries might be economically competitive on an electric utility system are identified. Particular attention is given to searching the Public Service Electric and Gas Company (PSE and G) system for installations of batteries which could defer or cancel costly transmission and/or distribution projects. Although the transmission and distribution data are based on specific applications on the PSE and G system, the generation data are based on a national reference system. The report analyzes and summarizes all costs and savings attributable to lead--acid batteries. 40 figures, 78 tables. (RWR)

  11. Comorbidity burden, healthcare resource utilization, and costs in chronic gout patients refractory to conventional urate-lowering therapy.

    Science.gov (United States)

    Wu, Eric Q; Forsythe, Anna; Guérin, Annie; Yu, Andrew P; Latremouille-Viau, Dominick; Tsaneva, Magda

    2012-11-01

    Patients with chronic gout refractory to conventional urate-lowering therapy have high rates of flares and incidence of tophi, which impose a significant disease and potentially economic burden. This study examined healthcare resource use and costs stratified by disease burden. Adult patients diagnosed with gout (ICD-9-CM:274.xx) and having had ≥3 flares defined by clinical surrogates within a 12-month period were selected for the case cohort from the Thomson MarketScan databases (2003/Q3-2008/Q3). Only patients who had received allopurinol treatment and a diagnosis of tophi (ICD-9-CM:274.8x) at any time before the first flare (index date) or within 12 months postindex were included and were matched in a 1:1 ratio with control gout-free subjects. The comorbidity burden, healthcare resource use, and annual healthcare costs (2008 US$) in the 12-month postindex period were compared between both cohorts using regression models adjusted for demographic characteristic and stratified for patients with ≥6 flares. A total of 679 gout patients met the inclusion criteria for the study and had a higher prevalence of comorbidities than their matched controls. Gout cohort had a significantly higher incidence of emergency room, hospitalizations, outpatient visits, and other medical services than did their matched controls (all comparisons, uncorrected P gout cohort incurred an incremental total annual healthcare cost of $10,222 where 40% of the annual medical cost was for gout-related care compared with control cohort (P gout have a significant economic burden compared with a gout-free population.

  12. Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan: A Nationwide Propensity Score-matched Study.

    Science.gov (United States)

    Peng, Li-Ning; Lu, Wan-Hsuan; Liang, Chih-Kuang; Chou, Ming-Yueh; Chung, Chih-Ping; Tsai, Shu-Ling; Chen, Zhi-Jun; Hsiao, Fei-Yuan; Chen, Liang-Kung

    2017-08-10

    To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Propensity score-matched case-control study using the National Health Insurance data. A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. Demographic characteristics, functional outcomes (modified Rankin Scale, Barthel Index, Lawton-Brody Instrumental Activities of Daily Living, Functional Oral Intake Scale, Mini-Nutritional Assessment, Berg Balance Test, Usual Gait Speed Test, 6-Minute Walk Test, Fugl-Meyer Assessment (modified sensation and motor), Mini-Mental State Examination, Motor Activity Log, and the Concise Chinese Aphasia Test), subsequent healthcare utilization (90-day stroke re-admission and emergency department visits), and 90-day mortality. After propensity score matching, baseline characteristics, stroke severity, and status of healthcare utilization before index stroke admission were similar between cases and controls. After PAC services, the case group obtained significant improvement in all functional domains and may have reduced subsequent disability. Among all functional assessments, balance was the most significantly improved domain and was suggestive for the reduction of subsequent falls risk and related injuries. Compared with controls, patients receiving PAC services had significantly lower 90-day hospital re-admissions [11.1% vs 21.0%, adjusted odds ratio (aOR) 0.47 with 95% confidence interval (CI) 0.34-0.64], stroke-related re-admissions (2.1% vs 8.8%, aOR 0.22, 95% CI 0.12-0.41), and emergency department visits (13.5% vs 24.0%, aOR 0.49, 95% CI 0.37-0.65), but the 90-day mortality rate remained similar between groups (1.4% case group vs 2.0% control group, aOR 0.68, 95% CI 0.29-1.62). PAC significantly improved the recovery of stroke patients in all functional domains through the program, with universal interorganizational

  13. Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis.

    Science.gov (United States)

    Gauthier, Geneviève; Guérin, Annie; Zhdanava, Maryia; Jacobson, William; Nomikos, George; Merikle, Elizabeth; François, Clément; Perez, Vanessa

    2017-06-19

    Although the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy. MDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003-2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori ("persistence"; "discontinuation"; "switch"; "dose escalation"; "augmentation"; and "combination"). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall. A high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.

  14. Robustness of the healthcare utilization results from the Rotavirus Efficacy and Safety Trial (REST evaluating the human-bovine (WC3 reassortant pentavalent rotavirus vaccine (RV5

    Directory of Open Access Journals (Sweden)

    Van Damme Pierre

    2010-06-01

    Full Text Available Abstract Background The Rotavirus Efficacy and Safety Trial was a placebo-controlled Phase III study that evaluated the safety and efficacy of a three-dose pentavalent rotavirus vaccine (RV5 including its effect on healthcare utilization for rotavirus gastroenteritis (RVGE. The per-protocol (PP analyses, which counted events occurring 14 days after dose 3 among infants without protocol violations, have already been published. This paper evaluates the consistency of the healthcare utilization results based on the modified intention to treat (MITT analyses with the PP analyses. The MITT analyses include all infants receiving at least one dose of vaccine or placebo and follow-up begins after dose 1. The paper also explores the consistency of the results for different subgroups of the study population with different types of surveillance. Methods Data on healthcare utilization for acute gastroenteritis were collected via telephone interviews after administration of the first dose. Parents were either contacted every 6 weeks or every 2 weeks depending on the substudy in which they were enrolled. Those contacted every 2 weeks were also asked to complete symptom diaries. Poisson regression was used to evaluate the effect of RV5 on the rates of RVGE-associated healthcare encounters in all of the analyses. Results In the first 2 years after vaccination, RV5 reduced the combined rate of hospitalizations and emergency department (ED visits 88.9% (95% CI: 84.9, 91.9 for all RVGE regardless of serotype in the MITT analysis compared with a 94.5% (95% CI: 91.2, 96.6 reduction based on the G1-G4 PP analysis. By type of surveillance, the rate reductions for the G1-G4 PP analysis were 91.0% (95% CI: 81.7, 95.5 and 95.9% (95% CI: 92.2, 97.8 among parents contacted every 2 weeks (number evaluable = 4,451 and every 6 weeks (number evaluable = 52,683 respectively. Conclusions Our analyses demonstrated that the effect of RV5 on reducing the rate of hospitalizations

  15. Patterns of Healthcare Utilization Among Veterans Infected With Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) and Coinfected With HIV/HCV: Unique Burdens of Disease

    Science.gov (United States)

    Katrak, Shereen; Park, Lawrence P.; Woods, Christopher; Muir, Andrew; Hicks, Charles; Naggie, Susanna

    2016-01-01

    Background. Hepatitis C virus (HCV) infection is a leading cause of cirrhosis and the primary cause of liver transplantation in the United States, and coinfection with human immunodeficiency virus (HIV) increases the risk of comorbidities. However, healthcare utilization (HCU) patterns among HIV/HCV-coinfected patients are poorly understood. This study compared the rates of HCU and reasons for hospital admission among HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans. Methods. Hepatitis C virus- and HIV-infected and HIV/HCV-coinfected veterans in care with the Department of Veterans Affairs (VA) from 1998 to 2009 (n = 335 371, n = 28 179, n = 13 471, respectively) were identified by HIV- and HCV-associated International Classification of Diseases, Ninth Revision codes from the clinical case registry. We assessed rates of HCU using emergency department (ED) visits, outpatient visits, and hospitalization and primary diagnoses associated with hospitalization. Independent risk factors associated with hospitalization were also examined. Results. Rates of outpatient and ED visits increased over the 11-year study period for all groups, with inpatient admission rates remaining stable. The HCU rates were consistently higher for the coinfected than other cohorts. The primary reason for hospital admission for all groups was psychiatric disease/substance use, accounting for 44% of all admissions. Nadir CD4 500 cells/mm3. Conclusions. As the current population of HCV-infected, HIV-infected, and HIV/HCV-coinfected veterans age, they will continue to place a substantial and increasing demand on the US healthcare system, particularly in their utilization of ED and outpatient services. These data suggest the need for an ongoing investment in mental health and primary care within the VA healthcare system. PMID:27704025

  16. Utilization and Accessibility of Healthcare on Pemba Island, Tanzania: Implications for Health Outcomes and Disease Surveillance for Typhoid Fever

    Science.gov (United States)

    Kaljee, Linda M.; Pach, Alfred; Thriemer, Kamala; Ley, Benedikt; Ali, Said M.; Jiddawi, Mohamed; Puri, Mahesh; von Seidlein, Lorenz; Deen, Jacqueline; Ochiai, Leon; Wierzba, Thomas; Clemens, John

    2013-01-01

    Salmonella enterica serotype Typhi (S. Typhi) was estimated to cause over 200,000 deaths and more than 21 million illnesses worldwide, including over 400,000 illnesses in Africa. The current study was conducted in four villages on Pemba Island, Zanzibar, in 2010. We present data on policy makers', health administrators', and village residents' and leaders' perceptions of typhoid fever, and hypothetical and actual health care use among village residents for typhoid fever. Qualitative data provided descriptions of home-based treatment practices and use of western pharmaceuticals, and actual healthcare use for culture-confirmed typhoid fever. Survey data indicate health facility use was associated with gender, education, residency, and perceptions of severity for symptoms associated with typhoid fever. Data have implications for education of policy makers and health administrators, design and implementation of surveillance studies, and community-based interventions to prevent disease outbreaks, decrease risks of complications, and provide information about disease recognition, diagnosis, and treatment. PMID:23208887

  17. Severe neonatal anemia from fetomaternal hemorrhage: report from a multihospital health-care system.

    Science.gov (United States)

    Christensen, R D; Lambert, D K; Baer, V L; Richards, D S; Bennett, S T; Ilstrup, S J; Henry, E

    2013-06-01

    The incidence of fetomaternal hemorrhage that is severe enough to cause neonatal anemia is not known. Owing to its relative rarity, much of the literature describing this condition is in the form of case reports and small case series. We performed a large, muiticentered, sequential, case series to determine the incidence, antecedents and outcomes. From the multicentered databases of Intermountain Healthcare, we obtained records of all neonates with hematocrit (Hct) anemia with evidence of fetomaternal hemorrhage (incidence estimate, 1 per 9160 live births). The initial Hgb ranged from 1.4 to 10.2 g dl(-1) (Hct 29.8%). The initial Hgb was neonatal Hgb was <3 g dl(-1) had reported absent fetal movement, as did 13 of 18 mothers when the initial Hgb was <7 g dl(-1). Outcomes were poorer in those with the lowest initial Hgb; in the two lowest, one died on day 1, and the other developed a grade 4 intraventricular hemorrhage (IVH). The adverse outcomes of death, IVH, periventricular leukomalacia, bronchopulmonary dysplasia or hypoxic-ischemic encephalopathy were common; occurring in 71% (17 of the 24), including all with an initial Hgb <5 g dl(-1) and all born at ≤35 weeks of gestation. Fetomaternal hemorrhage is a rare but sometimes devastating condition. Those with fetomaternal hemorrhage and an initial Hgb of <5 g dl(-1) are expected to need resuscitation at birth, to receive emergent transfusion support and to be at risk for death and major morbidities. Antenatal suspicion of this diagnosis should occur when absent fetal movement is reported. Improvements in rapid diagnosis are needed to prepare first responders and transfusion services.

  18. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  19. Multiple healthcare-associated infections in a patient with Crohn's disease: Case report

    Directory of Open Access Journals (Sweden)

    Jorge Bélem Oliveira Júnior

    2016-07-01

    Full Text Available Background and Objective: Healthcare-associated infections (HAIs are the main cause of death in hospitalized individuals worldwide, related with preexisting disease and invasive procedures. The present study aimed to identify the microorganisms in a immunosuppressed patient and their antimicrobial resistance profile. Case report: A 33-year-old man with Crohn's disease was admitted in a hospital for an enterostomy and cholecystectomy, with postoperative fever and gastrointestinal bleeding. Infections of the urinary tract, into the bloodstream and associated with vascular catheter were evaluated by collect of urine, blood and secretions from catheter tips, individually plated on specific media for direct identification and antibiogram in VITEK® 2. Two different vascular catheters samples and a hemoculture revealed Staphylococcus aureus strains β-lactamases producers, with macrolide-lincosamide-streptogramin B (MLS B and methicillin resistance phenotypes (MRSA, and one indication of VISA (Vancomycin-intermediate S. aureus. Pseudomonas aeruginosa and P. luteola were detected in catheter tips with different resistance profile, whereas Trichosporon asahii and Klebsiella pneumonia (ciprofloxacin/levofloxacin resistant were isolated from urine. Amikacin, meropenem polymyxin B, piperacillin/tazobactam, ciprofloxacin, cefepime and amphotericin B were administered to this patient. Conclusions: The patient survived even after multiple infections with pathogens usually envolved in HAIs and mortality in brazilian hospitals.

  20. Utility guidelines for reactor noise analysis: Final report

    Energy Technology Data Exchange (ETDEWEB)

    Sweeney, F.J.

    1987-02-01

    Noise analysis techniques have been extensively utilized to monitor the health and performance of nuclear power plant systems. However, few utilities have adequate programs to effectively utilize these techniques. These programs usually provide low-quality data, which can lead to misinterpretation and false alarms. The objective of this work is to provide utilities and noise analysts with guidelines for data acquisition, data analysis, and interpretation of noise analysis results for surveillance and diagnosis of reactor systems.

  1. Doctor as criminal: reporting of patient deaths to the police and criminal prosecution of healthcare providers in Japan

    Directory of Open Access Journals (Sweden)

    Maeda Shoichi

    2010-02-01

    Full Text Available Abstract Background In Japan, medical error leading to patient death is often handled through the criminal rather than civil justice system. However, the number of cases handled through the criminal system and how this has changed in recent years has not previously been described. Our aim was to determine the trend in reports of patient death to the police and the trend in the resulting prosecution of healthcare providers for medical error leading to patient death from 1998 to 2008. Methods We collected data regarding the number of police reports of patient death made by physicians, next-of-kin, and other sources between 1998 and 2008. We also collected data regarding the number of resulting criminal prosecutions of healthcare providers between 1998 and 2008. Reporting and prosecution trends were analyzed using annual linear regression models. Results Reports: The number physician reports of patient deaths to the police increased significantly during the study period (slope 18.68, R2 = 0.78, P 2 = 0.83, P Conclusions The reporting of patient deaths to the police by physicians increased significantly from 1998 to 2008 while those made by next-of-kin and others did not. The resulting criminal prosecutions of healthcare providers increased significantly during the same time period. The reasons for these increases are unclear and should be the focus of future research.

  2. Inequity of healthcare utilization on mammography examination and Pap smear screening in Thailand: Analysis of a population-based household survey

    Science.gov (United States)

    2017-01-01

    Healthcare in Thailand is not equally distributed, and not all people can equally access healthcare resources even if they are covered by health insurance. To examine factors associated with the utilization of mammography examination for breast cancer and Pap smear screening for cervical cancer, data from the national reproductive health survey conducted by the National Statistical Office of Thailand in 2009 was examined. The survey was carried out on 15,074,126 women aged 30–59 years. The results showed that the wealthier respondents had more mammograms than did the lower-income groups. The concentration index was 0.144. The data on Pap smears for cervical cancer also showed that the wealthier respondents were more likely to have had a Pap smear than their lower-income counterparts. The concentration index was 0.054. Determinants of mammography examination were education, followed by health welfare and wealth index, whereas the determinants of Pap smear screening were wealth index, followed by health welfare and education. The government should support greater education for women because education was associated with socioeconomic status and wealth. There should be an increase in the number of screening campaigns, mobile clinics, and low-cost mammograms and continued support for accessibility to mammograms, especially in rural areas and low-income communities. PMID:28282430

  3. Final Report Report: Smart Grid Ready PV Inverters with Utility Communication

    Energy Technology Data Exchange (ETDEWEB)

    Seal, Brian [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Huque, Aminul [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Rogers, Lindsey [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Key, Tom [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Riley, Cameron [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Li, Huijuan [Electric Power Research Inst. (EPRI), Knovville, TN (United States); York, Ben [Electric Power Research Inst. (EPRI), Knovville, TN (United States); Purcell, Chris [BPL Global, Inc., Canonsburg, PA (United States); Pacific, Oliver [Spirae, Inc., Fort Collins, CO (United States); Ropp, Michael [Northern Plains Power Technologies, Brookings, SD (United States); Tran, Teresa [DTE Energy, Detroit, MI (United States); Asgeirsson, Hawk [DTE Energy, Detroit, MI (United States); Woodard, Justin [National Grid, Warwick (United Kingdom); Steffel, Steve [Pepco Holdings, Inc., Washington, DC (United States)

    2016-03-30

    In 2011, EPRI began a four-year effort under the Department of Energy (DOE) SunShot Initiative Solar Energy Grid Integration Systems - Advanced Concepts (SEGIS-AC) to demonstrate smart grid ready inverters with utility communication. The objective of the project was to successfully implement and demonstrate effective utilization of inverters with grid support functionality to capture the full value of distributed photovoltaic (PV). The project leveraged ongoing investments and expanded PV inverter capabilities, to enable grid operators to better utilize these grid assets. Developing and implementing key elements of PV inverter grid support capabilities will increase the distribution system’s capacity for higher penetration levels of PV, while reducing the cost. The project team included EPRI, Yaskawa-Solectria Solar, Spirae, BPL Global, DTE Energy, National Grid, Pepco, EDD, NPPT and NREL. The project was divided into three phases: development, deployment, and demonstration. Within each phase, the key areas included: head-end communications for Distributed Energy Resources (DER) at the utility operations center; methods for coordinating DER with existing distribution equipment; back-end PV plant master controller; and inverters with smart-grid functionality. Four demonstration sites were chosen in three regions of the United States with different types of utility operating systems and implementations of utility-scale PV inverters. This report summarizes the project and findings from field demonstration at three utility sites.

  4. Software engineering principles applied to large healthcare information systems--a case report.

    Science.gov (United States)

    Nardon, Fabiane Bizinella; de A Moura, Lincoln

    2007-01-01

    São Paulo is the largest city in Brazil and one of the largest cities in the world. In 2004, São Paulo City Department of Health decided to implement a Healthcare Information System to support managing healthcare services and provide an ambulatory health record. The resulting information system is one of the largest public healthcare information systems ever built, with more than 2 million lines of code. Although statistics shows that most software projects fail, and the risks for the São Paulo initiative were enormous, the information system was completed on-time and on-budget. In this paper, we discuss the software engineering principles adopted that allowed to accomplish that project's goals, hoping that sharing the experience of this project will help other healthcare information systems initiatives to succeed.

  5. Least-cost utility planning consumer participation manual. [Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mitchell, C.; Wellinghoff, J.; Goldberg, F.

    1989-12-31

    This manual is designed to provide guidance to state consumer advocates and other state consumer groups interested in either initiating and/or participating in an Least-Cost Utility Planning (LCUP) process in their state. Least cost utility planning examined primarily as a regulatory framework to be implemented by an appropriate state authority -- usually the public utility commission -- for the benefit of the state`s citizens and electric utility customers. LCUP is also a planning process to be used by investor owned and public utilities to select, support and justify future expenditures in resource additions. This manual is designed as a ``How-To`` manual for implementing and participating in a statewide LCUP process. Its goal is to guide the reader through the LCUP maze so that meaningful, forward-looking, and cost minimizing electric utility planning can be initiated and sustained in your state.

  6. Solar thermal repowering utility value analysis. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, R.; Day, J.; Reed, B.; Malone, M.

    1979-12-01

    The retrofit of solar central receiver energy supply systems to existing steam-electric generating stations (repowering) is being considered as a major programmatic thrust by DOE. The determination of a government response appropriate to the opportunities of repowering is an important policy question, and is the major reason for the analysis. The study objective is to define a government role in repowering that constitutes an efficient program investment in pursuit of viable private markets for heliostat-based energy systems. In support of that objective, the study is designed to identify the scope and nature of the repowering opportunity within the larger context of its contributions to central receiver technology development and commercialization. The Supply and Integration Tasks are documented elsewhere. This report documents the Demand Task, determining and quantifying the sources of the value of repowering and of central receiver technology in general to electric utilities. The modeling tools and assumptions used in the Demand Task are described and the results are presented and interpreted. (MCW)

  7. Healthcare utilization and lost productivity due to infectious gastroenteritis, results from a national cross-sectional survey Australia 2008-2009.

    Science.gov (United States)

    Chen, Y; Ford, L; Hall, G; Dobbins, T; Kirk, M

    2016-01-01

    The aim of this study was to estimate the healthcare usage and loss of productivity due to gastroenteritis in Australia using the National Gastroenteritis Survey II. In 2008-2009, 7578 participants across Australia were surveyed about infectious gastroenteritis by telephone interview. A gastroenteritis case was defined as a person experiencing ⩾ 3 loose stools and/or ⩾ 2 vomits in a 24-h period, excluding cases with a non-infectious cause for their symptoms, such as pregnancy or consumption of alcohol. Lost productivity was considered any lost time from full- or part-time paid work due to having gastroenteritis or caring for someone with the illness. Interference with other daily activities was also examined along with predictors of healthcare-seeking practices using multivariable regression. Results were weighted to obtain nationally representative estimates using Stata v. 13·1. Of the 341 cases, 52 visited a doctor due to gastroenteritis, 126 reported taking at least one medication for their symptoms and 79 cases reported missing ⩾ 1 days' paid work due to gastroenteritis. Gastroenteritis results in a total of 13·1 million (95% confidence interval 6·7-19·5) days of missed paid work each year in Australia. The indirect costs of gastroenteritis are significant, particularly from lost productivity.

  8. 7 CFR 1001.30 - Reports of receipts and utilization.

    Science.gov (United States)

    2010-01-01

    ... receipts and utilization of skim milk, butterfat, milk protein, and other nonfat solids as the market... other than protein (other solids) contained in receipts of milk from producers; and (2) The utilization... SERVICE (Marketing Agreements and Orders; Milk), DEPARTMENT OF AGRICULTURE MILK IN THE NORTHEAST...

  9. Consulting report on the NASA technology utilization network system

    Science.gov (United States)

    Hlava, Marjorie M. K.

    1992-01-01

    The purposes of this consulting effort are: (1) to evaluate the existing management and production procedures and workflow as they each relate to the successful development, utilization, and implementation of the NASA Technology Utilization Network System (TUNS) database; (2) to identify, as requested by the NASA Project Monitor, the strengths, weaknesses, areas of bottlenecking, and previously unaddressed problem areas affecting TUNS; (3) to recommend changes or modifications of existing procedures as necessary in order to effect corrections for the overall benefit of NASA TUNS database production, implementation, and utilization; and (4) to recommend the addition of alternative procedures, routines, and activities that will consolidate and facilitate the production, implementation, and utilization of the NASA TUNS database.

  10. Siting guidelines for utility application of wind turbines. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.T.

    1983-01-01

    Utility-oriented guidelines are described for identifying viable sites for wind turbines. Topics and procedures are also discussed that are important in carrying out a wind turbine siting program. These topics include: a description of the Department of Energy wind resource atlases; procedures for predicting wind turbine performance at potential sites; methods for analyzing wind turbine economics; procedures for estimating installation and maintenance costs; methods for anlayzing the distribution of wind resources over an area; and instrumentation for documenting wind behavior at potential sites. The procedure described is applicable to small and large utilities. Although the procedure was developed as a site-selection tool, it can also be used by a utility who wishes to estimate the potential for wind turbine penetration into its future generation mix.

  11. Siting guidelines for utility application of wind turbines. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Pennell, W.T.

    1983-01-01

    Utility-oriented guidelines are described for identifying viable sites for wind turbines. Topics and procedures are also discussed that are important in carrying out a wind turbine siting program. These topics include: a description of the Department of Energy wind resource atlases; procedures for predicting wind turbine performance at potential sites; methods for analyzing wind turbine economics; procedures for estimating installation and maintenance costs; methods for anlayzing the distribution of wind resources over an area; and instrumentation for documenting wind behavior at potential sites. The procedure described is applicable to small and large utilities. Although the procedure was developed as a site-selection tool, it can also be used by a utility who wishes to estimate the potential for wind turbine penetration into its future generation mix.

  12. Differences in medication adherence and healthcare resource utilization patterns: older versus newer antidepressant agents in patients with depression and/or anxiety disorders.

    Science.gov (United States)

    Sheehan, David V; Keene, Matthew S; Eaddy, Michael; Krulewicz, Stan; Kraus, John E; Carpenter, David J

    2008-01-01

    Given the number of antidepressants available and their rising costs, healthcare payers have initiated restrictive reimbursement policies for newer antidepressants, without consideration for differences in their effectiveness or tolerability. The objective of this study was to comprehensively compare medication adherence rates and associated healthcare utilization costs for patients using later-generation versus earlier-generation antidepressants in a managed care setting. Antidepressants launched after 2002 were deemed third-generation antidepressants, while antidepressants available prior to 2002 were deemed first-generation (TCAs and MAOIs) and second-generation (serotonin and noradrenaline [norepinephrine]-dopamine reuptake inhibitors). Retrospective database analysis using medical and pharmacy data from over 75 managed care plans covering 55 million lives. All patients receiving an antidepressant between 1 January 2002 and 30 September 2004 were identified. The index date for patients was the date of their first antidepressant prescription within this time period. Patients had to (i) have a diagnosis of depression or anxiety disorder, or depression and anxiety disorder within 6 months prior to or 30 days after their index prescription; (ii) be at least 18 years of age, without having taken antidepressant therapy for 6 months prior to their index date; and (iii) be continuously eligible for 6 months prior to their index date and during their 6-month follow-up period. Patients were excluded if they had a diagnosis of psychosis-related disease, Alzheimer's or Parkinson's disease, or were initiated on psychosis-related medications. INTERVENTION/MAIN OUTCOME MEASURE: Patients meeting selection criteria were followed for 6 months to assess rates of antidepressant adherence, therapy change rates and medical healthcare costs. A total of 266 665 patients met the study criteria. Approximately 66% were female, with a mean age of 39 years. About 63% had a diagnosis of

  13. Knowledge, perception, practices and barriers of healthcare professionals in Bosnia and Herzegovina towards adverse drug reaction reporting and pharmacovigilance

    Directory of Open Access Journals (Sweden)

    Maša Amrain

    2014-09-01

    Full Text Available Introduction: Pharmacovigilance is an arm of patient care. No one wants to harm patients, but unfortunately any medicine will sometimes do just this. Underreporting of adverse drug reactions by healthcare professionals is a major problem in many countries. In order to determine whether our pharmacovigilance system could be improved, and identify reasons for under-reporting, a study to investigate the role of health care professionals in adverse drug reaction (ADR reporting was performed.Methods: A pretested questionnaire comprising of 20 questions was designed for assessment of knowledge, perceptions, practice and barriers toward ADR reporting on a random sample of 1000 healthcare professionals in Bosnia and Herzegovina.Results: Of the 1000 respondents, 870 (87% completed the questionnaire. The survey showed that 62.9% health care professionals would report ADR to the Agency for Medicinal Products and Medical Device of Bosnia and Herzegovina (ALMBIH. Most of surveyed respondents has a positive perception towards ADR reporting, and believes that this is part of their professional and legal obligation, and they also recognize the importance of reporting adverse drug reactions. Only small percent (15.4% of surveyed health care professionals reported adverse drug reaction.Conclusions: The knowledge of ADRs and how to report them is inadequate among health care professionals. Perception toward ADR reporting was positive, but it is not reflected in the actual practice of ADRs, probably because of little experience and knowledge regarding pharmacovigilance. Interventions such as education and training, focusing on the aims of pharmacovigilance, completing the ADR form and clarifying the reporting criteria are strongly recommended.

  14. Dechlorination Technology Manual. Final report. [Utility cooling water discharge systems

    Energy Technology Data Exchange (ETDEWEB)

    Aschoff, A.F.; Chiesa, R.J.; Jacobs, M.H.; Lee, Y.H.; Mehta, S.C.; Meko, A.C.; Musil, R.R.; Sopocy, D.M.; Wilson, J.A.

    1984-11-01

    On November 19, 1982, the United States Environmental Protection Agency (EPA) promulgated regulations severely restricting chlorination practices as they relate to utility cooling water discharge systems. EPRI authorized the preparation of a manual on dechlorination technology to assist utilities in evaluating the various alternatives available to them to meet these new requirements. The Dechlorination Technology Manual emphasizes the engineering aspects involved in the selection and design of dechlorination systems. However, background information is included concerning chemistry, regulatory requirements, environmental considerations and aquatic impacts. There is also a brief discussion of the various alternatives to dechlorination. Case studies are given to acquaint the user with the use of the manual for the design of chlorination facilities given various site-related characteristics, such as salt versus fresh waters. Numerous graphs and tables are presented to facilitate the selection and design process. 207 references, 66 figures, 60 tables.

  15. Drug utilization patterns and reported health status in ethnic German migrants (Aussiedler in Germany: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kostev Karel

    2011-06-01

    Full Text Available Abstract Background Inadequate utilization of healthcare services by migrant populations is an important public health concern. Inadequate drug consumption and poor compliance to the therapeutic regimen are common manifestations of low health-care seeking behavior present in migrants even in the countries with well-established healthcare systems. There are few studies on the use of medicines among the different groups of migrants in Germany. The objective of this study is to investigate drug consumption patterns of ethnic German migrants (Aussiedler and their current health status. Methods A cross-sectional study nested into a cohort of 18,621 individuals aged 20-70 years who migrated to Germany from the former Soviet Union between 1990 and 2005 was conducted. Data on consumption of drugs, drug handling, major health risk factors, and one-year disease prevalence were obtained for 114 individuals through a self-administered questionnaire and phone interviews. Results were compared to the data on the German population derived from the Disease Analyzer database and Robert Koch Institute (RKI annual reports. Direct age standardization, test of differences, Chi-square test, and descriptive statistics were applied as appropriate. For drug classification the Anatomical Therapeutic Chemical (ATC system was used. Results Of the respondents, 97% reported to have at least one disease within a 12-month period. The one-year prevalence of asthma (6.9%, hypertension (26.7%, chronic bronchitis (8.6%, and diabetes (4.9% in migrants was similar to the general German population. 51% regularly took either over-the-counter (OTC medication or prescription medicines. Six ATC groups were analyzed. The highest drug consumption was reported for the ATC cardiovascular (22%, nervous (9%, and muskulo-skeletal system (8%. 30% used OTC medicines obtained in the country of origin. Difficulties with drug handling were rare. Alcohol consumption did not differ from the German

  16. Acceptability and utility of an electronic psychosocial assessment (myAssessment) to increase self-disclosure in youth mental healthcare: a quasi-experimental study.

    Science.gov (United States)

    Bradford, Sally; Rickwood, Debra

    2015-12-01

    Technology is increasingly being used in youth mental healthcare to support service delivery and improve health outcomes. The current study trialed a new electronic psychosocial application (myAssessment) that aims to provide a holistic assessment of relevant risk and protective factors in youth mental healthcare. The study aimed to determine whether myAssessment was acceptable to all users, and whether it affected: reporting of certain behaviors and ratings of self-disclosure; youth ratings of control, fears of judgmental reactions or time-efficiency; clinician ratings of time-efficiency or their ability to formulate a treatment plan; and the therapeutic alliance. The application was tested at a youth mental health service using a quasi-experimental two phase Treatment-as-Usual/Intervention design. Three hundred thirty nine youth and 13 clinicians participated across both phases. Reporting of behaviors, self-disclosure, youth control, judgmental reactions, time efficiency, ability to formulate treatment plans, and the therapeutic alliance were compared between groups. myAssessment was found to be widely accepted by both young people and clinicians. Use of myAssessment resulted in reporting of behaviors that were 2.78 through 10.38 times higher for a variety of substances (use of tobacco, alcohol, cannabis, sedatives, hallucinogens, and opioids), in identifying non-heterosexual sexual orientation, having had sex, an STI check, sex without a condom, having felt pressured to have sex in the past, having self-harmed, and in having put themselves in an unsafe situation. Participants who used the application also reported being less likely to lie on past experiences of being bullied, substance use, and self-harm. Use of the application resulted in improved youth ratings of time efficiency in session. The application was found to have no impact on youth control, judgmental reactions, formulation of treatment plans, or the therapeutic alliance. Electronic psychosocial

  17. Self-reported receipt of healthcare professional’s weight management counselling is associated with self-reported weight management behaviours of type 2 diabetes mellitus patients

    OpenAIRE

    Mogre, Victor; Wanaba, Peter; Apala, Peter; Nsoh, Jonas A.

    2016-01-01

    Background Weight loss has been shown to influence the health outcomes of type 2 diabetes patients. Providing weight management counselling to diabetes patients may help them adopt appropriate weight management behaviours to lose weight. This study determined the association between self-reported receipt of healthcare professional’s weight management counselling and the weight management behaviours of type 2 diabetes patients. Methods This cross-sectional study was conducted among 378 type 2 ...

  18. Moral distress among healthcare professionals: report of an institution-wide survey.

    Science.gov (United States)

    Whitehead, Phyllis B; Herbertson, Robert K; Hamric, Ann B; Epstein, Elizabeth G; Fisher, Joan M

    2015-03-01

    Moral distress is a phenomenon affecting many professionals across healthcare settings. Few studies have used a standard measure of moral distress to assess and compare differences among professions and settings. A descriptive, comparative design was used to study moral distress among all healthcare professionals and all settings at one large healthcare system in January 2011. Data were gathered via a web-based survey of demographics, the Moral Distress Scale-Revised (MDS-R), and a shortened version of Olson's Hospital Ethical Climate Scale (HECS-S). Five hundred ninety-two (592) clinicians completed usable surveys (22%). Moral distress was present in all professional groups. Nurses and other professionals involved in direct patient care had significantly higher moral distress than physicians (p = .001) and other indirect care professionals (p Moral distress was negatively correlated with ethical workplace climate (r = -0.516; p moral distress for all professional groups, but the groups varied in other identified sources. Providers working in adult or intensive care unit (ICU) settings had higher levels of moral distress than did clinicians in pediatric or non-ICU settings (p moral distress levels than those who never considered leaving (p moral distress than those without this training (p = .005). Although there may be differences in perspectives and experiences, moral distress is a common experience for clinicians, regardless of profession. Moral distress is associated with burnout and intention to leave a position. By understanding its root causes, interventions can be tailored to minimize moral distress with the ultimate goal of enhancing patient care, staff satisfaction, and retention. © 2014 Sigma Theta Tau International.

  19. Patients with a congenital heart defect and Type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare

    NARCIS (Netherlands)

    Schoormans, Dounya; Mulder, Barbara J. M.; van Melle, Joost P.; Pieper, Els G.; van Dijk, Arie P. J.; Sieswerda, Gert-jan T. J.; Hulsbergen-Zwarts, Mariet S.; Plokker, Thijs H. W. M.; Brunninkhuis, Leo G. H.; Vliegen, Hubert W.; Sprangers, Mirjam A. G.

    2012-01-01

    Background: Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congen

  20. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition.

    Science.gov (United States)

    Ganle, John Kuumuori; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

    2014-12-21

    To reduce financial barriers to access, and improve access to and use of skilled maternal and newborn healthcare services, the government of Ghana, in 2003, implemented a new maternal healthcare policy that provided free maternity care services in all public and mission healthcare facilities. Although supervised delivery in Ghana has increased from 47% in 2003 to 55% in 2010, strikingly high maternal mortality ratio and low percentage of skilled attendance are still recorded in many parts of the country. To explore health system factors that inhibit women's access to and use of skilled maternal and newborn healthcare services in Ghana despite these services being provided free. We conducted qualitative research with 185 expectant and lactating mothers and 20 healthcare providers in six communities in Ghana between November 2011 and May 2012. We used Attride-Stirling's thematic network analysis framework to analyze and present our data. We found that in addition to limited and unequal distribution of skilled maternity care services, women's experiences of intimidation in healthcare facilities, unfriendly healthcare providers, cultural insensitivity, long waiting time before care is received, limited birthing choices, poor care quality, lack of privacy at healthcare facilities, and difficulties relating to arranging suitable transportation were important health system barriers to increased and equitable access and use of services in Ghana. Our findings highlight how a focus on patient-side factors can conceal the fact that many health systems and maternity healthcare facilities in low-income settings such as Ghana are still chronically under-resourced and incapable of effectively providing an acceptable minimum quality of care in the event of serious obstetric complications. Efforts to encourage continued use of maternity care services, especially skilled assistance at delivery, should focus on addressing those negative attributes of the healthcare system that

  1. Hawaii alternative fuels utilization program. Phase 3, final report

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, C.M.; Staackmann, M.

    1996-08-01

    The Hawaii Alternative Fuels Utilization Program originated as a five-year grant awarded by the US Department of Energy (USDOE) to the Hawaii Natural Energy Institute (HNEI) of the University of Hawaii at Manoa. The overall program included research and demonstration efforts aimed at encouraging and sustaining the use of alternative (i.e., substitutes for gasoline and diesel) ground transportation fuels in Hawaii. Originally, research aimed at overcoming technical impediments to the widespread adoption of alternative fuels was an important facet of this program. Demonstration activities centered on the use of methanol-based fuels in alternative fuel vehicles (AFVs). In the present phase, operations were expanded to include flexible fuel vehicles (FFVs) which can operate on M85 or regular unleaded gasoline or any combination of these two fuels. Additional demonstration work was accomplished in attempting to involve other elements of Hawaii in the promotion and use of alcohol fuels for ground transportation in Hawaii.

  2. To what extent are adverse events found in patient records reported by patients and healthcare professionals via complaints, claims and incident reports?

    Directory of Open Access Journals (Sweden)

    van der Wal Gerrit

    2011-02-01

    Full Text Available Abstract Background Patient record review is believed to be the most useful method for estimating the rate of adverse events among hospitalised patients. However, the method has some practical and financial disadvantages. Some of these disadvantages might be overcome by using existing reporting systems in which patient safety issues are already reported, such as incidents reported by healthcare professionals and complaints and medico-legal claims filled by patients or their relatives. The aim of the study is to examine to what extent the hospital reporting systems cover the adverse events identified by patient record review. Methods We conducted a retrospective study using a database from a record review study of 5375 patient records in 14 hospitals in the Netherlands. Trained nurses and physicians using a method based on the protocol of The Harvard Medical Practice Study previously reviewed the records. Four reporting systems were linked with the database of reviewed records: 1 informal and 2 formal complaints by patients/relatives, 3 medico-legal claims by patients/relatives and 4 incident reports by healthcare professionals. For each adverse event identified in patient records the equivalent was sought in these reporting systems by comparing dates and descriptions of the events. The study focussed on the number of adverse event matches, overlap of adverse events detected by different sources, preventability and severity of consequences of reported and non-reported events and sensitivity and specificity of reports. Results In the sample of 5375 patient records, 498 adverse events were identified. Only 18 of the 498 (3.6% adverse events identified by record review were found in one or more of the four reporting systems. There was some overlap: one adverse event had an equivalent in both a complaint and incident report and in three cases a patient/relative used two or three systems to complain about an adverse event. Healthcare professionals

  3. The Utility of Annual Reports: An International Study

    OpenAIRE

    Lucia S Chang; Kenneth S Most; Carlos W Brain

    1983-01-01

    This article reports on major study which is part of ongoing international research into the use and usefulness of financial statements for investment decisions. The survey reported covered 4,000 individual investors, 900 institutional investors and 900 financial analysts, in 3 countries. It was found that the 3 groups in all 3 countries revealed a strong belief in the importance of financial statements for investment decisions whether “buy” or “hold/sell.” It was also found that the individu...

  4. General practitioners’ experiences with provision of healthcare to patients with self-reported multiple chemical sensitivity

    Science.gov (United States)

    Skovbjerg, Sine; Johansen, Jeanne Duus; Rasmussen, Alice; Thorsen, Hanne; Elberling, Jesper

    2009-01-01

    Objective To describe general practitioners’ (GPs’) evaluation of and management strategies in relation to patients who seek medical advice because of multiple chemical sensitivity (MCS). Design A nationwide cross-sectional postal questionnaire survey. The survey included a sample of 1000 Danish GPs randomly drawn from the membership list of GPs in the Danish Medical Association. Setting Denmark. Results Completed questionnaires were obtained from 691 GPs (69%). Within the last 12 months 62.4% (n = 431) of the GPs had been consulted by at least one patient with MCS. Of these, 55.2% of the GPs evaluated the patients’ complaints as chronic and 46.2% stated that they were rarely able to meet the patients’ expectations for healthcare. The majority, 73.5%, had referred patients to other medical specialties. The cause of MCS was perceived as multi-factorial by 64.3% of the GPs, as somatic/biologic by 27.6%, and as psychological by 7.2%. Partial or complete avoidance of chemical exposures was recommended by 86.3%. Clinical guidelines, diagnostic tools, or more insight in the pathophysiology were requested by 84.5% of the GPs. Conclusion Despite the lack of formal diagnostic labelling the patient with MCS is well known by GPs. The majority of the GPs believed that MCS primarily has a multi-factorial explanation. However, perceptions of the course of the condition and management strategies differed, and many GPs found it difficult to meet the patients’ expectations for healthcare. The majority of the GPs requested more knowledge and clinical guidelines for the management of this group of patients. PMID:19452353

  5. Materials research and beam line operation utilizing NSLS. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Liedl, G.L.

    1993-06-01

    MATRIX, a participating research team of Midwest x-ray scattering specialists, continues to operate beam line X-18A at NSLS. Operations of this line now provides state-of-the-art capabilities to a wide range of people in the Materials Science and Engineering research community. Improvements of the beam line continue to be a focus of MATRIX. Throughout this past year the emphasis has been shifting towards improvement in ``user friendly`` aspects. Simplified control operations and a shift to single-user personal computer has been a major part of the effort. Over the past year all 232 operational days were fully utilized. Beam line tests coupled with MATRIX members combined to use 284 days. General user demand for use of the beam line continues to be strong and four groups were provided 48 operating days. Research production has been growing as NSLS and the beam line become a more stable type of operation. For 1992 the MATRIX group published six articles. To date, for 1993 the same group has published, submitted, or has in preparation nine articles. Recent research milestones include: the first quantitative structural information on the as-quenched and early stages of decomposition of supersaturated Al-Li alloys; the first quantitative diffuse scattering measurements on a complex system (Co substitute for Cu YBCO superconductor); demonstration of capabilities of a new UHV surface diffraction chamber with in-situ characterization and temperature control (30-1300K); feasibility of phasing structure factors in a quasicrystal using multiple Bragg scattering.

  6. Computer utilization and clinical judgment in psychological assessment reports.

    Science.gov (United States)

    Lichtenberger, Elizabeth O

    2006-01-01

    The process of assessment report writing is a complex one, involving both the statistical evaluation of data and clinical methods of data interpretation to appropriately answer referral questions. Today, a computer often analyzes data generated in a psychological assessment, at least in part. In this article, the author focuses on the interaction between the decision-making processes of human clinicians and the test interpretations that are computer-based. The benefits and problems with computers in assessment are highlighted and are presented alongside the research on the validity of automated assessment, as well as research comparing clinicians and computers in the decision-making process. The author concludes that clinical judgment and computer-based test interpretation each have weaknesses. However, by using certain strategies to reduce clinicians' susceptibility to errors in decision making and to ensure that only valid computer-based test interpretations are used, clinicians can optimize the accuracy of conclusions that they draw in their assessment report.

  7. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  8. Non-nosocomial healthcare-associated left-sided Pseudomonas aeruginosa endocarditis: a case report and literature review.

    Science.gov (United States)

    Hagiya, Hideharu; Tanaka, Takeshi; Takimoto, Kohei; Yoshida, Hisao; Yamamoto, Norihisa; Akeda, Yukihiro; Tomono, Kazunori

    2016-08-20

    With the development of invasive medical procedures, an increasing number of healthcare-associated infective endocarditis cases have been reported. In particular, non-nosocomial healthcare-associated infective endocarditis in outpatients with recent medical intervention has been increasingly identified. A 66-year-old man with diabetes mellitus and a recent history of intermittent urethral self-catheterization was admitted due to a high fever. Repeated blood cultures identified Pseudomonas aeruginosa, and transesophageal echocardiography uncovered a new-onset severe aortic regurgitation along with a vegetative valvular structure. The patient underwent emergency aortic valve replacement surgery and was successfully treated with 6 weeks of high-dose meropenem and tobramycin. Historically, most cases of P. aeruginosa endocarditis have occurred in the right side of the heart and in outpatients with a history of intravenous drug abuse. In the case presented, the repeated manipulations of the urethra may have triggered the infection. Our literature review for left-sided P. aeruginosa endocarditis showed that non-nosocomial infection accounted for nearly half of the cases and resulted in fatal outcomes as often as nosocomial cases. A combination therapy with anti-pseudomonal beta-lactams or carbapenems and aminoglycosides may be the preferable treatment. Medical treatment alone may be effective, and surgical treatment should be carefully considered. We presented a rare case of native aortic valve endocarditis caused by P. aeruginosa. This case illustrates the importance of identifying the causative pathogen(s), especially for outpatients with a recent history of medical procedures.

  9. Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers.

    Science.gov (United States)

    Dockery, Lisa; Jeffery, Debra; Schauman, Oliver; Williams, Paul; Farrelly, Simone; Bonnington, Oliver; Gabbidon, Jheanell; Lassman, Francesca; Szmukler, George; Thornicroft, Graham; Clement, Sarah

    2015-08-30

    Delayed treatment seeking for people experiencing symptoms of mental illness is common despite available mental healthcare. Poor outcomes are associated with untreated mental illness and caregivers may eventually need to seek help on the service user's behalf. More attention has recently focused on the role of stigma in delayed treatment seeking. This study aimed to establish the frequency of stigma- and non-stigma-related treatment barriers reported by 202 service users and 80 caregivers; to compare treatment barriers reported by service users and caregivers; and to investigate demographic predictors of reporting stigma-related treatment barriers. The profile of treatment barriers differed between service users and caregivers. Service users were more likely to report stigma-related treatment barriers than caregivers across all stigma-related items. Service users who were female, had a diagnosis of schizophrenia or with GCSEs (UK qualifications usually obtained at age 16) were significantly more likely to report stigma-related treatment barriers. Caregivers who were female or of Black ethnicities were significantly more likely to report stigma-related treatment barriers. Multifaceted approaches are needed to reduce barriers to treatment seeking for both service users and caregivers, with anti-stigma interventions being of particular importance for the former group. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Advanced hydrogen/method utilization technology demonstration. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Lynch, F.; Fulton, J. [Hydrogen Consultants, Inc., Littleton, CO (United States)

    1994-04-01

    The overall objective of the work was to seek homogeneous blend ratios of hydrogen:methane that provide ``leverage`` with respect to exhaust emissions or engine performance. The leverage sought was a reduction in exhaust emissions or improved efficiency in proportions greater than the percentage of hydrogen energy in the blended fuel gas mixture. The scope of the study included the range of air/fuel mixtures from the lean limit to slightly richer than stoichiometric. This encompasses two important modes of engine operation for emissions control; lean burn pre-catalyst (some natural gas engines have no catalyst) and post-catalyst; and stoichiometric with three-way catalyst. The report includes a brief discussion of each of these modes.

  11. Innovation with information technologies in healthcare

    CERN Document Server

    Berkowitz, Lyle

    2012-01-01

    This book offers healthcare executives, consultants and vendors a truly helpful and practical resource for planning and implementing healthcare IT, one which provides real life examples as well as advice on how to utilize HIT in a truly innovative manner.

  12. Muskrat population dynamics and vegetation utilization : A management plan : Quarterly progress report : April, May, June 1979

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Quarterly report on a study of muskrat population dynamics and vegetation utilization, being led by Utah State University for a doctorate dissertation. The study...

  13. Muskrat population dynamics and vegetation utilization : A management plan : Report on 1980 field season

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Report for the 1980 field season on a study of muskrat population dynamics and vegetation utilization, being led by Utah State University for a doctorate...

  14. Mobile healthcare.

    Science.gov (United States)

    Morgan, Stephen A; Agee, Nancy Howell

    2012-01-01

    Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.

  15. Self-reported access to and quality of healthcare for diabetes

    DEFF Research Database (Denmark)

    Dixon, John B; Browne, Jessica L; Rice, Toni

    2014-01-01

    BACKGROUND: Given reported pejorative views that health professionals have about patients who are severely obese, we examined the self-reported views of the quality and availability of diabetes care from the perspective of adults with type 2 diabetes (T2DM), stratified by body mass index (BMI). M...

  16. Activity report on the utilization of research reactors. Japanese Fiscal Year, 1998

    Energy Technology Data Exchange (ETDEWEB)

    Toyoda, Masayuki; Koyama, Yoshimi [eds.] [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2000-03-01

    This is the second issue of the activity report on the utilization of research reactors in the fields of neutron beam experiments, neutron activation analysis, radioisotope production, etc., performed during Japanese Fiscal Year 1998 (April 1, 1998 - March 31, 1999). All reports in this volume were described by users from JAERI and also users from the other organizations, i.e., universities, national research institutes and private companies, who have utilized our research reactor utilization facilities for the purpose of the above studies. (author)

  17. Activity report on the utilization of research reactors. Japanese Fiscal Year, 1999

    Energy Technology Data Exchange (ETDEWEB)

    Toyoda, Masayuki [ed.] [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2001-03-01

    This is the second issue of the activity report on the utilization of research reactors in the fields of neutron beam experiments, neutron activation analysis, radioisotope production, etc., performed during Japanese Fiscal Year 1999 (April 1, 1999 - March 31, 2000). All reports in this volume were described by users from JAERI and also users from the other organizations, i.e., universities, national research institutes and private companies, who have utilized our research reactor utilization facilities for the purpose of the above studies. (author)

  18. How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  19. How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  20. Self-reported adverse reactions in 4337 healthcare workers immunizations against novel H1N1 influenza

    Directory of Open Access Journals (Sweden)

    Seybold Joachim

    2011-08-01

    Full Text Available Abstract Purpose The use of the 2009 H1N1 vaccine has generated much debate concerning safety issues among the general population and physicians. It was questioned if this is a safe vaccine. Therefore, we investigated the safety of an inactivated monovalent H1N1 pandemic influenza vaccine Methods We focused on the H1N1 pandemic influenza vaccine Pandemrix® and applied a self reporting questionnaire in a population of healthcare workers (HCWs and medical students at a major university hospital. Results In total, 4337 individuals were vaccinated, consisting of 3808 HCWs and 529 medical students. The vaccination rate of the employees was higher than 40%. The majority of individuals were vaccinated in November 2009. In total, 291 of the 4337 vaccinations were reported to lead to one or more adverse reactions (6.7%. Local reactions were reported in 3.8%, myalgia and arthralgia in 3.7%, fatigue in 3.7%, headache in 3.1%. Conclusions Our data together with available data from several national and international institutions points to a safe pandemic influenza vaccine.

  1. Self-administered outpatient parenteral antimicrobial therapy: a report of three years experience in the Irish healthcare setting.

    LENUS (Irish Health Repository)

    Kieran, J

    2012-02-01

    Outpatient parenteral antibiotic therapy (OPAT) was first reported in 1972. OPAT programmes are not well established in Ireland, with no reported outcomes in the literature. An OPAT programme was established at St. James Hospital in 2006. Demographics, diagnoses and outcomes of the first 60 courses are reported. A retrospective analysis of prospectively recorded data was performed on patients treated from March 2006 to February 2009. The data was analysed using SPSS v.17. Sixty OPAT courses were administered to 56 patients, 57 percent of which were male. The median age was 50 years, the median inpatient stay was 19 days, the median duration of OPAT was 16 days and 1,289 inpatient bed days were saved. The additional cost per day of OPAT was 167.60 euros. Vancomycin was the most prescribed antimicrobial, administered to 35%. Musculoskeletal infection was the indication for treatment in 50%. Confirmatory microbiological diagnosis was identified in 72%, most frequently due to Staphylococcus aureus (68%). Only minor adverse events were recorded. Clinical cure was achieved in 92.8%. A patient satisfaction survey showed high satisfaction. OPAT is a safe and effective way of providing parenteral antibiotic therapy in the Irish healthcare system. Better integration of funding and the appointment of Infectious Diseases specialists will facilitate its expansion.

  2. Hypoglycemia After Initiation of Basal Insulin in Patients with Type 2 Diabetes in the United States: Implications for Treatment Discontinuation and Healthcare Costs and Utilization.

    Science.gov (United States)

    Dalal, Mehul R; Kazemi, Mahmood; Ye, Fen; Xie, Lin

    2017-08-04

    Hypoglycemia and fear of hypoglycemia may contribute to basal insulin discontinuation, poor glycemic control, and increased healthcare burden in patients with type 2 diabetes (T2D). This study aimed to determine the impact of hypoglycemia soon after basal insulin initiation on treatment discontinuation and economic outcomes in patients with T2D. Hypoglycemic events within 6 months of basal insulin initiation were identified using retrospective cohort data from patients with T2D, at least 18 years of age, initiated on basal insulin therapy in the Clinformatics™ Data Mart for Multiplan claims database from January 1, 2008, through August 31, 2012. Data were adjusted for baseline characteristics. Discontinuation was established for patients with 12-month follow-up data, while discontinuation risk was assessed in the extended analysis (6- to 24-month follow-up) by Cox regression analysis. Healthcare use and costs were determined. Of 55,608 patients, 4.5% experienced hypoglycemia within 6 months of basal insulin initiation. Patients with hypoglycemia were more likely to discontinue basal insulin within 12 months of initiation (79.0% vs. 74.2%; P cause ($30,719 vs. $19,079; P < 0.001) healthcare costs. US patients with T2D who experienced hypoglycemia within 6 months of basal insulin initiation were more likely to discontinue treatment, accompanied by a greater healthcare burden. Sanofi US, Inc.

  3. Intimate partner violence reported by female and male users of healthcare units

    Science.gov (United States)

    Barros, Claudia Renata dos Santos; Schraiber, Lilia Blima

    2017-01-01

    ABSTRACT OBJECTIVE To analyze nonfatal violence suffered and committed by adult men and women, in an intimate relationship. METHODS The participants in the research were women aged between 15 and 49 years and men between 18 and 60 years, interviewed by face-to-face questionnaire application. The sample selection was of consecutive type, according to the order of arrival of the users. We conducted temporarily independent investigations and covered different health services to avoid couples and relationships in which the retaliation could be overvalued. To improve the comparison, we also examined reports of men and women from the same service, i.e., a service that was common to both investigations. We compared the situations suffered by women according to their reports and cross-linked the information to what men, according to their own reports, do against intimate partners or ex-partners. We also examined the cross-linked situation in reverse: the violence committed by women against their partners, according to their reports, in comparison with the violence suffered by men, also according to their reports, even if, in this case, the exam refers only to physical violence. The variables were described using mean, standard deviation, frequencies and proportions, and the hypothesis testing used was: Fisher’s exact and Pearson’s Chi-square tests, adopting a significance level of 5%. RESULTS Victimization was greater among women, regardless of the type of violence, when perpetrated by intimate partner. The perception of violence was low in both genders; however, women reported more episodes of multiple recurrences of any violence and sexual abuse suffered than men acknowledged to have perpetrated. CONCLUSIONS The study in its entirety shows significant gender differences, whether about the prevalence of violence, whether about the perception of these situations. PMID:28225908

  4. Intimate partner violence reported by female and male users of healthcare units

    Directory of Open Access Journals (Sweden)

    Claudia Renata dos Santos Barros

    Full Text Available ABSTRACT OBJECTIVE To analyze nonfatal violence suffered and committed by adult men and women, in an intimate relationship. METHODS The participants in the research were women aged between 15 and 49 years and men between 18 and 60 years, interviewed by face-to-face questionnaire application. The sample selection was of consecutive type, according to the order of arrival of the users. We conducted temporarily independent investigations and covered different health services to avoid couples and relationships in which the retaliation could be overvalued. To improve the comparison, we also examined reports of men and women from the same service, i.e., a service that was common to both investigations. We compared the situations suffered by women according to their reports and cross-linked the information to what men, according to their own reports, do against intimate partners or ex-partners. We also examined the cross-linked situation in reverse: the violence committed by women against their partners, according to their reports, in comparison with the violence suffered by men, also according to their reports, even if, in this case, the exam refers only to physical violence. The variables were described using mean, standard deviation, frequencies and proportions, and the hypothesis testing used was: Fisher’s exact and Pearson’s Chi-square tests, adopting a significance level of 5%. RESULTS Victimization was greater among women, regardless of the type of violence, when perpetrated by intimate partner. The perception of violence was low in both genders; however, women reported more episodes of multiple recurrences of any violence and sexual abuse suffered than men acknowledged to have perpetrated. CONCLUSIONS The study in its entirety shows significant gender differences, whether about the prevalence of violence, whether about the perception of these situations.

  5. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    Science.gov (United States)

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  6. Acute hepatitis B in a healthcare worker: A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, H.J.; Van Der Waaij, L.A.; Schirm, J.; Kallenberg, Cees; van Steenbergen, J.; Wolters, B.

    2009-01-01

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we

  7. Acute hepatitis B in a healthcare worker : A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, Hein J.; van der Waaij, Laurens A.; Schirm, Jurien; Kallenberg, Cees G. M.; van Steenbergen, Jim; Wolters, Bert

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we

  8. Acute hepatitis B in a healthcare worker : A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, Hein J.; van der Waaij, Laurens A.; Schirm, Jurien; Kallenberg, Cees G. M.; van Steenbergen, Jim; Wolters, Bert

    2009-01-01

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we desc

  9. Acute hepatitis B in a healthcare worker: A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, H.J.; Van Der Waaij, L.A.; Schirm, J.; Kallenberg, Cees; van Steenbergen, J.; Wolters, B.

    2009-01-01

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we desc

  10. Acute hepatitis B in a healthcare worker : A case report of genuine vaccination failure

    NARCIS (Netherlands)

    Boot, Hein J.; van der Waaij, Laurens A.; Schirm, Jurien; Kallenberg, Cees G. M.; van Steenbergen, Jim; Wolters, Bert

    2009-01-01

    Background: Individuals who reach the antibody threshold level of 10 IU/I against the surface protein of the hepatitis B virus (HBV) after completion of a series of hepatitis B vaccination are considered to be long-term protected against a clinically manifest HBV infection. Case report: Here we desc

  11. Useful Interplay Between Spontaneous ADR Reports and Electronic Healthcare Records in Signal Detection

    NARCIS (Netherlands)

    A.C. Pacurariu (Alexandra C.); S.M.J.M. Straus (Sabine); G. Trifirò (Gianluca); M.J. Schuemie (Martijn); R. Gini (Rosa); R.M.C. Herings (Ron); G. Mazzaglia (Giampiero); G. Picelli (Gino); L. Scotti (Lorenza); L. Pedersen (Lars); P. Arlett (Peter); J. van der Lei (Johan); M.C.J.M. Sturkenboom (Miriam); P.M. Coloma (Preciosa)

    2015-01-01

    textabstractBackground and Objective: Spontaneous reporting systems (SRSs) remain the cornerstone of post-marketing drug safety surveillance despite their well-known limitations. Judicious use of other available data sources is essential to enable better detection, strengthening and validation of si

  12. Health service utilization in IBD: comparison of self-report and administrative data

    Science.gov (United States)

    2011-01-01

    Background The reliability of self-report regarding health care utilization in inflammatory bowel disease (IBD) is unknown. If proven reliable, it could help justify self-report as a means of determining health care utilization and associated costs. Methods The Manitoba IBD Cohort Study is a population-based longitudinal study of participants diagnosed within 7 years of enrollment. Health care utilization was assessed through standardized interview. Participants (n = 352) reported the total number of nights hospitalized, frequency of physician contacts in the prior 12 months and whether the medical contacts were for IBD-related reasons or not. Reports of recent antibiotic use were also recorded. Actual utilization was drawn from the administrative database of Manitoba Health, the single comprehensive provincial health insurer. Results According to the administrative data, 15% of respondents had an overnight hospitalization, while 10% had an IBD-related hospitalization. Self-report concordance was highly sensitive (92%; 82%) and specific (96%; 97%, respectively). 97% of participants had contact with a physician in the previous year, and 69% had IBD-related visits. Physician visits were significantly under-reported and there was a trend to over-report the number of nights in hospital. Conclusions Self-report data can be helpful in evaluating health service utilization, provided that the researcher is aware of the systematic sources of bias. Outpatient visits are well identified by self-report. The discordance for the type of outpatient visit may be either a weakness of self-report or a flaw in diagnosis coding of the administrative data. If administrative data are not available, self-report information may be a cost-effective alternative, particularly for hospitalizations. PMID:21627808

  13. Health service utilization in IBD: comparison of self-report and administrative data

    Directory of Open Access Journals (Sweden)

    Walker John R

    2011-05-01

    Full Text Available Abstract Background The reliability of self-report regarding health care utilization in inflammatory bowel disease (IBD is unknown. If proven reliable, it could help justify self-report as a means of determining health care utilization and associated costs. Methods The Manitoba IBD Cohort Study is a population-based longitudinal study of participants diagnosed within 7 years of enrollment. Health care utilization was assessed through standardized interview. Participants (n = 352 reported the total number of nights hospitalized, frequency of physician contacts in the prior 12 months and whether the medical contacts were for IBD-related reasons or not. Reports of recent antibiotic use were also recorded. Actual utilization was drawn from the administrative database of Manitoba Health, the single comprehensive provincial health insurer. Results According to the administrative data, 15% of respondents had an overnight hospitalization, while 10% had an IBD-related hospitalization. Self-report concordance was highly sensitive (92%; 82% and specific (96%; 97%, respectively. 97% of participants had contact with a physician in the previous year, and 69% had IBD-related visits. Physician visits were significantly under-reported and there was a trend to over-report the number of nights in hospital. Conclusions Self-report data can be helpful in evaluating health service utilization, provided that the researcher is aware of the systematic sources of bias. Outpatient visits are well identified by self-report. The discordance for the type of outpatient visit may be either a weakness of self-report or a flaw in diagnosis coding of the administrative data. If administrative data are not available, self-report information may be a cost-effective alternative, particularly for hospitalizations.

  14. Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study

    Directory of Open Access Journals (Sweden)

    Fahey Tom

    2009-06-01

    Full Text Available Abstract Background Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD, depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. Methods Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60 and refugees (n = 28 from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36, presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. Results Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2–17.9 and depression/anxiety (OR 5.8, 95% CI: 2.2–15.4, while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3–12.7; OR 3.4, 95% CI: 1.2–10.1, high levels of pre migration stressors (OR 3.6, 95% CI: 1.1–11.9; OR 3.3, 95% CI: 1.0–10.4 or post migration stressors (OR 17.3, 95% CI: 4.9–60.8; OR 3.9, 95% CI: 1.2–12.3 were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (χ2 = 19.74, df = 1, P In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found

  15. Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study.

    LENUS (Irish Health Repository)

    Toar, Magzoub

    2009-01-01

    BACKGROUND: Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. METHODS: Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety\\/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. RESULTS: Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression\\/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression\\/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression\\/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P < 0.001).In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found between these groups

  16. Public Utility Regulatory Policies Act of 1978. Annual report to Congress

    Energy Technology Data Exchange (ETDEWEB)

    None,

    1980-05-01

    Titles I and III of the Public Utility Regulatory Policies Act of 1978 (PURPA) establish retail regulatory policies for electric and natural gas utilities, respectively, aimed at achieving three purposes: conservation of energy supplied by electric and gas utilities; efficiency in the use of facilities and resources by these utilities; equitable rates to electricity and natural gas consumers. PURPA also continues the pilot utility implementation program, authorized under Title II of the Energy Conservation and Production ACT (ECPA), to encourage adoption of cost-based rates and efficient energy-management practices. The purpose of this report is twofold: (1) to summarize and analyze the progress that state regulatory authorities and certain nonregulated utilities have made in their consideration of the PURPA standards; and (2) to summarize the Department of Energy (DOE) activities relating to PURPA and ECPA. The report provides a broad overview and assessment of the status of electric and gas regulation nationwide, and thus helps provide the basis for congressional and DOE actions targeted on the utility industry to address pressing national energy problems.

  17. Electric utilities in the 1970's: financial practices and performance. Analysis report

    Energy Technology Data Exchange (ETDEWEB)

    Connor, E.G.

    1980-12-01

    Characteristics of financial factors that are controlled by regulatory bodies and which have a significant impact upon the financial condition of investor-owned electric utilities are explained. Specifically, the report emphasizes matters affecting a utility's cost of service such as: the composition of operating costs; normalization versus flow-through accounting (particularly where depreciation and the investment tax credit are concerned); the rate base; and construction work in progress and the related allowance for funds used during construction. Also reviewed is aggregate investor-owned utility financial data for the 1970 to 1977 period. A selected bibliography of 22 items is appended. 3 tables.

  18. Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners

    DEFF Research Database (Denmark)

    Bjerre, Liv; Henningsen, Inge Biehl; Skovgaard, Lasse;

    2011-01-01

    Aim of the study: This study assesses the changes in self-reported quality of life (QoL) from hospitalisation to 18 months later among people with multiple sclerosis (MS) who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners......Lwas found within the areas of emotional well-being and thinking/fatigue. Conclusion: The results indicate that collaboration between healthcare providers andCAMpractitioners can improve treatment outcomes regarding some of the psychological aspects of QoL over a period of 18 months for people with MS....

  19. Demand for outpatient healthcare: empirical findings from rural India.

    Science.gov (United States)

    Sarma, Sisira

    2009-01-01

    Price, income and health status are likely to affect the demand for healthcare in developing countries, and their quantitative effects are unclear in the literature. Some studies report that prices are not important determinants, while others conclude that prices are important determinants of the demand for healthcare. Knowledge of the extent to which price, income and health status affect the demand for healthcare is crucial for the design of effective health policy in developing countries. To examine the role of monetary and non-monetary price, income, and a variety of individual- and household-specific characteristics on the demand for healthcare in rural India. Utilizing micro data from the 52nd round of India's National Sample Survey, a variable choice set based on geographical location, price, income and the severity of illness was constructed to reflect the underlying true choice-generating process in rural India. Nested multinomial logit models were estimated and simulations with respect to prices and income were conducted to estimate price and income elasticities. Contrary to many earlier studies on the demand for healthcare in developing countries, it was found that prices and income were statistically significant determinants of the choice of healthcare provider by individuals in rural India. Demand for healthcare was found to be price and income inelastic, corroborating the findings from other developing countries. Distance to formal healthcare facilities negatively affected the demand for outpatient healthcare, an effect that was mitigated as access to transportation improved. Age, sex, healthy days, educational status of the household members and the number of children and adults living in the household also affected the choice of healthcare provider in rural India. After controlling for a number of sociodemographic factors, it was found that prices, income and distance are statistically significant determinants of the provider chosen by individuals

  20. Self-reported diabetes self-management competence and support from healthcare providers in achieving autonomy are negatively associated with diabetes distress in adults with Type 1 diabetes

    DEFF Research Database (Denmark)

    Mohn, J; Graue, M; Assmus, J

    2015-01-01

    with greater perceived distress. CONCLUSIONS: There was an indirect (fully mediated) relationship between autonomy support and diabetes distress; autonomy support was associated with increased perceived competence, which, in turn, was associated with reduced distress. Healthcare providers' communication styles......AIM: To investigate the associations of self-perceived competence in diabetes management and autonomy support from healthcare providers with diabetes distress in adults with Type 1 diabetes mellitus that is not optimally controlled [HbA(1c) ≥ 64 mmol/mol (8.0%)]. METHODS: This cross-sectional study...... comprised blood sampling and three self-report questionnaires, the Problem Areas in Diabetes scale, the Perceived Competence in Diabetes Scale and a measure of autonomy support by healthcare providers, the Health Care Climate Questionnaire. We fitted blockwise linear regression models to assess...

  1. Self-reported hand hygiene practices, and feasibility and acceptability of alcohol-based hand rubs among village healthcare workers in Inner Mongolia, China.

    Science.gov (United States)

    Li, Y; Wang, Y; Yan, D; Rao, C Y

    2015-08-01

    Good hand hygiene is critical to reduce the risk of healthcare-associated infections. Limited data are available on hand hygiene practices from rural healthcare systems in China. To assess the feasibility and acceptability of sanitizing hands with alcohol-based hand rubs (ABHRs) among Chinese village healthcare workers, and to assess their hand hygiene practice. Five hundred bottles of ABHR were given to village healthcare workers in Inner Mongolia, China. Standardized questionnaires collected information on their work load, availability, and usage of hand hygiene facilities, and knowledge, attitudes, and practices of hand hygiene. In all, 369 (64.2%) participants completed the questionnaire. Although 84.5% of the ABHR recipients believed that receiving the ABHR improved their hand hygiene practice, 78.8% of recipients would pay no more than US$1.5 out of their own pocket (actual cost US$4). The majority (77.2%) who provided medical care at patients' homes never carried hand rubs with them outside their clinics. In general, self-reported hand hygiene compliance was suboptimal, and the lowest compliance was 'before touching a patient'. Reported top three complaints with using ABHR were skin irritation, splashing, and unpleasant residual. Village doctors with less experience practised less hand hygiene. The overall acceptance of ABHR among the village healthcare workers is high as long as it is provided to them for free/low cost, but their overall hand hygiene practice is suboptimal. Hand hygiene education and training is needed in settings outside of traditional healthcare facilities. Published by Elsevier Ltd.

  2. Geothermal direct-heat utilization assistance: Quarterly project progress report, January--March 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-05-01

    The report summarizes geothermal activities of the Geo-Heat Center at Oregon Institute of Technology for the second quarter of FY-95. It describes 92 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, resources and equipment. Research activities are summarized on geothermal energy cost evaluation, low temperature resource assessment and ground-source heat pump case studies and utility programs. Outreach activities include the publication of a geothermal direct heat Bulletin, dissemination of information, geothermal library, and progress monitor reports on geothermal resources and utilization.

  3. Geothermal direct-heat utilization assistance. Quarterly project progress report, January--March 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    This report summarizes geothermal technical assistance, R&D, and technology transfer activities of the Geo-Heat Center. It describes 95 contacts with parties during this period related to technical assistance with goethermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics, and resources. Research activities are summarized on geothermal district heating system cost evaluation and silica waste utilization project. Outreach activities include publication of a geothermal direct use Bulletin, dissemination of information, goethermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  4. Odor Control Test Report of the Urine Containment Bag (UCB) for Orion Utilization

    Science.gov (United States)

    Casper, Stephanie; Williams, Nichole M. M.

    2010-01-01

    The purpose of this report is to summarize the conclusions for the odor control test of the Urine Containment Bag (UCB), P/N SDD46107234-306 in an environment simulating a space craft capsule. JSC 65891, Odor Control Test Plan of the Urine Containment Bag (UCB) for Orion Utilization, documents the test plan. The details of the test set-up and data reduction are detailed in the WSTF test report for this test WSTF #10-44500, Odor Control Test Plan of the Urine Containment Bag (UCB) for Orion Utilization,. This document outlines the project conclusions and forward plans with regard to trash containment for Constellation.

  5. The Michigan regulatory incentives study for electric utilities. Phase 1, Final report

    Energy Technology Data Exchange (ETDEWEB)

    Reid, M.W.; Weaver, E.M. [Barakat and Chamberlin, Inc., Oakland, CA (United States)

    1991-06-17

    This is the final report of Phase I of the Michigan Regulatory Incentives Study for Electric Utilities, a three-phase review of Michigan`s regulatory system and its effects on resource selection by electric utilities. The goal of Phase I is to identify and analyze financial incentive mechanisms that encourage selection of resources in accord with the principles of integrated resource planning (IRP) or least-cost planning (LCP). Subsequent study phases will involve further analysis of options and possibly a collaborative formal effort to propose regulatory changes. The Phase I analysis proceeded in three steps: (1) identification and review of existing regulatory practices that affect utilities; selection of resources, particularly DSM; (2) preliminary analysis of ten financial mechanisms, and selection of three for further study; (3) detailed analysis of the three mechanisms, including consideration of how they could be implemented in Michigan and financial modeling of their likely impacts on utilities and ratepayers.

  6. Quality management tools: facilitating clinical research data integrity by utilizing specialized reports with electronic case report forms.

    Science.gov (United States)

    Trocky, N M; Fontinha, M

    2005-01-01

    Data collected throughout the course of a clinical research trial must be reviewed for accuracy and completeness continually. The Oracle Clinical (OC) data management application utilized to capture clinical data facilitates data integrity through pre-programmed validations, edit and range checks, and discrepancy management modules. These functions were not enough. Coupled with the use of specially created reports in Oracle Discoverer and Integrated Review, both ad-hoc query and reporting tools, research staff have enhanced their ability to clean, analyze and report more accurate data captured within and among Case Report Forms (eCRFs) by individual study or across multiple studies.

  7. Commercialization of PV-powered pumping systems for use in utility PV service programs. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-03-01

    The project described in this report was a commercialization effort focused on cost-effective remote water pumping systems for use in utility-based photovoltaic (PV) service programs. The project combined a commercialization strategy tailored specifically for electric utilities with the development of a PV-powered pumping system that operates conventional ac pumps rather than relying on the more expensive and less reliable PV pumps on the market. By combining these two attributes, a project goal was established of creating sustained utility purchases of 250 PV-powered water pumping systems per year. The results of each of these tasks are presented in two parts contained in this Final Summary Report. The first part summarizes the results of the Photovoltaic Services Network (PSN) as a new business venture, while the second part summarizes the results of the Golden Photon system installations. Specifically, results and photographs from each of the system installations are presented in this latter part.

  8. Queueing for healthcare.

    Science.gov (United States)

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  9. Screening Bilingual Preschoolers for Language Difficulties: Utility of Teacher and Parent Reports

    Science.gov (United States)

    Pua, Emmanuel Peng Kiat; Lee, Mary Lay Choo; Rickard Liow, Susan J.

    2017-01-01

    Purpose: The utility of parent and teacher reports for screening 3 types of bilingual preschoolers (English-first language [L1]/Mandarin-second language[L2], Mandarin-L1/English-L2, or Malay-L1/English-L2) for language difficulty was investigated in Singapore with reference to measures of reliability, validity, sensitivity, and specificity in an…

  10. Utility Assessment Report for SPIDERS Phase 2: Ft. Carson (Rev 1.0)

    Energy Technology Data Exchange (ETDEWEB)

    Barr, Jonathan L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Tuffner, Francis K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Hadley, Mark D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Schneider, Kevin P. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2014-01-01

    This document contains the Utility Assessment Report (UAR) for the Phase 2 operational Demonstration (OD) of the Smart Power Infrastructure Demonstration for Energy Reliability and Security (SPIDERS) Joint Capability Technology Demonstration (JCTD). The UAR for Phase 2 shows that the SPIDERS system was able to meet the requirements of the Implementation Directive at Ft. Carson.

  11. Coal and energy: a southern perspective. Regional characterization report for the National Coal Utilization Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Boercker, F. D.; Davis, R. M.; Goff, F. G.; Olson, J. S.; Parzyck, D. C.

    1977-08-01

    This publication is the first of several reports to be produced for the National Coal Utilization Assessment, a program sponsored by the Assistant Administrator for Environment and Safety through the Division of Technology Overview of ERDA. The purpose of the report is to present the state and regional perspective on energy-related issues, especially those concerning coal production and utilization for 12 southern states. This report compiles information on the present status of: (1) state government infrastructure that deals with energy problems; (2) the balance between energy consumption and energy production; (3) the distribution of proved reserves of various mineral energy resources; (4) the major characteristics of the population; (5) the important features of the environment; and (6) the major constraints to increased coal production and utilization as perceived by the states and regional agencies. Many energy-related characteristics described vary significantly from state to state within the region. Regional and national generalizations obscure these important local variations. The report provides the state and regional perspective on energy issues so that these issues may be considered objectively and incorporated into the National Coal Utilization Assessment. This Assessment is designed to provide useful outputs for national, regional, and local energy planners.

  12. ADVANCED UTILITY SIMULATION MODEL, REPORT OF SENSITIVITY TESTING, CALIBRATION, AND MODEL OUTPUT COMPARISONS (VERSION 3.0)

    Science.gov (United States)

    The report gives results of activities relating to the Advanced Utility Simulation Model (AUSM): sensitivity testing. comparison with a mature electric utility model, and calibration to historical emissions. The activities were aimed at demonstrating AUSM's validity over input va...

  13. Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria

    Directory of Open Access Journals (Sweden)

    Florence F Folami

    2017-01-01

    Full Text Available Background: The use of complementary and alternative medicine (CAM has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%. Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69% had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.

  14. Cost and quality of fuels for electric utility plants: Energy data report. 1980 annual

    Energy Technology Data Exchange (ETDEWEB)

    1981-06-25

    In 1980 US electric utilities reported purchasng 594 million tons of coal, 408.5 million barrels of oil and 3568.7 billion ft/sup 3/ of gas. As compared with 1979 purchases, coal rose 6.7%, oil decreased 20.9%, and gas increased for the fourth year in a row. This volume presents tabulated and graphic data on the cost and quality of fossil fuel receipts to US electric utilities plants with a combined capacity of 25 MW or greater. Information is included on fuel origin and destination, fuel types, and sulfur content, plant types, capacity, and flue gas desulfurization method used, and fuel costs. (LCL)

  15. 18 CFR 260.300 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

    Science.gov (United States)

    2010-04-01

    ..., Quarterly financial report of electric utilities, licensees, and natural gas companies. 260.300 Section 260... ENERGY APPROVED FORMS, NATURAL GAS ACT STATEMENTS AND REPORTS (SCHEDULES) § 260.300 FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas companies. (a)...

  16. Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada

    Directory of Open Access Journals (Sweden)

    Sherilee L. Harper

    2015-05-01

    Full Text Available Background: The incidence of self-reported acute gastrointestinal illness (AGI in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives: This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design: Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC medication utilization related to AGI symptoms. Results: In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4 and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1 were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills were significantly associated with increased odds of taking OTC medication. Conclusions: While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.

  17. Self-report measures of patient utility: should we trust them?

    Science.gov (United States)

    Hanita, M

    2000-05-01

    As self-reports, measures of patient utility are susceptible to the effects of cognitive biases in patients. This article presents often overlooked problems in these measures by outlining cognitive processes involved in patient self-report. It is argued that these measures: 1) require overly complex mental operations; 2) fail to elicit thoughtful response by default; 3) may be biased by patients' mood; 4) are affected by both researchers' choice of measurement instruments and patients' choice of judgment strategies; 5) tend to reflect the disproportionate influence of patients' values that happen to be recallable at the time of measurement; and 6) are affected by patients' fear of regret. It is suggested that solutions for these problems should involve: a) improving the methods of administration; b) developing measures that are less taxing to patients; and c) redefining the concept of patient utility as judged, as opposed to retrieved, evaluation. Published by 2000 Elsevier Science Inc.

  18. Detection of events of public health importance under the international health regulations: a toolkit to improve reporting of unusual events by frontline healthcare workers

    Directory of Open Access Journals (Sweden)

    Bitar Dounia

    2011-09-01

    Full Text Available Abstract Background The International Health Regulations (IHR (2005 require countries to notify WHO of any event which may constitute a public health emergency of international concern. This notification relies on reports of events occurring at the local level reaching the national public health authorities. By June 2012 WHO member states are expected to have implemented the capacity to "detect events involving disease or death above expected levels for the particular time and place" on the local level and report essential information to the appropriate level of public health authority. Our objective was to develop tools to assist European countries improve the reporting of unusual events of public health significance from frontline healthcare workers to public health authorities. Methods We investigated obstacles and incentives to event reporting through a systematic literature review and expert consultations with national public health officials from various European countries. Multi-day expert meetings and qualitative interviews were used to gather experiences and examples of public health event reporting. Feedback on specific components of the toolkit was collected from healthcare workers and public health officials throughout the design process. Results Evidence from 79 scientific publications, two multi-day expert meetings and seven qualitative interviews stressed the need to clarify concepts and expectations around event reporting in European countries between the frontline and public health authorities. An analytical framework based on three priority areas for improved event reporting (professional engagement, communication and infrastructure was developed and guided the development of the various tools. We developed a toolkit adaptable to country-specific needs that includes a guidance document for IHR National Focal Points and nine tool templates targeted at clinicians and laboratory staff: five awareness campaign tools, three

  19. 76 FR 78659 - Solicitation of Written Comments on the Draft Report and Draft Recommendations of the Healthcare...

    Science.gov (United States)

    2011-12-19

    ..._personnel_influenza_vacc_subgroup.html . In addition to general comments, NVPO is seeking input on... Healthcare Personnel Influenza Vaccination Subgroup for Consideration by the National Vaccine Advisory Committee on Achieving the Healthy People 2020 Annual Coverage Goals for Influenza Vaccination in...

  20. Reported Diabetes Mellitus Prevalence Rates in the Colombia Healthcare System from 2009 to 2012: Analysis by Regions Using Data of the Official Information Sources.

    Science.gov (United States)

    Barengo, Noël C; Tamayo, Diana Carolina

    2015-01-01

    The objective of this study was to describe the reported diabetes mellitus (DM) prevalence rates of the 20-79-year-old population in Colombia from 2009 to 2012 reported by the healthcare system. Information on number of patients treated for DM was obtained by the Integral Information System of Social Protection (SISPRO), the registry of the Ministry of Health and Social Protection, and the High Cost Account (CAC), an organization to trace high expenditure diseases. From both sources age-standardized reported DM prevalence rates per 100.000 inhabitants from 2009 to 2012 were calculated. Whereas the reported DM prevalence rates of SISPRO revealed an increase from 964/100.000 inhabitants (2009) to 1398/100.000 inhabitants in 2012 (mean annual increase 141/100.000; p value: 0.001), the respective rates in the CAC register were 1082/100.000 (2009) and 1593/100.000 in 2012 (mean annual increase 165/100.000; p value: 0.026). The number of provinces reporting not less than 19% of the highest national reported DM prevalence rates (1593/100.000) increased from two in 2009 to ten in 2012. Apparently, the registries and the information retrieving system have been improved during 2009 and 2012, resulting in a greater capacity to identify and report DM cases by the healthcare system.

  1. Reported Diabetes Mellitus Prevalence Rates in the Colombia Healthcare System from 2009 to 2012: Analysis by Regions Using Data of the Official Information Sources

    Science.gov (United States)

    Barengo, Noël C.; Tamayo, Diana Carolina

    2015-01-01

    The objective of this study was to describe the reported diabetes mellitus (DM) prevalence rates of the 20–79-year-old population in Colombia from 2009 to 2012 reported by the healthcare system. Information on number of patients treated for DM was obtained by the Integral Information System of Social Protection (SISPRO), the registry of the Ministry of Health and Social Protection, and the High Cost Account (CAC), an organization to trace high expenditure diseases. From both sources age-standardized reported DM prevalence rates per 100.000 inhabitants from 2009 to 2012 were calculated. Whereas the reported DM prevalence rates of SISPRO revealed an increase from 964/100.000 inhabitants (2009) to 1398/100.000 inhabitants in 2012 (mean annual increase 141/100.000; p value: 0.001), the respective rates in the CAC register were 1082/100.000 (2009) and 1593/100.000 in 2012 (mean annual increase 165/100.000; p value: 0.026). The number of provinces reporting not less than 19% of the highest national reported DM prevalence rates (1593/100.000) increased from two in 2009 to ten in 2012. Apparently, the registries and the information retrieving system have been improved during 2009 and 2012, resulting in a greater capacity to identify and report DM cases by the healthcare system. PMID:26494999

  2. [Improving healthcare and its manageability].

    Science.gov (United States)

    Eddes, Eric Hans

    2013-01-01

    Healthcare in the Netherlands is facing serious challenges. With an ageing population, the consumption of healthcare is on the rise. Quality needs to go up while costs have to go down. The Netherlands Institute for Social Research estimates that healthcare costs, as a percentage of the Gross Domestic Product, will rise from 13% in 2011 (90 billion euros) up to 31% in 2040. Clear choices need to be made in the near future; otherwise, the cost of healthcare will become prohibitive. This commentary explains why volume-directed healthcare alone is not the magic answer. Besides criteria related to process and structure, we are also in need of robust and valid data. Clinical auditing combined with patient-reported outcome measures (PROMs) and financial data will give the additional tools needed to improve and manage healthcare.

  3. Strategies to Improve Healthcare Websites

    OpenAIRE

    Johnson, Constance; Peterson, Susan K; Turley, James P.; Ensor, Joe; Amos, Christopher; Spitz, Margaret; Levin, Bernard; Berry, Donald

    2006-01-01

    Healthcare websites that are influential in healthcare decision-making must be evaluated for accuracy, readability and understandability by the average population. Most existing frameworks for designing and evaluating interactive websites focus on the utility and usability of the site. Although these are significant to the design of the basic site, they are not sufficient. We have developed an iterative framework that considers additional attributes.

  4. Strategies to Improve Healthcare Websites

    Science.gov (United States)

    Johnson, Constance; Peterson, Susan K.; Turley, James P.; Ensor, Joe; Amos, Christopher; Spitz, Margaret; Levin, Bernard; Berry, Donald

    2006-01-01

    Healthcare websites that are influential in healthcare decision-making must be evaluated for accuracy, readability and understandability by the average population. Most existing frameworks for designing and evaluating interactive websites focus on the utility and usability of the site. Although these are significant to the design of the basic site, they are not sufficient. We have developed an iterative framework that considers additional attributes. PMID:17238588

  5. Geothermal direct-heat utilization assistance. Quarterly report, October--December 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-12-31

    This report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-97. It describes 174 contracts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics and resources. Research activities are summarized on greenhouse peaking. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  6. Geothermal direct-heat utilization assistance. Quarterly project progress report, July 1995--September 1995

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.

    1995-12-01

    The report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the fourth quarter of FY-95. It describes 80 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment and resources. Research activities are summarized on low-temperature resource assessment, geothermal energy cost evaluation and marketing strategy for geothermal district heating. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  7. Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis.

    Directory of Open Access Journals (Sweden)

    Baltica Cabieses

    Full Text Available Chile, a South American country recently defined as a high-income nation, carried out a major healthcare system reform from 2005 onwards that aimed at reducing socioeconomic inequality in health. This study aimed to estimate income-related inequality in self-reported health status (SRHS in 2000 and 2013, before and after the reform, for the entire adult Chilean population.Using data on equivalized household income and adult SRHS from the 2000 and 2013 CASEN surveys (independent samples of 101 046 and 172 330 adult participants, respectively we estimated Erreygers concentration indices (CIs for above average SRHS for both years. We also decomposed the contribution of both "legitimate" standardizing variables (age and sex and "illegitimate" variables (income, education, occupation, ethnicity, urban/rural, marital status, number of people living in the household, and healthcare entitlement.There was a significant concentration of above average SRHS favoring richer people in Chile in both years, which was less pronounced in 2013 than 2000 (Erreygers corrected CI 0.165 [Standard Error, SE 0.007] in 2000 and 0.047 [SE 0.008] in 2013. To help interpret the magnitude of this decline, adults in the richest fifth of households were 33% more likely than those in the poorest fifth to report above-average health in 2000, falling to 11% in 2013. In 2013, the contribution of illegitimate factors to income-related inequality in SRHS remained higher than the contribution of legitimate factors.Income-related inequality in SRHS in Chile has fallen after the equity-based healthcare reform. Further research is needed to ascertain how far this fall in health inequality can be attributed to the 2005 healthcare reform as opposed to economic growth and other determinants of health that changed during the period.

  8. Management support services to the Office of Utility Technologies. Final technical report

    Energy Technology Data Exchange (ETDEWEB)

    1993-12-16

    The Office of Utility Technologies works cooperatively with industry and the utility sector to realize the market potential for energy efficiency and renewable energy technologies. Under this contract, BNF has provided management support services for OUT R&D activities for the following Program offices: (1) Office of Energy Management; (2) Office of Solar Energy Conversion; (3) Office of Renewable Energy Conversion; and (4) Deputy Assistant Secretary. During the period between 4/17/91 and 9/17/93, BNF furnished the necessary personnel, equipment, materials, facilities and travel required to provide management support services for each of the above Program Offices. From 9/18/93 to 12/17/93, BNF has been involved in closeout activities, including final product deliverables. Research efforts that have been supported in these Program Offices are: (1) for Energy Management -- Advanced Utility Concepts Division; Utility Systems Division; Integrated Planning; (2) for Solar Energy Conversion -- Photovoltaics Division; Solar Thermal and Biomass Power Division; (3) for Renewable Energy Conversion -- Geothermal Division; Wind, Hydroelectric and Ocean Systems Division; (4) for the Deputy Assistant Secretary -- support as required by the Supporting Staff. This final report contains summaries of the work accomplished for each of the Program Offices listed above.

  9. Systematic review of model-based analyses reporting the cost-effectiveness and cost-utility of cardiovascular disease management programs.

    Science.gov (United States)

    Maru, Shoko; Byrnes, Joshua; Whitty, Jennifer A; Carrington, Melinda J; Stewart, Simon; Scuffham, Paul A

    2015-02-01

    The reported cost effectiveness of cardiovascular disease management programs (CVD-MPs) is highly variable, potentially leading to different funding decisions. This systematic review evaluates published modeled analyses to compare study methods and quality. Articles were included if an incremental cost-effectiveness ratio (ICER) or cost-utility ratio (ICUR) was reported, it is a multi-component intervention designed to manage or prevent a cardiovascular disease condition, and it addressed all domains specified in the American Heart Association Taxonomy for Disease Management. Nine articles (reporting 10 clinical outcomes) were included. Eight cost-utility and two cost-effectiveness analyses targeted hypertension (n=4), coronary heart disease (n=2), coronary heart disease plus stoke (n=1), heart failure (n=2) and hyperlipidemia (n=1). Study perspectives included the healthcare system (n=5), societal and fund holders (n=1), a third party payer (n=3), or was not explicitly stated (n=1). All analyses were modeled based on interventions of one to two years' duration. Time horizon ranged from two years (n=1), 10 years (n=1) and lifetime (n=8). Model structures included Markov model (n=8), 'decision analytic models' (n=1), or was not explicitly stated (n=1). Considerable variation was observed in clinical and economic assumptions and reporting practices. Of all ICERs/ICURs reported, including those of subgroups (n=16), four were above a US$50,000 acceptability threshold, six were below and six were dominant. The majority of CVD-MPs was reported to have favorable economic outcomes, but 25% were at unacceptably high cost for the outcomes. Use of standardized reporting tools should increase transparency and inform what drives the cost-effectiveness of CVD-MPs. © The European Society of Cardiology 2014.

  10. 18 CFR 141.400 - FERC Form No. 3-Q, Quarterly financial report of electric utilities, licensees, and natural gas...

    Science.gov (United States)

    2010-04-01

    ..., Quarterly financial report of electric utilities, licensees, and natural gas companies. 141.400 Section 141..., licensees, and natural gas companies. (a) Prescription. The quarterly report of electric utilities, licensees, and natural gas companies, designated as FERC Form No. 3-Q, is prescribed for the...

  11. Workplace interpersonal conflicts among the healthcare workers: Retrospective exploration from the institutional incident reporting system of a university-affiliated medical center

    Science.gov (United States)

    Huang, Szu-Fen; Liang, Huey-Wen; Chen, Li-Chin; Lin, Chia-Kuei; Huang, Hsiao-Fang; Hsieh, Ming-Yuan; Sun, Jui-Sheng

    2017-01-01

    Objective There have been concerns about the workplace interpersonal conflict (WIC) among healthcare workers. As healthcare organizations have applied the incident reporting system (IRS) widely for safety-related incidents, we proposed that this system might provide a channel to explore the WICs. Methods We retrospectively reviewed the reports to the IRS from July 2010 to June 2013 in a medical center. We identified the WICs and typed these conflicts according to the two foci (task content/process and interpersonal relationship) and the three properties (disagreement, interference, and negative emotion), and analyzed relevant data. Results Of the 147 incidents with WIC, the most common related processes were patient transfer (20%), laboratory tests (17%), surgery (16%) and medical imaging (16%). All of the 147 incidents with WIC focused on task content or task process, but 41 (27.9%) also focused on the interpersonal relationship. We found disagreement, interference, and negative emotion in 91.2%, 88.4%, and 55.8% of the cases, respectively. Nurses (57%) were most often the reporting workers, while the most common encounter was the nurse-doctor interaction (33%), and the majority (67%) of the conflicts were experienced concurrently with the incidents. There was a significant difference in the distribution of worker job types between cases focused on the interpersonal relationship and those without (p = 0.0064). The doctors were more frequently as the reporter when the conflicts focused on the interpersonal relationship (34.1%) than not on it (17.0%). The distributions of worker job types were similar between those with and without negative emotion (p = 0.125). Conclusions The institutional IRS is a useful place to report the workplace interpersonal conflicts actively. The healthcare systems need to improve the channels to communicate, manage and resolve these conflicts. PMID:28166260

  12. [Privatization in healthcare management: an adverse effect of the economic crisis and a symptom of bad governance. SESPAS report 2014].

    Science.gov (United States)

    Sánchez-Martínez, Fernando I; Abellán-Perpiñán, José María; Oliva-Moreno, Juan

    2014-06-01

    It is often asserted that public management of healthcare facilities is inefficient. On the basis of that unproven claim, it is argued that privatization schemes are needed. In this article we review the available evidence, in Spain and other countries, on the application of private management mechanisms to publicly funded systems similar to the Spanish national health system. The evidence suggests that private management of healthcare services is not necessarily better than public management, nor vice versa. Ownership-whether public or private-of health care centers does not determine their performance which, on the contrary, depends on other factors, such as the workplace culture or the practice of suitable monitoring by the public payer. Promoting competition among centers (irrespective of the specific legal form of the management arrangements), however, could indeed lead to improvements under some circumstances. Therefore, it is advisable to cease the narrow-minded debate on the superiority of one or other model in order to focus on improving healthcare services management per se. Understanding that good governance affects health policies, the management of health care organizations, and clinical practice is, undoubtedly, an essential requirement but may not necessarily lead to policies that stimulate the solvency of the system. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  13. The Hazards of Data Mining in Healthcare.

    Science.gov (United States)

    Househ, Mowafa; Aldosari, Bakheet

    2017-01-01

    From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

  14. A meta-analysis of health status, health behaviors, and healthcare utilization outcomes of the Chronic Disease Self-Management Program.

    Science.gov (United States)

    Brady, Teresa J; Murphy, Louise; O'Colmain, Benita J; Beauchesne, Danielle; Daniels, Brandy; Greenberg, Michael; House, Marnie; Chervin, Doryn

    2013-01-01

    The Chronic Disease Self-Management Program (CDSMP) is a community-based self-management education program designed to help participants gain confidence (self-efficacy) and skills to better manage their chronic conditions; it has been implemented worldwide. The objective of this meta-analysis was to quantitatively synthesize the results of CDSMP studies conducted in English-speaking countries to determine the program's effects on health behaviors, physical and psychological health status, and health care utilization at 4 to 6 months and 9 to 12 months after baseline. We searched 8 electronic databases to identify CDSMP-relevant literature published from January 1, 1999, through September 30, 2009; experts identified additional unpublished studies. We combined the results of all eligible studies to calculate pooled effect sizes. We included 23 studies. Eighteen studies presented data on small English-speaking groups; we conducted 1 meta-analysis on these studies and a separate analysis on results by other delivery modes. Among health behaviors for small English-speaking groups, aerobic exercise, cognitive symptom management, and communication with physician improved significantly at 4- to 6-month follow-up; aerobic exercise and cognitive symptom management remained significantly improved at 9 to 12 months. Stretching/strengthening exercise improved significantly at 9 to 12 months. All measures of psychological health improved significantly at 4 to 6 months and 9 to 12 months. Energy, fatigue, and self-rated health showed small but significant improvements at 4 to 6 months but not at 9 to 12 months. The only significant change in health care utilization was a small improvement in the number of hospitalization days or nights at 4 to 6 months Small to moderate improvements in psychological health and selected health behaviors that remain after 12 months suggest that CDSMP delivered in small English-speaking groups produces health benefits for participants and would be

  15. Trichomonads in pleural effusion: case report, literature review and utility of PCR for species identification.

    Science.gov (United States)

    Leterrier, Marion; Morio, Florent; Renard, Beno T; Poirier, Anne-Sophie; Miegeville, Michel; Chambreuil, Guy

    2012-01-01

    Trichomonas tenax is a flagellated protozoan commonly found in the human oral cavity but of unusual occurrence in pulmonary infections. We describe a case of a 67-year-old patient with glioblastoma who presented with severe pleurisy in the post-operative period while she was receiving high-dose corticotherapy. Several motile flagellated protozoa were identified in the pleural fluid. Trichomonas tenax was identified by molecular methods. Pulmonary infections with Trichomonads might be underestimated because of diagnostic difficulties. The utility of molecular biology for species identification is underlined and the pathogenicity of Trichomonad parasites in human lungs is discussed in light of previously reported cases.

  16. Final Technical Report Laramie County Community College: Utility-Scale Wind Energy Technology

    Energy Technology Data Exchange (ETDEWEB)

    Douglas P. Cook

    2012-05-22

    The Utility-Scale Wind Energy Technology U.S. Department of Energy (DOE) grant EE0000538, provided a way ahead for Laramie County Community College (LCCC) to increase educational and training opportunities for students seeking an Associate of Applied Science (AAS) or Associate of Science (AS) degree in Wind Energy Technology. The DOE grant enabled LCCC to program, schedule, and successfully operate multiple wind energy technology cohorts of up to 20-14 students per cohort simultaneously. As of this report, LCCC currently runs four cohorts. In addition, the DOE grant allowed LCCC to procure specialized LABVOLT electronic equipment that directly supports is wind energy technology curriculum.

  17. Summary report of working group I CO{sub 2} capture, fixation/utilization, and disposal

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    The topics of our working group were divided into four key areas: CO{sub 2} Capture, Utilization/Fixation, Ocean Disposal, and Land Disposal. Fourteen presentations were made as follows: CO{sub 2} Capture: Toshikatsu Hakuta (Japan) and Rod Judkins, Bruce St. John, and Alan Wolsky (US). Utilization/Fixation: Hironori Arakawa, Yasuo Asada, and Takashi lbusuki (Japan) and Ed Lipinsky (US). Ocean Disposal: Yuji Shindo (Japan) and Eric Adams, Gerard Nihous, and Wheeler North (US). Land Disposal: Shoichi Tanaka (Japan) and Roger Bailey (US/Canada). Co-chairs for this working group were Toshikatsu Hakuta (Japan) and Howard Herzog (US). This document contains only a summary outline of research needs in the area of CO{sub 2} capture and sequestration. It should be used in conjunction with other assessments made in this area. For the U.S., a DOE report entitled A Research Needs Assessment for the Capture, Utilization and Disposal of Carbon Dioxide from Fossil Fuel-Fired Power Plants will be forthcoming in 1993.

  18. Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature.

    Science.gov (United States)

    Goodman, Daisy; Ogrinc, Greg; Davies, Louise; Baker, G Ross; Barnsteiner, Jane; Foster, Tina C; Gali, Kari; Hilden, Joanne; Horwitz, Leora; Kaplan, Heather C; Leis, Jerome; Matulis, John C; Michie, Susan; Miltner, Rebecca; Neily, Julia; Nelson, William A; Niedner, Matthew; Oliver, Brant; Rutman, Lori; Thomson, Richard; Thor, Johan

    2016-12-01

    Since its publication in 2008, SQUIRE (Standards for Quality Improvement Reporting Excellence) has contributed to the completeness and transparency of reporting of quality improvement work, providing guidance to authors and reviewers of reports on healthcare improvement work. In the interim, enormous growth has occurred in understanding factors that influence the success, and failure, of healthcare improvement efforts. Progress has been particularly strong in three areas: the understanding of the theoretical basis for improvement work; the impact of contextual factors on outcomes; and the development of methodologies for studying improvement work. Consequently, there is now a need to revise the original publication guidelines. To reflect the breadth of knowledge and experience in the field, we solicited input from a wide variety of authors, editors and improvement professionals during the guideline revision process. This Explanation and Elaboration document (E&E) is a companion to the revised SQUIRE guidelines, SQUIRE 2.0. The product of collaboration by an international and interprofessional group of authors, this document provides examples from the published literature, and an explanation of how each reflects the intent of a specific item in SQUIRE. The purpose of the guidelines is to assist authors in writing clearly, precisely and completely about systematic efforts to improve the quality, safety and value of healthcare services. Authors can explore the SQUIRE statement, this E&E and related documents in detail at http://www.squire-statement.org. 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/.

  19. Transparent and accurate reporting increases reliability, utility, and impact of your research: reporting guidelines and the EQUATOR Network

    Directory of Open Access Journals (Sweden)

    Schulz Kenneth F

    2010-04-01

    Full Text Available Abstract Although current electronic methods of scientific publishing offer increased opportunities for publishing all research studies and describing them in sufficient detail, health research literature still suffers from many shortcomings. These shortcomings seriously undermine the value and utility of the literature and waste scarce resources invested in the research. In recent years there have been several positive steps aimed at improving this situation, such as a strengthening of journals' policies on research publication and the wide requirement to register clinical trials. The EQUATOR (Enhancing the QUAlity and Transparency Of health Research Network is an international initiative set up to advance high quality reporting of health research studies; it promotes good reporting practices including the wider implementation of reporting guidelines. EQUATOR provides free online resources http://www.equator-network.org supported by education and training activities and assists in the development of robust reporting guidelines. This paper outlines EQUATOR's goals and activities and offers suggestions for organizations and individuals involved in health research on how to strengthen research reporting.

  20. Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir® HFA with and without integrated dose counters

    Directory of Open Access Journals (Sweden)

    Kerwin EM

    2017-05-01

    Full Text Available Edward M Kerwin,1 Thomas J Ferro,2 Rinat Ariely,3 Debra E Irwin,4 Ruchir Parikh3 1Clinical Trials Division, Clinical Research Institute of Southern Oregon, PC, Medford, OR, 2Global Medical Affairs, 3Global Health Economics and Outcome Research, Teva Pharmaceuticals, Frazer, PA, 4Outcomes Research, Truven Health Analytics, Durham, NC, USA Background: Accurate tracking of the administered dose of asthma rescue inhalers is critical for optimal disease management and is related to reductions in rates of unscheduled health care utilization in asthma patients. There are few published data on the real-world impact of rescue inhalers with integrated dose counters (IDCs on health care resource utilization (HRU for asthma patients. This study evaluates HRU among users of ProAir® hydrofluoroalkane (HFA (albuterol sulfate inhalation aerosol, with IDC versus without IDC, in asthma patients.Methods: This was a retrospective administrative claims study of asthma patients receiving a new prescription for albuterol inhalation aerosol without IDC during 2 years (January 2011–December 2012 or with IDC during the first full year after IDC implementation in the USA (July 2013–July 2014. Six months of continuous enrollment with medical and prescription drug benefits were required before and after the first prescription during the study period. Data on respiratory-related hospitalizations and emergency department (ED visits were collected during the follow-up period.Results: A total of 135,305 (32% patients used albuterol inhalation aerosol with IDC, and 287,243 (68% patients received albuterol inhalation aerosol without IDC. After adjusting for baseline confounding factors, the odds ratio (OR for experiencing a respiratory-related hospitalization (OR=0.92; 95% confidence interval [CI] 0.88–0.96 or ED visit (OR=0.92; 95% CI 0.90–0.94 was significantly lower among patients using albuterol inhalation aerosol with IDC versus without IDC.Conclusion: In a real

  1. Region-specific study of the electric utility industry. Phase I, final report

    Energy Technology Data Exchange (ETDEWEB)

    Wacaster, A.J. (ed.)

    1985-07-01

    This report describes the financial background of the electric utility industry in VACAR, reports on the present condition of the industry and then assesses the future of this industry. The Virginia-Carolinas subregion (VACAR) of the Southeastern Electric Reliability Council (SERC) was selected for this regional study because of its cooperativeness and its representative mix of powerplants, for example coal, hydro, nuclear, oil. It was found that the supply of future economic electricity is in jeopardy because of the regulatory process, the increasing risk associated with large scale generating stations and the weakening of the nuclear option. A number of options for the future were considered, including deregulation, government ownership and retaining the present system with modifications. The option selected to improve the present condition of the electricity industry was to make the present system work. The present system is sound, and with modifications, problems could be solved within the existing framework. 8 figs., 4 tabs.

  2. Utility of Double Filtration Plasmapheresis in Acute Antibody Mediated Renal Allograft Rejection: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Yalçın SOLAK

    2011-09-01

    Full Text Available Plasmapheresis is an extracorporeal procedure, which is often employed to rapidly lower circulating titers of autoantibodies, immune complexes or toxins. There are two types of plasmapheresis namely, regular plasmapheresis (RPP by centrifugation and membrane filtration, and double filtration plasmapheresis (DFPP which is a special form of membrane filtration in which two membranes called as plasma separator and plasma fractionator are employed to filter macromolecules more selectively. DFPP have several advantages over RP. Despite widespread utilization of DFPP in the setting of ABO blood group incompatible kidney transplantation, there is no report regarding DFPP in patients with antibody mediated acute renal allograft rejection who are good candidates for beneficial effects of DFPP. Here we report three renal transplant recipients in whom DFPP was applied as a component of anti-rejection treatment regimen.

  3. Geothermal direct-heat utilization assistance. Quarterly report, January - March 1997

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.

    1997-04-01

    This report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the second quarter of FY-97. It describes 176 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics and resources. Research activities are summarized on well pumping in commercial groundwater heat pump systems. A memorandum of understanding between the GHC and EIA is described. Work accomplishments on the Guidebook are discussed. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  4. Systems analysis research for energy conversion and utilization technologies (ECUT). FY 1985 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Eberhardt, J.J.; Gunn, M.E.; Levinson, T.M.

    1985-11-01

    This Annual Report highlights ECUT accomplishments in the Systems Analysis Project for FY 1985. The Systems Analysis Project was established in 1980 along with the ECUT Division. The Systems Analysis mission is to identify, analyze, and assess R and D needs and research program strategies for advanced conservation technologies. The PNL Systems Analysis staff conducts topical research, provides technical studies, and plans program activities in three areas related to energy conversion and utilization technologies: (1) technology assessment, (2) engineering analysis, and (3) project evaluation and review. This report summarizes the technical results and accomplishments of the FY 1985 projects. They relate mostly to tribology, improved ctalysts, regenerative heat exchangers, robotics and electronics industries, and bioprocessing.

  5. Screening Bilingual Preschoolers for Language Difficulties: Utility of Teacher and Parent Reports.

    Science.gov (United States)

    Pua, Emmanuel Peng Kiat; Lee, Mary Lay Choo; Rickard Liow, Susan J

    2017-04-14

    The utility of parent and teacher reports for screening 3 types of bilingual preschoolers (English-first language [L1]/Mandarin-second language[L2], Mandarin-L1/English-L2, or Malay-L1/English-L2) for language difficulty was investigated in Singapore with reference to measures of reliability, validity, sensitivity, and specificity in an English-medium kindergarten setting. The index tests were teachers' ratings of the English language ability of 5-year-olds (N = 85) on the Bilingual Language Assessment Battery (BLAB): Preschool Teacher Report (Pua, Lee, & Rickard Liow, 2013) and parents' ratings of their child's home language ability (N = 78 English-L1, Mandarin-L1, or Malay-L1) on the BLAB: Preschool Parent Report (Pua, Lee, & Rickard Liow, 2013). The reference standards were objective measures of single-word receptive vocabulary (80 items) and expressive vocabulary (140 items) in the child's L1 and L2, as proxies for language ability. BLAB Teacher Reports for the English receptive and expressive subscales showed concurrent validity for all 3 bilingual groups, as well as generally high sensitivity and specificity. In contrast, BLAB Parent Reports for L1 receptive ability failed to show significant correlations with the objective measures of receptive vocabulary. Subjective teacher ratings may be an effective method of screening bilingual preschoolers for language difficulty, thereby prompting referral to clinicians.

  6. Review of Prior Commercial Building Energy Efficiency Retrofit Evaluation: A Report to Snohomish Public Utilities District

    Energy Technology Data Exchange (ETDEWEB)

    Price, Phillip N. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division

    2014-11-01

    Snohomish County Public Utilities District (the District or Snohomish PUD) provides electricity to about 325,000 customers in Snohomish County, Washington. The District has an incentive programs to encourage commercial customers to improve energy efficiency: the District partially reimburses the cost of approved retrofits if they provide a level of energy performance improvement that is specified by contract. In 2013 the District contracted with Lawrence Berkeley National Laboratory to provide a third-party review of the Monitoring and Verification (M&V) practices the District uses to evaluate whether companies are meeting their contractual obligations. This work helps LBNL understand the challenges faced by real-world practitioners of M&V of energy savings, and builds on a body of related work such as Price et al. (2013). The District selected a typical project for which they had already performed an evaluation. The present report includes the District's original evaluation as well as LBNL's review of their approach. The review is based on the document itself; on investigation of the load data and outdoor air temperature data from the building evaluated in the document; and on phone discussions with Bill Harris of the Snohomish County Public Utilities District. We will call the building studied in the document the subject building, the original Snohomish PUD report will be referred to as the Evaluation, and this discussion by LBNL is called the Review.

  7. Analysis of fluorescent reporters indicates heterogeneity in glucose uptake and utilization in clonal bacterial populations.

    Science.gov (United States)

    Nikolic, Nela; Barner, Thomas; Ackermann, Martin

    2013-11-15

    In this study, we aimed at investigating heterogeneity in the expression of metabolic genes in clonal populations of Escherichia coli growing on glucose as the sole carbon source. Different metabolic phenotypes can arise in these clonal populations through variation in the expression of glucose transporters and metabolic enzymes. First, we focused on the glucose transporters PtsG and MglBAC to analyze the diversity of glucose uptake strategies. Second, we analyzed phenotypic variation in the expression of genes involved in gluconeogenesis and acetate scavenging (as acetate is formed and excreted during bacterial growth on glucose), which can reveal, for instance, phenotypic subpopulations that cross-feed through the exchange of acetate. In these experiments, E. coli MG1655 strains containing different transcriptional GFP reporters were grown in chemostats and reporter expression was measured with flow cytometry. Our results suggest heterogeneous expression of metabolic genes in bacterial clonal populations grown in glucose environments. The two glucose transport systems exhibited different level of heterogeneity. The majority of the bacterial cells expressed the reporters for both glucose transporters MglBAC and PtsG and a small fraction of cells only expressed the reporter for Mgl. At a low dilution rate, signals from transcriptional reporters for acetyl-CoA synthetase Acs and phosphoenolpyruvate carboxykinase Pck indicated that almost all cells expressed the genes that are part of acetate utilization and the gluconeogenesis pathway, respectively. Possible co-existence of two phenotypic subpopulations differing in acs expression occurred at the threshold of the switch to overflow metabolism. The overflow metabolism results in the production of acetate and has been previously reported to occur at intermediate dilution rates in chemostats with high concentration of glucose in the feed. Analysis of the heterogeneous expression of reporters for genes involved in

  8. Variable compensation in Primary Healthcare: a report on the experience in Curitiba, Rio de Janeiro, Brazil, and Lisbon, Portugal.

    Science.gov (United States)

    Poli Neto, Paulo; Faoro, Nilza Teresinha; Prado Júnior, José Carlos do; Pisco, Luís Augusto Coelho

    2016-05-01

    How professionals are compensated may affect how they perform their tasks. Fixed compensation may take the form of wages, payment for productivity or capitation. In addition to fixed compensation, there are numerous mechanisms for variable compensation. This article describes the experience of Curitiba and Rio de Janeiro in Brazil, and Lisbon in Portugal, using different models of performance-based compensation. In all three of these examples, management felt the need to offer monetary reward to achieve certain goals. The indicators analyzed the structure, processes and outcomes, and assessed professionals individual and as part of healthcare teams. In Lisbon, variable compensation can be as high as 40% of the base wage, while in Curitiba and Rio de Janeiro it is limited to 10%. Despite the growing use of this management tool in Brazil and the world, further studies are required to analyze the effectiveness of variable compensation.

  9. Occupational exposure of healthcare and research staff to static magnetic stray fields from 1.5–7 Tesla MRI scanners is associated with reporting of transient symptoms

    Science.gov (United States)

    Schaap, Kristel; Christopher-de Vries, Yvette; Mason, Catherine K; de Vocht, Frank; Portengen, Lützen; Kromhout, Hans

    2014-01-01

    Objectives Limited data is available about incidence of acute transient symptoms associated with occupational exposure to static magnetic stray fields from MRI scanners. We aimed to assess the incidence of these symptoms among healthcare and research staff working with MRI scanners, and their association with static magnetic field exposure. Methods We performed an observational study among 361 employees of 14 clinical and research MRI facilities in The Netherlands. Each participant completed a diary during one or more work shifts inside and/or outside the MRI facility, reporting work activities and symptoms (from a list of potentially MRI-related symptoms, complemented with unrelated symptoms) experienced during a working day. We analysed 633 diaries. Exposure categories were defined by strength and type of MRI scanner, using non-MRI shifts as the reference category for statistical analysis. Non-MRI shifts originated from MRI staff who also participated on MRI days, as well as CT radiographers who never worked with MRI. Results Varying per exposure category, symptoms were reported during 16–39% of the MRI work shifts. We observed a positive association between scanner strength and reported symptoms among healthcare and research staff working with closed-bore MRI scanners of 1.5 Tesla (T) and higher (1.5 T OR=1.88; 3.0 T OR=2.14; 7.0 T OR=4.17). This finding was mainly driven by reporting of vertigo and metallic taste. Conclusions The results suggest an exposure-response association between exposure to strong static magnetic fields (and associated motion-induced time-varying magnetic fields) and reporting of transient symptoms on the same day of exposure. Trial registration number 11-032/C PMID:24714654

  10. Building healthcare workers' confidence to work with same-sex parented families.

    Science.gov (United States)

    von Doussa, Henry; Power, Jennifer; McNair, Ruth; Brown, Rhonda; Schofield, Margot; Perlesz, Amaryll; Pitts, Marian; Bickerdike, Andrew

    2016-06-01

    This article reports on a qualitative study of barriers and access to healthcare for same-sex attracted parents and their children. Focus groups were held with same-sex attracted parents to explore their experiences with healthcare providers and identify barriers and facilitators to access. Parents reported experiencing uncomfortable or anxiety-provoking encounters with healthcare workers who struggled to adopt inclusive or appropriate language to engage their family. Parents valued healthcare workers who were able to be open and honest and comfortably ask questions about their relationships and family. A separate set of focus groups were held with mainstream healthcare workers to identity their experiences and concerns about delivering equitable and quality care for same-sex parented families. Healthcare workers reported lacking confidence to actively engage with same-sex attracted parents and their children. This lack of confidence related to workers' unfamiliarity with same-sex parents, or lesbian, gay and bisexual culture, and limited opportunities to gain information or training in this area. Workers were seeking training and resources that offered information about appropriate language and terminology as well as concrete strategies for engaging with same-sex parented families. For instance, workers suggested they would find it useful to have a set of 'door opening' questions they could utilize to ask clients about their sexuality, relationship status or family make-up. This article outlines a set of guidelines for healthcare providers for working with same-sex parented families which was a key outcome of this study.

  11. Utilization of SRS pond ash in controlled low strength material. Technical report

    Energy Technology Data Exchange (ETDEWEB)

    Langton, C.A.; Rajendran, N.

    1995-12-01

    Design mixes for Controlled Low Strength Material (CLSM) were developed which incorporate pond ashes (fly ashes) from the A-Area Ash Pile, the old F-Area Ash Basin and the D-Area Ash Basin. CLSM is a pumpable, flowable, excavatable backfill used in a variety of construction applications at SRS. Results indicate that CLSM which meets all of the SRS design specifications for backfill, can be made with the A-, D-, and F-Area pond ashes. Formulations for the design mixes are provided in this report. Use of the pond ashes may result in a cost savings for CLSM used at SRS and will utilize a by-product waste material, thereby decreasing the amount of material requiring disposal.

  12. Utility-scale grid-tied PV inverter reliability workshop summary report.

    Energy Technology Data Exchange (ETDEWEB)

    Granata, Jennifer E.; Quintana, Michael A.; Tasca, Coryne Adelle (SRA International, Inc., Fairfax, VA); Atcitty, Stanley

    2011-07-01

    A key to the long-term success of the photovoltaic (PV) industry is confidence in the reliability of PV systems. Inverters are the most commonly noted cause of PV system incidents triggered in the field. While not all of these incidents are reliability-related or even necessarily failures, they still result in a loss of generated power. With support from the U.S. Department of Energy's Solar Energy Technologies Program, Sandia National Laboratories organized a Utility-Scale Grid-Tied Inverter Reliability Workshop in Albuquerque, New Mexico, January 27-28, 2011. The workshop addressed the reliability of large (100-kilowatt+) grid-tied inverters and the implications when such inverters fail, evaluated inverter codes and standards, and provided discussion about opportunities to enhance inverter reliability. This report summarizes discussions and presentations from the workshop and identifies opportunities for future efforts.

  13. Mathematical model of a utility firm. Final technical report, Part I

    Energy Technology Data Exchange (ETDEWEB)

    1983-08-21

    Utility companies are in the predicament of having to make forecasts, and draw up plans for the future, in an increasingly fluid and volatile socio-economic environment. The project being reported is to contribute to an understanding of the economic and behavioral processes that take place within a firm, and without it. Three main topics are treated. One is the representation of the characteristics of the members of an organization, to the extent to which characteristics seem pertinent to the processes of interest. The second is the appropriate management of the processes of change by an organization. The third deals with the competitive striving towards an economic equilibrium among the members of a society in the large, on the theory that this process might be modeled in a way which is similar to the one for the intra-organizational ones. This volume covers mainly the first topic.

  14. Thorium utilization program. Quarterly progress report for the period ending May 31, 1977

    Energy Technology Data Exchange (ETDEWEB)

    1977-06-01

    Results of work performed under the National HTGR Fuel Recycle Program (also known as the Thorium Utilization Program) at General Atomic Company are presented. Results of work on this program prior to June 1974 were included in a quarterly series on the HTGR Base Program. The work reported includes the development of unit processes and equipment for reprocessing of High-Temperature Gas-Cooled Reactor (HTGR) fuel, the design and development of an integrated pilot line to demonstrate the head end of HTGR reprocessing using unirradiated fuel materials, and design work in support of Hot Engineering Tests (HET). Work is also described on trade-off studies concerning the required design of facilities and equipment for the large-scale recycle of HTGR fuels in order to guide the development activities for HTGR fuel recycle.

  15. TRW Advanced Slagging Coal Combustor Utility Demonstration. Fourth Quarterly progress report, August 1989--October 1989

    Energy Technology Data Exchange (ETDEWEB)

    1989-12-31

    The TRW Advanced Slagging Coal Combustor Demonstration Project consists of retrofitting Orange and Rockland (O&R) Utility Corporation`s Lovett Plant Unit No. 3 with four (4) slagging combustors which will allow the gas/ou desip unit to fire 2.5 sulfur coal. The slogging combustor process will provide NO{sub x} and SO{sub x} emissions that meet NSPS and New York State Envirommental Standards. TRW-CBU scope of work includes the engineering, design and supply of the slogging combustors, coal and limestone feed systems and a control system for these components. During this report period, the design activities for all systems progressed to permit the release of specifications and requests for proposals. Award of contracts for long-delivery items and major equipment are being placed to meet the revised program schedule.

  16. Pharmacovigilance: Empowering healthcare professionals

    Directory of Open Access Journals (Sweden)

    Mugoša Snežana S.

    2015-01-01

    Full Text Available Introduction: Spontaneous reporting of adverse reactions is of greatest importance for obtaining information about adverse drug reactions (ADRs after granting the marketing authorization. The most important role and also the greatest responsibility belong to healthcare professionals. Their active participation is a prerequisite for the existence of an effective national drug safety monitoring. Methods: This paper examines the legislative framework concerning the pharmacovigilance system in Montenegro. The information was collected from scientific articles and the website of the Agency for Medicines and Medical Devices of Montenegro. Topic: Key segments of pharmacovigilance system are presented, with a special reference to the importance of spontaneous reporting of ADRs, results of spontaneous reporting of ADRs according to the latest Agency's Annual report on the results of spontaneous reporting of adverse reactions to medicines, possible reasons for underreporting ADRs, as well as the new EU regulation on pharmacovigilance. Conclusions: Spontaneous reporting of ADRs remains the cornerstone of pharmacovigilance systems. Hence, continuous education of healthcare professionals is needed, with the aim of improving their awareness of the importance of ADRs and risk factors that lead to them, in order to reduce the incidence of ADRs and to increase the number of reported suspected ADRs.

  17. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  18. Licensed Healthcare Facilities

    Data.gov (United States)

    California Department of Resources — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  19. Licensed Healthcare Facilities

    Data.gov (United States)

    California Department of Resources — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  20. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  1. Torsadogenic risk of antipsychotics: combining adverse event reports with drug utilization data across Europe.

    Directory of Open Access Journals (Sweden)

    Emanuel Raschi

    Full Text Available BACKGROUND: Antipsychotics (APs have been associated with risk of torsade de Pointes (TdP. This has important public health implications. Therefore, (a we exploited the public FDA Adverse Event Reporting System (FAERS to characterize their torsadogenic profile; (b we collected drug utilization data from 12 European Countries to assess the population exposure over the 2005-2010 period. METHODS: FAERS data (2004-2010 were analyzed based on the following criteria: (1 ≥ 4 cases of TdP/QT abnormalities; (2 Significant Reporting Odds Ratio, ROR [Lower Limit of the 95% confidence interval>1], for TdP/QT abnormalities, adjusted and stratified (Arizona CERT drugs as effect modifiers; (3 ≥ 4 cases of ventricular arrhythmia/sudden cardiac death (VA/SCD; (4 Significant ROR for VA/SCD; (5 Significant ROR, combined by aggregating TdP/QT abnormalities with VA and SCD. Torsadogenic signals were characterized in terms of signal strength: from Group A (very strong torsadogenic signal: all criteria fulfilled to group E (unclear/uncertain signal: only 2/5 criteria. Consumption data were retrieved from 12 European Countries and expressed as defined daily doses per 1,000 inhabitants per day (DID. RESULTS: Thirty-five antipsychotics met at least one criterium: 9 agents were classified in Group A (amisulpride, chlorpromazine, clozapine, cyamemazine, haloperidol, olanzapine, quetiapine, risperidone, ziprasidone. In 2010, the overall exposure to antipsychotics varied from 5.94 DID (Estonia to 13.99 (France, 2009. Considerable increment of Group A agents was found in several Countries (+3.47 in France: the exposure to olanzapine increased across all Countries (+1.84 in France and peaked 2.96 in Norway; cyamemazine was typically used only in France (2.81 in 2009. Among Group B drugs, levomepromazine peaked 3.78 (Serbia; fluphenazine 1.61 (Slovenia. CONCLUSIONS: This parallel approach through spontaneous reporting and drug utilization analyses highlighted drug- and

  2. Hot dry rock geothermal energy for U.S. electric utilities. Draft final report

    Energy Technology Data Exchange (ETDEWEB)

    1993-06-01

    In order to bring an electric utility component into the study of hot dry rock geothermal energy called for in the Energy Policy Act of 1992 (EPAct), EPRI organized a one-day conference in Philadelphia on January 14,1993. The conference was planned as the first day of a two-day sequence, by coordinating with the U.S. Geological Survey (USGS) and the U.S. Department of Energy (DOE). These two federal agencies were charged under EPAct with the development of a report on the potential for hot dry rock geothermal energy production in the US, especially the eastern US. The USGS was given lead responsibility for a report to be done in association with DOE. The EPRI conference emphasized first the status of technology development and testing in the U.S. and abroad, i.e., in western Europe, Russia and Japan. The conference went on to address the extent of knowledge regarding the resource base in the US, especially in the eastern half of the country, and then to address some practical business aspects of organizing projects or industries that could bring these resources into use, either for thermal applications or for electric power generation.

  3. A cloud-based home health care information sharing system to connect patients with home healthcare staff -A case report of a study in a mountainous region.

    Science.gov (United States)

    Nomoto, Shinichi; Utsumi, Momoe; Sasayama, Satoshi; Dekigai, Hiroshi

    2017-01-01

    We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

  4. Opportunities to more fully utilize safeguards information reported to the IAEA at Gas Centrifuge Enrichment Plants

    Energy Technology Data Exchange (ETDEWEB)

    Garner, James R [ORNL; Whitaker, J Michael [ORNL

    2015-01-01

    In an effort to increase transparency and to strengthen IAEA safeguards, more countries are adopting practices that provide the IAEA with more timely, safeguards-relevant information to confirm nuclear operations are as declared. At Gas Centrifuge Enrichment Plants (GCEPs) potential examples include installing unattended IAEA instruments that transmit selected information back to Vienna, instruments that collect and store measurement information on-site, and daily facility operator submissions of material receipts, shipments, or utilization of key operational systems (e.g., UF6 feed stations) to on-site mail boxes. Recently the IAEA has implemented the use of on-site mailbox systems supplemented with short notice or unannounced inspections to maintain effectiveness without significantly increasing the number of inspection days. While these measures significantly improves the IAEA’s effectiveness, we have identified several opportunities for how the use of this information could be improved and how some additional information would further improve safeguards. This paper presents concepts for how the safeguards information currently collected at GCEPs could be more effectively utilized through enhancing the way that raw data is displayed visually so that it is more intuitive to the inspector and provides for more effective inspection planning and execution, comparing information with previous IAEA inspection activities (lists of previous verified inventory), through comparing data with operator supplied data when inspectors arrive (notional inventory change reports), and through evaluating the data over time to provide even greater confidence in the data and operations as declared in between inspections. This paper will also discuss several potential improvements to the submissions themselves, such as including occupancy information about product and tails stations and including weight information for each station.

  5. Identification, definition and evaluation of potential impacts facing the US electric utility industry over the next decade. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Grainger, J.J.; Lee, S.S.H.

    1993-11-26

    There are numerous conditions of the generation system that may ultimately develop into system states affecting system reliability and security. Such generation system conditions should also be considered when evaluating the potential impacts on system operations. The following five issues have been identified to impact system reliability and security to the greatest extent: transmission access/retail wheeling; non-utility generators and independent power producers; integration of dispersed storage and generation into utility distribution systems; EMF and right-of-way limitations; Clean Air Act Amendments. Strictly speaking, some issues are interrelated and one issue cannot be completely dissociated from the others. However, this report addresses individual issues separately in order to determine all major aspects of bulk power system operations affected by each issue. The impacts of the five issues on power system reliability and security are summarized. This report examines the five critical issues that the US electric utility industry will be facing over the next decade. The investigation of their impacts on utility industry will be facing over the next decade. The investigation of their impacts on utility system reliability and security is limited to the system operation viewpoint. Those five issues will undoubtedly influence various planning aspects of the bulk transmission system. However, those subjects are beyond the scope of this report. While the issues will also influence the restructure and business of the utility industry politically, sociologically, environmentally, and economically, all discussion included in the report are focused only on technical ramifications.

  6. Self-reported Health Care Utilization of Patients with Inflammatory Bowel Disease Correlates Perfectly with Medical Records

    NARCIS (Netherlands)

    Severs, Mirjam; Petersen, Roosmarijn E.; Siersema, Peter D.; Mangen, Marie Josee J; Oldenburg, Bas

    2015-01-01

    Studies on the costs of health care in patients with inflammatory bowel disease (IBD) are increasingly conducted through the collection of self-reported data. We aimed to assess the concordance between estimated annual costs based on self-reported health care utilization and administrative data in I

  7. Agreement between Self-Report and Archival Public Service Utilization Data among Chronically Homeless Individuals with Severe Alcohol Problems

    Science.gov (United States)

    Clifasefi, Seema L.; Collins, Susan E.; Tanzer, Kenneth; Burlingham, Bonnie; Hoang, Sara E.; Larimer, Mary E.

    2011-01-01

    Public service utilization data are often used as key outcomes in studies on homelessness. Although self-report data on these outcomes are accessible and cost-effective, various factors may affect retrospective recall in homeless populations. It is therefore necessary to establish validity of self-report to ensure the integrity of studies…

  8. First reported case of infective endocarditis caused by community-acquired methicillin-resistant Staphylococcus aureus not associated with healthcare contact in Brazil

    Directory of Open Access Journals (Sweden)

    Claudio Querido Fortes

    Full Text Available We report here the first case of endocarditis due to CA-MRSA not associated with healthcare contact in Brazil in Brazil. A previously healthy patient presented with history of endocarditis following a traumatic wound infection. Patient had multiple positive blood cultures within 72 h of admission and met modified Duke's criterion for infective endocarditis. The isolate was typed as Staphylococcal cassette chromosome (SCC mec type IV and was positive for presence of Panton-Valentine leukocidin (PVL. Increased incidence of CA-MRSA endocarditis is a challenge for the internist to choose the best empirical therapy. Several authors have suggested an empirical therapy with both a beta-lactam and an anti-MRSA agent for serious S. aureus infections. Our patient was treated with Vancomycin and made complete recovery in 3 months.

  9. First reported case of infective endocarditis caused by community-acquired methicillin-resistant Staphylococcus aureus not associated with healthcare contact in Brazil

    Directory of Open Access Journals (Sweden)

    Claudio Querido Fortes

    2008-12-01

    Full Text Available We report here the first case of endocarditis due to CA-MRSA not associated with healthcare contact in Brazil in Brazil. A previously healthy patient presented with history of endocarditis following a traumatic wound infection. Patient had multiple positive blood cultures within 72 h of admission and met modified Duke's criterion for infective endocarditis. The isolate was typed as Staphylococcal cassette chromosome (SCC mec type IV and was positive for presence of Panton-Valentine leukocidin (PVL. Increased incidence of CA-MRSA endocarditis is a challenge for the internist to choose the best empirical therapy. Several authors have suggested an empirical therapy with both a beta-lactam and an anti-MRSA agent for serious S. aureus infections. Our patient was treated with Vancomycin and made complete recovery in 3 months.

  10. Big Data Analytics in Healthcare

    Directory of Open Access Journals (Sweden)

    Ashwin Belle

    2015-01-01

    Full Text Available The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

  11. Big Data Analytics in Healthcare.

    Science.gov (United States)

    Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan

    2015-01-01

    The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

  12. Interoperative fundus image and report sharing in compliance with integrating the healthcare enterprise conformance and web access todigital imaging and communication in medicinepersistent object protocol

    Directory of Open Access Journals (Sweden)

    Hui-Qun Wu

    2013-12-01

    Full Text Available AIM:To address issues in interoperability between different fundus image systems, we proposed a web eye-picture archiving and communication system (PACS framework in conformance with digital imaging and communication in medicine (DICOM and health level 7 (HL7 protocol to realize fundus images and reports sharing and communication through internet.METHODS: Firstly, a telemedicine-based eye care work flow was established based on integrating the healthcare enterprise (IHE Eye Care technical framework. Then, a browser/server architecture eye-PACS system was established in conformance with the web access to DICOM persistent object (WADO protocol, which contains three tiers.RESULTS:In any client system installed with web browser, clinicians could log in the eye-PACS to observe fundus images and reports. Multipurpose internet mail extensions (MIME type of a structured report is saved as pdf/html with reference link to relevant fundus image using the WADO syntax could provide enough information for clinicians. Some functions provided by open-source Oviyam could be used to query, zoom, move, measure, view DICOM fundus images.CONCLUSION:Such web eye-PACS in compliance to WADO protocol could be used to store and communicate fundus images and reports, therefore is of great significance for teleophthalmology.

  13. Utility of Teacher-Report Assessments of Autistic Severity in Japanese School Children

    Directory of Open Access Journals (Sweden)

    Yoko Kamio

    2013-01-01

    Full Text Available Recent studies suggest that many children with milder autism spectrum disorder (ASD are undiagnosed, untreated, and being educated in mainstream classes without support and that school teachers might be the best persons to identify a child’s social deviance. At present, only a few screening measures using teacher ratings of ASD have been validated. The aim of this study was to examine the utility of teacher ratings on the Social Responsiveness Scale (SRS, a quantitative measure of ASD. We recruited 130 participants aged 4 to 17 years from local schools or local pediatric outpatient clinics specializing in neurodevelopmental disorders that included 70 children with ASD. We found that the teacher-report SRS can be reliably and validly applied to children as a screening tool or for other research purposes, and it also has cross-cultural comparability. Although parent-teacher agreement was satisfactory overall, a discrepancy existed for children with ASD, especially for girls with ASD. To improve sensitivity in children at higher risk, especially girls, we cannot overstate the importance of using standardized norms specific to gender, informant, and culture.

  14. Cesium removal demonstration utilizing crystalline silicotitanate sorbent for processing Melton Valley Storage Tank supernate: Final report

    Energy Technology Data Exchange (ETDEWEB)

    Walker, J.F. Jr.; Taylor, P.A.; Cummins, R.L. [and others

    1998-03-01

    This report provides details of the Cesium Removal Demonstration (CsRD), which was conducted at Oak Ridge National Laboratory (ORNL) on radioactive waste from the Melton Valley Storage Tanks. The CsRD was the first large-scale use of state-of-the-art sorbents being developed by private industry for the selective removal of cesium and other radionuclides from liquid wastes stored across the DOE complex. The crystalline silicotitanate sorbent used in the demonstration was chosen because of its effectiveness in laboratory tests using bench-scale columns. The demonstration showed that the cesium could be removed from the supernate and concentrated on a small-volume, solid waste form that would meet the waste acceptance criteria for the Nevada Test Site. During this project, the CsRD system processed > 115,000 L (30,000 gal) of radioactive supernate with minimal operational problems. Sluicing, drying, and remote transportation of the sorbent, which could not be done on a bench scale, were successfully demonstrated. The system was then decontaminated to the extent that it could be contact maintained with the use of localized shielding only. By utilizing a modular, transportable design and placement within existing facilities, the system can be transferred to different sites for reuse. The initial unit has now been removed from the process building and is presently being reinstalled for use in baseline operations at ORNL.

  15. Feasibility study of utilization of coal mine refuse, Estill County, Kentucky. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1976-08-01

    Reported is a feasibility study of commercial utilization for Eastern KY coal mine refuse at the South-East Coal Co. Cleaning plant in Estill County, KY. Included are descriptions of the physical facilities, sampling and testing methodology, geotechnical properties analyses, typical coal analyses, mineralogical characterizations, slow and quick firing test results, general marketing review of products, and environmental aspects. A good potential for economic development in Estill County exists with the anticipated uses of coal mine refuse as a raw material for the production of construction materials, particularly sintered lightweight aggregate. The refuse responded to the sintering process and a high quality, lightweight product was produced. The aggregate performed well in structural concrete and bituminous surfacing mixes. Other potential uses would be for lightweight concrete masonry blocks and soilless growing media. Inherent characteristics of the sintered material would provide for highly skid-resistant road surfacing aggregate and highly insulative structural building products. Market research results point to definitely feasible markets in East and East-Central KY and to the need for extensive, intensive marketing programs for commercial success of the proposed products. (Portions of this document are not fully legible)

  16. A Case Report of Clonazepam Dependence: Utilization of Therapeutic Drug Monitoring During Withdrawal Period.

    Science.gov (United States)

    Kacirova, Ivana; Grundmann, Milan; Silhan, Petr; Brozmanova, Hana

    2016-03-01

    Clonazepam is long-acting benzodiazepine agonist used in short-acting benzodiazepine withdrawal; however, recent observations suggest the existence of its abuse. We demonstrate a 40-year-old man with a 20-year history of psychiatric care with recently benzodiazepine dependence (daily intake of ∼60 mg of clonazepam and 10 mg of alprazolam). High serum levels of both drugs were analyzed 3 weeks before admission to hospitalization (clonazepam 543.9 ng/mL, alprazolam 110 ng/mL) and at the time of admission (clonazepam 286.2 ng/mL, alprazolam 140 ng/mL) without any signs of benzodiazepine intoxication. Gradual withdrawal of clonazepam with monitoring of its serum levels and increase of gabapentin dose were used to minimize physical signs and symptoms of clonazepam withdrawal. Alprazolam was discontinued promptly. Clinical consequences of the treatment were controllable tension, intermittent headache, and rarely insomia. It is the first case report showing utilization of therapeutic drug monitoring during withdrawal period in the patient with extreme toleration to severe benzodiazepine dependence.

  17. On Utilization and Importance of Perl Status Reporter (SRr) in Text Mining

    CERN Document Server

    Sharma, Sugam; Cohly, Hari

    2010-01-01

    In Bioinformatics, text mining and text data mining sometimes interchangeably used is a process to derive high-quality information from text. Perl Status Reporter (SRr) is a data fetching tool from a flat text file and in this research paper we illustrate the use of SRr in text or data mining. SRr needs a flat text input file where the mining process to be performed. SRr reads input file and derives the high quality information from it. Typically text mining tasks are text categorization, text clustering, concept and entity extraction, and document summarization. SRr can be utilized for any of these tasks with little or none customizing efforts. In our implementation we perform text categorization mining operation on input file. The input file has two parameters of interest (firstKey and secondKey). The composition of these two parameters describes the uniqueness of entries in that file in the similar manner as done by composite key in database. SRr reads the input file line by line and extracts the parameter...

  18. Background report for the formerly utilized Manhattan Engineer District/Atomic Energy Commission sites program

    Energy Technology Data Exchange (ETDEWEB)

    None

    1980-09-01

    The Department of Energy is conducting a program to determine radiological conditions at sites formerly used by the Army Corps of Engineers' Manhattan Engineer District and the Atomic Energy Commission in the early years of nuclear energy development. Also included in the program are sites used in the Los Alamos plutonium development program and the Trinity atomic bomb test site. Materials, equipment, buildings, and land became contaminated, primarily with naturally occurring radioactive nuclides. They were later decontaminated in accordance with the standards and survey methods in use at that time. Since then, however, radiological criteria, and proposed guidelines for release of such sites for unrestricted use have become more stringent as research on the effects of low-level radiation has progressed. In addition, records documenting some of these decontamination efforts cannot be found, and the final radiological conditions of the sites could not be adequately determined from the records. As a result, the Formerly Utilized Sites Program was initiated in 1974 to identify these formerly used sites and to reevaluate their radiological status. This report covers efforts through June 1980 to determine the radiological status of sites for which the existing conditions could not be clearly defined. Principal contractor facilities and associated properties have already been identified and activities are continuing to identify additional sites. Any new sites located will probably be subcontractor facilities and areas used for disposal of contractor waste or equipment; however, only limited information regarding this equipment and material has been collected to date. As additional information becomes available, supplemental reports will be published.

  19. Electricity pricing and the financial health of electric utilities in the United States. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1984-08-01

    The electric utility industry in the United States is characterized by wide diversity in utility ownership, management, cost structure, and regulation. There are approxiately 240 investor-owned utilities in the US. There are more than 1900 government utilities in the US. There are more than 50 regulatory commissions which regulate retail prices to ultimate customers. This substantial diversity in regulatory policies, processes, and rules applied to utilities across the country as well as significant regional variations in costs results in a wide variation in electricity prices and financial health among utilities. Prices and financial conditions for the industry as a whole also have varied substantially over time. During the 1960s, utilities were financially healthy, and real electricity prices were falling. In the decade following the Arab oil embargo in 1973, however, the industry was characterized by poor financial health and rapidly rising prices, although the reasons for these conditions varied somewhat between the first part of the decade and the last few years (1980-82) of the decade. Improved economic conditions during 1983 have contributed to improved utility financial health. A continuation of these economic conditions would result in continued financial stability for most utilties. Some individual utilities - particularly those with large constuction programs and those facing substantial reductions in the demand for electricity - may continue to exhibit financial problems. Utilities that have attempted to complete large nuclear projects during the presence of sharply declining load growth face severe financial problems. Prospects for the future financial health of the industry depend critically on the future demand for electricity, requirements for new generating capacity and other utility investments, and resolution of several policy issues affecting utility ratemaking, operations, and financial accounting.

  20. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration

    OpenAIRE

    Graaf, E.S. van de; Despriet, D. D.; Klaver, C.C.W.; Simonsz, H.J.

    2016-01-01

    BACKGROUND: Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case-control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bil...

  1. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration

    OpenAIRE

    van de Graaf, Elizabeth S.; Despriet, Dominiek D. G.; Klaver, Caroline C.W.; Simonsz, Huibert J.

    2016-01-01

    Background Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3–3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case–control study aimed to measure loss of utility in patients with amblyopia with recent decrease of vision in their better eye. As these patients are rare, the sample was supplemented by patients with bila...

  2. Economic feasibility of alternative utility-sponsored weatherization programs in Maryland. Phase 2. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Dubinsky, R.; Thibodeau, T.

    1983-05-01

    The economic costs and benefits of sponsoring weatherization programs are presented for Maryland utilities that operate Residential Conservation Service (RCS) programs. The key issues investigated are: the potential for cost-effective weatherization in each utility's service area; the savings in fuel and generating capacity that are likely to result from alternative weatherization programs; and the cost-effectiveness of such programs to each utility and to its ratepayers.

  3. The cost and performance of utility commercial lighting programs. A report from the Database on Energy Efficiency Programs (DEEP) project

    Energy Technology Data Exchange (ETDEWEB)

    Eto, J.; Vine, E.; Shown, L.; Sonnenblick, R.; Payne, C. [Lawrence Berkeley Lab., CA (United States). Energy and Environment Div.

    1994-05-01

    The objective of the Database on Energy Efficiency Programs (DEEP) is to document the measured cost and performance of utility-sponsored, energy-efficiency, demand-side management (DSM) programs. Consistent documentation of DSM programs is a challenging goal because of problems with data consistency, evaluation methodologies, and data reporting formats that continue to limit the usefulness and comparability of individual program results. This first DEEP report investigates the results of 20 recent commercial lighting DSM programs. The report, unlike previous reports of its kind, compares the DSM definitions and methodologies that each utility uses to compute costs and energy savings and then makes adjustments to standardize reported program results. All 20 programs were judged cost-effective when compared to avoided costs in their local areas. At an average cost of 3.9{cents}/kWh, however, utility-sponsored energy efficiency programs are not ``too cheap to meter.`` While it is generally agreed upon that utilities must take active measures to minimize the costs and rate impacts of DSM programs, the authors believe that these activities will be facilitated by industry adoption of standard definitions and reporting formats, so that the best program designs can be readily identified and adopted.

  4. Tire Development for Effective Transportation and Utilization of Used Tires, CRADA 01-N044, Final Report

    Energy Technology Data Exchange (ETDEWEB)

    Susan M. Maley

    2004-03-31

    Scrap tires represent a significant disposal and recycling challenge for the United States. Over 280 million tires are generated on an annual basis, and several states have large stockpiles or abandoned tire piles that are slated for remediation. While most states have programs to address the accumulation and generation of scrap tires, most of these states struggle with creating and sustaining recycling or beneficial end use markets. One of the major issues with market development has been the costs associated with transporting and processing the tires into material for recycling or disposal. According to a report by the Rubber Manufactures Association tire-derived fuel (TDF) represents the largest market for scrap tires, and approximately 115 million tires were consumed in 2001 as TDF (U.S. Scrap Tire Markets, 2001, December 2002, www.rma.org/scraptires). This market is supported primarily by cement kilns, followed by various industries including companies that operate utility and industrial boilers. However the use of TDF has not increased and the amount of TDF used by boiler operators has declined. The work completed through this cooperative research and development agreement (CRADA) has shown the potential of a mobile tire shredding unit to economically produce TDF and to provide an alterative low cost fuel to suitable coal-fired power systems. This novel system addresses the economic barriers by processing the tires at the retailer, thereby eliminating the costs associated with hauling whole tires. The equipment incorporated into the design allow for small 1-inch chunks of TDF to be produced in a timely fashion. The TDF can then be co-fired with coal in suitable combustion systems, such as a fluidized bed. Proper use of TDF has been shown to boost efficiency and reduce emissions from power generation systems, which is beneficial to coal utilization in existing power plants. Since the original scope of work outlined in the CRADA could not be completed because

  5. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration

    NARCIS (Netherlands)

    Graaf, E.S. van de; Despriet, D.D.; Klaver, C.C.W.; Simonsz, H.J.

    2016-01-01

    BACKGROUND: Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational

  6. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration

    NARCIS (Netherlands)

    Graaf, E.S. van de; Despriet, D.D.; Klaver, C.C.W.; Simonsz, H.J.

    2016-01-01

    BACKGROUND: Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observational case-contr

  7. Patient-reported utilities in bilateral visual impairment from amblyopia and age-related macular degeneration

    NARCIS (Netherlands)

    E.S. van de Graaf (Elizabeth); D.D.G. Despriet (Dominique); C.C.W. Klaver (Caroline); H.J. Simonsz (Huib)

    2016-01-01

    textabstractBackground: Utility of visual impairment caused by amblyopia is important for the cost-effectiveness of screening for amblyopia (lazy eye, prevalence 3-3.5 %). We previously measured decrease of utility in 35-year-old persons with unilateral persistent amblyopia. The current observationa

  8. Serial murder by healthcare professionals.

    Science.gov (United States)

    Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

    2008-01-01

    The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

  9. Healthcare seeking behaviour among Chinese elderly.

    Science.gov (United States)

    Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

    2017-04-18

    Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

  10. The utility of a Personal Values Report for medical decision-making.

    Science.gov (United States)

    Henderson, W; Corke, C

    2015-09-01

    Our aim was to determine if a patient's Personal Values Report (PVR) has a positive impact on a doctor's decisions regarding treatment. We conducted a prospective cohort study delivering a short, web-based hypothetical case-centred questionnaire to intensive care doctors practising in Australia and New Zealand. One hundred and twenty-four intensive care consultants and registrars agreed to participate in an online questionnaire in two routine mailings between November 2013 and February 2014. We evaluated the effect of a PVR on clinical decision-making in a case-based scenario. In addition, participants rated the utility of the PVR on their decision-making process. Participants were presented with a difficult scenario in a frail elderly man where death was almost inevitable without aggressive support but survival with severe disability was possible with significant intervention. Most doctors (52.4%) elected to continue ventilation and admit to ICU. After the PVR was made available, only 8.1% of doctors continued to choose to admit the patient to the ICU. In all cases where admission to the ICU was chosen after seeing the PVR, the admission to the ICU was stated to be to permit family to arrive before withdrawing support (an approach which was consistent with the values stated in the PVR). One hundred and twenty-one of the 124 participants (97.6%) agreed or strongly agreed that the PVR helped them get an understanding of the patient's wishes, whereas none of the participants (0%) were unsure, disagreed or strongly disagreed with this statement. The remaining 2.4% did not answer the question. It is surmised that PVRs pre-written by patients are potentially an effective and valuable tool for use in helping doctors make decisions regarding patient care.

  11. Monitoring rheumatoid arthritis using an algorithm based on patient-reported outcome measures: a first step towards personalised healthcare

    NARCIS (Netherlands)

    Hendrikx, J.; Fransen, J.; Riel, P.L.C.M. van

    2015-01-01

    OBJECTIVES: The objective of this proof of concept study was to evaluate alerts generated by a patient-reported outcome measure (PROM)-based algorithm for monitoring patients with rheumatoid arthritis (RA). METHODS: The algorithm was constructed using an example PROM score of an equally weighted mea

  12. Preliminary report on a cost-utility analysis of revascularization by percutaneous coronary intervention for ischemic heart disease.

    Science.gov (United States)

    Takura, Tomoyuki; Tachibana, Kouichi; Isshiki, Takaaki; Sumitsuji, Satoru; Kuroda, Tadashi; Mizote, Isamu; Ide, Seiko; Nanto, Shinsuke

    2017-04-01

    Few socioeconomic studies have so far reported on revascularization for stable ischemic heart disease in Japan. This study aimed to validate the sensitivity of the health-related quality of life (HRQOL) scale for determining the pathology and medical technology to be used and to validate the application of a cost-utility analysis model. We studied 32 patients who had undergone percutaneous coronary intervention (PCI) (mean age 67.9 ± 7.3 years). For HRQOL, utility and quality of life (QOL) were examined using the EuroQol 5 Dimension (EQ-5D) and EuroQol Visual Analogue Scale (EQ-VAS), respectively. The changes in the utility index before and after PCI were compared between the PCI and coronary angiography (CAG) groups to determine the sensitivity of the EQ-5D that was used to calculate quality-adjusted life years (QALY). Additionally, to estimate the cost-utility of PCI 120 months after the procedure, we analyzed our study results and the results of previous reports using the Markov chain model. The utility index was found to improve in the PCI group (0.08 ± 0.15), whereas it decreased in the CAG group (-0.02 ± 0.11) (p = 0.049). The estimated result of the cost-utility analysis as the increase in utility above baseline level was the expected value, that is, 70,000 US$/QALY. Our findings suggest that QALY may be valid as a utility index in the clinical and economic evaluation of PCI in Japan.

  13. Healthcare Use for Pain in Women Waiting for Gynaecological Surgery

    Directory of Open Access Journals (Sweden)

    Sarah Walker

    2016-01-01

    Full Text Available Background. Pain while waiting for surgery may increase healthcare utilization (HCU preoperatively. Objective. Examine the association between preoperative pain and HCU in the year prior to gynecological surgery. Methods. 590 women waiting for surgery in a Canadian tertiary care centre were asked to report on HCU in the year before surgery. Pain was assessed using the Brief Pain Inventory. Results. 33% reported moderate to severe pain intensity and interference in the week before surgery. Sixty-one percent (n=360 reported a total of 2026 healthcare visits, with 21% (n=126 reporting six or more visits in the year before surgery. After controlling for covariates, women with moderate to severe (>3/10 pain intensity/interference reported higher odds of overall HCU (≥3 pain-related visits to family doctor or specialist in the past year or ≥1 to emergency/walk-in clinic compared to women with no or mild pain. Lower body mass index (BMI < 30 versus ≥30 and anxiety and/or depression were associated with emergency department or walk-in visits but not visits to family doctors or specialists. Conclusions. There is a high burden of pain in women awaiting gynecological surgery. Decisions about resource allocation should consider the impact of pain on individuals and the healthcare system.

  14. Review of Reports to COSPAR: COSPAR Policy and Guidelines for the Utilization and Care of Animals Used in Space Research

    Science.gov (United States)

    Dunlap, Alex

    The purpose of this session is to review the reports by the various countries that have flown animals in space during the proceeding 2 years to be in compliance with the Cospar resolution: Cospar Policy and Guidelines for the Utilization and Care of Animals Used in Space Research.

  15. Industrial applications study. Volume II. Industrial data base. Final report. [Waste heat recovery and utilization

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Harry L.; Hamel, Bernard B.; Karamchetty, Som; Steigelmann, William H.; Gajanana, Birur C.; Agarwal, Anil P.; Klock, Lawrence W.; Henderson, James M.; Calobrisi, Gary; Hedman, Bruce A.; Koluch, Michael; Biancardi, Frank; Bass, Robert; Landerman, Abraham; Peters, George; Limaye, Dilip; Price, Jeffrey; Farr, Janet

    1976-12-01

    An initial evaluation of the waste heat recovery and utilization potential in the manufacturing portion of the industrial sector is presented. The scope of this initial phase addressed the feasibility of obtaining in-depth energy information in the industrial sector. Within this phase, the methodology and approaches for data gathering and assessment were established. Using these approaches, energy use and waste heat profiles were developed at the 2-digit level; with this data, waste heat utilization technologies were evaluated.

  16. Legal-institutional arrangements facilitating offshore wind energy conversion systems (WECS) utilization. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Mayo, L.H.

    1977-09-01

    Concern for the continuing sufficiency of energy supplies in the U.S. has tended to direct increasing attention to unconventional sources of supply, including wind energy. Some of the more striking proposals for the utilization of wind energy relate to offshore configurations. The legal-institutional arrangements for facilitating the utilization of offshore wind energy conversion systems (WECS) are examined by positioning three program alternatives and analyzing the institutional support required for the implementation of each.

  17. Results of a healthcare worker (HCW) survey on environmental awareness as an instrument for the preparation of an environmental report for the University Medicine Greifswald.

    Science.gov (United States)

    Heiden, Jens-Uwe; Kramer, Axel; Bornewasser, Manfred; Lemanski, Sandra; Below, Harald

    2011-01-01

    Environmental reporting is increasingly important for medical facilities. Currently, hospitals can determine the content of an environmental report as they see fit. To examine the utility and scope of an employee survey as an instrument for the preparation of an environmental report at the University Hospital Greifswald. For this purpose a questionnaire was developed with a focus on environmental behaviour and the significance attached to the protection of the environment. The employees of the University Medicine Greifswald attach an unexpectedly high significance to the protection of the environment. Based on this finding, this potential should be used to promote the optimal implementation of ecological-economic behaviour within the University Medicine. An employee survey is a useful instrument in the preparation of an environmental report.

  18. Utility planning using least-cost principles and the role of externalities - staff report on a Keystone policy dialogue

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    For over two years, The Keystone Center facilitated a two-phase dialogue on Utility Planning Using Least-Cost Principles and, in the second phase, on the role of Externalities. The intent of this report is to assist policy-makers faced with decisions about changes to traditional utility regulation and planning. This report is not a consensus document, rather it is staff written summary of two years of discussion on the issues. As a concept, least-cost planning has been discussed since the 1970`s and many states have implemented such programs since the mid-1980`s. Yet, the actual goals and objectives of least-cost planning remain a source of controversy between affected interest groups. Some industry observers believe that least-cost planning can help reconcile the often conflicting demands between increased capacity requirements and concerns about the external costs of power production. In traditional utility regulation practices, capital investments are rewarded and revenue is a direct function of sales. However, a number state public utility commissions have altered their practices to allow for returns on investments in more efficient end-use equipment (also known as ratebasing conservation) and adjusting revenues to account for sales lost due to utility conservation programs. Other states are planning these types of changes. Still others are observing the impacts of the changes before they commit.

  19. Assessment of the potential of solar thermal small power systems in small utilities. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Steitz, P.; Mayo, L.G.; Perkins, S.P. Jr.

    1978-11-01

    This study involved an assessment of the potential economic benefit of small solar thermal electric power systems to small municipal and rural electric utilities. Five different solar thermal small power system configurations were considered in the study representing three different solar thermal technologies. The configurations included: (1) 1-MW, 2-MW, and 10-MW parabolic dish concentrators with a 15-kW heat engine mounted at the focal point of each dish. These systems utilized advanced battery energy storage. (2) A 10-MW system with variable slat concentrators and central steam Rankine energy conversion. This system utilized sensible thermal energy storage. (3) A 50-MW central receiver system consisting of a field of heliostats concentrating energy on a tower-mounted receiver and a central steam Rankine conversion system. This system also utilized sensible thermal storage. The approach used in determining the potential for solar thermal small power systems in the small utility market involved a comparison of the economics of power supply expansion plans for seven hypothetical small utilities through the year 2000 both with and without the solar thermal small power systems. Insolation typical of the Southwestern US was assumed. A comparison of the break-even capital costs with the range of plant costs estimated in this study yields the following conclusions: (1) The parabolic dish concentrator systems could be economically competitive with conventional generation if the lowest capital costs can be achieved. (2) The variable slat concentrator and central receiver systems would have to achieve lower costs than the lowest in the cost ranges generally assumed in the study to become economically competitive. (3) All of the solar thermal plant types are potentially more competitive in utilities which are heavily dependent upon oil.

  20. Strategies for reducing morbidity and mortality from diabetes through health-care system interventions and diabetes self-management education in community settings. A report on recommendations of the Task Force on Community Preventive Services.

    Science.gov (United States)

    2001-09-28

    Reducing morbidity and mortality and improving quality of life for persons with diabetes is an ongoing challenge for health-care providers and organizations and public health practitioners. Interventions are available that focus on persons with diabetes, health-care systems, families, and public policies. The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of seven population-oriented interventions that can be implemented by health-care organizations and communities. Two of these interventions focus on health-care systems (disease and case management), and five focus on persons with diabetes (diabetes self-management education delivered in community settings). On the basis of these reviews, the Task Force has made recommendations regarding use of these seven interventions. The Task Force strongly recommends disease and case management in health-care systems for persons with diabetes. Diabetes self-management education is recommended in community gathering places (e.g., community centers or faith institutions) for adults and in the home for children and adolescents with type 1 diabetes. Evidence was insufficient to recommend diabetes self-management education interventions in other settings (i.e., schools, work sites, and recreational camps) or in the home for adults with type 2 diabetes. This report provides additional information regarding these recommendations, briefly describes how the reviews were conducted, provides sources of full reviews of interventions and information to assist in applying the interventions locally, and describes additional diabetes-related work in progress.

  1. Contact Allergy in Danish Healthcare Workers

    DEFF Research Database (Denmark)

    Schwensen, Jakob F; Menné, Torkil; Sommerlund, Mette;

    2015-01-01

    . The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common...... in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus...

  2. Evaluation of higher distribution and/or utilization voltages. Fourth interim report (August 1980): assessment of optimum distribution configuration

    Energy Technology Data Exchange (ETDEWEB)

    1981-04-01

    This interim report provides documentation on the fourth task, Assessment of Optimum Distribution Configuration, of DOE Contract No. ET-78-C-01-2866, Evaluation of Higher Distribution and/or Utilization Voltages. The work performed under this task includes the development of a computer model for assessment of life cycle costs for the distribution and utilization systems, the development of an optimization algorithm to enable distribution system configuration optimization and a net energy analysis to determine potential net energy savings. Input data for this task derive from Task 3. The major output of this task is a documented computer code.

  3. Business resilience: Reframing healthcare risk management.

    Science.gov (United States)

    Simeone, Cynthia L

    2015-09-01

    The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

  4. Industrial applications study. Volume IV. Industrial plant surveys. Final report. [Waste heat recovery and utilization

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Harry L.; Hamel, Bernard B.; Karamchetty, Som; Steigelmann, William H.; Gajanana, Birur C.; Agarwal, Anil P.; Klock, Lawrence M.; Henderson, James M.; Calobrisi, Gary; Hedman, Bruce A.; Koluch, Michael; Biancardi, Frank; Bass, Robert; Landerman, Abraham; Peters, George; Limaye, Dilip; Price, Jeffrey; Farr, Janet

    1977-01-01

    An initial evaluation of the waste heat recovery and utilization potential in the manufacturing portion of the industrial sector is presented. The scope of this initial phase addressed the feasibility of obtaining in-depth energy information in the industrial sector. Within this phase, the methodology and approaches for data gathering and assessment were established. Using these approaches, energy use and waste heat profiles were developed at the 2-digit level; with this data, waste heat utilization technologies were evaluated. This study represents an important first step in the evaluation of waste heat recovery potential.

  5. Fraud Detection in Healthcare

    Energy Technology Data Exchange (ETDEWEB)

    Chandola, Varun [ORNL; Schryver, Jack C [ORNL; Sukumar, Sreenivas R [ORNL

    2015-01-01

    We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.

  6. Healthcare Firms and the ERP Systems

    Directory of Open Access Journals (Sweden)

    A. Garefalakis

    2016-04-01

    Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

  7. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  8. Report on Utilities Usage and Cost, 1980-81 to 1984-85.

    Science.gov (United States)

    Alabama State Commission on Higher Education, Montgomery.

    The consumption and cost of energy and other types of utilities by state college campuses were analyzed by the Alabama Commission on Higher Education. A focus of attention has been changes in energy usage per square foot from year to year as an indicator of the institutions' energy conservation and, over time, of the changing characteristics of…

  9. National Utility Financial Statement model (NUFS). Volume III of III: software description. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1981-10-29

    This volume contains a description of the software comprising the National Utility Financial Statement Model (NUFS). This is the third of three volumes describing NUFS provided by ICF Incorporated under contract DEAC-01-79EI-10579. The three volumes are entitled: model overview and description, user's guide, and software guide.

  10. Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

    2007-01-01

    Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine gastroi

  11. Performance indicators: healthcare professionals' views.

    Science.gov (United States)

    Gu, Xiuzhu; Itoh, Kenji

    2016-08-08

    Purpose - The purpose of this paper is to capture factors behind professional views of indicator usefulness as a common structure for assessing healthcare performance and their important characteristics to design limited key performance indicators (PIs) for holistic hospital management. Design/methodology/approach - Two surveys were conducted using self-administered questionnaires, in which hospital manager/staff respondents were asked to rate the 52 PIs' usefulness. In total, 228 manager and 894 staff responses were collected. Findings - Eight factors were elicited from manager and staff responses as performance measures with 72 percent cumulative variance accounted for. Hospital managers and staff showed similar performance measure perceptions: high-utility acknowledgment on safety, operational efficiency and patient/employee satisfaction but relatively low-employee development concerns. Manager indicator usefulness perceptions were rather homogeneous and significantly higher than staff for almost all performance measures. Practical implications - Homogeneous manager views mean that a single key PI set for hospital management may be established regardless of hospital attributes. The following aspects may be measures that should be managed in a healthcare organization based on their key PIs: patient/employee safety, operational efficiency, financial effectiveness and patient/employee satisfaction. Originality/value - This is a pilot study on hospital management PIs in Japan. The eight-dimensional factor structure and findings about healthcare provider perceptions may be useful for healthcare management.

  12. Hawaii Utility Integration Initiatives to Enable Wind (Wind HUI) Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Dora Nakafuji; Lisa Dangelmaier; Chris Reynolds

    2012-07-15

    To advance the state and nation toward clean energy, Hawaii is pursuing an aggressive Renewable Portfolio Standard (RPS), 40% renewable generation and 30% energy efficiency and transportation initiatives by 2030. Additionally, with support from federal, state and industry leadership, the Hawaii Clean Energy Initiative (HCEI) is focused on reducing Hawaii's carbon footprint and global warming impacts. To keep pace with the policy momentum and changing industry technologies, the Hawaiian Electric Companies are proactively pursuing a number of potential system upgrade initiatives to better manage variable resources like wind, solar and demand-side and distributed generation alternatives (i.e. DSM, DG). As variable technologies will continue to play a significant role in powering the future grid, practical strategies for utility integration are needed. Hawaiian utilities are already contending with some of the highest penetrations of renewables in the nation in both large-scale and distributed technologies. With island grids supporting a diverse renewable generation portfolio at penetration levels surpassing 40%, the Hawaiian utilities experiences can offer unique perspective on practical integration strategies. Efforts pursued in this industry and federal collaborative project tackled challenging issues facing the electric power industry around the world. Based on interactions with a number of western utilities and building on decades of national and international renewable integration experiences, three priority initiatives were targeted by Hawaiian utilities to accelerate integration and management of variable renewables for the islands. The three initiatives included: Initiative 1: Enabling reliable, real-time wind forecasting for operations by improving short-term wind forecasting and ramp event modeling capabilities with local site, field monitoring; Initiative 2: Improving operators situational awareness to variable resources via real-time grid condition

  13. Community perceptions and factors influencing utilization of health services in Uganda

    Directory of Open Access Journals (Sweden)

    Galea Sandro

    2009-07-01

    Full Text Available Abstract Background Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization. Study Objective To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda. Methods We used a qualitative study design using Focus Group Discussions (FGD to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest' using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings. Results Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as

  14. Information Technology for Healthcare

    Directory of Open Access Journals (Sweden)

    Abbas Yazdanpanah

    2016-04-01

    Full Text Available The article produced below hopes to focus on the use of information technology solutions for improving healthcare delivery systems. It explains evolution of IT-Enhanced healthcare from Telemedicine to e-health, including definition and requirements of telemedical systems. It also traces the evolution of contemporary telemedical systems and the challenges faced by future technologies including legal and formal aspects of telemedicine as well as its acceptance among users. It overviews access to telecommunication technologies, with basic requirements for such communications. It also presents the requirements and architectures of Internet-based medical systems, with focus on Internet telemedical services, Web services and portal technologies. The next-generation point-of-care information systems are also discussed. This article also covers security and safety of telemedical systems in context of legal acts affecting the security of e-medical systems. Wireless hospital and telecare applications with requirements for mobile access from PDA devices to medical database are also considered. Electronic health records describe the progress in constructing a common set of data structures contained in medical records and reports on the main standardization efforts. Decision support systems in medicine covers knowledge based and expert systems which support physicians in making medical decisions by providing interactive tools, Since e-health network services are available over the Internet it covers the requirements and architecture of telematics networks and the organizational models for such networks.

  15. Evaluation of Orange and Rockland Utilities, Inc.`s competitive bidding program for demand-side resources. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Peters, J.S.; Stucky, L.; Seratt, P.; Darden-Butler, D. [Barakat and Chamberlin, Inc., Portland, OR (United States)

    1993-02-01

    The process evaluation reports on the implementation of Orange and Rockland Utilities demand-side bidding program in New York State during 1991 and 1992. The program is implemented by two energy service companies in Orange and rockland`s New York State service territory. The process evaluation methodology included interviews with utility staff (3), energy service company staff (2), and participating (6) and nonparticipating (7) utility customers. The two energy service companies had enrolled 14 customers in the program by summer 1992. One company had achieved 90% of their 2.75 MW bid and the other had achieved less than 90% of their 6.9 MW bid. Critical factors in success were determination of a reasonable bid amount for the market and marketing to the appropriate customers. Customers most interested in the program included those with limited access to capital and medium-sized firms with poor cash flows, particularly schools and hospitals. The findings also show that due to the incentive structure and associated need for substantial customer contributions, lighting measures dominate all installations. Customers, however, were interested in the potential savings and six of the nonparticipants chose to either install measures on their own or enroll in the utility`s rebate program.

  16. Hawaii Utility Integration Initiatives to Enable Wind (Wind HUI) Final Technical Report

    Energy Technology Data Exchange (ETDEWEB)

    Dora Nakafuji; Lisa Dangelmaier; Chris Reynolds

    2012-07-15

    To advance the state and nation toward clean energy, Hawaii is pursuing an aggressive Renewable Portfolio Standard (RPS), 40% renewable generation and 30% energy efficiency and transportation initiatives by 2030. Additionally, with support from federal, state and industry leadership, the Hawaii Clean Energy Initiative (HCEI) is focused on reducing Hawaii's carbon footprint and global warming impacts. To keep pace with the policy momentum and changing industry technologies, the Hawaiian Electric Companies are proactively pursuing a number of potential system upgrade initiatives to better manage variable resources like wind, solar and demand-side and distributed generation alternatives (i.e. DSM, DG). As variable technologies will continue to play a significant role in powering the future grid, practical strategies for utility integration are needed. Hawaiian utilities are already contending with some of the highest penetrations of renewables in the nation in both large-scale and distributed technologies. With island grids supporting a diverse renewable generation portfolio at penetration levels surpassing 40%, the Hawaiian utilities experiences can offer unique perspective on practical integration strategies. Efforts pursued in this industry and federal collaborative project tackled challenging issues facing the electric power industry around the world. Based on interactions with a number of western utilities and building on decades of national and international renewable integration experiences, three priority initiatives were targeted by Hawaiian utilities to accelerate integration and management of variable renewables for the islands. The three initiatives included: Initiative 1: Enabling reliable, real-time wind forecasting for operations by improving short-term wind forecasting and ramp event modeling capabilities with local site, field monitoring; Initiative 2: Improving operators situational awareness to variable resources via real-time grid condition

  17. Geothermal direct-heat utilization assistance. Quarterly progress report, April--June 1993

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    Progress is reported on the following R&D activities: evaluation of lineshaft turbine pump problems, geothermal district heating marketing strategy, and greenhouse peaking analysis. Other activities are reported on technical assistance, technology transfer, and the geothermal progress monitor.

  18. A pilot study of an mHealth application for healthcare workers: poor uptake despite high reported acceptability at a rural South African community-based MDR-TB treatment program.

    Directory of Open Access Journals (Sweden)

    Krisda H Chaiyachati

    Full Text Available As the South African province of KwaZulu-Natal addresses a growing multidrug-resistant tuberculosis (MDR-TB epidemic by shifting care and treatment from trained specialty centers to community hospitals, delivering and monitoring MDR-TB therapy has presented new challenges. In particular, tracking and reporting adverse clinical events have been difficult for mobile healthcare workers (HCWs, trained health professionals who travel daily to patient homes to administer and monitor therapy. We designed and piloted a mobile phone application (Mobilize for mobile HCWs that electronically standardized the recording and tracking of MDR-TB patients on low-cost, functional phones.We assess the acceptability and feasibility of using Mobilize to record and submit adverse events forms weekly during the intensive phase of MDR-TB therapy and evaluate mobile HCW perceptions throughout the pilot period.All five mobile HCWs at one site were trained and provided with phones. Utilizing a mixed-methods evaluation, mobile HCWs' usage patterns were tracked electronically for seven months and analyzed. Qualitative focus groups and questionnaires were designed to understand the impact of mobile phone technology on the work environment.Mobile HCWs submitted nine of 33 (27% expected adverse events forms, conflicting with qualitative results in which mobile HCWs stated that Mobilize improved adverse events communication, helped their daily workflow, and could be successfully expanded to other health interventions. When presented with the conflict between their expressed views and actual practice, mobile HCWs cited forgetfulness and believed patients should take more responsibility for their own care.This pilot experience demonstrated poor uptake by HCWs despite positive responses to using mHealth. Though our results should be interpreted cautiously because of the small number of mobile HCWs and MDR-TB patients in this study, we recommend carefully exploring the motivations

  19. Electric utility engineer`s FGD manual -- Volume 1: FGD process design. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-04

    Part 1 of the Electric Utility Engineer`s Flue Gas Desulfurization (FGD) Manual emphasizes the chemical and physical processes that form the basis for design and operation of lime- and limestone-based FGD systems applied to coal- or oil-fired steam electric generating stations. The objectives of Part 1 are: to provide a description of the chemical and physical design basis for lime- and limestone-based wet FGD systems; to identify and discuss the various process design parameters and process options that must be considered in developing a specification for a new FGD system; and to provide utility engineers with process knowledge useful for operating and optimizing a lime- or limestone-based wet FGD system.

  20. Agribusiness geothermal energy utilization potential of Klamath and Western Snake River Basins, Oregon. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.J.

    1978-03-01

    Resource assessment and methods of direct utilization for existing and prospective food processing plants have been determined in two geothermal resource areas in Oregon. Ore-Ida Foods, Inc. and Amalgamated Sugar Company in the Snake River Basin; Western Polymer Corporation (potato starch extraction) and three prospective industries--vegetable dehydration, alfalfa drying and greenhouses--in the Klamath Basin have been analyzed for direct utilization of geothermal fluids. Existing geologic knowledge has been integrated to indicate locations, depth, quality, and estimated productivity of the geothermal reservoirs. Energy-economic needs and balances, along with cost and energy savings associated with field development, delivery systems, in-plant applications and fluid disposal have been calculated for interested industrial representatives.

  1. Geothermal direct-heat utilization assistance: Federal assistance program. Quarterly project progress report, October--December 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-02-01

    The report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-96. It describes 90 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment and resources. Research activities are summarized on low-temperature resource assessment, geothermal district heating system cost evaluation and silica waste utilization project. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, development of a webpage, and progress monitor reports on geothermal resources and utilization.

  2. IEA Agreement on the production and utilization of hydrogen: 1999 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Elam, Carolyn C. (National Renewable Energy Lab, Golden, CO (US)) (ed.)

    2000-01-31

    The annual report begins with an overview of the IEA Hydrogen Agreement, including guiding principles and their strategic plan followed by the Chairman's report providing the year's highlights. Annex reports included are: the final report for Task 11, Integrated Systems; task updates for Task 12, Metal Hydrides and Carbon for Hydrogen Storage, Task 13, Design and Optimization of Integrated Systems, Task 14, Photoelectrolytic Production of Hydrogen, and Task 15, Photobiological Production of Hydrogen; and a feature article by Karsten Wurr titled 'Large-Scale Industrial Uses of Hydrogen: Final Development Report'.

  3. Defense Infrastructure: Improvements in DOD Reporting and Cybersecurity Implementation Needed to Enhance Utility Resilience Planning

    Science.gov (United States)

    2015-07-01

    At the installation level, the public works, general facilities, or civil engineering departments oversee and manage the day- to-day operations...Corps Installation Command; and within the Air Force, the Air Force Civil Engineer. DOD Roles and Responsibilities for Management of Utility...which were multiday electrical disruptions that occurred as a result of the June 2012 derecho storm, including a disruption at Marine Corps Base

  4. El Centro Geothermal Utility Core Field Experiment environmental-impact report and environmental assessment

    Energy Technology Data Exchange (ETDEWEB)

    1979-08-01

    The City of El Centro is proposing the development of a geothermal energy utility core field experiment to demonstrate the engineering and economic feasibility of utilizing moderate temperature geothermal heat, on a pilot scale, for space cooling, space heating, and domestic hot water. The proposed facility is located on part of a 2.48 acre (1 hectare) parcel owned in fee by the City in the southeastern sector of El Centro in Imperial County, California. Geothermal fluid at an anticipated temperature of about 250/sup 0/F (121/sup 0/C) will heat a secondary fluid (water) which will be utilized directly or processed through an absorption chiller, to provide space conditioning and water heating for the El Centro Community Center, a public recreational facility located approximately one-half mile north of the proposed well site. The geothermal production well will be drilled to 8500 feet (2590m) and an injection well to 4000 feet (1220m) at the industrially designated City property. Once all relevant permits are obtained it is estimated that site preparation, facility construction, the completion and testing of both wells would be finished in approximately 26 weeks. The environmental impacts are described.

  5. Childhood bullying and healthcare adherence in adulthood.

    Science.gov (United States)

    Sansone, Randy A; Bohinc, R Jordan; Wiederman, Michael W

    2015-12-01

    The relationship between childhood bullying and healthcare adherence in adulthood has been rarely studied, but one published study suggests that being bullied in childhood is related to lower healthcare adherence among adolescents. This previous study examined few adherence variables and was limited to youths. In this study, we assessed five variables for childhood bullying as related to seven measures of healthcare adherence among a cohort of adult primary care outpatients. Using a cross-sectional, self-report survey methodology in a sample of 263 consecutive internal medicine outpatients, we examined five aspects of bullying and seven aspects of adherence with general healthcare. Being a victim of bullying, type of bullying (emotional, physical), number of years bullied and number of bullies each evidenced no statistical relationships with healthcare adherence. However, being a bully demonstrated several statistical relationships with healthcare adherence, indicating less adherence to instructions provided by healthcare professionals. Despite all of the deleterious psychological and physical effects of being bullied in childhood, there was no evidence that non-adherence with healthcare in adulthood is one of them. In contrast, bullies evidenced several areas of reduced healthcare adherence. © The Author(s) 2015.

  6. Effect of interrupting free healthcare for children: Drawing lessons at the critical moment of national scale-up in Burkina Faso.

    Science.gov (United States)

    Druetz, Thomas; Bicaba, Abel; Some, Telesphore; Kouanda, Seni; Ly, Antarou; Haddad, Slim

    2017-07-01

    With solid evidence that free healthcare increases the utilization of health services, Burkina Faso recently exempted all children under five and pregnant women from direct payment at health facilities. However, there is little insight into the capacity to maintain the gains attributable to free healthcare under routine conditions of implementation at the national scale. In particular, the repercussions of its interruption are unknown. The objective is to assess the effects of a sequence of natural interventions including the introduction, interruption and reintroduction of free healthcare on health-seeking practices and utilization of healthcare facilities by children under five. This is an embedded mixed methods study conducted in Kaya district, Burkina Faso. The quantitative component is based on a reversal longitudinal design. Pooled interrupted time-series analysis was performed to assess changes in the monthly number of visits from January 2005 to March 2015. Qualitative data were collected through in-depth interviews with health personnel and mothers to better understand the quantitative results. The results show that visits to health centres dropped immediately and significantly when free healthcare was interrupted (-146, CI95% [-255; -37]). They increased again when free healthcare was reintroduced (+89, CI95% [-11; 187]). Both urban and rural centres were affected. Self-medication and visits to traditional healers were reported more frequently during the withdrawal of free healthcare, and tensions between the population and health personnel increased. Implementation problems other than insufficient funding limited the coverage or intensity of free healthcare. While removing user fees could potentially improve mothers and children's health in Burkina Faso, this study shows that demand for healthcare remains highly sensitive to price changes. Gains in utilization attributable to free healthcare may vanish rapidly if user fees are reintroduced. It is

  7. Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chi-Shin Wu

    Full Text Available PURPOSE: The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization. METHODS: In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports. RESULTS: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions. CONCLUSION: We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

  8. An Examination of Temporal Trends in Electricity Reliability Based on Reports from U.S. Electric Utilities

    Energy Technology Data Exchange (ETDEWEB)

    Eto, Joseph H.; LaCommare, Kristina Hamachi; Larsen, Peter; Todd, Annika; Fisher, Emily

    2012-01-06

    Since the 1960s, the U.S. electric power system has experienced a major blackout about once every 10 years. Each has been a vivid reminder of the importance society places on the continuous availability of electricity and has led to calls for changes to enhance reliability. At the root of these calls are judgments about what reliability is worth and how much should be paid to ensure it. In principle, comprehensive information on the actual reliability of the electric power system and on how proposed changes would affect reliability ought to help inform these judgments. Yet, comprehensive, national-scale information on the reliability of the U.S. electric power system is lacking. This report helps to address this information gap by assessing trends in U.S. electricity reliability based on information reported by electric utilities on power interruptions experienced by their customers. Our research augments prior investigations, which focused only on power interruptions originating in the bulk power system, by considering interruptions originating both from the bulk power system and from within local distribution systems. Our research also accounts for differences among utility reliability reporting practices by employing statistical techniques that remove the influence of these differences on the trends that we identify. The research analyzes up to 10 years of electricity reliability information collected from 155 U.S. electric utilities, which together account for roughly 50% of total U.S. electricity sales. The questions analyzed include: 1. Are there trends in reported electricity reliability over time? 2. How are trends in reported electricity reliability affected by the installation or upgrade of an automated outage management system? 3. How are trends in reported electricity reliability affected by the use of IEEE Standard 1366-2003?

  9. Factors Affecting Adverse Drug Reaction Reporting of Healthcare Professionals and Their Knowledge, Attitude, and Practice towards ADR Reporting in Nekemte Town, West Ethiopia

    Directory of Open Access Journals (Sweden)

    Lense Temesgen Gurmesa

    2016-01-01

    Full Text Available Background. Adverse drug reactions are global problems of major concern. Adverse drug reaction reporting helps the drug monitoring system to detect the unwanted effects of those drugs which are already in the market. Aims. To assess the knowledge, attitude, and practice of health care professionals working in Nekemte town towards adverse drug reaction reporting. Methods and Materials. A cross-sectional study design was conducted on a total of 133 health care professionals by interview to assess their knowledge, attitude, and practice using structured questionnaire. Results. Of the total respondents, only 64 (48.2%, 56 (42.1%, and 13 (9.8% health care professionals have correctly answered the knowledge, attitude, and practice assessment questions, respectively. Lack of awareness and knowledge on what, when, and to whom to report adverse drug reactions and lack of commitments of health care professionals were identified as the major discouraging factors against adverse drug reaction reporting. Conclusion. This study has revealed that the knowledge, attitude, and practice of the health care professionals working in Nekemte town towards spontaneous adverse drug reaction reporting were low that we would like to recommend the concerned bodies to strive on the improvement of the knowledge, attitude, and practice status of health care professionals.

  10. Geothermal direct-heat utilization assistance. Quarterly project progress report, July 1996--September 1996. Federal Assistance Program

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.

    1996-11-01

    This report summarizes geothermal technical assistance, R&D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the fourth quarter of FY-96. It describes 152 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, equipment, economics and resources. Research activities are summarized on greenhouse peaking. Outreach activities include the publication of a geothermal direct use Bulletin, dissemination of information, geothermal library, technical papers and seminars, and progress monitor reports on geothermal resources and utilization.

  11. Geothermal direct-heat utilization assistance. Quarterly report, July--September 1993

    Energy Technology Data Exchange (ETDEWEB)

    1993-11-01

    This report details activities from July through September 1993, Topics addressed are: Technical Assistance; Research and Development Activities; Technology Transfer; Geothermal Progress Monitor; and Personnel.

  12. Geothermal direct-heat utilization assistance. Quarterly project progress report, January--March 1994

    Energy Technology Data Exchange (ETDEWEB)

    1994-05-01

    The Geo-Heat Center provides technical assistance on geothermal direct heat applications to developers, consultants and the public which could include: data and information on low-temperature (< 1500 C) resources, space and district heating, geothermal heat pumps, greenhouses, aquaculture, industrial processes and other technologies. This assistance could include preliminary engineering feasibility studies, review of direct-use project plans, assistance in project material and equipment selection, analysis and solutions of project operating problems, and information on resources and utilization. The following are brief descriptions of technical assistance provided during the second quarter of the program.

  13. Feasibility of direct utilization of selected geothermal water for aquaculture of macrobrachium rosenbergii. Technical report

    Energy Technology Data Exchange (ETDEWEB)

    Spinosa, C.

    1984-05-01

    The feasibility was tested of direct utilization of geothermal water for the aquaculture of Malaysian freshwater prawns (Macrobrachium rosenbergii). A problem with using geothermal water for aquaculture is the chemical composition of the water with high flouride levels being a particular problem. Results show that (1) some geothermal water in Idaho can be used directly for the aquaculture of Macrobrachium rosenbergii, (2) high flouride levels cannot be directly correlated with high mortality rates and (3) low flouride levels do not correlate with high growth rates.

  14. Report: Congressionally Requested Information on EPA Utilization of Integrated Risk Information System

    Science.gov (United States)

    Report #13-P-0127, January 31, 2013. 85 percent of the EPA survey respondents reported that they have used IRIS as their primary source for cancer values and 81 percent have used IRIS as their primary source for non-cancer values.

  15. Maternal education and child healthcare in Bangladesh.

    Science.gov (United States)

    Huq, Mohammed Nazmul; Tasnim, Tarana

    2008-01-01

    Child health is one of the important indicators for describing mortality conditions, health progress and the overall social and economic well being of a country. During the last 15 years, although Bangladesh has achieved a significant reduction in the child mortality rate, the levels still remain very high. The utilization of qualified providers does not lead to the desired level; only a third relies on qualified providers. This study is mainly aimed at investigating the influence of maternal education on health status and the utilization of child healthcare services in Bangladesh. This study is based on the data of the Household Income Expenditure Survey (HIES) conducted by the Bangladesh Bureau of Statistics (BBS) during 2000. The analysis of the findings reveals that 19.4% of the children under five reported sickness during 30 days prior to the survey date. Moreover, approximately one out of every thirteen children suffers from diarrhoea in the country. It is striking to note that a significant portion of the parents relied on unqualified or traditional providers for the children's healthcare because of low cost, easy accessibility and familiarity of the services. The study suggests that maternal education is a powerful and significant determinant of child health status in Bangladesh. Maternal education also positively affects the number of children receiving vaccination. In order to improve the health condition of children in Bangladesh maternal education should be given top priority. The public policies should not just focus on education alone, but also consider other factors, such as access to health facilities and quality of services. Health awareness campaign should be strengthened as part of the public health promotion efforts. More emphasis should also be given to government-NGO (Non Government Organization) partnerships that make vaccination programs successful and, thereby, reduce the incidence of preventable diseases.

  16. Non-electric utilization of geothermal energy in the San Luis Valley, Colorado. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Vorum, M.; Coury, G.E.; Goering, S.W.; Fritzler, E.A.

    1978-02-01

    Information on the geothermal resources of the San Luis Valley, Colorado, has been gathered and reviewed and a preliminary, quantitative assessment of the magnitude and quality of resources present was carried out. Complete process designs were developed for the processes of producing crystal sugar from beets and for malting barley for use in the brewing industry, in each case adapting the processes to use a 302/sup 0/F geothermal water supply as the main process energy source. A parametric design analysis was performed for a major pipeline to be used to ship geothermal water, and thus deliver its heat, out of the San Luis Valley to three major Colorado cities along the eastern threshold of the Rocky Mountains. Cost estimates for capital equipment and energy utilization are presented. The analyses of the two process applications indicate favorable economics for conversion and operation as geothermally-heated plants. A major geothermal water pipeline for this region is seriously limited on achievement of the economy of scale by the physical absence of significant demand for heat energy. Finally, the development and utilization of Colorado's San Luis Valley geothermal groundwaters hold the potential to contribute to the prudent and beneficial management of that area's natural water resources systems.

  17. The market potential for SMES in electric utility applications. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1994-06-01

    Superconducting magnetic energy storage (SMES) is an emerging technology with features that are potentially attractive in electric utility applications. This study evaluates the potential for SMES technology in the generation, transmission, distribution, and use of electric energy; the time frame of the assessment is through the year 2030. Comparisons are made with other technology options, including both commercially available and advanced systems such as various peaking generation technologies, transmission stability improvement technologies, and power quality enhancement devices. The methodology used for this study focused on the needs of the market place, the capabilities of S and the characteristics of the competing technologies. There is widespread interest within utilities for the development of SMES technology, but there is no general consensus regarding the most attractive size. Considerable uncertainty exists regarding the eventual costs and benefits of commercial SMES systems, but general trends have been developed based on current industry knowledge. Results of this analysis indicate that as storage capacity increases, cost increases at a rate faster than benefits. Transmission system applications requiring dynamic storage appear to have the most attractive economics. Customer service applications may be economic in the near term, but improved ride-through capability of end-use equipment may limit the size of this market over time. Other applications requiring greater storage capacity appear to be only marginally economic at best.

  18. IEA Agreement on the Production and utilization of hydrogen: 1998 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Elam, Carolyn C. (National Renewable Energy Lab, Golden, CO (US)) (ed.)

    1999-01-31

    The annual report includes an overview of the IEA Hydrogen Agreement, including its guiding principles. The Chairman's report section includes highlights of the agreement for 1998. Annex reports are given on various tasks: Task 10, Photoproduction of Hydrogen, Task 11, Integrated Systems, and Task 12, Metal Hydrides and Carbon for Hydrogen Storage. Lastly, a feature article by Karsten Wurr, E3M Material Consulting, GmbH, Hamburg Germany, is included titled 'Hydrogen in Material Science and Technology: State of the Art and New Tendencies'.

  19. IEA Agreement on the production and utilization of hydrogen: 1996 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Elam, Carolyn C. (National Renewable Energy Lab, Golden, CO (US)) (ed.)

    1997-01-31

    The annual report includes an overview of the IEA Hydrogen Agreement, including a brief summary of hydrogen in general. The Chairman's report provides highlights for the year. Sections are included on hydrogen energy activities in the IEA Hydrogen Agreement member countries, including Canada, European Commission, Germany, Japan, Netherlands, Norway, Spain, Sweden, Switzerland, and the US. Lastly, Annex reports are given for the following tasks: Task 10, Photoproduction of Hydrogen, Task 11, Integrated Systems, and Task 12, Metal Hydrides and Carbon for Hydrogen Storage.

  20. Thorium utilization program progress report, July 1, 1975--September 30, 1976

    Energy Technology Data Exchange (ETDEWEB)

    Lotts, A.L.; Kasten, P.R.

    1977-07-01

    Status of the following tasks is reported: program management and analysis; reprocessing development; refabrication development; waste treatment; fuels irradiation and examination; HTGR fuel recycle demonstration facility; hot engineering test project; and cold prototype refabrication development. (LK)

  1. Geothermal direct-heat utilization assistance. Quarterly project progress report, April--June 1993

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.

    1993-06-01

    Technical assistance was provided to 60 requests from 19 states. R&D progress is reported on: evaluation of lineshaft turbine pump problems, geothermal district heating marketing strategy, and greenhouse peaking analysis. Two presentations and one tour were conducted, and three technical papers were prepared. The Geothermal Progress Monitor reported: USGS Forum on Mineral Resources, Renewable Energy Tax Credits Not Working as Congress Intended, Geothermal Industry Tells House Panel, Newberry Pilot Project, and Low-Temperature Geothermal Resources in Nevada.

  2. Improving Healthcare Logistics Processes

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes

    provision whilst providing high quality care. Logistics activities in hospitals provide a significant opportunity for cost containment in healthcare through the implementation of best practices. Literature provides little guidance on how to improve healthcare logistics processes. This study investigates......Healthcare costs are increasing due to an ageing population and more sophisticated technologies and treatments. At the same time, patients expect high quality care at an affordable cost. The healthcare industry has therefore experienced increasing pressures to reduce the cost of healthcare...... logistics processes in hospitals and aims to provide theoretically and empirically based evidence for improving these processes to both expand the knowledge base of healthcare logistics and provide a decision tool for hospital logistics managers to improve their processes. Case studies were conducted...

  3. Advanced system demonstration for utilization of biomass as an energy source. Environmental report

    Energy Technology Data Exchange (ETDEWEB)

    McCollom, M.

    1979-01-01

    The conclusions and findings of extensive analyses undertaken to assess the environmental impacts and effects of the proposal to assist in an Advanced System Demonstration for Utilization of Biomass as an Energy Source by means of a wood-fueled power plant. Included are a description of the proposed project, a discussion of the existing environment that the project would affect, a summary of the project's impacts on the natural and human environments, a discussion of the project's relationships to other government policies and plans, and an extensive review of the alternatives which were considered in evaluating the proposed action. All findings of the research undertaken are discussed. More extensive presentations of the methods of analysis used to arrive at the various conclusions are available in ten topical technical appendices.

  4. Utilization of lightweight materials made from coal gasification slags. Quarterly report, March 1995--May 1995

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-06-01

    Integrated-gasification combined-cycle (IGCC) technology is an emerging technology that utilizes coal for power generation and production of chemical feedstocks. However, this process generates large amounts of solid waste, consisting of vitrified ash (slag) along with some unconverted carbon, which is disposed of as solid waste. In previous projects, Praxis investigated the utilization of {open_quotes}as-generated{close_quotes} slags for a wide variety of applications in road construction, cement and concrete production, agricultural applications, and as a landfill material. From these studies, we found that it would be extremely difficult for {open_quotes}as-generated{close_quotes} slag to find large-scale acceptance in the marketplace even at no cost because the materials it could replace were abundantly available at very low cost. It became apparent that a more promising approach would be to develop a variety of value-added products from slag that meet specific industry requirements. This approach was made feasible by the discovery that slag could be made into a lightweight material by controlled heating in a kiln at temperatures between 1400 and 1700{degrees}F. These results indicated the potential for using such materials as substitutes for conventional lightweight aggregates (LWA). The technology to produce lightweight and ultra-lightweight aggregates (ULWA) from slag was subsequently developed by Praxis with funding from the Electric Power Research Institute (EPRI), Illinois Clean Coal Institute (ICCI), and internal resources. The major objectives of the subject project, funded by DOE`s Morgantown Energy Technology Center (METC), are to demonstrate the technical and economic viability of commercial production of LWA and ULWA from slag and to test the suitability of these aggregates for various applications.

  5. Social marketing in healthcare

    OpenAIRE

    Radha Aras

    2011-01-01

    BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsoc...

  6. Healthcare professionals' perspectives on environmental sustainability.

    Science.gov (United States)

    Dunphy, Jillian L

    2014-06-01

    Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions. What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome? Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines. A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity. Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector's focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties. The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour. The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to

  7. The Adult ADHD Self-Report Scale (ASRS: utility in college students with attention-deficit/hyperactivity disorder

    Directory of Open Access Journals (Sweden)

    Sarah Gray

    2014-03-01

    Full Text Available Background. The number of students with Attention Deficit/Hyperactivity Disorder (ADHD enrolled in colleges and universities has increased markedly over the past few decades, giving rise to questions about how best to document symptoms and impairment in the post-secondary setting. The aim of the present study was to investigate the utility and psychometric properties of a widely-used rating scale for adults with ADHD, the Adult ADHD Self-Report Scale (ASRS-V1.1, in a sample of post-secondary students with ADHD.Methods. A total of 135 college students (mean age = 24, 42% males with ADHD were recruited from Student Disability Services in post-secondary institutions. We compared informant responses on the ASRS administered via different modalities. First, students’ self-report was ascertained using the ASRS Screener administered via telephone interview, in which they were asked to provide real-life examples of behavior for each of the six items. Next, students self-reported symptoms on the 18-item paper version of the ASRS Symptom Checklist administered about 1–2 weeks later, and a collateral report using an online version of the 18-item ASRS Symptom Checklist. Students also completed self-report measures of everyday cognitive failure (CFQ and executive functioning (BDEFS.Results. Results revealed moderate to good congruency between the 18-item ASRS-Self and ASRS-Collateral reports (correlation = .47, and between student self-report on the 6-item telephone-based and paper versions of the ASRS, with the paper version administered two weeks later (correlation = .66. The full ASRS self-report was related to impairment, such as in executive functioning (correlation = .63 and everyday cognitive failure (correlation = .74. Executive functioning was the only significant predictor of ASRS total scores.Discussion. Current findings suggest that the ASRS provides an easy-to-use, reliable, and cost-effective approach for gathering information about current

  8. The Adult ADHD Self-Report Scale (ASRS): utility in college students with attention-deficit/hyperactivity disorder.

    Science.gov (United States)

    Gray, Sarah; Woltering, Steven; Mawjee, Karizma; Tannock, Rosemary

    2014-01-01

    Background. The number of students with Attention Deficit/Hyperactivity Disorder (ADHD) enrolled in colleges and universities has increased markedly over the past few decades, giving rise to questions about how best to document symptoms and impairment in the post-secondary setting. The aim of the present study was to investigate the utility and psychometric properties of a widely-used rating scale for adults with ADHD, the Adult ADHD Self-Report Scale (ASRS-V1.1), in a sample of post-secondary students with ADHD. Methods. A total of 135 college students (mean age = 24, 42% males) with ADHD were recruited from Student Disability Services in post-secondary institutions. We compared informant responses on the ASRS administered via different modalities. First, students' self-report was ascertained using the ASRS Screener administered via telephone interview, in which they were asked to provide real-life examples of behavior for each of the six items. Next, students self-reported symptoms on the 18-item paper version of the ASRS Symptom Checklist administered about 1-2 weeks later, and a collateral report using an online version of the 18-item ASRS Symptom Checklist. Students also completed self-report measures of everyday cognitive failure (CFQ) and executive functioning (BDEFS). Results. Results revealed moderate to good congruency between the 18-item ASRS-Self and ASRS-Collateral reports (correlation = .47), and between student self-report on the 6-item telephone-based and paper versions of the ASRS, with the paper version administered two weeks later (correlation = .66). The full ASRS self-report was related to impairment, such as in executive functioning (correlation = .63) and everyday cognitive failure (correlation = .74). Executive functioning was the only significant predictor of ASRS total scores. Discussion. Current findings suggest that the ASRS provides an easy-to-use, reliable, and cost-effective approach for gathering information about current symptoms of

  9. Socially-assigned race, healthcare discrimination and preventive healthcare services.

    Directory of Open Access Journals (Sweden)

    Tracy Macintosh

    Full Text Available BACKGROUND: Race and ethnicity, typically defined as how individuals self-identify, are complex social constructs. Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than self-identified non-Hispanic whites. However, beyond self-identification, these outcomes may vary depending on whether racial/ethnic minorities are perceived by others as being minority or white; this perception is referred to as socially-assigned race. PURPOSE: To examine the associations between socially-assigned race and healthcare discrimination and receipt of selected preventive services. METHODS: Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System "Reactions to Race" module. Respondents from seven states and the District of Columbia were categorized into 3 groups, defined by a composite of self-identified race/socially-assigned race: Minority/Minority (M/M, n = 6,837, Minority/White (M/W, n = 929, and White/White (W/W, n = 25,913. Respondents were 18 years or older, with 61.7% under age 60; 51.8% of respondents were female. Measures included reported healthcare discrimination and receipt of vaccinations and cancer screenings. RESULTS: Racial/ethnic minorities who reported being socially-assigned as minority (M/M were more likely to report healthcare discrimination compared with those who reported being socially-assigned as white (M/W (8.9% vs. 5.0%, p = 0.002. Those reporting being socially-assigned as white (M/W and W/W had similar rates for past-year influenza (73.1% vs. 74.3% and pneumococcal (69.3% vs. 58.6% vaccinations; however, rates were significantly lower among M/M respondents (56.2% and 47.6%, respectively, p-values<0.05. There were no significant differences between the M/M and M/W groups in the receipt of cancer screenings. CONCLUSIONS: Racial/ethnic minorities who reported being socially-assigned as white are more likely to receive

  10. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  11. Basic Research Needs for Solar Energy Utilization. Report of the Basic Energy Sciences Workshop on Solar Energy Utilization, April 18-21, 2005

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, N. S.; Crabtree, G.; Nozik, A. J.; Wasielewski, M. R.; Alivisatos, P.; Kung, H.; Tsao, J.; Chandler, E.; Walukiewicz, W.; Spitler, M.; Ellingson, R.; Overend, R.; Mazer, J.; Gress, M.; Horwitz, J.; Ashton, C.; Herndon, B.; Shapard, L.; Nault, R. M.

    2005-04-21

    World demand for energy is projected to more than double by 2050 and to more than triple by the end of the century. Incremental improvements in existing energy networks will not be adequate to supply this demand in a sustainable way. Finding sufficient supplies of clean energy for the future is one of society?s most daunting challenges. Sunlight provides by far the largest of all carbon-neutral energy sources. More energy from sunlight strikes the Earth in one hour (4.3 ? 1020 J) than all the energy consumed on the planet in a year (4.1 ? 1020 J). We currently exploit this solar resource through solar electricity ? a $7.5 billion industry growing at a rate of 35?40% per annum ? and solar-derived fuel from biomass, which provides the primary energy source for over a billion people. Yet, in 2001, solar electricity provided less than 0.1% of the world's electricity, and solar fuel from modern (sustainable) biomass provided less than 1.5% of the world's energy. The huge gap between our present use of solar energy and its enormous undeveloped potential defines a grand challenge in energy research. Sunlight is a compelling solution to our need for clean, abundant sources of energy in the future. It is readily available, secure from geopolitical tension, and poses no threat to our environment through pollution or to our climate through greenhouse gases. This report of the Basic Energy Sciences Workshop on Solar Energy Utilization identifies the key scientific challenges and research directions that will enable efficient and economic use of the solar resource to provide a significant fraction of global primary energy by the mid 21st century. The report reflects the collective output of the workshop attendees, which included 200 scientists representing academia, national laboratories, and industry in the United States and abroad, and the U.S. Department of Energy?s Office of Basic Energy Sciences and Office of Energy Efficiency and Renewable Energy.

  12. Economic feasibility of alternative utility-sponsored weatherization programs in Maryland. Phase II. Summary report

    Energy Technology Data Exchange (ETDEWEB)

    Dubinsky, R.; Thibodeau, T.

    1982-12-01

    This report summarizes the results of a study of the economic impacts of residential energy conservation programs on Potomac Edison, Potomac Electric Power Company, Washington Gas Light Company, Delmarva Power and Light Company, and Southern Maryland Electric Cooperative. The report is intended to provide policy makers with information concerning the advantages and disadvantages and costs and benefits of various program options. These findings can assist the policy maker in determining what kinds of residential conservation programs are appropriate for Maryland, how large they should be, how they should be implemented and who should pay for them.

  13. IEA agreement on the production and utilization of hydrogen: 2000 annual report

    Energy Technology Data Exchange (ETDEWEB)

    Elam, Carolyn C. [National Renewable Energy Lab., Golden, CO (US)] (ed.)

    2001-12-01

    The 2000 annual report of the IEA Hydrogen Agreement contains an overview of the agreement, including its guiding principles, latest strategic plan, and a report from the Chairman, Mr. Neil P. Rossmeissl, U.S. Department of Energy. Overviews of the National Hydrogen Programs of nine member countries are given: Canada, Japan, Lithuania, the Netherlands, Norway, Spain, Sweden, Switzerland, and the United States. Task updates are provided on the following annexes: Annex 12 - Metal Hydrides and Carbon for Hydrogen Storage, Annex 13 - Design and Optimization of Integrated Systems, Annex 14 - Photoelectrolytic Production of Hydrogen, and, Annex 15 - Photobiological Production of Hydrogen.

  14. Cellular localization of choline-utilization proteins in Streptococcus pneumoniae using novel fluorescent reporter systems

    NARCIS (Netherlands)

    Eberhardt, Alice; Wu, Ling J.; Errington, Jeff; Vollmer, Waldemar; Veening, Jan-Willem

    2009-01-01

    P>The molecular mechanisms underlying cell growth, cell division and pathogenesis in Streptococcus pneumoniae are still not fully understood. Single-cell methodologies are potentially of great value to investigate S. pneumoniae cell biology. Here, we report the construction of novel plasmids for sin

  15. Assessing the Utility of Automatic Cancer Registry Notifications Data Extraction from Free-Text Pathology Reports.

    Science.gov (United States)

    Nguyen, Anthony N; Moore, Julie; O'Dwyer, John; Philpot, Shoni

    2015-01-01

    Cancer Registries record cancer data by reading and interpreting pathology cancer specimen reports. For some Registries this can be a manual process, which is labour and time intensive and subject to errors. A system for automatic extraction of cancer data from HL7 electronic free-text pathology reports has been proposed to improve the workflow efficiency of the Cancer Registry. The system is currently processing an incoming trickle feed of HL7 electronic pathology reports from across the state of Queensland in Australia to produce an electronic cancer notification. Natural language processing and symbolic reasoning using SNOMED CT were adopted in the system; Queensland Cancer Registry business rules were also incorporated. A set of 220 unseen pathology reports selected from patients with a range of cancers was used to evaluate the performance of the system. The system achieved overall recall of 0.78, precision of 0.83 and F-measure of 0.80 over seven categories, namely, basis of diagnosis (3 classes), primary site (66 classes), laterality (5 classes), histological type (94 classes), histological grade (7 classes), metastasis site (19 classes) and metastatic status (2 classes). These results are encouraging given the large cross-section of cancers. The system allows for the provision of clinical coding support as well as indicative statistics on the current state of cancer, which is not otherwise available.

  16. THE TRAINING AND UTILIZATION OF CHILD BEHAVIOR CONSULTANTS IN THE SCHOOLS. FINAL REPORT.

    Science.gov (United States)

    Erie County Board of Cooperative Educational Services, Buffalo, NY.

    THE PURPOSE OF THIS REPORT IS TO EVALUATE THE OBJECTIVES AND PRE-OPERATIONAL TRAINING OF A PROGRAM DESIGNED TO PROVIDE CHILD BEHAVIOR CONSULTANTS (CBCS) FOR SCHOOLS. THE EVALUATION IS BASED ON QUESTIONNAIRE DATA, CASE STUDIES, AND INTERVIEWS WITH TEACHERS AND STUDENTS. WHETHER THERE WERE ACTUAL PERSONALITY DIFFERENCES BETWEEN STUDENTS WHO WERE…

  17. 77 FR 16494 - Revised Public Utility Filing Requirements for Electric Quarterly Reports

    Science.gov (United States)

    2012-03-21

    ... product product Definition SIMULTANEOUS EXCHANGE Simultaneous exchanges occur when a pair of... Quarterly Report (EQR) Data Dictionary to add ``Simultaneous Exchange'' to the list of available Product... Exchange'' to the list of available Product Names in the EQR. This revision would allow for...

  18. Effects of atmospheric variability on energy utilization and conservation. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Reiter, E.R.; Burns, C.C.; Cochrane, H.; Johnson, G.R.; Leong, H.; Sheaffer, J.D.

    1980-07-01

    Research progress for the period September 1979 to July 1980 is reported. Research was structured along four major tasks: (1) atmospheric circulation and climate variability; (2) urban mesoclimate; (3) energy demand modelling; and (4) economic implications of weather variability and energy demand: stimulating residential energy conservation through the financial section. (ACR)

  19. Appendix B: Site Visit Reports. Assessment of Research Needs for Coal Utilization

    Energy Technology Data Exchange (ETDEWEB)

    Penner, S.S.

    1983-05-01

    This section contains edited copies of site-visit and other reports prepared by CCAWG members. Some of the hand-out materials prepared by DOE contractors and others are included (without explication) to permit readers the construction of a coherent picture of work in progress.

  20. Polypharmacy in HIV: impact of data source and gender on reported drug utilization.

    Science.gov (United States)

    Furler, Michelle D; Einarson, Thomas R; Walmsley, Sharon; Millson, Margaret; Bendayan, Reina

    2004-10-01

    Drug use in HIV is complex and may involve multiple therapeutic and nontherapeutic agents including prescription, over-the-counter, complementary and alternative medicine, and social/recreational drugs. This study was designed to assess the extent of such drug use in HIV-infected men and women. One hundred four adults were recruited through the HIV Ontario Observational Database from HIV outpatient clinics throughout Ontario, Canada. Patient demographics and data on drug use and physician awareness of drug use were collected through in-person interviews and medical chart review. All patient interviews and 96% of medical charts revealed the use of at least one drug. Eighty-five percent of patients reported use of antiretroviral medications; nearly 70% used highly active antiretroviral therapy. Patients used significantly more drugs by patient report (15.7 +/- 7.7) than by medical chart review (8.4 +/- 5.0) reporting up to 39 drugs per person. Pill burden was substantial, averaging 20.7 +/- 12.5 and ranged up to 69 "pills-per-day." Patient-reported physician awareness of drug use was highest for prescription drugs and lowest for social/recreational drugs; correspondingly agreement between medical chart and patient report ranged from 80% for antiretrovirals to 10% for non-prescribed drugs. The drug and pill burden faced by patients with HIV is considerable. Prevalence of use for specific drug classes varied with both data source and gender while number of drugs used differed only by data source. Our findings emphasize the complexity of pharmacotherapy in HIV and the need for comprehensive drug assessment, particularly because of the risks of drug-drug interactions and decreased adherence secondary to therapeutic complexity.

  1. Utilization of ash from municipal solid waste combustion. Final report, Phase I

    Energy Technology Data Exchange (ETDEWEB)

    Jones, C.M.; Hartman, R.M.; Kort, D.; Rapues, N.

    1994-09-01

    This ash study investigates several aspects of Municipal Waste Combustion (MWC) ash utilization to develop an alternative to the present disposal practice of landfilling in a lined monofill. Ash was investigated as a daily or final cover for municipal waste in the landfill to prevent erosion and as a road construction aggregate. Samples of eight mixtures of ash and other materials, and one sample of soil were analyzed for chemical constituents. Biological tests on these mixters were conducted, along with erosion tests and sieve analyses. A chemical analysis of each sieve size was conducted. Geotechnical properties of the most promising materials were made. Findings to this point include: all ash samples take have passed the EPA TCLP testing; chemical analysis of bottom and combined ash samples indicate less than expected variability; selected ash mixtures exhibited very low coefficients of hydraulic conductivity; all but one of the ash mixtures exhibited greater erosion resistance than the currently used landfill cover material; MWC combined analysis indicates this is a viable alternative for landfill cover; MWC ash size reactions and chemical analysis show bottom and combined ash to be a viable alternative for road construction.

  2. Report on neutron beam utilization and study of high Tc superconductors at NRI

    Energy Technology Data Exchange (ETDEWEB)

    Vuong Huu Tan [Nuclear Physics Dept., Nuclear Research Inst. (NRI), Dalat (Viet Nam)

    1998-10-01

    Utilization of reactor neutron beams at NRI for research and applications up to November 1996 had been presented at the last Workshop in Jakarta (25-28 Nov., 1996). This paper describes new research and applications carried out at Nuclear Physics Department of NRI after that time. They consist of neutron beam developments, neutron activation cross section measurements for waste disposal assessment and in-vivo prompt gamma neutron activation analysis for Cd determination in organs. After the last Sub-Workshop on Neutron Scattering in Serpong (21-23 Nov., 1996), we were accepted to participate in the Regional Program on Study of High Tc Superconductors with the topic `The mechanism of Pb and Sb dopant role on superconductivity of 2223 phase of Bi-Sr-Ca-Cu-O system`. Indeed, this study has begun at NRI only since August, 1997 due to the problem of materials. The study has been carried out in collaboration with the Hanoi State University (Superconductors Department) where experts and equipment for superconductors research have been considered as the best ones in Vietnam. Primary results in this study are presented in this workshop. (author)

  3. A status report on international utility-scale wind energy markets

    Energy Technology Data Exchange (ETDEWEB)

    Rackstraw, K.; Vaupen, S. [American Wind Energy Association, Washington, DC (United States)

    1997-12-31

    AWEA`s latest ten-year projections for new installations of utility-scale wind turbines show nearly 30,000 new megawatts (MW) should be installed between the years 1997 and 2006. The study also briefly explores the potential impact of a significant event, such as a fossil fuel price spike or a strong move to slow global climate change, that could double installed new wind capacity to nearly 60,000 MW over the same period. This outlook is substantially more optimistic than last year`s (about 20,000 MW), but the numbers are somewhat skewed by rolling the outlook forward one year. In other words, the new projections cover a ten-year period beginning one year later than last year`s study. The skewing is a result of substituting the lowest year in last year`s study with the highest year in the new ten-year period (2006), when far more capacity additions can be expected. In addition, AWEA has adjusted upward the numbers for some countries, most notably Germany, Denmark, Spain, Italy, China and the US. Last year`s projections were decidedly, and purposefully, conservative but trends are such that greater optimism about future markets is justified.

  4. Utilization of agricultural wastes for production of ethanol. Progress report, October 1979-May 1980

    Energy Technology Data Exchange (ETDEWEB)

    Singh, B.

    1980-05-01

    The project proposes to develop methods to utilize agricultural wastes, especially cottonseed hulls and peanut shells to produce ethanol. Initial steps will involve development of methods to break down cellulose to a usable form of substrates for chemical or biological digestion. The process of ethanol production will consist of (a) preparatory step to separate fibrous (cellulose) and non-fibrous (non-cellulosic compounds). The non-cellulosic residues which may include grains, fats or other substrates for alcoholic fermentation. The fibrous residues will be first pre-treated to digest cellulose with acid, alkali, and sulfur dioxide gas or other solvents. (b) The altered cellulose will be digested by suitable micro-organisms and cellulose enzymes before alcoholic fermentation. The digester and fermentative unit will be specially designed to develop a prototype for pilot plant for a continuous process. The first phase of the project will be devoted toward screening of a suitable method for cellulose modification, separation of fibrous and non-fibrous residues, the micro-organism and enzyme preparations. Work is in progress on: the effects of various microorganisms on the degree of saccharification; the effects of higher concentrations of acids, alkali, and EDTA on efficiency of microbial degradation; and the effects of chemicals on enzymatic digestion.

  5. Utility of PDL progenitors for in vivo tissue regeneration: a report of 3 cases

    Science.gov (United States)

    Feng, F; Akiyama, K; Liu, Y; Yamaza, T; Wang, T-M; Chen, J-H; Wang, BB; Huang, G T-J; Wang, S; Shi, S

    2010-01-01

    Objective Periodontal disease is an inflammatory disorder with widespread morbidities involving both oral and systemic health. The primary goal of periodontal treatment is the regeneration of the lost or diseased periodontium. In this study, we retrospectively examined feasibility and safety of reconstructing the periodontal intrabony defects with autologous periodontal ligament progenitor (PDLP) implantation in three patients. Materials and Methods In this retrospective pilot study, we treated 16 teeth with at least one deep intrabony defect of probing depth (PD) ≥ 6 mm with PDLP transplantation and evaluated clinical outcome measures in terms of probing depth, gingival recession and attachment gain for a duration of 32–72 months. Furthermore, we compare PDLPs with standard PDL stem cells (PDLSCs) and confirmed that PDLPs possessed progenitor characters. Results Clinical examination indicated that transplantation of PDLPs may provide therapeutic benefit for the periodontal defects. All treated patients showed no adverse effects during the entire course of follow up. We also found that PDLPs were analogous to PDLSCs in terms of high proliferation, expression of mesenchymal surface molecules, multipotent differentiation, and in vivo tissue regain. However, PDLPs failed to express scleraxis, a marker of tendon, as seen in PDLSCs. Conclusions This study demonstrated clinical and experimental evidences supporting a potential efficacy and safety of utilizing autologous PDL cells in the treatment of human periodontitis. PMID:20355278

  6. Direct utilization of geothermal energy for Pagosa Springs, Colorado. Final report, June 1979-June 1984

    Energy Technology Data Exchange (ETDEWEB)

    Goering, S.W.; Garing, K.L.; Coury, G.

    1984-08-01

    The Pagosa Springs Geothermal District Heating System was conceptualized, designed, and constructed between 1979 to 1984 under the US Department of Energy Program Opportunity Notice (PON) program to demonstrate the feasibility for utilizing moderate temperature geothermal resources for direct-use applications. The Pagosa Springs system successfully provides space heating to public buildings, school facilities, residences, and commercial establishments at costs significantly lower than costs of available conventional fuels. The Pagosa Springs project encompassed a full range of technical, institutional, and economic activities. Geothermal reservoir evaluations and testing were performed, and two productive approx.140/sup 0/F geothermal supply wells were successfully drilled and completed. Transmission and distribution system design, construction, startup, and operation were achieved with minimum difficulty. The geothermal system operation during the first two heating seasons has been fully reliable and well respected in the community. The project has proven that low to moderate-temperature waters can effectively meet required heating loads, even for harsh winter-mountain environments. The principal difficulty encountered has been institutional in nature and centers on the obtaining of the geothermal production well permits and the adjudicated water rights necessary to supply the geothermal hot water fluids for the full operating life of the system. 28 figs., 15 tabs.

  7. Comments on the Hurricane Juan report to the Nova Scotia Utility and Review Board

    Energy Technology Data Exchange (ETDEWEB)

    Tedesco, R.R.

    2004-05-14

    Nova Scotia Power Inc. (NSPI) has responded to several recommendations made by an independent consultant regarding its emergency response to Hurricane Juan which hit the Halifax Regional Municipality on September 28, 2003. NSPI is in agreement with most of the recommendations and is enhancing its preparedness for use in disaster scenarios similar to Hurricane Juan. Several recommendations have already been implemented by the power company including, improvements to call centre technology and processes, and better coordination with the electricity market operator and municipal responders. Lessons learned from Hurricane Juan were applied during a snow storm in February 2004, particularly in terms of communications. NSPI strongly disagrees with the consultant's recommendation to bring in hundreds of line crews from outside the region in advance of a major storm. NSPI argues that doing so, would have tripled or quadrupled Hurricane Juan costs to $40 or $50 million with little or no improvement on restoration times. Nova Scotia Power Inc. is a wholly-owned subsidiary of Emera (EMA-TSX). The utility provides more than 97 per cent of electric generation, transmission, and distribution to more than 460,000 customers across Nova Scotia. NSPI is committed to supporting Nova Scotian communities by providing safe, reliable power.

  8. Direct utilization of geothermal energy in western South Dakota agribusiness. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Howard, S.M.

    1983-09-01

    This project involved the direct utilization of geothermal energy for (1) space heating of farm and ranch buildings, (2) drying grain, and (3) providing warm stock water during the winter. The site for this demonstration project was the Diamond Ring Ranch north of Midland, South Dakota. Geothermal water flowing from an existing well into the Madison Aquifer was used to heat four homes, a shop, a hospital barn for cattle, and air for a barn and grain dryer. This site is centrally located in the western region of South Dakota where geothermal water is available from the Madison Aquifer. The first year of the project involved the design of the heating systems and its construction while the following years were for operation, testing, demonstrating, and monitoring the system. Required modifications and improvements were made during this period. Operating modifications and improvements were made during this period. Operating experience showed that such application of geothermal resources is feasible and can result in substantial fuel savings. Economic analyses under a variety of assumptions generally gave payback periods of less than ten years. Numerous technical recommendations are made. The most significant being the necessity of passive protection from freezing of remote geothermal systems subject to winter shut downs caused by power or equipment failure. The primary institutional recommendation is to incorporate a use for the geothermal water such as irrigation or stock watering into agribusiness-related geothermal development.

  9. Workplace Bullying among Healthcare Workers

    Directory of Open Access Journals (Sweden)

    María José Montero-Simó

    2013-07-01

    Full Text Available This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08. The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

  10. Workplace Bullying among Healthcare Workers

    Science.gov (United States)

    Ariza-Montes, Antonio; Muniz, Noel M.; Montero-Simó, María José; Araque-Padilla, Rafael Angel

    2013-01-01

    This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers. PMID:23887621

  11. Occupational exposure of healthcare and research staff to static magnetic stray fields from 1.5-7 Tesla MRI scanners is associated with reporting of transient symptoms.

    NARCIS (Netherlands)

    Schaap, Kristel; Christopher-de Vries, Yvette; Mason, Catherine K; de Vocht, Frank; Portengen, Lützen; Kromhout, Hans

    2014-01-01

    OBJECTIVES: Limited data is available about incidence of acute transient symptoms associated with occupational exposure to static magnetic stray fields from MRI scanners. We aimed to assess the incidence of these symptoms among healthcare and research staff working with MRI scanners, and their assoc

  12. Financial constraints in capacity planning: a national utility regulatory model (NUREG). Volume I of III: methodology. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1981-10-29

    This report develops and demonstrates the methodology for the National Utility Regulatory (NUREG) Model developed under contract number DEAC-01-79EI-10579. It is accompanied by two supporting volumes. Volume II is a user's guide for operation of the NUREG software. This includes description of the flow of software and data, as well as the formats of all user data files. Finally, Volume III is a software description guide. It briefly describes, and gives a listing of, each program used in NUREG.

  13. Geothermal direct-heat utilization assistance. Quarterly project progress report, July--September 1997

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-10-01

    This report summarizes geothermal technical assistance, R and D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the fourth quarter of FY-97 (July--September 1997). It describes 213 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include requests for general information including maps, geothermal heat pumps, resource and well data, space heating and cooling, greenhouses, acquaculture, equipment, district heating, resorts and spas, and industrial applications. Research activities include the completion of a Comprehensive Greenhouse Developer Package. Work accomplished on the revision of the Geothermal Direct Use Engineering and Design Guidebook are discussed. Outreach activities include the publication of the Quarterly Bulletin (Vol. 18, No. 3), dissemination of information mainly through mailings of publications, geothermal library acquisition and use, participation in workshops, short courses, and technical meetings by the staff, and progress monitor reports on geothermal activities.

  14. Evaluation of technology modifications required to apply clean coal technologies in Russian utilities. Final report

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-12-01

    The report describes the following: overview of the Russian power industry; electric power equipment of Russia; power industry development forecast for Russia; clean coal technology demonstration program of the US Department of Energy; reduction of coal TPS (thermal power station) environmental impacts in Russia; and base options of advanced coal thermal power plants. Terms of the application of clean coal technology at Russian TPS are discussed in the Conclusions.

  15. Military Hydrology. Report 8. Feasibility of Utilizing Satellite and Radar Data in Hydrologic Forecasting.

    Science.gov (United States)

    1985-09-01

    Keown , Chief, ECG, under the general super- vision of Dr. Lewis E. Link, Chief, ESD, and Dr. John Harrison, Chief, EL. During the preparation of this... Martin , D. W., Stout, J., and Sikdar, 1). N. 1976. "Rainfall Estimation from Geo- synchronous Satellite Imagery During Daylight Hours," NOAA...Technical Report ERL 356-WMPO 7, US Department of Commerce. Griffith, C. G., Woodley, W. L., Grube, P. G., Martin , D. W., Stout, J., and Sikdar. D. N. 1978

  16. Geothermal direct-heat utilization assistance. Quarterly project progress report, July 1994--September 1994

    Energy Technology Data Exchange (ETDEWEB)

    1994-10-01

    This paper is a third quarter 1994 report of activities of the Geo-Heat Center of Oregon Institute of Technology. It describes contacts with parties during this period related to assistance with geothermal direct heat applications. Areas dealt with include geothermal heat pumps, space heating, greenhouses, aquaculture, resources, and equipment. Research is also being conducted on failures of vertical lineshaft turbines in geothermal wells.

  17. Multidisciplinary research program directed toward utilization of solar energy through bioconversion of renewable resources. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Finnerty, W. R.

    1976-07-01

    Progress is reported in four research areas of solar bioconversion. The first program deals with the genetic selection of superior trees, physiological basis of vigor, tissue culture, haploid cell lines, and somatic hybridization. The second deals with the physiology of paraquat-induced oleoresin biogenesis. Separate abstracts were prepared for the other two program areas: biochemical basis of paraquat-induced oleoresin production in pines and biochemistry of methanogenesis. (JSR)

  18. Potential utility of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism: a case report.

    Science.gov (United States)

    Sato, Takeshi; Muroya, Koji; Hanakawa, Junko; Yamashita, Sumimasa; Nozawa, Kumiko; Masudo, Katsuhiko; Yamakawa, Tadashi; Asakura, Yumi; Hasegawa, Tomonobu; Adachi, Masanori

    2016-07-01

    We report a Japanese pedigree with familial primary hyperparathyroidism due to a CDC73 mutation. To our knowledge, this is the first report of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism. The proband had severe psychomotor retardation and received laryngotracheal separation surgery. At 19 yr of age, he developed acute pancreatitis. Hypercalcemia (12.2-13.8 mg/dL), elevated levels of intact PTH (86-160 pg/mL), and a tumor detected upon neck ultrasonography led to the diagnosis of primary hyperparathyroidism. Family history and biochemical examinations revealed that three family members (the proband's mother, elder brother, and maternal grandfather) had primary hyperparathyroidism. We identified a novel heterozygous mutation, c.240delT, p.Glu81Lysfs*28, in the CDC73 gene in three affected family members, excluding the proband's elder brother who refused genetic testing. Parathyroidectomy for the proband was considered as high-risk, because the tumor was located close to the tracheostomy orifice. After receiving approval from the institutional review board and obtaining the consent, we initiated cinacalcet treatment. At 22 yr of age, treatment with 100 mg of cinacalcet maintained serum calcium levels below 11.0 mg/dL with no apparent side effects. Our report presents the potential efficacy of cinacalcet as a treatment for CDC73-related primary hyperparathyroidism, in particularly inoperative cases.

  19. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

    Science.gov (United States)

    Heinrich, Sven; Deister, Arno; Birker, Thomas; Hierholzer, Cornelia; Weigelt, Ina; Zeichner, Dirk; Angermeyer, Matthias C; Roick, Christiane; König, Hans-Helmut

    2011-01-30

    Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

  20. Multicultural healthcare: a transatlantic project.

    Science.gov (United States)

    Koskinen, Liisa; Jokinen, Pirkko

    2007-01-01

    Healthcare is increasingly multicultural, posing a challenge for nurse educators in both Europe and the United States. Nursing education faculties are responding to the challenge of internationalization, for instance, by participating in international student exchange projects to foster students' intercultural competence. The authors describe an educational model constructed during a transatlantic project between European and American universities. The benefits of the project from the Finnish partner's perspective are also reported.

  1. Utilization of lightweight materials made from coal gasification slags. Quarterly report, September 1--November 30, 1997

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-12-31

    In previous projects, Praxis investigated the utilization of as-generated slags for a wide variety of applications in road construction, cement and concrete production, agricultural applications, and as a landfill material. From these studies, the authors found that it would be extremely difficult for as-generated slag to find large-scale acceptance in the marketplace even at no cost because the materials it could replace were abundantly available at very low cost. It became apparent that a more promising approach would be to develop a variety of value-added products from slag that meet specific industry requirements. This approach was made feasible by the discovery that slag undergoes expansion and forms a lightweight material when subjected to controlled heating in a kiln at temperatures between 1,400 and 1,700 F. These results confirmed the potential for using expanded slag as a substitute for conventional lightweight aggregates (LWA). The technology to produce lightweight and ultra-lightweight aggregates (ULWA) from slag was subsequently developed by Praxis. The major objectives of the subject project are to demonstrate the technical and economic viability of commercial production of LWA and ULWA from slag and to test the suitability of these aggregates for various applications. The project goals are to be accomplished in two phases: Phase 1, comprising the production of LWA and ULWA from slag at the large pilot scale, and Phase 2, which involves commercial evaluation of these aggregates in a number of applications. This document summarizes the Phase 2 accomplishments to date along with the major accomplishments from Phase 1.

  2. Fuel utilization improvements in a once-through PWR fuel cycle. Final report on Task 6

    Energy Technology Data Exchange (ETDEWEB)

    Dabby, D.

    1979-06-01

    In studying the position of the United States Department of Energy, Non-proliferation Alternative Systems Assessment Program, this report determines the uranium saving associated with various improvement concepts applicable to a once-through fuel cycle of a standard four-loop Westinghouse Pressurized Water Reactor. Increased discharged fuel burnup from 33,000 to 45,000 MWD/MTM could achieve a 12% U/sub 3/O/sub 8/ saving by 1990. Improved fuel management schemes combined with coastdown to 60% power, could result in U/sub 3/O/sub 8/ savings of 6%.

  3. Evaluating Lean in healthcare.

    Science.gov (United States)

    Burgess, Nicola; Radnor, Zoe

    2013-01-01

    The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Data were collected using content analysis methods, which relies on how "Lean" methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. This research is the first to examine more closely "how" Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

  4. Geothermal direct-heat utilization assistance. Quarterly progress report, January--March 1993

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, P.

    1993-03-30

    CHC (Geo-Heated Center) staff provided assistance to 103 requests from 26 states, and from Canada, Egypt, Mexico, China, Poland and Greece. A breakdown of the requests according to application include: space and district heating (19), geothermal heat pumps (24), greenhouses (10), aquaculture (4), industrial (4), equipment (3), resources (27), electric power (2) and other (20). Progress is reported on: (1) evaluation of lineshaft turbine pump problems, (2) pilot fruit drier and (3) geothermal district heating marketing tools and equipment investigation. Four presentations and two tours were conducted during the quarter, GHC Quarterly Bulletin Vol. 14, No. 4 was prepared, 14 volumes were added to the library and information was disseminated to 45 requests. Progress reports are on: (1) GHP Teleconference 93, (2) California Energy Buys Glass Mountain Prospect from Unocal and Makes Deal for Newberry Caldera, (3) New Power Plant Planned, (4) Vale to Get Power Plant, (5) BPA Approves Geothermal Project, (6) Update: San Bernardino Reservoir Study, (7) Twenty-nine Palms Geothermal Resources, (8) Geo-Ag Heat Center, Lake County, and (9) Update: Geothermal Wells at Alturas.

  5. Utilization of fuel cells to beneficially use coal mine methane. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Brown, J.T.; O`Brien, D.G.; Miller, A.R.; Atkins, R.; Sanders, M.

    1996-03-01

    DOE has been given the responsibility to encourage industry to recover and use methane that is currently being released to the atmosphere. At this time the only method being employed at the Left Fork Mine to remove methane is the mine ventilation system. The methane content was measured at one one-hundredth of a percent. To prevent this methane from being vented to the atmosphere, degasification wells are proposed. To use the coal mine methane, it is proposed to use phosphoric-acid fuel cells to convert methane to electric power. These fuel cells contain (1) a steam reformer to convert the methane to hydrogen (and carbon dioxide), (2) the fuel cell stack, and (3) a power conditioner that provides 200 kW of 60 Hz alternating current output. The environmental impacts and benefits of using this technology ware summarized in the report. The study indicates the methane emission reduction that could be achieved on a national and Global level. The important point being that this technology is economically viable as is demonstrated in the report.

  6. Case-study application of venture analysis: the integrated energy utility. Volume 2. Technical report

    Energy Technology Data Exchange (ETDEWEB)

    Fein, E; Gordon, T J; King, R; Kropp, F G; Shuchman, H L; Stover, J; Hausz, W; Meyer, C

    1978-11-01

    Application of venture analysis would, at a minimum, need to address issues involving careful definition of the product/service being considered; market needs that the product will satisfy; investment/manufacturing costs; minimum selling price needed to achieve desired ROI or other financial measure; market potential at relevant prices; potential for competitors to obsolete the product before investment is recovered; assessment of companies' resources and capabilities to supply the product. There is clearly no single method for performing every venture analysis, because the economic and structural environment associated with each industry varies widely. These and other factors produce differences in cost structure, marketing organizations, and nature of products which dictate that an appropriate method of venture analysis must be tailored to each industry. The initial chapter of the report presents some brief remarks concerning the important concepts that all venture analyses must consider and then describes in detail the method used for the venture analyzed in this report. The case study addresses IEUS for commercialization. The type of IEUS investigated supplies electricity and thermal energy; the thermal energy distributed in the form of high-temperature water, i.e., water from at least 90/sup 0/C upwards to 200/sup 0/C. (MCW)

  7. Geothermal direct-heat utilization assistance. Quarterly project progress report, October--December 1997

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-01-01

    This report summarizes geothermal technical assistance, R and D and technology transfer activities of the Geo-Heat Center at Oregon Institute of Technology for the first quarter of FY-98 (October--December 1997). It describes 216 contacts with parties during this period related to technical assistance with geothermal direct heat projects. Areas dealt with include requests for general information including maps and material for high school debates, and material on geothermal heat pumps, resource and well data, space heating and cooling, greenhouses, aquaculture, equipment, district heating, resorts and spas, industrial applications, electric power and snow melting. Research activities include work on model construction specifications of lineshaft submersible pumps and plate heat exchangers, a comprehensive aquaculture developer package and revisions to the Geothermal Direct Use Engineering and Design Guidebook. Outreach activities include the publication of the Quarterly Bulletin (Vol. 18, No. 4) which was devoted entirely to geothermal activities in South Dakota, dissemination of information mainly through mailings of publications, tours of local geothermal uses, geothermal library acquisition and use, participation in workshops, short courses and technical meetings by the staff, and progress monitor reports on geothermal activities.

  8. The utility of fistulography in the diagnosis of thyroglossal duct cyst with fistulous tract: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Honghua Zhu, MD

    2015-01-01

    Full Text Available Thyroglossal duct cyst (TGDC is one of the most common congenital, midline, cervical lesions originating from an embryonic thyroglossal duct remnant. It is usually diagnosed clinically. Imaging is used to confirm the clinical diagnosis, and fistulography is very helpful in the diagnosis and surgical planning for thyroglossal fistulous tract. Fistulographs show the direction, length, and anatomy of the remnant tracts and the small tracts connecting a TGDC to the tongue base at the foramen cecum. This report presents a case of TGDC in a 12-year-old boy and demonstrates the utility of fistulography imaging in the diagnosis of TGDC with fistulous tract. In this case, fistulography was performed after cannulating the external opening of the fistula. The patient underwent a resection, including thyroglossal tract removal and further excision of the mid portion of the hyoid bone (the Sistrunk procedure. The postoperative pathology report indicated thyroglossal duct remnants with no evidence of malignancy.

  9. Soft robots for healthcare applications design, modeling, and control

    CERN Document Server

    Xie, Shane; Meng, Wei

    2017-01-01

    This book presents novel applications of mechatronics to provide better clinical rehabilitation services and new insights into emerging technologies utilized in soft robots for healthcare, and is essential reading for researchers and students working in these and related fields.

  10. High Performance Healthcare Buildings: A Roadmap to Improved Energy Efficiency

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Brett C.; Tschudi, William F.

    2009-09-08

    This document presents a road map for improving the energy efficiency of hospitals and other healthcare facilities. The report compiles input from a broad array of experts in healthcare facility design and operations. The initial section lists challenges and barriers to efficiency improvements in healthcare. Opportunities are organized around the following ten themes: understanding and benchmarking energy use; best practices and training; codes and standards; improved utilization of existing HVAC designs and technology; innovation in HVAC design and technology; electrical system design; lighting; medical equipment and process loads; economic and organizational issues; and the design of next generation sustainable hospitals. Achieving energy efficiency will require a broad set of activities including research, development, deployment, demonstration, training, etc., organized around 48 specific objectives. Specific activities are prioritized in consideration of potential impact, likelihood of near- or mid-term feasibility and anticipated cost-effectiveness. This document is intended to be broad in consideration though not exhaustive. Opportunities and needs are identified and described with the goal of focusing efforts and resources.

  11. Healthcare professionals and the ethics of healthcare marketing.

    Science.gov (United States)

    Hammond, Kevin L; Jurkus, Anthony F

    1993-01-01

    The article explores marketing ethics considerations in the application of marketing to healthcare. While we realize that acceptance of healthcare marketing by all stakeholders is important for successful marketing, we emphasize its level of acceptance by healthcare professionals. The high levels of resistance to advertising and other forms of healthcare marketing by healthcare professionals has been largely based on the grounds that the practices are unethical. The nature of the resistance thus invites this exploration of healthcare marketing (and the marketing concept), marketing ethics, and the acceptance (rejection) by healthcare professionals of healthcare marketing.

  12. Hydrogen storage and production in utility systems. Second annual progress report

    Energy Technology Data Exchange (ETDEWEB)

    Salzano, F.J. (ed.)

    1975-08-01

    Progress in the following three areas is reported: engineering analysis and design; hydrogen production and auxiliaries; and hydrogen storage development. Process designs for the 26-MW electric storage facility were completed. Work to determine the allowed break-even capital cost of ''black box'' electric storage devices is completed. Studies of the performance and temperature dependence of power consumption versus current density were completed for the Solid Polymer Electrolyte and KOH small multi-cell modules. Test Bed A-1, for long-term attrition studies, was operated for 1200 hydride-dehydride cycles. About 60 percent of the starting FeTi alloy suffered a factor of ten size reduction, but the ability to absorb hydrogen showed no decrease. (LK)

  13. [Utility of infliximab therapy in severe enterorrhagia associated with Crohn's disease. Report of three cases].

    Science.gov (United States)

    Alcalde Vargas, Alfonso; Justiniano, José Manuel Herrera; Carnerero, Eduardo Leo; Salado, Claudio Trigo; Domingo, Ignacio Gutiérrez; Galán, José Luis Márquez

    2011-01-01

    Severe lower gastrointestinal (GI) bleeding is an infrequent complication in Crohn's disease. We report the cases of three patients with Crohn's disease, localized in distinct areas, who developed severe enterorrhagia requiring multiple transfusions. All three patients responded favorably to infliximab administration, which resolved the life-threatening hemorrhages and avoided emergency surgical resection, which had seemed inevitable. Based on this clinical experience and a review of the literature comparing infliximab with other pharmacological options, we believe that this drug should be the treatment of choice in patients with Crohn's disease who develop severe lower gastrointestinal bleeding. This strategy can, in some cases, avoid surgery if the bleeding stops due to rapid healing of the deep mucosal lesions causing the hemorrhagic episode.

  14. Preliminary report on self-healing minefield (frogs) concepts and utility in battle

    Energy Technology Data Exchange (ETDEWEB)

    Greenwalt, R J; Magnoli, D

    2000-01-13

    The purpose of this study is to determine battlefield effectiveness of the self-healing minefield (''Frogs'') concept system compared to basecases of the standard AP/AT (anti-personnel/anti-tank) mixed minefield, the AT (anti-tank) pure minefield, and no minefields. This involves tactical modeling where a basecase with and without mines is compared to the concept system. However, it is first necessary to establish system characteristics and behavior of the Frog mine and minefield in order to do the tactical modeling. This initial report provides emerging insights into various minefield parameters in order to allow better program definition early in the conceptual development. In the following sections of this report, we investigate the self-healing minefield's ground pattern and several concepts for movement (''jump'') of a mine. Basic enemy breaching techniques are compared for the different mine movement concepts. These results are then used in the (Joint Conflict and Tactical Simulation) JCATS tactical model to evaluate minefield effects in a combat situation. The three basecases and the Frogs concept are used against a North Korean mechanized rifle battalion and outcomes are compared. Preliminary results indicate: (1) Possible breaching techniques for the self-healing minefield were proposed and compared through simulation modeling. Of these, the best breaching counter to the self-healing minefield is the ''wide-lane'' breach technique. (2) Several methods for mine movement are tested and the optimal method from this group was selected for use in the modeling. However, continued work is needed on jump criteria; a more sophisticated model may reduce the advantage of the breach counter. (3) The battle scenario used in this study is a very difficult defense for Blue. In the three baseline cases (no mines, AT mines only, and mixed AT/AP minefield), Blue loses. Only in the Frog case does Blue win, and

  15. Health State Utility Values for Age-Related Macular Degeneration: Review and Advice.

    Science.gov (United States)

    Butt, Thomas; Tufail, Adnan; Rubin, Gary

    2017-02-01

    Health state utility values are a major source of uncertainty in economic evaluations of interventions for age-related macular degeneration (AMD). This review identifies and critiques published utility values and methods for eliciting de novo utility values in AMD. We describe how utility values have been used in healthcare decision making and provide guidance on the choice of utility values for future economic evaluations for AMD. Literature was searched using PubMed, and health technology assessments (HTA) were searched using HTA agency websites to identify articles reporting utility values or approaches to derive utility values in AMD and articles applying utilities for use in healthcare decision making relating to treatments for AMD. A total of 70 studies qualified for data extraction, 22 of which were classified as containing utility values and/or elicitation methods, and 48 were classified as using utility values in decision making. A large number of studies have elicited utility values for AMD, although those applied to decision making have focused on a few of these. There is an appreciation of the challenges in the measurement and valuation of health states, with recent studies addressing challenges such as the insensitivity of generic health-related quality of life (HRQoL) questionnaires and utility in the worse-seeing eye. We would encourage careful consideration when choosing utility values in decision making and an explicit critique of their applicability to the decision problem.

  16. Healthcare architects' professional autonomy: interview case studies.

    Science.gov (United States)

    Kim, Duk-Su; Shepley, Mardelle McCuskey

    2008-01-01

    The purpose of this project was to understand the nature of an architect's professional power. The central questions were: (1) What is the impact of specialized knowledge on the professional autonomy of architects in general? and (2) What are the relationships between task complexity, specialized knowledge, and the professional autonomy of healthcare architects in particular? To answer these questions, this research utilized interviews and focus groups. Focus groups provided in-depth knowledge on a sub-question: How do real-world situations restrict or reinforce the professional autonomy of healthcare architects? The interviews on this sub-question were project-specific to help gain an understanding of the impact that healthcare design complexity and research utilization have on practice and professional autonomy. Two main relationships were discovered from the interviews and focus groups. One was the relationship between the context of healthcare design complexity and the culture of healthcare design practice. The other was the relationship between changing professional attitudes and the consequences of changes in the profession.

  17. A design thinking framework for healthcare management and innovation.

    Science.gov (United States)

    Roberts, Jess P; Fisher, Thomas R; Trowbridge, Matthew J; Bent, Christine

    2016-03-01

    The business community has learned the value of design thinking as a way to innovate in addressing people's needs--and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice.

  18. The utility of abbreviated patient-reported outcomes for predicting survival in early stage colorectal cancer.

    Science.gov (United States)

    Hsu, Tina; Speers, Caroline H; Kennecke, Hagen F; Cheung, Winson Y

    2017-05-15

    Patient-reported outcomes (PROs) are increasingly used in clinical settings. Prior research suggests that PROs collected at baseline may be associated with cancer survival, but most of those studies were conducted in patients with breast or lung cancer. The objective of this study was to determine the correlation between prospectively collected PROs and cancer-specific outcomes in patients with early stage colorectal cancer. Patients who had newly diagnosed stage II or III colorectal cancer from 2009 to 2010 and had a consultation at the British Columbia Cancer Agency completed the brief Psychosocial Screen for Cancer (PSSCAN) questionnaire, which collects data on patients' perceived social supports, quality of life (QOL), anxiety and depression, and general health. PROs from the PSSCAN were linked with the Gastrointestinal Cancers Outcomes Database, which contains information on patient and tumor characteristics, treatment details, and cancer outcomes. Cox regression models were constructed for overall survival (OS), and Fine and Gray regression models were developed for disease-specific survival (DSS). In total, 692 patients were included. The median patient age was 67 years (range, 26-95 years), and the majority had colon cancer (61%), were diagnosed with stage III disease (54%), and received chemotherapy (58%). In general, patients felt well supported and reported good overall health and QOL. On multivariate analysis, increased fatigue was associated with worse OS (hazard ratio [HR], 1.99; P = .00007) and DSS (HR, 1.63; P = .03), as was lack of emotional support (OS: HR, 4.36; P = .0003; DSS: HR, 1.92; P = .02). Although most patients described good overall health and QOL and indicated that they were generally well supported, patients who experienced more pronounced fatigue or lacked emotional support had a higher likelihood of worse OS and DSS. These findings suggest that abbreviated PROs can inform and assist clinicians to identify patients who have a worse

  19. Successful treatment of severe sepsis and diarrhea after vagotomy utilizing fecal microbiota transplantation: a case report.

    Science.gov (United States)

    Li, Qiurong; Wang, Chenyang; Tang, Chun; He, Qin; Zhao, Xiaofan; Li, Ning; Li, Jieshou

    2015-02-09

    Dysbiosis of intestinal microbiota likely plays an important role in the development of gut-derived infections, making it a potential therapeutic target against sepsis. However, experience with fecal microbiota transplantation (FMT) in the treatment of sepsis and knowledge of the underlying mechanisms are extremely lacking. In this article, we describe a case of a patient who developed sepsis after a vagotomy and later received an infusion of donor feces microbiota, and we report our findings. A 44-year-old woman developed septic shock and severe watery diarrhea 4 days after undergoing a vagotomy. Antibiotics, probiotics and supportive treatment strategies were used for about 30 day after surgery, but the patient's fever, bacteremia and watery diarrhea persisted. Considering the possibility of intestinal dysbiosis, we evaluated the structure and composition of the patient's fecal microbiota using 16S rDNA-based molecular techniques. As expected, the gut microbiota was extensively disrupted; therefore, a donor fecal suspension was delivered into the patient by nasoduodenal tube. The patient's clinical outcomes and shifts of the gut microbiota following the treatment were also determined. Dramatically, the patient's septic symptoms and severe diarrhea were successfully controlled following FMT. Her stool output markedly declined after 7 days and normalized 16 days after FMT. A significant modification in her microbiota composition was consistently seen, characterized by a profound enrichment of the commensals in Firmicutes and depletion of opportunistic organisms in Proteobacteria. Furthermore, we identified a reconstituted bacterial community enriched in Firmicutes and depleted of Proteobacteria members that was associated with fecal output, plasma markers of inflammation and T helper cells. In this report, we describe our initial experience with FMT, in which we successfully used it in the treatment of a patient with sepsis and severe diarrhea after a vagotomy. Our

  20. Utility advanced turbine systems (ATS) technology readiness testing. Technical progress report, January 1--March 31, 1998

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    The overall objective of the Advanced Turbine System (ATS) Phase 3 Cooperative Agreement between GE and the US Department of Energy (DOE) is the development of the GE 7H and 9H combined cycle power systems. The major effort will be expended on detail design. Validation of critical components and technologies will be performed including: hot gas path component testing, sub-scale compressor testing, steam purity test trials, and rotational heat transfer confirmation testing. Processes will be developed to support the manufacture of the first system, which was to have been sited and operated in Phase 4 but will now be sited and operated commercially by GE. This change has resulted from DOE`s request to GE for deletion of Phase 4 in favor of a restructured Phase 3 (as Phase 3R) to include full speed, no load (FSNL) testing of the 7H gas turbine. Technology enhancements that are not required for the first machine design but will be critical for future ATS advances in performance, reliability, and costs will be initiated. Long-term tests of materials to confirm design life predictions will continue. This report summarizes work accomplished in 1Q98.

  1. Improved Clinical Outcomes of Patients With Type 2 Diabetes Mellitus Utilizing Integrative Medicine: A Case Report

    Science.gov (United States)

    Grise, Diane E.; McAllister, Heath M.

    2015-01-01

    This case report demonstrates a successful approach to managing patients with type 2 diabetes mellitus (DM2). Botanical herbs (including Gymnema sylvestre) and nutrients (including alpha lipoic acid and chromium) were used alongside metformin to help improve insulin sensitization; however, the greatest emphasis of treatment for this patient centered on a low-carbohydrate, whole-foods diet and regular exercise that shifted the focus to the patient's role in controlling their disease. Research on DM2 often focuses on improving drug efficacy while diet and lifestyle are generally overlooked as both a preventive and curative tool. During the 7 months of treatment, the patient's hemoglobin A1c and fasting glucose significantly decreased to within normal ranges and both cholesterol and liver enzyme markers normalized. A significant body of evidence already exists advocating for disease management using various diets, including Mediterranean, low-carb, and low-fat vegan diets; however, no clear dietary standards have been established. This study supports the use of naturopathic medicine as well as dietary and lifestyle changes to develop the most efficacious approach for the treatment of DM2. PMID:25984419

  2. Byproducts Utilization Program: Sewage Sludge Irradiation Project. Progress report, July-December 1983

    Energy Technology Data Exchange (ETDEWEB)

    1984-12-01

    Engineering support for a demonstration-scale irradiator design included assisting the City of Albuquerque in preparing a comprehensive site plan for their proposed sludge handling and treatment facilities. The solar sludge dryer has been delivered to SNLA. A preliminary sludge drying experiment indicated the importance of optimizing stirring and air flow. Installation of instrumentation and mechanical equipment continued. The Sandia Irradiator for Dried Sewage Solids (SIDSS) was used to irradiate 23 tons of dried, digested sewage sludge for the New Mexico State University (NMSU) Department of Crop and Soil Sciences. Gamma Irradiation Facility (GIF) operations included irradiation of ground pork for Toxoplasma gondii inactivation experiments, irradiation of surgical supplies and soil samples. Beneficial Uses Shipping Systems (BUSS) cask activities included near completion of the two full-scale cask bodies. Work continued on the Cask Safety Analysis Report (SAR) including additional analyses to reconfigure the six strontium fluoride capsules and/or reduce the number of capsules accommodated. NMSU has indicated no regrowth of salmonellae occurred in the irradiated sludge stockpile, while salmonellae did regrow in the unirradiated stockpile. Analyses of raw and digested sewage sludge from the Albuquerque Waste Water Treatment Plant showed levels of Yersinia enterocolitica (a human pathogen of emerging significance) to be below detection limits.

  3. Evacuated tubular collector utilizing a heat pipe. Progress report, May 1 1975--August 31, 1975

    Energy Technology Data Exchange (ETDEWEB)

    Ortabasi, U.; Fehlner, F.P.

    1975-01-01

    Research and development activities performed by the Corning Glass Works solar group during the period from May 1, 1975 to August 31, 1975 are reported. The analytical studies encompassed optical modeling of a modified cusp reflector, fresnel losses from tubular enclosures as a function of orientation, preliminary work on a digital Monte-Carlo Ray Tracing Computer Code and the determination of U/sub L/ losses as a function of vacuum level and temperature of the absorber. Compatible enclosure materials, wicks and working fluids were selected to assemble heat pipes for use as solar collector absorbers. Cusp reflectors with good accuracy were fabricated from various commercial bright aluminum sheet and their optical properties determined. Evacuation techniques were developed and special bake-out procedures were worked out to assemble the evacuated tubular collectors. The work on selective coatings narrowed down the field of potential absorber films to ''black chrome'' which has good stability in vacuum and the necessary ..cap alpha../epsilon value. Six different heat pipes and one flow-through absorber were fabricated and were partially characterized for thermal performance. Indoor and outdoor test facilities were completed and calibrated within proposed NBS standards. They are now available for parametric as well as true-life experiments with solar radiation.

  4. Factors Influencing Healthcare Service Quality

    OpenAIRE

    Ali Mohammad Mosadeghrad

    2014-01-01

    Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production o...

  5. Self-reported occupational exposure to HIV and factors influencing its management practice: a study of healthcare workers in Tumbi and Dodoma Hospitals, Tanzania

    OpenAIRE

    Mashoto, Kijakazi O; Mubyazi, Godfrey M; Mohamed, Hussein; Malebo, Hamisi M

    2013-01-01

    Background Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their duties. However, in Tanzania, there is little or no information on factors that influence the practice of managing occupational exposure to...

  6. Healthcare professionals' accounts of challenges in managing motor neurone disease in primary healthcare: a qualitative study.

    Science.gov (United States)

    Lerum, Sverre Vigeland; Solbraekke, Kari Nyheim; Frich, Jan C

    2017-02-22

    Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.

  7. Annual report on operation, utilization and technical development of hot laboratories

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-12-01

    This report describes activities, in the fiscal year 2000, of the Reactor Fuel Examination Facility (RFEF), the Waste Safety Testing Facility (WASTEF) and the Research Hot Laboratory (RHL) which belong to the Department of Hot laboratories. In the RFEF, reassembling of a PWR fuel irradiated in the Takahama Unit 3 has been continued. Also, non-destructive tests on a BWR fuel assembly irradiated in the Fukushima-2 unit 1 have been carried out. To support R and D works in JAERI, refabrications of segmented fuel rods have been done using irradiated LWR fuel rods for pulse irradiation in the NSRR. And post irradiation examinations (PIEs) have been performed for the pulse-irradiated fuel rods, Rock-like OXide fuel (ROX) samples irradiated in the JRR-3M and mixed carbonitride fuel samples irradiated in the JOYO. In the WASTEF, migration tests on the radioactive nuclides for terrestrial environment, leaching tests for evaluation of barrier performance and characterization on irradiated ROX fuels have been carried out. Also, reliability tests on equipment materials used in reprocessing plants have been performed in order to clarify the corrosion behavior in the simulated environment. In addition, as one project in its technological pursuit for the transmutation of transuraniums (TRU), the examination of converting TRU to its nitride using the Carbothermic Reduction method has been continuously carried out. In the RHL, PIEs have been performed on segment fuels irradiated in the NSRR, LWR pressure vessel materials and a candidate material for the first wall of nuclear fusion reactor irradiated in research and test reactors. (author)

  8. Cogeneration and Small Power Production Quarterly Report to the California Public Utilities Commission Fourth Quarter 1983

    Energy Technology Data Exchange (ETDEWEB)

    None

    1983-01-01

    At the end of 1983, the number of signed contracts and letter agreements for cogeneration and small power production projects was 305, with a total estimated nominal capacity of 2,389 MW. Of these totals, 202 projects, capable of producing 566 MW, are operational (Table A). A map indicating the location of operational facilities under contract with PG and E is provided as Figure A. Developers of cogeneration, solid waste, or biomass projects had signed 101 contracts with a potential of 1,408 MW. In total, 106 contracts and letter agreements had been signed with projects capable of producing 1,479 MW. PG and E also had under active discussion 29 cogeneration projects that could generate a total of 402 MW to 444 MW, and 13 solid waste or biomass projects with a potential of 84 MW to 89 MW. One contract had been signed for a geothermal project, capable of producing 80 MW. There were 7 solar projects with signed contracts and a potential of 37 MW, as well as 3 solar projects under active discussion for 31 MW. Wind farm projects under contract numbered 28, with a generating capability of 618 MW. Also, discussions were being conducted with 14 wind farm projects, totaling 365 MW. There were 100 wind projects of 100 kW or less with signed contracts and a potential of 1 MW, as well as 8 other small wind projects under active discussion. There were 59 hydroelectric projects with signed contracts and a potential of 146 MW, as well as 72 projects under active discussion for 169 MW. In addition, there were 31 hydroelectric projects, with a nominal capacity of 185 MW, that PG and E was planning to construct. Table B displays the above information. In tabular form, in Appendix A, are status reports of the projects as of December 31, 1983.

  9. Cogeneration and Small Power Production Quarterly Report to the California Public Utilities Commission Second Quarter 1983

    Energy Technology Data Exchange (ETDEWEB)

    None

    1983-01-01

    In the Second Quarter of 1983, the number of signed contracts and committed projects rose from 223 to 240, with a total estimated nominal capacity of these projects of 1,449 MW. Of this nominal capacity, about 361 MW is operational, and the balance is under contract for development. A map indicating the location of currently operating facilities is provided as Figure A. Of the 240 signed contracts and committed projects, 75 were cogeneration, solid waste, or biomass projects with a potential of 740 MW. PG and E also had under active discussion 32 cogeneration projects that could generate a total of 858 MW to 921 MW, and 10 solid waste/biomass projects with a potential of 113 MW to 121 MW. Two contracts have been signed with geothermal projects, capable of producing 83 MW. There are 6 solar projects with signed contracts and a potential of 36 MW, as well as another solar project under active discussion for 30 MW. Wind farm projects under contract number 19, with a generating capability of 471 MW. Also, discussions are being conducted with 12 wind farm projects, totaling 273 to 278 MW. There are 89 wind projects of 100 kW or less with signed contracts and a potential of almost 1 MW, as well as 10 other projects under active discussion. There are 47 hydroelectric projects with signed contracts and a potential of 110 MW, as well as 65 projects under active discussion for 175 MW. In addition, there are 30 hydroelectric projects, with a nominal capacity of 291 MW, that PG and E is constructing or planning to construct. Table A displays the above information. In tabular form, in Appendix A, are status reports of the projects as of June 30, 1983.

  10. The Cadmio XML healthcare record.

    Science.gov (United States)

    Barbera, Francesco; Ferri, Fernando; Ricci, Fabrizio L; Sottile, Pier Angelo

    2002-01-01

    The management of clinical data is a complex task. Patient related information reported in patient folders is a set of heterogeneous and structured data accessed by different users having different goals (in local or geographical networks). XML language provides a mechanism for describing, manipulating, and visualising structured data in web-based applications. XML ensures that the structured data is managed in a uniform and transparent manner independently from the applications and their providers guaranteeing some interoperability. Extracting data from the healthcare record and structuring them according to XML makes the data available through browsers. The MIC/MIE model (Medical Information Category/Medical Information Elements), which allows the definition and management of healthcare records and used in CADMIO, a HISA based project, is described in this paper, using XML for allowing the data to be visualised through web browsers.

  11. Possibilities for Healthcare Computing

    Institute of Scientific and Technical Information of China (English)

    Peter Szolovits

    2011-01-01

    Advances in computing technology promise to aid in achieving the goals of healthcare.We review how such changes can support each of the goá1s of healthcare as identified by the U.S.Institute of Medicine:safety,effectiveness,patient-centricity,timeliness,efficiency,and equitability.We also describe current foci of computing technology research aimed at realizing the ambitious goals for health information technology that have been set by the American Recovery and Reinvestment Act of 2009 and the Health Reform Act of 2010.Finally,we mention efforts to build health information technologies to support improved healthcare delivery in developing countries.

  12. Migrants' access to healthcare

    DEFF Research Database (Denmark)

    Norredam, Marie

    2011-01-01

    according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why......' healthcare entitlements. Different definitions of migration and ethnicity were investigated including: country of birth and residence status. Substudy I showed a tendency towards more advanced stage at diagnosis or unknown stage among most subgroups of migrant women with a history of cancer compared to non...

  13. Quality measurement in healthcare.

    Science.gov (United States)

    Lazar, Eliot J; Fleischut, Peter; Regan, Brian K

    2013-01-01

    Measurement is the basis for assessing potential improvements in healthcare quality. Measures may be classified into four categories: volume, structure, outcome, and process (VSOP). Measures of each type should be used with a full understanding of their cost and benefit. Although volume and structure measures are easily collected, impact on healthcare results is not always clear. Process measures are generally more difficult and expensive to collect, and the relationship between process and outcomes is only recently being explored. Knowledge of measure types and relationships among them, as well as emerging evidence on the role of patient satisfaction, must be used to guide improvements and ultimately for demonstrating value in healthcare.

  14. Healthcare financing: approaches and trends in India.

    Science.gov (United States)

    Bajpai, Vikas; Saraya, Anoop

    2010-01-01

    Despite the importance of healthcare for the well-being of society, there is little public debate in India on issues relating to it. The 'human capital approach' to finance healthcare largely relies on private investment in health, while the 'human development approach' envisages the State as the guarantorof preventive as well as curative care to achieve universalization of healthcare. The prevailing health indices of India and challenges in the field of public health require a human developmentapproach to healthcare. On the eve of independence, India adopted the human development approach, with the report of the Bhore Committee emphasizing the role of the State in the development and provision of healthcare. However, more recently, successive governments have moved towards the human capital approach. Instead of increasing state spending on health and expanding the public health infrastructure, the government has been relying more and more on the private sector. The public-private partnership has been touted as the new-age panacea for the ills of the Indian healthcare system. This approach has led to a stagnation of public health indices and a decrease in the access of the poor to healthcare.

  15. Cogeneration and Small Power Production Quarterly Report to the California Public Utilities Commission. Second Quarter 1984

    Energy Technology Data Exchange (ETDEWEB)

    None

    1984-01-01

    At the end of the Second Quarter of 1984, the number of signed contracts and letter agreements for cogeneration and small power production projects was 334, with total estimated nominal capacity of 2,876 MW. Of these totals, 232 projects, capable of producing 678 MW, are operational (Table A). A map indicating the location of operational facilities under contract with PG and E is provided as Figure A. Developers of cogeneration projects had signed 80 contracts with a potential of 1,161 MW. Thirty-three contracts had been signed for solid waste/biomass projects for a total of 298 MW. In total, 118 contracts and letter agreements had been signed with cogeneration, solid waste, and biomass projects capable of producing 1,545 MW. PG and E also had under active discussion 46 cogeneration projects that could generate a total of 688 MW to 770 MW, and 13 solid waste or biomass projects with a potential of 119 MW to 139 MW. One contract had been signed for a geothermal project, capable of producing 80 MW. Two geothermal projects were under active discussion for a total of 2 MW. There were 8 solar projects with signed contracts and a potential of 37 MW, as well as 4 solar projects under active discussion for 31 MW. Wind farm projects under contract numbered 34, with a generating capability of 1,042 MW, Also, discussions were being conducted with 23 wind farm projects, totaling 597 MW. There were 100 wind projects of 100 kW or less with signed contracts and a potential of 1 MW, as well as 7 other small wind projects under active discussion. There were 71 hydroelectric projects with signed contracts and a potential of 151 MW, as well as 76 projects under active discussion for 505 MW. In addition, there were 18 hydroelectric projects, with a nominal capacity of 193 MW, that PG and E was planning to construct. Table B displays the above information. Appendix A displays in tabular form the status reports of the projects as of June 30, 1984.

  16. [Healthcare patient loyalty].

    Science.gov (United States)

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  17. A comprehensive ubiquitous healthcare solution on an Android™ mobile device.

    Science.gov (United States)

    Hii, Pei-Cheng; Chung, Wan-Young

    2011-01-01

    Provision of ubiquitous healthcare solutions which provide healthcare services at anytime anywhere has become more favorable nowadays due to the emphasis on healthcare awareness and also the growth of mobile wireless technologies. Following this approach, an Android™ smart phone device is proposed as a mobile monitoring terminal to observe and analyze ECG (electrocardiography) waveforms from wearable ECG devices in real time under the coverage of a wireless sensor network (WSN). The exploitation of WSN in healthcare is able to substitute the complicated wired technology, moving healthcare away from a fixed location setting. As an extension to the monitoring scheme, medicine care is taken into consideration by utilizing the mobile phone as a barcode decoder, to verify and assist out-patients in the medication administration process, providing a better and more comprehensive healthcare service.

  18. Cobertura geográfica del sistema mexicano de salud y análisis espacial de la utilización de hospitales generales de la Secretaría de Salud en 1998 Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998

    Directory of Open Access Journals (Sweden)

    Juan E Hernández-Avila

    2002-11-01

    Full Text Available Objetivo. Determinar la cobertura geográfica del Sistema Mexicano de Salud y analizar la utilización en 1998 de los hospitales de la Secretaría de Salud (SSA. Material y métodos. Se desarrolló un Sistema de Información Geográfica (SIG con información sociodemográfica por localidad y ubicación espacial de unidades de atención de todo el sector salud, así como el registro de egresos por hospital de la SSA. Se determinó la utilización en 217 hospitales generales de la SSA mediante un modelo de estimación de máxima verosimilitud, que incluyó información sobre los recursos humanos, la infraestructura adicional y la población 25 km a la redonda. Resultados. En 1998, 10 806 localidades con 72 millones de habitantes contaban con al menos una unidad de atención de salud del sector público y 97.2% de la población se encontraba a menos de 50 km de una, pero más de 18 millones de personas vivían en localidades rurales sin unidades de atención. El promedio de ocupación fue de 48.5±28.5 por cada 100 camas/año, con gran variabilidad intra e interestatal. La utilización se asoció significativamente con el número de los médicos en la unidad, y en unidades del Instituto Mexicano del Seguro Social con la infraestructura adicional e índice de marginación. Conclusiones. La utilización del SIG eleva la capacidad analítica y proporciona estimadores más realistas de la cobertura y utilización de hospitales del sector.Objetive. To describe the geographical coverage of the Mexican Healthcare System (MHS services and to assess the utilization of its General Hospitals. Material and Methods. A Geographic Information System (GIS was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources

  19. Direct utilization of geothermal energy resources in food processing. Final report, May 17, 1978-May 31, 1982

    Energy Technology Data Exchange (ETDEWEB)

    Austin, J.C.

    1982-05-01

    In early 1978 financial assistance was granted for a project to utilize geothermal energy at Ore-Ida Foods, Inc.'s food processing plant in Ontario, Oregon. Specifically, the project included exploring, testing, and developing the potential geothermal resource; retrofitting the existing gas/oil-fired steam system; utilizing the geothermal resource for food processing, space heating, and hot potable water; and injecting the spent geothermal water back into a disposal well. Based on preliminary investigations which indicated the presence of a local geothermal resource, drilling began in August 1979. Although the anticipated resource temperature of 380/sup 0/F was reached at total well depth (10,054 feet), adequate flow to meet processing requirements could not be obtained. Subsequent well testing and stimulation techniques also failed to produce the necessary flow, and the project was eventually abandoned. However, throughout the duration of the project, all activities were carefully monitored and recorded to ensure the program's value for future evaluation. This report presents a culmination of data collected during the Ore-Ida project.

  20. Long-Term Monitoring of Utility-Scale Solar Energy Development and Application of Remote Sensing Technologies: Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Yuki [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division; Grippo, Mark A. [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division; Smith, Karen P. [Argonne National Lab. (ANL), Argonne, IL (United States). Environmental Science Division

    2014-09-30

    In anticipation of increased utility-scale solar energy development over the next 20 to 50 years, federal agencies and other organizations have identified a need to develop comprehensive long-term monitoring programs specific to solar energy development. Increasingly, stakeholders are requesting that federal agencies, such as the U.S. Department of the Interior Bureau of Land Management (BLM), develop rigorous and comprehensive long-term monitoring programs. Argonne National Laboratory (Argonne) is assisting the BLM in developing an effective long-term monitoring plan as required by the BLM Solar Energy Program to study the environmental effects of solar energy development. The monitoring data can be used to protect land resources from harmful development practices while at the same time reducing restrictions on utility-scale solar energy development that are determined to be unnecessary. The development of a long-term monitoring plan that incorporates regional datasets, prioritizes requirements in the context of landscape-scale conditions and trends, and integrates cost-effective data collection methods (such as remote sensing technologies) will translate into lower monitoring costs and increased certainty for solar developers regarding requirements for developing projects on public lands. This outcome will support U.S. Department of Energy (DOE) Sunshot Program goals. For this reason, the DOE provided funding for the work presented in this report.

  1. Healthcare Associated Infections - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - state data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  2. Healthcare Under Fire

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Tension between patients and hospital staff, insufficient health insurance coverage, and a limited supply of quality medical services are pressurizing China’s healthcare system reform Doctors and nurses, normally seen as protecting their patients, are in

  3. Healthcare Associated Infections - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by Centers for Disease Control and Prevention (CDC) and...

  4. Healthcare Associated Infections - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - national data. These measures are developed by Centers for Disease Control and Prevention (CDC) and...

  5. Coproduction of healthcare service.

    Science.gov (United States)

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.

  6. Low NO{sub x}/SO{sub x} Burner retrofit for utility cyclone boilers. Public design report

    Energy Technology Data Exchange (ETDEWEB)

    1991-09-01

    This Public Design Report provides available nonproprietary design information on the Low NO{sub x}SO{sub x} Burner Retrofit of Utility Cyclone Boilers project. In addition to the design aspects, the history of the project, the organization of the project, and the role of the funding parties are discussed. An overview of the Low NO{sub x}SO{sub x} (LNS) Burner, the cyclone boiler and the Southern Illinois Power Cooperative host site is presented. A detailed nonproprietary description of the individual process steps, plant systems, and resulting performance then follows. Narrative process descriptions, simplified process flow diagrams, input/output stream data, operating conditions and requirements are given for each unit. The plant demonstration program and start up provisions, the environmental considerations and control, monitoring and safety factors that are considered are also addressed.

  7. Patient Perspectives on Language Discordance During Healthcare Visits: Findings From the Extremely High-Density Multicultural State of Qatar.

    Science.gov (United States)

    Abdelrahim, Huda; Elnashar, Maha; Khidir, Amal; Killawi, Amal; Hammoud, Maya; Al-Khal, Abdul Latif; Fetters, Michael D

    2017-04-01

    Reducing language and cultural barriers in healthcare are significant factors in resolving health disparities. Qatar's rapidly growing multicultural population presents new challenges to the healthcare system. The purpose of this research was to explore patients' perspectives about language discordance, and the strategies used to overcome language barriers during patients' visits. Participants were recruited and interviewed from four language groups (Arabic = 24, English = 20, Hindi = 20, and Urdu = 20), all of whom were living in Qatar and utilizing Hamad General Hospital-Outpatient Clinics as a source of their healthcare services. Using qualitative analysis procedures, relevant themes and codes were generated and data analyzed using Atlas-ti. As for results, most participants had experienced or witnessed language barriers during their outpatient clinics visits. Participants essentially were unfamiliar with professional medical interpreters and described their adaptive solutions, for example utilizing incidental interpreters, stringing together fragments of multiple languages, and using body language. Those not speaking mainstream languages of Hamad General Hospital (English and Arabic) were more vulnerable to health disparities due to language barriers. Despite the patient impetus to do something, patient-reported adaptive strategies could compromise patients' safety and access to quality healthcare. Polices tackling the language barrier need to be reviewed in Qatar's multicultural healthcare system and similar settings.

  8. Public assessment of key performance indicators of healthcare in a Canadian province: the effect of age and chronic health problems.

    Science.gov (United States)

    Nurullah, Abu Sadat; Northcott, Herbert C; Harvey, Michael D

    2014-01-15

    This study explores the effect of age and chronic conditions on public perceptions of the health system, as measured by the Key Performance Indicators (KPIs) of healthcare, in the province of Alberta in Canada. Drawing from data collected by Government of Alberta's Department of Health and Wellness, this research examines two key questions: (1) Do people in the 65+ age group rate the KPIs of healthcare (i.e., availability, accessibility, quality, outcome, and satisfaction) more favorably compared to people in younger age groups in Alberta? (2) Does the rating of KPIs of healthcare in Alberta vary with different chronic conditions (i.e., no chronic problem, chronic illnesses without pain, and chronic pain)? The findings indicate that people in the older age group tend to rate the KPIs of healthcare more favorably compared to younger age groups in Alberta, net of socio-demographic factors, self-reported health status, and knowledge and utilization of health services. However, people experiencing chronic pain are less likely to rate the KPIs of healthcare favorably compared to people with no chronic health problem in Alberta. Discussion includes implications of the findings for the healthcare system in the province.

  9. Oral healthcare in transition in Eastern Europe.

    Science.gov (United States)

    Widström, E; Eaton, K A; Borutta, A; Dybizbánska, E; Broukal, Z

    2001-06-09

    Big changes have occurred in the oral healthcare delivery systems of most Eastern European countries since the fall of the Berlin wall in 1989 and the demise of communism in the former USSR in 1991. In the new situation it was necessary to reform the political and social systems including healthcare. Reforms were started to improve the economy and, in comparison with Western Europe, the generally lower living standards. It is difficult to obtain comprehensive data on oral healthcare in Eastern European countries but this paper reports data from nine countries and provides a 'macro' view of the current situation in these countries. Many countries seem to have adopted a Bismarckian model for the provision of oral healthcare based on a sickness insurance system.

  10. Healthcare leadership's diversity paradox.

    Science.gov (United States)

    Silver, Reginald

    2017-02-06

    Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

  11. Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.

    Science.gov (United States)

    Rogers, Stephanie E; Thrasher, Angela D; Miao, Yinghui; Boscardin, W John; Smith, Alexander K

    2015-10-01

    As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults. We aimed to examine the relationship between healthcare discrimination and new or worsened disability. This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012. Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 % female, 83.1 % white) were included in this study. Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years. In all, 12.6 % experienced discrimination infrequently and 5.9 % frequently. Almost one-third of participants (29 %) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 % of those who infrequently and 14.7 % of those who never experienced healthcare discrimination (p disability over 4 years (aHR = 1.63, 95 % CI 1.16-2.27). One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare

  12. Officer Computer Utilization Report

    Science.gov (United States)

    1992-03-01

    SIGNIFV11ANT @ YES PREVIOUSLY 0 00" for 0 months.)0 EXRML INFCN DYES BO0TH CURRENTLY AND PREVIOUSLY __________ -5- s- -js ! EC O : PESO A A JO BA K RO N INO...U SECO F: M This section asks questions about issues related to microcomputers, to include office automation and Information management. A

  13. The Imminent Healthcare and Emergency Care Crisis in Japan

    Directory of Open Access Journals (Sweden)

    Suzuki, Tetsuji

    2008-05-01

    Full Text Available Objectives: Japan has a universal healthcare system, and this paper describes the reality of the healthcare services provided, as well as current issues with the system.Methods: Academic, government, and press reports on Japanese healthcare systems and healthcare guidelines were reviewed.Results: The universal healthcare system of Japan is considered internationally to be both low-cost and effective because the Japanese population enjoys good health status with a long life expectancy, while healthcare spending in Japan is below the average given by the Organization for Economic Corporation and Development (OECD. However, in many regions of Japan the existing healthcare resources are seriously inadequate, especially with regard to the number of physicians and other health professionals. Because healthcare is traditionally viewed as