Brottes, Francois; Le Roux, Bruno
This document presents a private bill which, by introducing a progressive energy tariff, aims at speeding up energy transition (by inciting households to reduce their consumption, notably by insulating their housing), and at addressing the ineluctable issue of energy price increase. This private bill notably applies a bonus-malus concept by defining an energy consumption threshold which is to be determined by means of several parameters related to climate, housing occupancy, heating mode. This raises several issues concerning for example housing insulation of rented housing. All these aspects lead to a rather complex process to define and implement such a progressive pricing approach
Brottes, Francois; Le Roux, Bruno
This bill project aims at speeding up energy transition by inciting households to reduce their consumption, and at accompanying the unavoidable increase of energy prices. It introduces a rather complex process to establish the energy tariff, and notably a bonus-malus principle. The objective is to incite households to better insulate their main housing. It also takes social tariffs into account, defines institutions and representative for energy regulation, proposes the implementation of a public service for housing energy performance, and addresses the issue of energy supply in winter to households in precarious situation
RCN WALES is urging the public to sign an e-petition supporting draft legislation on safe staffing. The petition calls for support for the Safe Nursing Staffing Levels (Wales) Bill, drawn up by Welsh Liberal Democrat leader Kirsty Williams.
This bill was introduced into the US Senate on March 6, 1991 to require radon testing in schools. Radon may be especially hazardous to small children who spend a substantial portion of a day in school buildings. On April 20, 1989, the Administrator of the Environmental Protection Agency issued a national advisory recommending that all schools be tested for radon. There is a need for the federal government to provide financial assistance to states and local educational agencies for implementation of measures to reduce elevated levels of radon
This bill, entitled as the Department of Housing and Urban Development Radon Policy Act, has been introduced to provide for radon testing. The purposes of this Act are to: provide the Department of Housing and Urban Development with a mandate to establish a departmental radon policy and program; require the Department of Housing and Urban Development to use its programs to assist the EPA in addressing radon contamination; and require the Department of Housing and Urban Development, in coordination with the EPA, to develop a radon assessment and mitigation program which utilized EPA recommended guidelines and standards to ensure that occupants of housing covered under this Act are not exposed to elevated levels of radon
Good news about nurse staffing levels can be hard to find, so how fantastic that a protracted campaign in Wales finally paid off last week with the passage of legislation to ensure hospital wards are staffed safely. Next month, the Queen will give royal assent to the Safe Nurse Staffing Levels (Wales) Bill, which will save lives, produce better outcomes and enhance the patient experience of care.
Bill S. 2844 provides for radon testing and is cited as the Department of Housing and Urban Development Policy Act. The bill provides the Department of Housing and Urban Development (HUD) with a mandate to establish a departmental radon policy and program. The department will be required to use its programs to assist the Environmental Protection Agency (EPA) address radon contamination. The bill also requires HUD, in coordination with the EPA, to develop a radon assessment and mitigation program which utilizes EPA recommended guidelines and standards to ensure that occupants of housing covered under this act are not exposed to elevated levels of radon. The entire contents of the bill are presented in eight sections entitled: Short Title, findings, Purpose, Definitions, Program, Information, Cooperation with Environmental Protection Agency, and Authorization. The bill was referred to the Committee on Banking, Housing and Urban Affairs
The bill H.R. 4934 is aimed to provide a viable domestic uranium industry, to establish a program to fund reclamation and other remedial actions with respect to mill tailings at active uranium and thorium sites, and to establish a wholly-owned Government corporation to manage the Nation's uranium enrichment enterprise, operating as a continuing, commercial enterprise on a profitable and efficient basis. The contents of the bill are divided into four sections entitled: Introduction, Uranium Revitalization, Remedial Action Performed by the Owner or Licensee of Active Sites, and United States Enrichment Corporation. The section on the United States Enrichment Corporation further amends the previously amended Atomic Energy Act of 1954 to detail exactly how the corporation shall be established, funded, and managed. The bill was referred jointly to the Committee on Energy and Commerce, Interior and Insular Affairs, Science, Space and Technology, and Ways and Means
This bill proposes changes in the Black Lung Benefits Act with the intent of improving the existing legislation. Changes are proposed in sections of the act referring to: benefit overpayment; evidence; survivor benefits; responsible operator; attorney fees; administration; refilling; construction; and effective dates.
This report discusses a bill to authorize the Secretary of Energy to enter into privatization arrangements for activities carried out in connection with defense nuclear facilities, and for other purposes like: waste remediation and environmental restoration, including treatment, storage, and disposal; technical services; energy production; utility services; effluent treatment; general storage; fabrication and maintenance; and research and testing
H.R. 3236: A bill to improve treatment for veterans exposed to radiation while in military service, introduced in the US House of Representatives, One Hundred Second Congress, First Session, August 2, 1991
This bill was introduced into the US House of Representatives on August 2, 1991 to improve treatment for veterans exposed to radiation while in military service. A section addresses the expansion of the list of diseases presumed to be service-connected for certain radiation-exposed veterans and elimination of latency-period limitations. Another section examines other activities involving exposure to ionizing radiation
S. 1030: A bill to authorize private sector participation in providing products and services to support Department of Energy defense waste cleanup and modernization missions, introduced in the US Senate, One Hundred Second Congress, First Session, May 9, 1991
This bill was introduced into the US Senate on May 9, 1991 to authorize private sector participation in providing products and services to support Department of Energy defense waste cleanup and modernization. Congress finds that the management and cleanup of nuclear and hazardous waste and the modernization of Department of Energy facilities must be pursued expeditiously in order to protect the health and safety of the public and workers
S. 1697: A Bill to require local educational agencies to conduct testing for radon contamination in schools, and for other purposes. Introduced in the Senate of the United States, One Hundredth First Congress, Second Session, October 22, 1990
This bill was introduced into the U.S. Senate on September 28, 1989 to require local educational agencies to conduct testing for radon contamination in schools. Studies indicate that 54% of schools tested have at least one room with elevated levels of radon and that over 20% of all school rooms tested had elevated levels of radon. There is a need for improved information on proper methods and procedures for testing and remediation of radon in school buildings. In addition, there is a need for the federal government to provide financial assistance to states and local educational agencies for implementation of measures to reduce elevated levels of radon
First page Back Continue Last page Overview Graphics. Billing Trends. Internet access: Bandwidth becoming analogous to electric power. Only maximum capacity (load) is fixed; Charges based on usage (units). Leased line bandwidth: Billing analogous to phone calls. But bandwidth is variable.
Full Text Available Professor Bill Maurer is a renowned cultural anthropologist who conducts research on law, property, money and finance, focusing on the technological infrastructures and social relations of exchange and payment. Professor Maurer graduated from Stanford University in 1994 with a PhD in Anthropology. He moved to UC Irvine in 1996 as Assistant Professor, going on to become Chair of UC Irvine’s Department of Anthropology (2005-2011 and Associate Dean for Research and Graduate Studies in the Social Sciences (2011-2013. In July 2013 he assumed his current role as Dean of UC Irvine’s School of Social Sciences. Professor Maurer has published on topics ranging from offshore financial services to mobile phone-enabled money transfers, Islamic finance, alternative currencies, and the future of money. He is founding director of the Institute for Money, Technology and Financial Inclusion, funded by the Bill and Melinda Gates Foundation, and was the founding co-director of the Intel Science and Technology Center in Social Computing. He is the editor of six collections, as well as the author of Recharting the Caribbean: Land, Law and Citizenship in the British Virgin Islands (1997, Pious Property: Islamic Mortgages in the United States (2006, and Mutual Life, Limited: Islamic Banking, Alternative Currencies, Lateral Reason (2005. The latter received the Victor Turner Prize in 2005. Professor Maurer visited the University of Warwick in September 2014 under the auspices of Warwick’s Global Governance GRP.
Gavigan, Margaret; Fitzpatrick, Therese A; Miserendino, Carole
The traditional approaches to staffing and scheduling are often ineffective in assuring sufficient budgeting and deployment of staff to assure the right nurse at the right time for the right cost. As hospital merger activity increases, this exercise is further complicated by the need to rationalize staffing across multiple enterprises and standardize systems and processes. This Midwest hospital system successfully optimized staffing at the unit and enterprise levels by utilizing operations research methodologies. Savings were reinvested to improve staffing models which provided sufficient nonproductive coverage and patient-driven ratios. Over/under-staffing was eliminated in support of the system's recognition that adequate resource planning and deployment are critical to the culture of safety.
H.R. 1921: A bill to amend the Oil Pollution Act of 1990 to protect the environment of Antarctica from oil spills, and for other purposes, introduced in the US House of Representatives, One Hundred Second Congress, First Session, April 18, 1991
This bill was introduced into the US House of Representatives on April 18, 1991 to amend the Oil Pollution Act of 1990 to protect the environment of Antarctica from oil spills. Key features of this legislation address the following: civil penalty; removal, restoration, and compensation; financial responsibility; response plans; revolving fund; disclaimer; conforming and clerical amendments; and safety study
H.R. 3173: A Bill to apply the provisions of OSHA to certain Department of Energy nuclear facilities. Introduced in the House of Representatives, One Hundredth First Congress, First Session, August 4, 1989
H.R. 3173: A Bill to apply the provisions of OSHA to certain Department of Energy (DOE) nuclear facilities. The purpose is to improve and enforce standards for employee health and safety at DOE nuclear facilities
H.R. 1098: A Bill to establish a wholly-owned Government corporation to manage the Nation's uranium enrichment enterprise. Introduced in the House of Representatives, One Hundredth First Congress, First Session, February 23, 1989
H.R. 1098 is a bill to establish a wholly-owned Government corporation to manage the Nation's uranium enrichment enterprise, operating as a continuing commercial enterprise on a profitable and efficient basis, and for other purposes
Hooper, G.; Williams, C.C.P.; Ezra, D.
The Parliamentary Under-Secretary at the Department of Energy introduced the second reading of the Electricity Bill which provides for the restructuring and privatisation of the electricity supply industry throughout Great Britain. Three features at the heart of the Government's proposals are mentioned - first that the proposals will promote competition in electricity generation and supply of electricity so there will be a downward pressure on costs and prices, second is a new deal for customers and third is the security of electricity supply which will be ensured by the diversity of suppliers. The benefits of the scheme are outlined and then specific details of the Bill are considered. The debate which followed lasted six hours and is reported verbatim. The issues raised included environmental effects, efficiency, energy conservation, research and development and investment. (UK)
H.R. 5181: A Bill to provide for the establishment of a uranium enrichment corporation, and for other purposes. Introduced in the House of Representatives, One Hundredth Congress, Second Session, August 8, 1988
H.R. 5181 is a bill to provide for the establishment of a uranium enrichmen corporation, which will be an efficient provider of uranium enrichment services able, insofar as is consistent with maximizing the value of the corporation, to meet the needs of the United States for uranium enrichment services, and which will be suitable for eventual transfer to private ownership. Other aspects of the bill assure the recovery of the value of assets transferred to the corporation, maximize the value of the corporation to the United States, assure the recovery of the costs for decommissioning existing and future uranium enrichment facilities owned by the corporation, and prevent any further public subsidization of the Civilian Uranium Enrichment Program in the United States. After introduction, the bill was referred jointly to the Committees on Energy and Commerce and Interior and Insular Affairs
H.R.: a bill to grant the consent of the Congress to the Central Midwest Interstate Low-Level Radioactive Waste Compact. Introduced in the House of Representatives, Ninety-Ninth Congress, First Session, April 16, 1985
The revised bill, after submission to the House Committees on Interior and Insular Affairs and on Energy and Commerce, grants the Central Midwest Interstate Compact for the regional management and disposal of low-level radioactive wastes. The amended bill applies to the states of Illinois and Kentucky, and outlines procedures for the affected states to cooperate in the transport and the siting and operation of storage facilities. A compact commission to administer the program will include voting members from each eligible state. The bill also specifies the rights and obligations of participants and requirements for joining or withdrawing from the compact and for terminating the compact. Other sections cover related laws, congressional review, and penalties for non-compliance
H.R. 4121: A Bill to establish an independent safety board to oversee Department of Energy nuclear facilities. Introduced in the House of Representatives, One Hundredth Congress, Second Session, March 9, 1988
The bill H.R. 4121 if enacted would establish an independent safety board to oversee the Department of Energy nuclear facilities. This board would be a part of the executive branch and would be known as the Federal Facilities Nuclear Safety Board. The structure, functions, and powers of the Board as well as the responsibilities of the Secretary of Energy in full cooperation with the board, the format of board recommendations, the method of board reporting, and authorization for funding for the board are presented in detail. The bill was referred to the Committees on Energy and Commerce and Armed Services
A safe staffing app giving up-to-date information on the number of nurses on the wards at Nottingham University Hospitals NHS Trust scooped top prize at the inaugural Academy of Fabulous NHS Stuffawards in London last week.
...., Including On-Site Leased Workers From Balance Staffing, Insight Global Staffing, and Technisource..., Insight Global Staffing, and Technisource, Scarborough, Maine. The workers are engaged in activities... leased workers from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who...
The bill would amend certain sections of the Internal Revenue Act to provide tax incentives for renewable energy production. Qualified technologies include solar thermal, photovoltaic, wind, geothermal (other than dry steam), and biomass. The bill would also limit exclusion from gross income for parking and allow exclusion for employer subsidies for mass transit and van pooling. A tax credit would be allowed for retrofitting of home oil heaters. The bill would allow exclusion from gross income for energy and water conservation subsidies provided by public utilities. The Safe and Efficient Vehicles Incentive Act of 1991 is included in this bill. The net income limitation on percentage depletion would not apply to oil and gas wells and a crude oil production credit would be available for maintaining economically marginal wells. There is a credit for crude oil and natural gas exploration and development and the intangible drilling costs would be removed from the Alternative Minimum Tax. Several other credits for the petroleum industry are described
H.R.1671: A bill to amend the Internal Revenue Code of 1986 with respect to the treatment of foreign oil and gas income, introduced in the House of Representatives, One Hundred Second Congress, First Session, April 9, 1991
The bill explains special rules for foreign tax credit with respect to foreign oil and gas income by amending the following sections: certain taxes not creditable; separate baskets for foreign oil and gas extraction income and foreign oil related income; and elimination of deferral for foreign oil and gas extraction income. The effective date would be December 31, 1991
S. 1563: A Bill granting the consent of the Congress to amendments to the Southeast Interstate Low-Level Radioactive Waste Management Compact. Introduced in the Senate of the United States, One Hundredth First Congress, First Session, August 4, 1989
S. 1563: A Bill granting the consent of the Congress to amendments to the Southeast Interstate Low-Level Radioactive Waste Management Compact. The disposal facility located in Barnwell County, South Carolina shall be the considered the first host State disposal facility
H.R. 2738: A bill to amend title 38, United States Code, with respect to benefits for individuals who may have been exposed to ionizing radiation during military service, and for other purposes, introduced in the US House of Representatives, One Hundred Second Congress, First Session, June 24, 1991
This bill was introduced into the US House of Representatives on June 24, 1991 to amend title 38, United States Code with respect to benefits for individuals who may have been exposed to ionizing radiation during military service. Key features addressed in separate sections include the following: expansion of a list of diseases presumed to be service-connected for certain radiation-exposed veteran and elimination of latency-period limitations; and adjudication of claims based on exposure to ionizing radiation
Senate Bill 1821 amending the Nuclear Waste Policy Act of 1982 calls for the Nuclear Regulatory Commission to revise the guidelines for siting a secondary repository for nuclear wastes. The new law will add to the factors which disqualify a potential site those which impact on a foreign country, either its population or natural resources. It also calls for judicial review of the revised guidelines. The bill calls for all geographical sections of the US to be considered in the site selection process, but requires conformance with state and local laws as well as consideration of transportation modes and routes. An environmental impact statement will consider the transportation phase as well as the repository site. Financial assistance is available to the states and to Indian tribes to provide adequate public health protection
S.1234: A bill to amend the Internal Revenue Code of 1986 to provide tax relief to utilities installing acid rain reduction equipment, introduced in the Senate of the United States, One Hundred Second Congress, First Session, June 6, 1991
The bill would allow a tax credit of 6 2/3% of a taxpayer's investment in qualified acid rain control equipment for each of the three years beginning the year the equipment is placed in service. Additionally, a tax credit would be allowed during two years of construction progress, the amount being 6 2/3% of construction expenditures. The bill describes qualified acid rain property', tax-exempt financing of acid rain control property, tax credit for minerals used to reduce the sulfur in coal, coal cleaning minerals credit, exclusion from gross income of receipt of qualified Clean Air allowance and proceeds of disposition thereof, qualified Clean Air allowances, and amortization of acid rain control property
S.442: a bill to grant the consent of the Congress to the Rocky Mountain Low-Level Radioactive Waste Compact. Introduced in the Senate of the United States, Ninety-Ninth Congress, First Session, February 7, 1985
Congress grants the States of Arizona, Colorado, Nevada, New Mexico, Utah, and Wyoming the right to enter into the Rocky Mountain Interstate Low-Level Radioactive Waste Compact under S.442. Under the compact, each state assumes responsibility for cooperating in the management of low-level radioactive wastes. The bill summarizes this purpose, defines pertinent terms, and outlines the rights and obligations of the member states. It stipulates that within six years after the law is enacted in Nevada and one other state, a regional facility must be operating in a state other than Nevada. The facility board will impose a surcharge on each unit of waste received, and the host state may impose a state surcharge against expenses. The bill outlines board duties, conditions for Congressional consent, and the circumstances for withdrawal or exclusion
The report H.R. 1020 is a bill to amend the Nuclear Waste Policy Act of 1982. The purpose of the Act is to direct the Secretary of Energy to develop an integrated spent nuclear fuel management system and to commence acceptance of spent nuclear fuel and high-level radioactive waste in accordance with the acceptable schedule no later than January 31, 1998. The proposed legislative text is included
H.R. 2278: A Bill to provide for the establishment of a uranium enrichment corporation, and for other purposes. Introduced in the House of Representatives, One Hundredth First Congress, First Session, May 9, 1989
H.R. 2278 is a bill to provide for the establishment of a uranium enrichment corporation, and for other purposes. The purpose of the Act is to create a uranium enrichment corporation which will be an efficient provider of uranium enrichment services able, insofar as is consistent with maximizing the value of the Corporation, to meet the needs of the United States for uranium enrichment services, and which will be suitable for eventual transfer to private ownership
In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983. PMID:2033626
In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983.
Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.
Workload on nursing wards depends highly on patient arrivals and patient lengths of stay, which are both inherently variable. Predicting this workload and staffing nurses accordingly is essential for guaranteeing quality of care in a cost effective manner. This paper introduces a stochastic method
Kortbeek, Nikky; Braaksma, Aleida; Burger, C.A.J.; Bakker, P.J.M; Boucherie, Richardus J.
Workloads in nursing wards depend highly on patient arrivals and lengths of stay, both of which are inherently variable. Predicting these workloads and staffing nurses accordingly are essential for guaranteeing quality of care in a cost-effective manner. This paper introduces a stochastic method
On request, the Dutch Association for Energy, Environment and Water (VEMW) checks the energy bills for her customers. It appeared that in the year 2000 many small, but also big errors were discovered in the bills of 42 businesses
Weidner, Theodore J.
Examines the APPA's Trades Staffing Guidelines Task Force for college campus building maintenance and presents descriptions of the proposed guideline levels and a matrix of indicators for the Trades Staffing Guidelines. The levels and matrix are intended to mimic features of the custodial staffing guidelines. (GR)
S. 655: a Bill granting the consent of Congress to the Central Interstate Low-level Radioactive Waste Compact. Introduced in the Senate of the United States, Ninety-Ninth Congress, First Session, March 7, 1985
Congressional consent for a regional compact to handle low-level radioactive wastes applies to the central states of Arkansas, Iowa, Kansas, Louisiana, Minnesota, Missouri, Nebraska, North Dakota, and Oklahoma. The bill establishes the purpose and policy of the regional compacts as a way to more efficiently manage wastes and limit both the cost and number of facilities while allocating the benefits and costs of radioactive waste management among the participating states. Following a definition of pertinent terms, the articles outline the rights and obligations of compact parties, establish a commission with representatives from the member states, describe the procedures for developing and operating regional waste facilities, and describe procedural steps for revoking, withdrawing from, or terminating the compact
This bill contains the following: Title I - Residential, commercial, and Federal energy use: consumer and commercial products, and Federal energy management; Title II - Natural gas: natural gas pipeline regulatory reform, natural gas import/export deregulation, and structural reform of the Federal Energy Regulatory Commission; Title III - Oil: Alaska coastal plain oil and gas leasing, Naval Petroleum Reserve leasing, and oil pipeline deregulation; Title IV - Electricity generation and use: Public Utility Holding Company Act reform, and power marketing administration repayment reform; Title V - Nuclear power: licensing reform, nuclear waste management; Title VI - Renewable energy: PURPA size cap and co-firing reform, and hydroelectric power regulatory reform; Title VII - Alternative fuel: alternative and dual fuel vehicle credits, and alternative transportation fuels; Title VIII - Innovation and technology transfer; Title IX - Tax incentives
The Price-Anderson Act Amendments Act of 1985 (S.1225) amends the Atomic Energy Act of 1954 by incorporating past experiences and new developments into a fair and efficient system for compensating the public when there is an accident involving nuclear materials. Licensees under the Nuclear Regulatory Commission must carry liability insurance only to the extent that private sources can provide, although large nuclear power plants can combine financial protection from a variety of self-insurance and external sources. The bill describes a retrospective rating plan for allocating premiums and procedures for deferring premiums. There are provisions for compensation in the event of liabilities incurred during periods of storage, transfer, or disposal of spent nuclear fuel. No more than $100 million will be available in the compensation for incidents outside the US. If enacted, the indemnification period extends from August 30, 1954 to August 1, 2012
H.R. 1972: A bill to amend title 38, United States Code, with respect to benefits for veterans who may have been exposed to ionizing radiation during military service, and for other purposes, introduced in the US House of Representatives, One Hundred Second Congress, First Session, April 22, 1991
This bill was introduced into the US House of Representatives on April 22, 1991 to amend title 38, United States Code. This legislation involves benefits for veterans who may have been exposed to ionizing radiation during military service. Individual sections address the following: expansion of presumption of service connection for certain radiation-exposed reservists; expansion of list of diseases presumed to be service-connected for certain radiation-exposed veterans and elimination of latency-period limitations; and adjudication of claims based on exposure to ionizing radiation
Jones, Terry; Heui Bae, Sung; Murry, Nicole; Hamilton, Patti
This article describes the evolution of mandated nurse staffing committees in Texas from 2002 to 2009 and presents a study that analyzed nurse staffing trends in Texas using a secondary analysis of hospital staffing data (N = 313 hospitals) from 2000 to 2012 obtained from the American Hospital Association Annual Survey. Nurse staffing patterns based on three staffing variables for registered nurses (RNs), licensed vocational nurses (LVNs), and total licensed nurses were identified: full-time equivalents per 1,000 adjusted patient days, productive hours per adjusted patient day, and RN skill mix. Similar to national trends between 2000 and 2012, most Texas hospitals experienced an increase in RN and total nurse staffing, decrease in LVN staffing, and an increase in RN skill mix. The magnitude of total nurse staffing changes in Texas (5% increase) was smaller than national trends (13.6% increase). Texas's small, rural, government hospitals and those with the highest preregulation staffing levels experienced the least change in staffing between 2000 and 2012: median change of 0 to .13 full-time equivalents per 1,000 adjusted patient days and median change in productive hours per patient day of 0 to .23. The varying effects of staffing committees in different organizational contexts should be considered in future staffing legislative proposals and other policy initiatives. © The Author(s) 2015.
Findings of an independent review of charges to electricity bills and recommendations to assist in the development of a standard, province-wide residential electricity bill for Ontario are discussed. The review was requested by the province's Minister of Energy in an effort to dispel growing confusion about the variations in customer billing practices used by the province's 90+ local distribution companies. Key recommendations and findings were as follows: (1)Consumer bill formats issued by local distribution companies should be more consumer-friendly, adhere to minimum design standards, adapt uniform terminology and common line charges; (2) charges on customer bills should be grouped into four standard line items, with full details available to customers: the four line items should be a basic service charge, a charge for delivering electricity to the customer, a charge for the electricity itself, and a separate charge for retiring the outstanding debt of the former Ontario Hydro; (3) bills should take advantage of opportunities for promoting province-wide energy conservation, such as encouraging the long-term use of interval meters, presenting historical consumption data on residential bills on a period-to-period basis, and education and communications initiatives. Details of the recommendations, including the calculation of the fixed and variable components of usage charges, an explanation of the concept of electricity system loss adjustments, a method for phasing in the recommendations, and the anticipated benefits to consumers are provided
Describes the STAF (Science Teacher's Authoring Facility) computer-assisted instruction system developed at Leeds University (England), focusing on STAF language and major program features. Although programs for the system emphasize physical chemistry and organic spectroscopy, the system and language are general purpose and can be used in any…
Gray, J.H.N.; Stoddart, D.L.; Sinclair, R.M.; Ezra, D.
The House, in Committee, discussed the following matters in relation to the Atomic Energy Authority Bill; financing; trading; personnel conditions of employment; public relations; organization; research programmes; fuels; energy sources; information dissemination. (U.K.)
Parkinson, C.; Hogg, N.; Salmond, A.
The paper presents the first part of the Parliamentary debate on the second reading of the Electricity Bill, House of Commons, London 1988. The Bill sets out the government's proposals for the restructuring and privatisation of the electricity supply industry throughout Great Britain. Customers and suppliers, choice for the consumer, competition promotion, security of supply, nuclear power stations, and cost, are all discussed. (U.K.)
A report on the variety of retail electricity bills across the province, authored by Salvatore Badali of Deloitte Consulting, was recently released by the Ontario Government. The report was commissioned by the Government to examine the underlying reasons for the significant format differences and the wide variation of fixed and variable charges among the approximately 95 local electricity distribution companies across the province. Regarding the appropriateness of the charges the report recommends common definitions for local distribution company (LDC) fixed and variable costs, and consideration of options for reducing LDC charges, mainly by consolidating the sector and sharing such services as customer billing, accounting and out sourcing operations. Seven recommendations deal with bill simplification. These include bills that are clear and easy to read and provide sufficient information for consumers to verify charges; promote energy conservation, e.g. by including historical information; allow comparisons between retail suppliers and distributors; accommodate revenue collection, marketing needs and other billing services. The report also recommends clearly defined and consistently used terminology for standardized line items, suggests ways to provide consumer information in a form useful for making energy conservation decisions, development of an LDC scorecard to enable stake holders to compare their own LDCs with LDCs around the province, creation of a conservation and bill calculation website, consideration of further use of shared services, and solutions to address the removal of line losses from invoices
A report on the variety of retail electricity bills across the province, authored by Salvatore Badali of Deloitte Consulting, was recently released by the Ontario Government. The report was commissioned by the Government to examine the underlying reasons for the significant format differences and the wide variation of fixed and variable charges among the approximately 95 local electricity distribution companies across the province. Regarding the appropriateness of the charges the report recommends common definitions for local distribution company (LDC) fixed and variable costs, and consideration of options for reducing LDC charges, mainly by consolidating the sector and sharing such services as customer billing, accounting and out sourcing operations. Seven recommendations deal with bill simplification. These include bills that are clear and easy to read and provide sufficient information for consumers to verify charges; promote energy conservation, e.g. by including historical information; allow comparisons between retail suppliers and distributors; accommodate revenue collection, marketing needs and other billing services. The report also recommends clearly defined and consistently used terminology for standardized line items, suggests ways to provide consumer information in a form useful for making energy conservation decisions, development of an LDC scorecard to enable stake holders to compare their own LDCs with LDCs around the province, creation of a conservation and bill calculation website, consideration of further use of shared services, and solutions to address the removal of line losses from invoices.
Full Text Available On 11 August 2016, amending the Maternity Benefit Act, 1961, the new bill, The Maternity Benefit (Amendment Bill, 2016 was introduced and passed in the Rajya Sabha (or Council of States, the upper house of the Parliament of India. Central aim of this article is to critically review the amendments to the bill regarding geographies of maternity leave and its associated facilities.
Of immense importance to the coal industry is the announcement, on 7 June 2006 by US Senators Barack Obama (D-IL) and Jim Bunning (R-KY) of S.3325, the 'Coal-to-Liquid Fund Promotion Act of 2006'. This legislation creates tax incentives for coal-to-liquids (CTL) technologies and construction of CTL plants. If passed, this will create the infrastructure needed to make CTL a viable energy resource throughout America. The article gives comment and background to this proposed legislation. Illinois Basin coal is well suited for CTL because of its high Btu content. If Sasol constructs a proposed plant in Illinois it would increase coal production in the state by 10 mt. 1 fig.
Clark, Alan; Dalyell, Tam; Haynes, Frank
The Bill debated concerns the government's proposal for the future organisations of the atomic weapons establishment in the United Kingdom. The proposals arise from a full review carried out in 1989 and include points raised by the Select Committee on the Trident programme. Studies of productivity, pay and conditions, information systems and long term manufacturing strategy have been started to enable recommendations of the reorganisation of the establishments to be made. The details of the Bill were debated for just over two hours. The debate is reported verbatim. The main issues were over the principle of contractorisation, possible staff redundancies, conditions of employment, safety and security. The proposal that the Bill be read a second time was carried. (UK)
Radiotherapy requires competent professional staff to ensure safe and effective patient treatment and management. There is a need to provide guidelines that recommend appropriate staffing levels to support the initiation of new services as well as the expansion or upgrade of existing services as even simple upgrades or replacement of existing equipment may have a significant impact on staffing needs. Similarly, the introduction of education and training programmes will require staffing adjustments. A calculation algorithm was developed to predict staffing levels based on the inputs that are known or can be easily estimated. This publication complements other IAEA publications used to support the initiation of basic radiation medicine services including Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects, published in 2008
Full Text Available Chaired by honourable Prime Minister, Mr. Narendra Damodar Modi, the Union Cabinet on 24 August 2016 introduced and approved the draft bill on Assisted Reproductive Technologies (ART in India, known popularly as the Surrogacy (Regulation Bill, 2016. The bill aims at regulating the ever-proliferating unregulated surrogacy industry interalia banning commercial surrogacy services for single parents, homosexuals, cohabiting partners in addition to foreigners and overseas citizens of India. The key aim of this commentary is to make a nuanced examination of the draft bill aimed at gaining a deeper understanding of the practice of surrogacy and address gaps (if any that require interventions.
An easy to way to understand individual water use is to look at your water bill—not just the amount due, but how much water you used. Pull out your water bill and follow our steps to learn more about it.
The Human Resources Staffing Plan quantified the equivalent staffing needs required for the Tank Farm Contractor (TFC) and its subcontractors to execute the readiness to proceed baseline between FY 2000-2008. The TFC staffing needs were assessed along with the staffings needs of Fluor Hanford and the privatization contractor. The plan then addressed the staffing needs and recruitment strategies required to execute the baseline
S.83: A Bill to ensure the preservation of the Gulf of Mexico by establishing within the Environmental Protection Agency a Gulf of Mexico Program. Introduced in the Senate of the United States, One Hundred Third Congress, First Session, January 21, 1993
S. 83 may be cited as the open-quotes Gulf of Mexico Preservation Act of 1993.close quotes This Bill discusses findings pertaining to resources in the Gulf of Mexico, describes the establishment of the Gulf of Mexico Program, defines the establishment and duties of the Gulf of Mexico Program Office, and proposes a study of international issues. This Bill also includes an assessment to be prepared by the Administrator, a monitoring, management, protection and restoration plan, a grant program, authorization of appropriations, administrative provisions, and the relationship of the Bill to existing federal and state laws and international treaties
One of the first books on Autodesk's new Mudbox 3D modeling and sculpting tool!. Autodesk's Mudbox was used to create photorealistic creatures for The Dark Knight , The Mist , and others films. Now you can join the crowd interested in learning this exciting new digital modeling and sculpting tool with this complete guide. Get up to speed on all of Mudbox's features and functions, learn how sculpt and paint, and master the art of using effective workflows to make it all go easier.: Introduces Autodesk's Mudbox, an exciting 3D modeling and sculpting tool that enables you to create photorealistic
... 42 Public Health 1 2010-10-01 2010-10-01 false Facility staffing. 9.9 Section 9.9 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR... Biosafety Officer must have experience in developing and monitoring biohazards and dealing with biosafety...
A. I. Tolstoy
Full Text Available Determining staffing policy implementation of information security tasks is given. The basic requirements that must be taken into account when developing policies are defined. The policy framework is determined and recommendations for the design of such policies are formulated. Requirements for the implementation of the policy are defined.
McPhail, Ruth; Fisher, Ron; Harvey, Michael; Moeller, Miriam
This article explores the evolution of international staffing in an increasingly globalized and hypercompetitive marketplace. As the issue of staff retention becomes critical in global organizations, it is important to understand the types of managers that may be on or assigned to overseas assignments. The purpose of this article is to present a…
McHugh, Matthew D; Berez, Julie; Small, Dylan S
The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.
Napier, Rebecca H; Bruelheide, Lori S; Demann, Eric T K; Haug, Richard H
The purpose of this article is to highlight the importance of understanding various numeric and alpha-numeric codes for accurately billing dental and medically related services to private pay or third-party insurance carriers. In the United States, common dental terminology (CDT) codes are most commonly used by dentists to submit claims, whereas current procedural terminology (CPT) and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD.9.CM) codes are more commonly used by physicians to bill for their services. The CPT and ICD.9.CM coding systems complement each other in that CPT codes provide the procedure and service information and ICD.9.CM codes provide the reason or rationale for a particular procedure or service. These codes are more commonly used for "medical necessity" determinations, and general dentists and specialists who routinely perform care, including trauma-related care, biopsies, and dental treatment as a result of or in anticipation of a cancer-related treatment, are likely to use these codes. Claim submissions for care provided can be completed electronically or by means of paper forms.
H.R. 3653: a bill to amend the Price-Anderson provisions of the Atomic Energy Act of 1954 to extend and improve procedures for liability and indemnification for nuclear incidents. Introduced in the House of Representatives, Ninety-Ninth Congress, Second Session, October 30, 1985
The Price-Anderson Amendments Act of 1986 amends provisions of the Atomic Energy Act of 1954 in order to improve the liability and indemnification procedures for nuclear incidents. The bill places the primary financial responsibility for protection on large electrical generating facilities, with a limit of $200 million. The bill also makes changes in premium, borrowing authority, and indemnification agreements for licensing. Other changes include defense waivers and judicial reviews
Adams, Matthew C.; And Others
Discusses school preventive maintenance and the variables associated with maintenance staffing standards that address a zero-based budgeting environment. Explores preventive-maintenance measurement for staffing requirements, defines staffing levels and job descriptions, and outlines the factors to consider when creating a maintenance program and…
Baugh, Christopher W; Suri, Pawan; Caspers, Christopher G; Granovsky, Michael A; Neal, Keith; Ross, Michael A
Outpatients receive observation services to determine the need for inpatient admission. These services are usually provided without the use of condition-specific protocols and in an unstructured manner, scattered throughout a hospital in areas typically designated for inpatient care. Emergency department observation units (EDOUs) use protocolized care to offer an efficient alternative with shorter lengths of stay, lower costs and higher patient satisfaction. EDOU growth is limited by existing policy barriers that prevent a "two-service" model of separate professional billing for both emergency and observation services. The majority of EDOUs use the "one-service" model, where a single composite professional fee is billed for both emergency and observation services. The financial implications of these models are not well understood. We created a Monte Carlo simulation by building a model that reflects current clinical practice in the United States and uses inputs gathered from the most recently available peer-reviewed literature, national survey and payer data. Using this simulation, we modeled annual staffing costs and payments for professional services under two common models of care in an EDOU. We also modeled cash flows over a continuous range of daily EDOU patient encounters to illustrate the dynamic relationship between costs and revenue over various staffing levels. We estimate the mean (±SD) annual net cash flow to be a net loss of $315,382 ±$89,635 in the one-service model and a net profit of $37,569 ±$359,583 in the two-service model. The two-service model is financially sustainable at daily billable encounters above 20 while in the one-service model, costs exceed revenue regardless of encounter count. Physician cost per hour and daily patient encounters had the most significant impact on model estimates. In the one-service model, EDOU staffing costs exceed payments at all levels of patient encounters, making a hospital subsidy necessary to create a
Buerhaus, Peter I
The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.
Given a computation center with --10,000 MIPS supporting --1,000 users, what are the staffing requirements? The attempt in this paper is to list the functions and staff size required in a central computing or centrally supported computing complex. The organization assumes that although considerable computing power would exist (mostly for online) in the four interaction regions (IR) that there are functions/capabilities better performed outside the IR and in this model at a ''central computing facility.'' What follows is one staffing approach, not necessarily optimal, with certain assumptions about numbers of computer systems, media, networks and system controls, that is, one would get the best technology available. Thus, it is speculation about what the technology may bring and what it takes to operate it. From an end user support standpoint it is less clear, given the geography of an SSC, where and what the consulting support should look like and its location
Lievens, Yolande; Defourny, Noémie; Coffey, Mary
includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40...... of countries can be distinguished on the basis of available personnel resources and socio-economic status. CONCLUSIONS: The average personnel figures in Europe are now consistent with, or even more favourable than the QUARTS recommendations, probably reflecting a combination of better availability as such......, in parallel with the current use of more complex treatments than a decade ago. A considerable variation in available personnel and delivered courses per year however persists among the highest and lowest staffing levels. This not only reflects the variation in cancer incidence and socio-economic determinants...
military-unique knowledge or skills required; (2) military incumbency is required by law, Executive Order, treaty or international agreement (e.g., DPH...civilian employment . 1 Thomas H. Barth et al., “(U) Staffing for Cyberspace Operations,” IDA Paper P...DoD cyberspace strategies, doctrine, and current concepts of operation and employment for CMF. Additionally, the team conducted interviews with
Neubert , Gilles; Adjadj , Philippe
International audience; For a long time, contingent staffing was considered as the responsability of the Human Resource department. The high needs of workforce flexibility combined with disseminated agencies have led some companies to a great number of labor suppliers. This situation has produced important cost variation, poor quality of service, and important risk due to the mistunderstanding by local managers of legal considerations. To face this situation, companies have started to move fr...
Hahn, H.A.; Houghton, F.K.
This paper reports on a project related to human resource management of the Department of Energy's (DOE's) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment safety, and health concerns. For the of the current paper, human resource management activities are identified as ''Staffing'' and include the of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability. The work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development
Recent events at the Peach Bottom nuclear power plant have demonstrated the need to establish a quantifiable basis for assessing the safety significance of long work hours on nuclear power plant operators. The incidents at TMI-2, Chernobyl, and Bhopal, which all occurred during the late evening/night shift, further highlight the importance of the relationship between shift scheduling and performance. The objective of this project is to estimate, using statistical analysis on data from the nuclear industry, the effects on safety of staffing levels, overtime, and shift scheduling for operators and maintenance personnel. Regarding staffing levels, the Nuclear Regulatory Commission (NRC) currently has no explicit regulation concerning the minimum acceptable levels of staffing in a plant that has an operating license. The NRC has no systematic method for collecting data on the number of licensed operators on the operating crews. In 1982 the NRC recommended that plants write into their technical specifications a model policy on overtime. Currently, 77 nuclear power plant units have the model policy or a modification of it written into their technical specifications; 33 units have no policy on overtime. The model policy sets limits on overtime for safety related personnel, although these limits can be exceeded with plant manger approval. The US nuclear power industry has three types of shift schedules: (1) forward-rotating 8-hour/day shift schedules, (2) backward-rotating 8-hour/day schedules, and (3) 12-hour/day schedules
Using the Spent Nuclear Fuel (SNF) Project's current process flow concepts and knowledge from cognizant engineering and operational personnel, an initial assessment of the SNF Project radiological exposure and resource requirements was completed. A small project team completed a step by step analysis of fuel movement in the K Basins to the new interim storage location, the Canister Storage Building (CSB). This analysis looked at fuel retrieval, conditioning of the fuel, and transportation of the fuel. This plan describes the staffing structure for fuel processing, fuel movement, and the maintenance and operation (M ampersand O) staffing requirements of the facilities. This initial draft does not identify the support function resources required for M ampersand O, i.e., administrative and engineering (technical support). These will be included in future revisions to the plan. This plan looks at the resource requirements for the SNF subprojects, specifically, the operations of the facilities, balances resources where applicable, rotates crews where applicable, and attempts to use individuals in multi-task assignments. This plan does not apply to the construction phase of planned projects that affect staffing levels of K Basins
Hahn, H.A.; Houghton, F.K.
This paper reports on a project related to human resource management of the Department of Energy (DOEs) High-Level Waste (HLW) Tank program. Safety and reliability of waste tank operations is impacted by several issues, including not only the design of the tanks themselves, but also how operations and operational personnel are managed. As demonstrated by management assessments performed by the Tiger Teams, DOE believes that the effective use of human resources impacts environment, safety, and health concerns. For the purposes of the current paper, human resource management activities are identified as 'Staffing' and include the process of developing the functional responsibilities and qualifications of technical and administrative personnel. This paper discusses the importance of staff plans and management in the overall view of safety and reliability, the work activities and procedures associated with the project, a review of the results of these activities, including a summary of the literature and a preliminary analysis of the data. We conclude that, although identification of staffing issues and the development of staffing plans contributes to the overall reliability and safety of the HLW tanks, the relationship is not well understood and is in need of further development
S. 705: A Bill to assure fair consideration of the interests of states likely to be affected by the establishment of low-level radioactive waste disposal facilities. Introduced in the Senate of the United States, One Hundredth First Congress, First Session, April 5, 1989
S. 705 is a bill to assure fair consideration of the interests of states likely to be affected by the establishment of low-level radioactive waste disposal facilities. Notification of adjacent states is proposed when waste disposal operations are contemplated at border sites
H.R. 2372: A Bill to provide jurisdiction and procedures for claims for compassionate payments for injuries due to exposure to radiation from nuclear testing. Introduced in the House of Representatives, One Hundredth First Congress, First Session, May 16, 1989
H.R. 2372 is a bill to provide jurisdiction and procedures for claims for compassionate payments for injuries due to exposure to radiation from nuclear testing. The Act proposes the use of a Trust Fund Board of Directors to disburse funds under prescribed conditions
Deeken, Debra Jean; Wakefield, Douglas; Kite, Cora; Linebaugh, Jeanette; Mitchell, Blair; Parkinson, Deidre; Misra, Madhukar
Ensuring that the level of nurse staffing used to care for patients is appropriate to the setting and service intensity is essential for high-quality and cost-effective care. This article describes the development, validation, and implementation of the clinic technical skills permission list developed specifically to guide nurse staffing decisions in physician clinics of an academic medical center. Results and lessons learned in using this staffing guideline are presented.
U.S. Department of Health & Human Services — Reducing Costs, Protecting Consumers - The Affordable Care Act on the One Year Anniversary of the Patients Bill of Rights For too long, too many hard working...
Bennett, A.F.; Cryer, Bob; Carlisle, Kenneth; Dean, Paul.
The debate concerns the authorisation of payment of the money required to reorganise the atomic weapons establishment in the United Kingdom provided for in the Atomic Weapons Establishment Bill in progress through Parliament. In the Bill the contractorisation of the establishment is recommended and some sort of Government owned company operated scheme set up. The debate lasted about half an hour and is reported verbatim. The issues raised concerned the actual sums likely to be incurred in the formation of a Company to carry out the designated activities of the Bill. These are connected with the research, development, production or maintenance of nuclear devices and the premises needed. The government spokesman suggested the sums required to support the Bill would not be large and the resolution was agreed to without a vote. (UK)
H.R. 1083: a bill to amend the Low-Level Radioactive Waste Policy Act to improve procedures for the implementation of compacts providing for the establishment and operation of regional disposal facilities for low-level radioactive waste, and for other purposes. Introduced in the US House of Representatives, Ninety-Nineth Congress, First Session, February 7, 1984
The main purpose of H.R. 1083 is to amend the Low-Level Radioactive Waste Act to improve the procedures for establishing regional disposal facilities. The bill defines several terms affecting compacts between states and the federal government. It also outlines state and federal responsibilities for disposing of low-level radioactive wastes, establishes procedures for Congressional review of each compact every five years, and designates the limitations of regional facilities for accepting wastes. The bill concludes with requirements for adequate financing of waste disposal facilities and both technical and financial assistance to states. Implementation of this Act will be the cooperative responsibility of the Nuclear Regulatory Commission, Secretary of Energy, and Secretary of Transportation
H.R. 5051: a bill to authorize funding for research on the potential atmospheric, climatic, biological, health, and environmental consequences of nuclear explosions and nuclear exchanges... Introduced in the House of Representatives, Ninety-Ninth Congress, Second Session, June 18, 1986
The Nuclear Winter Research Act of 1986 authorizes funding to study the potential consequences of nuclear explosions. The research will cover possible atmospheric, climatic, biological, health, or environmental changes to see if the nuclear winter theory is plausible. The bill authorizes $8.5 million over a five-year period for the Department of Defense study. It also establishes a Nuclear Winter Study Commission to determine and evaluate what implications these potential effects have for defense policy
H.R.2041: a bill to authorize appropriations to the Department of Energy for civilian energy programs for fiscal year 1986 and fiscal year 1987, and for other purposes. Introduced in the House of Representatives, Ninety-Ninth Congress, First Session, April 15, 1985
The Civilian Energy Programs Authorization for Fiscal Years 1986 and 1987 (H.R.2041) authorizes DOE spending of $8.87 billion for civilian research and development; $206 million for specified conservation, regulation, and information programs; $276.8 million for power marketing administration; and $2.98 billion for activities in uranium supply and enrichment, nuclear waste management, and community energy programs. The bill indicates where revenues from fees and other revenues will apply
S.1043: a Bill to authorize appropriations for the Department of Energy for national security programs for fiscal year 1986, and for other purposes. Introduced in the Senate of the United States, Ninety-Ninth Congress, First Session, May 1, 1985
The National Security Programs Authorization Act for Fiscal Year 1986 authorizes funds for research and development of weapons, critical materials, and the processing and waste disposal of nuclear materials. Section 102 identifies 72 specific projects by location involving plant and capital equipment. Section 202 specifies the conditions for placing limits on construction projects when current estimated costs exceed appropriated amounts by more than 25%. The Bill concludes with provisions for transferring funds, authority for emergency design funds, and the availability of appropriated funds
H.R. 4895: a bill to establish a requirement that no person may offer any high-level radioactive waste for transportation in interstate commerce unless licensed for such offering by the Nuclear Regulatory Commission, and for other purposes. Introduced in the House of Representatives, Ninety-Ninth Congress, Second Session, May 22, 1986
The Nuclear Waste Transportation Act requires that anyone offering high-level radioactive waste for transportation in interstate commerce must be licensed. The bill describes the qualifications and requirements for obtaining a license either to offer the wastes or to transport it, the procedures for issuance, notification to political subdivisions and Indian tribes, and routing. It also includes time restrictions and enforcement authority. High-level radioactive materials include spent nuclear fuel and reprocessing materials
Horstmann, S; Rizos, T; Güntner, J; Hug, A; Jenetzky, E; Krumsdorf, U; Veltkamp, R
Detecting paroxysmal atrial fibrillation (pAF) soon after acute cerebral ischaemia has a major impact on secondary stroke prevention. Recently, the STAF score, a composite of clinical and instrumental findings, was introduced to identify stroke patients at risk of pAF. We aimed to validate this score in an independent study population. Consecutive patients admitted to our stroke unit with acute ischaemic stroke were prospectively enrolled. The diagnostic work-up included neuroimaging, neuroultrasound, baseline 12-channel electrocardiogram (ECG), 24-h Holter ECG, continuous ECG monitoring, and echocardiography. Presence of AF was documented according to the medical history of each patient and after review of 12-lead ECG, 24-h Holter ECG, or continuous ECG monitoring performed during the stay on the ward. Additionally, a telephone follow-up visit was conducted for each patient after 3 months to inquire about newly diagnosed AF. Items for each patient-age, baseline NIHSS, left atrial dilatation, and stroke etiology according to the TOAST criteria - were assessed to calculate the STAF score. Overall, 584 patients were enrolled in our analysis. AF was documented in 183 (31.3%) patients. In multivariable analysis, age, NIHSS, left atrial dilatation, and absence of vascular etiology were independent predictors for AF. The logistic AF-prediction model of the STAF score revealed fair classification accuracy in receiver operating characteristic curve analysis with an area under the curve of 0.84. STAF scores of ≥5 had a sensitivity of 79% and a specificity of 74% for predicting AF. The value of the STAF score for predicting the risk of pAF in stroke patients is limited. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.
van der Veen, Egbert; Veltman, Bart
Many rostering methods first create shifts from some given staffing levels, and after that create rosters from the set of created shifts. Although such a method has some nice properties, it also has some bad ones. In this paper we outline a method that creates rosters directly from staffing levels.
Small, Erika E.; Doll, Jessica L.; Bergman, Shawn M.; Heggestad, Eric D.
Developing students' practical skills in strategic staffing and selection within the classroom can be challenging. This article describes a staffing system simulation designed to engage students and develop applied skills in strategic recruiting, assessment, and evaluation of job applicants. Instructors looking for a multifaceted team project…
H.R. 3653: a Bill to amend the Price-Anderson provisions of the Atomic Energy Act of 1954 to extend and improve procedures for liability and indemnification for nuclear incidents. Introduced in the House of Representatives, Ninety-Ninth Congress, First Session, October 30, 1985
The Price-Anderson Amendments Act of 1985 extends the coverage from August 1, 1987 to August 1, 1997 and improves liability and indemnification procedures. It establishes premium amounts and limits annual levels to $10 million. The aggregate liability for a single nuclear incident is set at $500 million plus the cost of nuclear insurance required for the licensee as a function of the rated electrical capacity. A commission to administer compensation will function following an incident and until dissolved by the president. The bill also provides for the consolidation of claims from a single incident
Earmarked funds in the $268 billion defense appropriations bill for fiscal year 1991 stirred congressional debate in late October. Senator Sam Nunn (D-Ga.), chairman of the Senate Armed Services Committee, charged that the defense bill contains questionable projects totaling tens of millions of dollars. AGU opposes legislative earmarking of money for particular institutions, maintaining that the practice prevents the best use of federal funding by circumventing competitive review. Nunn noted on the Senate floor that the appropriations bill provided specific funds for cited institutions—contravening a federal law promoting competition. “ If these programs have merit, they will succeed in a fair and competent review in competition,” Nunn said. “If no other institution in the country is able to compete, there should be no fear whatever of competition… But no one else in the world is allowed to compete to work on these projects.”
Eadie, A.; Goodlad, A.; Fisher, M.; Griffiths, P.; Coombs, S.
The discussions of one of the standing committees of the House of Lords on the Atomic Energy Authority Bill are reported verbatim. Clauses 6, 9 and new clauses 3, 2 and 4 were discussed. The amendments to the clauses were put and debated. The safety requirements of the nuclear industry and the money necessary for these are discussed. At the end of the debate on each clause (and amendments if any), the decision of the House as to its agreement or otherwise is recorded. It was agreed that the Bill, as amended by the committee, should be reported to the (full) House of Lords. The debate lasted 1 3/4 hours.
West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin
To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on
Center for Law and Education (NJ3), 2009
This paper presents two forms of the Educational Quality Bill of Rights (EQBR). The first is a "one-page version", with a very brief single sentence identification of a key element of quality education in response to each of the key questions about the school (covering standards/learning goals, curriculum, instruction, etc.). The second is a "much…
The entrepreneurial spirit is still top in Bill Gates' mind as he look toward healthcare and other growth industries. Microsoft's CEO has not intention of going the way of other large technology companies that became obsolete before they could compete today.
This article comments the slight decrease of the French energy bill in 2007 and its evolution since 1970, as well as the energy price fluctuations during 2007. While noticing the importance of the dollar fall, the authors discuss the evolution of oil product prices and its different indicators (crude oil annual average quotation, Brent annual average quotation, and imported oil annual average price), the evolution of natural gas prices, of coal prices, of electricity prices. The global decrease of energy imports is then discussed, including quantities of imported crude oil from various origins, refined products, gas from various origins as well, solid mineral fuels. The balance between exports and imports is commented as a whole, and with some particular countries, enabling an assessment of energy independence. The bill evolution for oil and for gas is briefly discussed, and the global value is assessed with respect to the French GDP or as an amount of work days for French inhabitants. Several graphs and tables are given, gathering several data which have been discussed: energy trade (imports, exports, and bill), comparison of bill with other economic aggregates, average prices of imported energy expressed in dollars and in euros, average price of imported crude oil, etc
Kalisch, Beatrice; Lee, Kyung Hee
The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses. This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units. Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction. Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff. Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career. © 2012 John Wiley & Sons Ltd.
Shurberg, D.A.; Haber, S.B. [Brookhaven National Lab., Upton, NY (United States); Morisseau, D. [Nuclear Regulatory Commission, Washington, DC (United States)] [and others
The objective of this project is to provide a technical basis for the establishment of criteria for minimum staffing levels of licensed and non-licensed NPP shift personnel. Minimum staffing levels for the purpose of this study, are defined as those necessary for successful accomplishment of all safety and additional functions that must be performed in order for the licensee to meet applicable regulatory requirements. This project involves a multi-faceted approach to the investigation of the issue. Relevant NRC documentation was identified and reviewed. Using the information obtained from this documentation review, a test plan was developed to aid in the collection of further information regarding the adequacy of current shift staffing levels. The test plan addresses three different activities to be conducted to provide information to the NRC for use in the assessment of current minimum staffing levels. The first activity is collection of data related to industry shift staffing practices through site visits to seven nuclear power plants. The second activity is a simulator study, which will use licensed operator crews responding to a simulated event, under two different staffing levels. Finally, workload models will be constructed for both licensed and non-licensed personnel, using a priori knowledge of the simulator scenarios with data resulting from one of the staffing levels studied in the simulator, and the data collected from the site visits. The model will then be validated against the data obtained from the second staffing level studied in the simulator. The validated model can then be used to study the impact of changing staffing-related variables on the plant shift crew`s ability to effectively mitigate an event.
Weiss, Manfred; Marx, Gernot; Iber, Thomas
Intensive care medicine remains one of the most cost-driving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks (performed in every patient) and additional tasks (necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society of Anesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.
McHugh, Matthew D.; Ma, Chenjuan
Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes. PMID:25121923
Houseman, Susan N.; Polivka, Anne E.
In this paper, we examine the job stability of workers in a wide range of flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. We draw upon two data sources in our analysis. The first is a nationwide survey of employers on their use of flexible staffing arrangements conducted by the Upjohn Institute for Employment Research. This survey provides evidence on why employers use various types of flex...
Fejerskov, Adam Moe
Det amerikanske uddannelsessystem bliver for tiden udsat for hård kritik, ledt an af Microsoft stifteren Bill Gates. Gates har indtil videre brugt 3 mia. kroner på at skabe opbakning til tiltag som præstationslønning af lærere og strømlining af pensum på tværs af alle skoler i landet...
Dorr, David A; Horn, Susan D; Smout, Randall J
To examine potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing. A retrospective cost study using differences in adverse outcome rates of pressure ulcers (PUs), urinary tract infections (UTIs), and hospitalizations per resident per day from low staffing and adequate staffing nursing homes. Cost savings from reductions in these events are calculated in dollars and compared with costs of increasing nurse staffing. Eighty-two nursing homes throughout the United States. One thousand three hundred seventy-six frail elderly long-term care residents at risk of PU development. Event rates are from the National Pressure Ulcer Long-Term Care Study. Hospital costs are estimated from Medicare statistics and from charges in the Healthcare Cost and Utilization Project. UTI costs and PU costs are from cost-identification studies. Time horizon is 1 year; perspectives are societal and institutional. Analyses showed an annual net societal benefit of 3,191 dollars per resident per year in a high-risk, long-stay nursing home unit that employs sufficient nurses to achieve 30 to 40 minutes of registered nurse direct care time per resident per day versus nursing homes that have nursing time of less than 10 minutes. Sensitivity analyses revealed a robust set of estimates, with no single or paired elements reaching the cost/benefit equality threshold. Increasing nurse staffing in nursing homes may create significant societal cost savings from reduction in adverse outcomes. Challenges in increasing nurse staffing are discussed.
Stone, Patricia W; Dick, Andrew; Pogorzelska, Monika; Horan, Teresa C; Furuya, E Yoko; Larson, Elaine
The nature of infection prevention and control is changing; however, little is known about current staffing and structure of infection prevention and control programs. Our objectives were to provide a snapshot of the staffing and structure of hospital-based infection prevention and control programs in the United States. A Web-based survey was sent to 441 hospitals that participate in the National Healthcare Safety Network. The response rate was 66% (n = 289); data were examined on 821 professionals. Infection preventionist (IP) staffing was significantly negatively related to bed size, with higher staffing in smaller hospitals (P hospital epidemiologists were reported to have authority to close beds for outbreaks always or most of the time (n = 225, 78%). Only 32% (n = 92) reported using an electronic surveillance system to track infections. This study is the first to provide a comprehensive description of current infection prevention and control staffing, organization, and support in a select group of hospitals across the nation. Further research is needed to identify effective staffing levels for various hospital types as well as examine how the IP role is changing over time.
... provided in the customer's special contract. (c) Service fee billing. The utility shall render service fee... 25 Indians 1 2010-04-01 2010-04-01 false Billing. 175.30 Section 175.30 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER INDIAN ELECTRIC POWER UTILITIES Billing, Payments, and...
... ADMINISTRATION AND AUDIT SERVICES Indirect Cost Rates 942.704 Billing rates. (b) When the contracting officer or auditor responsible for establishing billing rates, in accordance with 48 CFR 42.704, has not established... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Billing rates. 942.704...
Harrington, Charlene; Schnelle, John F.; McGregor, Margaret; Simmons, Sandra F.
Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U.S. facilities have dangerously low staffing. Second, the barriers to staffing reform are discussed. These include economic concerns about costs and a focus on financial incentives. The enforcement of existing staffing standards has been weak, and strong nursing home industry political opposition has limited efforts to establish higher standards. Researchers should study the ways to improve staffing standards and new payment, regulatory, and political strategies to improve nursing home staffing and quality. PMID:27103819
Nadolski, Charles; Britt, Pheraby; Ramos, Leah C
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
This paper addresses the questions related to the cost of China's bank restructuring and how it has been financed. We first propose a framework for recognizing losses. Then, we examine the recent major moves by the Chinese Government to repair the country's bank balance sheets. Finally, we explore the implications of the Chinese Government's methods of funding bank restructuring. We find that the Chinese Government has been decisive in confronting the costly task of bank restructuring. So far, Chinese taxpayers have paid most of the bill for bank restructuring.
Baggett, Margarita; Batcheller, Joyce; Blouin, Ann Scott; Behrens, Elizabeth; Bradley, Carol; Brown, Mary J; Brown, Diane Storer; Bolton, Linda Burnes; Borromeo, Annabelle R; Burtson, Paige; Caramanica, Laura; Caspers, Barbara A; Chow, Marilyn; Christopher, Mary Ann; Clarke, Sean P; Delucas, Christine; Dent, Robert L; Disser, Tony; Eliopoulos, Charlotte; Everett, Linda Q; Garcia, Amy; Glassman, Kimberly; Goodwin, Susan; Haagenson, Deb; Harper, Ellen; Harris, Kathy; Hoying, Cheryl L; Hughes-Rease, Marsha; Kelly, Lesly; Kiger, Anna J; Kobs-Abbott, Ann; Krueger, Janelle; Larson, Jackie; March, Connie; Martin, Deborah Maust; Mazyck, Donna; Meenan, Penny; McGaffigan, Patricia; Myers, Karen K; Nell, Kate; Newcomer, Britta; Cathy, Rick; O'Rourke, Maria; Rosa, Billy; Rose, Robert; Rudisill, Pamela; Sanford, Kathy; Simpson, Roy L; Snowden, Tami; Strickland, Bob; Strohecker, Sharon; Weems, Roger B; Welton, John; Weston, Marla; Valentine, Nancy M; Vento, Laura; Yendro, Susan
The Patient Protection and Affordable Care Act (PPACA, 2010) and the Institute of Medicine's (IOM, 2011) Future of Nursing report have prompted changes in the U.S. health care system. This has also stimulated a new direction of thinking for the profession of nursing. New payment and priority structures, where value is placed ahead of volume in care, will start to define our health system in new and unknown ways for years. One thing we all know for sure: we cannot afford the same inefficient models and systems of care of yesterday any longer. The Data-Driven Model for Excellence in Staffing was created as the organizing framework to lead the development of best practices for nurse staffing across the continuum through research and innovation. Regardless of the setting, nurses must integrate multiple concepts with the value of professional nursing to create new care and staffing models. Traditional models demonstrate that nurses are a commodity. If the profession is to make any significant changes in nurse staffing, it is through the articulation of the value of our professional practice within the overall health care environment. This position paper is organized around the concepts from the Data-Driven Model for Excellence in Staffing. The main concepts are: Core Concept 1: Users and Patients of Health Care, Core Concept 2: Providers of Health Care, Core Concept 3: Environment of Care, Core Concept 4: Delivery of Care, Core Concept 5: Quality, Safety, and Outcomes of Care. This position paper provides a comprehensive view of those concepts and components, why those concepts and components are important in this new era of nurse staffing, and a 3-year challenge that will push the nursing profession forward in all settings across the care continuum. There are decades of research supporting various changes to nurse staffing. Yet little has been done to move that research into practice and operations. While the primary goal of this position paper is to generate research
van der Veen, Egbert; Hans, Elias W.; Veltman, Bart; Berrevoets, Leo M.; Berden, Hubert J.J.M.
We study how flexibility in workforce capacity can be used to efficiently match capacity and demand. Flexibility in workforce capacity is introduced by the annualized hours regime. Annualized hours allow organizations to measure working time per year, instead of per month or per week. An additional
Congress occasionally passes new laws that affect how clinical laboratories handle test orders from physicians and, subsequently, process the billing for tests. Once a bill is signed into law, it is forwarded to administrative agencies, which draft regulations and administrative procedures, under which the intentions of Congress are carried out. In the case of laboratory test ordering and billing, the Centers for Medicare and Medicaid Services (CMS) has the greatest influence over how these regulations and procedures are defined. Unfortunately, in many cases, billing rules have been promulgated in ways that create the need for hospitals and commercial laboratories to expend huge sums of money to bill within the confines of the administrative rules; cause clinical laboratories to suffer from omissions and mistakes of other parties who are part of the patient care process but are not accountable for the billing information they provide to laboratories; and, frankly, in some respects, simply defy common sense.
Krajenta, Rick; Lamerato, Lois; Wells, Karen
Background Healthcare utilization data, specifically diagnoses and procedures, can be processed through different administrative systems. Billing data are generated by the care provider while claims data are generated by the payer. These two sources can represent the data content differently and incorporating the data from these systems into the VDW has presented a unique set of challenges. We present options for reconciling these two data sources to create a VDW that includes all patients including those outside of the HMO member realm. Methods Henry Ford Health System (HFHS) captures patients, care providers, procedures, diagnoses and medical supply information through a proprietary system. Outpatient billing information is entered by clinic staff using an optical scanning device and clinic-specific forms. Other additional procedures and/or supplies are entered into the system using a transaction capture application. Ancillary services such as imaging and pathology are imported into the billing system from their proprietary information systems. The main function of this system is to generate bills for services performed. The data elements are standardized to contain required justification for reimbursement from all payer types. Standard codes sets, ICD9, HCPCS and CPT4, are required. The data can also be used to evaluate workload and staffing levels, project future needs and characterize trends in service demands. HFHS uses this data source to build VDW files. Results Major differences between claims and billing data exist. Claims data are based on health plan contract with bundled procedures, coverage exclusions and deductibles affecting content. Billing data are based solely on services provided. The potential for overwhelming amounts of data in billing sources is possible due to the level of detail; however, this same level of detail is a rich source for specific care components that would not otherwise be present in claims records. Conclusion Billing data are
Manojlovich, Milisa; Sidani, Souraya; Covell, Christine L; Antonakos, Cathy L
Inconsistent findings in more than 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. The aim of this study was to examine the construct validity of nurse dose by determining its association with methicillin-resistant Staphylococcus aureus (MRSA) infections and reported patient falls on a sample of inpatient adult acute care units. Staffing data came from 26 units in Ontario, Canada, and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from infection control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were associated significantly with both outcomes. Active ingredient (education, experience, skill mix) and intensity (full-time employees, registered nurse [RN]:patient ratio, RN hours per patient day) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls, and coefficients were again negative, but coefficient sizes differed. By conceptualizing nurse and staffing variables (education, experience, skill mix, full-time employees, RN:patient ratio, RN hours per patient day) as attributes of nurse dose and by including these in the same analysis, it is possible to determine their relative influence on MRSA infections and reported patient falls.
Zainudin, WNRA; Ramli, NA
In 2016, Tenaga Nasional Berhad (TNB) had introduced an upgrade in its Billing and Customer Relationship Management (BCRM) as part of its long-term initiative to provide its customers with greater access to billing information. This includes information on real and suggested power consumption by the customers and further details in their billing charges. This information is useful to help TNB customers to gain better understanding on their electricity usage patterns and items involved in their billing charges. Up to date, there are not many studies done to measure public understanding on current electricity bills and whether this understanding could contribute towards positive impacts. The purpose of this paper is to measure public understanding on current TNB electricity bills and whether their satisfaction towards energy-related services, electricity utility services, and their awareness on the amount of electricity consumed by various appliances and equipment in their home could improve this understanding on the electricity bills. Both qualitative and quantitative research methods are used to achieve these objectives. A total of 160 respondents from local universities in Malaysia participated in a survey used to collect relevant information. Using Ordered Probit model, this paper finds respondents that are highly satisfied with the electricity utility services tend to understand their electricity bills better. The electric utility services include management of electricity bills and the information obtained from utility or non-utility supplier to help consumers manage their energy usage or bills. Based on the results, this paper concludes that the probability to understand the components in the monthly electricity bill increases as respondents are more satisfied with their electric utility services and are more capable to value the energy-related services.
Feng, Zhanlian; Grabowski, David C; Intrator, Orna; Zinn, Jacqueline; Mor, Vincent
We examined the impact of state Medicaid payment rates and case-mix reimbursement on direct care staffing levels in US nursing homes. We used a recent time series of national nursing home data from the Online Survey Certification and Reporting system for 1996-2004, merged with annual state Medicaid payment rates and case-mix reimbursement information. A 5-category response measure of total staffing levels was defined according to expert recommended thresholds, and examined in a multinomial logistic regression model. Facility fixed-effects models were estimated separately for Registered Nurse (RN), Licensed Practical Nurse (LPN), and Certified Nurse Aide (CNA) staffing levels measured as average hours per resident day. Higher Medicaid payment rates were associated with increases in total staffing levels to meet a higher recommended threshold. However, these gains in overall staffing were accompanied by a reduction of RN staffing and an increase in both LPN and CNA staffing levels. Under case-mix reimbursement, the likelihood of nursing homes achieving higher recommended staffing thresholds decreased, as did levels of professional staffing. Independent of the effects of state, market, and facility characteristics, there was a significant downward trend in RN staffing and an upward trend in both LPN and CNA staffing. Although overall staffing may increase in response to more generous Medicaid reimbursement, it may not translate into improvements in the skill mix of staff. Adjusting for reimbursement levels and resident acuity, total staffing has not increased after the implementation of case-mix reimbursement.
Hsieh Tsungling; Yang Chihwei; Lin Chiuhsiangjoe
The key goals of staffing and qualifications review element are to ensure that the right numbers of people with the appropriate skills and abilities are available to support plant operations and events. If the staffing level is too few, excessive stress that caused human errors possibly will be placed on the operators. Accordingly, this study developed a staffing evaluation technique based on CPM-GOMS for the mental tasks such as operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation technique. The results indicated the performance of evaluated staffing level via the staffing evaluation technique was significantly higher than that of non-evaluated staffing level; thus, validity of the staffing evaluation technique can be accepted. Finally, the implications for managerial practice on the findings of this study were discussed. (author)
"Help Wanted" signs are springing up outside schools. The shortage of school administrators is not coming, it is here. To thwart the shortage and keep schools on the cutting edge, diligence in cultivating, training, and inspiring a new generation of school leaders--especially for the principalship, must be exercised. Staffing the Principalship…
Salt, John; Wood, Peter
This article suggests that as their internal labor markets become more multinational in scope, UK universities may acquire similar staffing characteristics to commercial multinational enterprises (MNEs). Comparing evidence from four UK universities with several surveys of MNEs it concludes that, although there are broad similarities in the…
Department of Health (Ireland)
Flexible Training Strategy (National Task Force on Medical Staffing) The Flexible Training Strategy, while endorsing flexible/part-time options recognises that the preferred option for the majority of doctors-in-training and consultants is most likely to continue to be full-time training and work. Click here to download PDF
Obtaining effective security resourcing and staffing for smaller healthcare facilities presents many difficulties, according to the author In this article, he provides guidance to security practitioners on taking existing data and translating it into a language that administration will understand and appreciate.
... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false State agency staffing requirements. 653.111 Section 653.111 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR SERVICES... ethnic characteristics in the work force shall be distributed in substantially the same proportion among...
... OPERATORS MARITIME SECURITY PROGRAM (MSP) Billing and Payment Procedures § 296.40 Billing procedures. Submission of voucher. For contractors operating under more than one MSP Operating Agreement, the contractor may submit a single monthly voucher applicable to all its MSP Operating Agreements. Each voucher...
... officer (or cognizant Federal agency official) or auditor responsible under 42.705 for establishing the... contracting officer (or cognizant Federal agency official) or auditor shall establish billing rates on the... officer (or cognizant Federal agency official) or auditor should ensure that the billing rates are as...
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is
Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses
A newly proposed regulation in Ontario will require the mandatory tracking of 358 airborne pollutants by the electricity sector as well as by other large industrial facilities such as iron and steel manufacturers and petroleum refiners. If passed, the regulation would make Ontario the first jurisdiction in the world to require monitoring and reporting of a full suite of major greenhouse gases, including smog and acid-rain causing emissions. The proposed regulation also provides for immediate public access to any reported information. Ontario residents can comment on the proposed regulation through the Environmental Bill of Rights registry. A new, more severe hazardous waste regulation will also take effect on March 31, 2001, whereby testing for 88 contaminants will be done according to a new standard called the Toxicity Characteristic Leaching Procedure (TCLP). This new regulation also introduces a new 'derived from' rule which requires that a listed hazardous waste keep its classification until it can be demonstrated otherwise. Ontario's list of hazardous wastes has been updated to include 129 new chemicals and industrial processes. The Ontario Ministry has also adopted the Canada-wide Standards for Particulate Matter and Ozone, as well as the Canada-wide Standards for mercury emissions from base metal smelters as well as from incineration of sewage sludge and municipal, medical, hazardous waste
Castle, Nicholas G.
Purpose: This study describes the creation and use of a web-based resource, designed to help nursing homes implement quality improvements through changes in staffing characteristics. Design and Methods: Information on staffing characteristics (i.e., staffing levels, turnover, stability, and use of agency staff), facility characteristics (e.g.,…
Williams, Alicia D.; Protheroe, Nancy; Parks, Michael C.
Staffing patterns in American public-school systems are presented in this report of the 2000-01 school year. The report addresses the following: why information about staffing ratios is important; how many people currently work in public schools; what proportion of these are teachers, administrators, and support staff; current staffing patterns in…
van Oostveen, Catharina J.; Mathijssen, Elke; Vermeulen, Hester
To obtain in-depth insight into the perceptions of nurses in the Netherlands regarding current nurse staffing levels and use of nurse-to-patient-ratios (NPR) and patient classification systems (PCS). In response to rising health care demands due to ageing of the patient population and increasing
Maldonado, Angela Q; Seiger, Todd C; Urann, Christina L; McCleary, Jo Ann; Goroski, Angela L; Ojogho, Okechukwu N
The economic impact of out-patient pharmacy services in a transplant program was evaluated. Full-time kidney transplant pharmacy services were implemented at Providence Sacred Heart Medical Center (PSHMC) in the fall of 2008, with two pharmacists combining hours to provide one full-time-equivalent position. At PSHMC, posttransplantation patients are seen three times per week. The number of patient visits with pharmacists for 2010 was compared with the total number of patient visits. The face-to-face time spent with the patient was translated to a level of billing that was associated with a set reimbursement schedule. For each patient encounter in which a pharmacist was involved, the incremental difference between the nursing and pharmacy levels of billing was examined, as were the levels most often billed by pharmacists. The difference in billing levels between pharmacists and nurses for the same patient encounter was also evaluated. Overall, pharmacist visits accounted for 208 (22%) of the 994 out-patient kidney transplant visits in 2010, with pharmacists billing at a higher level of acuity compared with nursing for the same patient encounter 48% of the time. This translated to an approximate increase of $100 per patient visit. For the one-year study period, pharmacists utilizing facility- fee billing increased out-patient reimbursement by approximately $10,000. By utilizing outpatient facility-fee billing for pharmacy services, the transplant program at PSHMC increased reimbursement in the outpatient setting.
Sérgio Roberto da Silva
Full Text Available Colombia has been one of the first countries to introduce electronic billing process on a voluntary basis, from a traditional to a digital version. In this context, the article analyzes the electronic billing process implemented in Colombia and the advantages. Methodological research is applied, qualitative, descriptive and documentary; where the regulatory framework and the conceptualization of the model is identified; the process of adoption of electronic billing is analyzed, and finally the advantages and disadvantages of its implementation is analyzed. The findings indicate that the model applied in Colombia to issue an electronic billing in sending and receiving process, is not complex, but it requires a small adequate infrastructure and trained personnel to reach all sectors, especially the micro and business which is the largest business network in the country.
Bowblis, John R; Hyer, Kathryn
To study the effect of minimum nurse staffing requirements on the subsequent employment of nursing home support staff. Nursing home data from the Online Survey Certification and Reporting (OSCAR) System merged with state nurse staffing requirements. Facility-level housekeeping, food service, and activities staff levels are regressed on nurse staffing requirements and other controls using fixed effect panel regression. OSCAR surveys from 1999 to 2004. Increases in state direct care and licensed nurse staffing requirements are associated with decreases in the staffing levels of all types of support staff. Increased nursing home nurse staffing requirements lead to input substitution in the form of reduced support staffing levels. © Health Research and Educational Trust.
Paes, B; Mitchell, A; Hunsberger, M; Blatz, S; Watts, J; Dent, P; Sinclair, J; Southwell, D
Advances in technology have improved the survival rates of infants of low birth weight. Increasing service commitments together with cutbacks in Canadian training positions have caused concerns about medical staffing in neonatal intensive care units (NICUs) in Ontario. To determine whether an imbalance exists between the supply of medical personnel and the demand for health care services, in July 1985 we surveyed the medical directors, head nurses and staff physicians of nine tertiary level NICUs and the directors of five postgraduate pediatric residency programs. On the basis of current guidelines recommending an ideal neonatologist:patient ratio of 1:6 (assuming an adequate number of support personnel) most of the NICUs were understaffed. Concern about the heavy work pattern and resulting lifestyle implications has made Canadian graduates reluctant to enter this subspecialty. We propose strategies to correct staffing shortages in the context of rapidly increasing workloads resulting from a continuing cutback of pediatric residency positions and restrictions on immigration of foreign trainees.
U.S. Environmental Protection Agency — These data represent predicted current distributions of all introduced mammals, birds, reptiles, amphibians and butterflies in the Middle-Atlantic region. These data...
Kalisch, Beatrice J; Lee, Hyunhwa
This study aimed to explore whether and how staff characteristics, staffing, and scheduling variables are associated with the level of teamwork in nursing staff on acute care hospital patient units. This was a cross-sectional study with a sample of 1,758 nursing staff members from two different hospitals on 38 patient care units who completed the Nursing Teamwork Survey in 2008. This study focused on nursing teams who are stationed on a particular patient care unit (as opposed to visitors to the units). The return rate was 56.9%. The sample was made up of 77.4% nurses (registered nurses and licensed practical nurses), 11.9% assistive personnel, and 7.9% unit secretaries. Teamwork varied by unit and service type, with the highest scores occurring in pediatrics and maternity and the lowest scores on the medical-surgical and emergency units. Staff with less than 6 months of experience, those working 8- or 10-hour shifts (as opposed to 12 hours or a combination of 8 and 12 hours), part-time staff (as opposed to full time), and those working on night shift had higher teamwork scores. The higher teamwork scores were also associated with no or little overtime. The higher perception of the adequacy of staffing and the fewer patients cared for on a previous shift, the higher the teamwork scores. There is a relationship between selected staff characteristics, aspects of work schedules, staffing, and teamwork. Nursing staff want to work where teamwork is high, and perceptions of good staffing lead to higher teamwork. Higher teamwork scores correlated with those who worked less overtime.
This thesis deals with problems of takeover of employees in outsourcing. The capital purpose is to compare the staffing model of outsourcing in selected companies. To compare in selected companies I chose multi-criteria analysis. This thesis is dividend into six chapters. The first charter is devoted to the theoretical part. In this charter describes the basic concepts as outsourcing, personal aspects, phase of the outsourcing projects, communications and culture. The rest of thesis is devote...
The energy situation in France is presented. Data and charts illustrate the prices evolution at the import for the petroleum and the other energies, the exchanged energies volume and the bill for each energy sector. (A.L.B.)
Intended for use by wastewater and water supply utilities, one side of the utility bill insert has information for customers that discharge to sanitary sewer systems; the other side is for customers with septic systems.
Dooskin, Herbert P.
A computer facility billing procedure should be designed so that the full costs of a computer center operation are equitably charged to the users. Design criteria, costing methods, and management's role are discussed. (Author/MLF)
Pilar Alexandra Moreno
Full Text Available This article broadly describes the analysis, design and development of the system utilitarian, called “Reading and billing calculation site through mobile devices.” The application is oriented Public Services Companies, first water services, to perform part of the billing process “in place” through phones or any mobile devices compatible with Android. Will enable you to take readings of service consumption, recording new gauging, online update and control the information for users and turnover. This technology is considered as such one site billing method as through Internet is connected with the database of the company, sending and receiving date information, which makes the calculation of the billing for the reading period, bringing benefits to the client and the service generating company.
... of the month. The applicant will be billed by the National Finance Center (NFC) using the Foundation... voluntary laboratory services and other services were rendered at a particular Science and Technology...
Grumman, David L.
Electric bills can be reduced by lowering electric consumption and by controlling demand -- the amount of electricity used at a certain point in time. Gives tips to help reduce electric demand at peak power periods. (Author/DN)
Full Text Available Staffing in an organization can be defined as a series of processes and efforts to acquire, develop, motivate, and evaluate the overall human resources. It is required within the organization in achieving its goals. In staffing, putting a person in a work should be in accordance with his capabilities and expertise so that all are expected to be achieved. Job placement principle is the principle of humanity, democracy, the right man on the right place, equal pay for equal work, unity of direction, the principle of unity of purpose, unity of command, Efficiency and Productivity Work. The concept is the placement, promotion, transfer and demotion. Staffing in the Qur'an and Hadith seen from education management is an employee must complete properly, responsibility, trust, has the capability and expertise, serve, work ethic, strong and trustworthy, honest, sincere, true and trustful, physical and mental strength, and high manners. Professionalism in view of sharia is characterized by three things, namely ahliyah (expertise, himmatul 'charity (high work ethic, trustworthy (reliable.
Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus
Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Thwaites, D I
In 1989 IPSM brought out a policy document on the role of the physical scientist in radiotherapy. At roughly the same time IPSM also produced recommended minimum staffing levels for the medical physics support of radiotherapy, which drew heavily on comprehensive reviews of both physicist and physics technician staffing carried out by the Scottish Radiotherapy Physicists Group in 1980 (updated in 1989). The IPSM figures remain professional recommendations and have not been taken up by any official body. However some of the Scottish figures were included in a SHHD Planning Council Scientific Advisory report and so have some measure of official endorsement. All these figures were derived specifically for the UK situation of essentially regional oncology centres, where generally medium to large radiotherapy departments are the norm, to concentrate equipment, expertise and experience. Thus there are approximately 60 centres for a population of 55 million. In addition the recommendations reflect the typical structure of UK departments, in terms of professional roles and relationships. The current situation regarding physicist and physics technician numbers is reviewed, using evidence from recent surveys. The UK and other recommendations are applied to a number of representative centres and the figures obtained are compared to each other and to the actual staffing levels
Meulmeester, P.; Haffner, R.C.G.
The liberalization of the energy market for small-scale consumers in the Netherlands coincides with a period in which consumers have to pay high energy bills. However, the cause of this is not the liberalization, but the high oil prices and raised taxes. In this article an overview is given of the total energy bill n the Netherlands, its components and the first effects of the liberalization process [nl
Simpson, Kathleen Rice; Lyndon, Audrey; Ruhl, Catherine
To evaluate responses of registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to a survey that sought their recommendations for staffing guidelines and their perceptions of the consequences of inadequate nurse staffing. The goal was to use these member data to inform the work of the AWHONN nurse staffing research team. Secondary analysis of responses to the 2010 AWHONN nurse staffing survey. Online. AWHONN members (N = 884). Review of data from an online survey of AWHONN members through the use of thematic analysis for descriptions of the consequences of inadequate nurse staffing during the childbirth process. Three main themes emerged as consequences of inadequate staffing or being short-staffed: Missed Care, Potential for Failure to Rescue, and Job-Related Stress and Dissatisfaction. These themes are consistent with those previously identified in the literature related to inadequate nurse staffing. Based on the responses from participants in the 2010 AWHONN nurse staffing survey, consequences of inadequate staffing can be quite serious and may put patients at risk for preventable harm. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Introducing ZBrush 4 launches readers head-on into fulfilling their artistic potential for sculpting realistic creature, cartoon, and hard surface models in ZBrush. ZBrush's innovative technology and interface can be intimidating to both digital-art beginners as well as veterans who are used to a more conventional modeling environment. This book dispels myths about the difficulty of ZBrush with a thorough tour and exploration of the program's interface. Engaging projects also allow the reader to become comfortable with digital sculpting in with a relaxed and fun book atmosphere. Introducing ZB
Nickerson, C.; Planken, B.C.
Introducing Business English provides a comprehensive overview of this topic, situating the concepts of Business English and English for Specific Business Purposes within the wider field of English for Special Purposes. This book draws on contemporary teaching and research contexts to demonstrate
This private bill indicates which new articles and which modifications are introduced in the French energy code to implement progressive energy tariffs and favour energy savings by households. These new articles define how a bonus-malus on household energy consumptions is determined. They also define accompanying measures
Answering key questions such as 'Why study grammar?' and 'What is standard English?', Introducing English Grammar guides readers through the practical analysis of the syntax of English sentences. With all special terms carefully explained as they are introduced, the book is written for readers with no previous experience of grammatical analysis. It is ideal for all those beginning their study of linguistics, English language or speech pathology, as well as students with primarily literary interests who need to cover the basics of linguistic analysis. The approach taken is in line with current research in grammar, a particular advantage for students who may go on to study syntax in more depth. All the examples and exercises use real language taken from newspaper articles, non-standard dialects and include excerpts from studies of patients with language difficulties. Students are encouraged to think about the terminology as a tool kit for studying language and to test what can and cannot be described using thes...
Nuclear power will be protected from the vagaries of the free market by requiring the 12 privatised distribution companies to take around 15-20% of their power from non-fossil (i.e. nuclear) sources. The Electricity Bill also requires producers of fossil-fuelled electricity to charge a compulsory levy which will be used to finance the non-fossil quota. The extra cost of generating electricity by nuclear means compared with the alternatives will be recouped via the 'levy' after the new PWRs have come into operation. Producers of power which is neither nuclear nor fossil will not be required to make this levy, so renewable energies may gain a small competitive advantage. The financial implications of privatisation have not been fully clarified, especially regarding nuclear power with its associated expenses of radioactive waste disposal and decommissioning. Energy efficiency may be encouraged by the Bill, but competition may not result from the Bill. (author)
This article reflects on the history of the NHS in Wales and how this has led to its current structure. How this structure supports integrated working across primary, community and secondary care and how further integration with social care is moving forward and its direct effects on district nursing are explored. This article describes how district nursing is meeting these challenges. Support for district nurses as part of integrated multiprofessional teams is being developed to promote appropriately staffed teams centred on meeting the requirements of people within a designated area and ensuring that home is the best and first place of care.
Mark, Barbara; Harless, David W; Spetz, Joanne
In 2004, California became the first state to implement minimum-nurse-staffing ratios in acute care hospitals. We examined the wages of registered nurses (RNs) before and after the legislation was enacted. Using four data sets-the National Sample Survey of Registered Nurses, the Current Population Survey, the National Compensation Survey, and the Occupational Employment Statistics Survey-we found that from 2000 through 2006, RNs in California metropolitan areas experienced real wage growth as much as twelve percentage points higher than the growth in the wages of nurses employed in metropolitan areas outside of California.
In the fall of 2011, I taught a graduate food studies course at New York University devoted to the farm bill, a massive and massively opaque piece of legislation passed most recently in 2008 and up for renewal in 2012. The farm bill supports farmers, of course, but also specifies how the United States deals with such matters as conservation, forestry, energy policy, organic food production, international food aid, and domestic food assistance. My students came from programs in nutrition, food studies, public health, public policy, and law, all united in the belief that a smaller scale, more regionalized, and more sustainable food system would be healthier for people and the planet.
Full Text Available Programs and project evaluation models can be extremely useful in project planning and management. The aim is to set the right questions as soon as possible in order to see in time and deal with the unwanted program effects, as well as to encourage the positive elements of the project impact. In short, different evaluation models are used in order to minimize losses and maximize the benefits of the interventions upon small or large social groups. This article introduces some of the most recently used evaluation models.
Bloom, J R; Alexander, J A; Nuchols, B A
The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.
The operator of the Energy Department's Savannah River weapons plant has at least 1,800 more employees than it needs, and could save $400 million over a five-year period by cutting its staff accordingly, a DOE inspector general study says. Most of the boat - 1,206 employees - was attributed to excessive numbers of managers, with the inspector general concluding that Westinghouse Savannah River Co. had roughly twice as many layers of management than two other DOE weapons contractors. The study also concluded that Westinghouse in fiscal year 1992 significantly understated its actual staffing levels in reports to DOE, failing to disclose 1,765 full-time employees or the equivalent hours worked. Through such underreporting Westinghouse was able to open-quotes circumvent staffing ceilings established by the department,close quotes the study added. Overall, DOE Inspector General John Layton said Westinghouse's staff levels substantially exceeded those needed for efficient operation of the South Carolina nuclear weapons facility. Layton based his analysis on efficiency standards attained by other DOE weapons plant contractors, such as Martin Marietta Energy Systems at DOE's Oak Ridge, Tenn., plant and EG ampersand G Rocky Flats, as well as widely utilized worker performance requirements used by the Navy and private sector companies that perform work similar to that done at Savannah River
Harris, John Alexander; Engberg, John; Castle, Nicholas George
The objective of this study is to examine how increasing body mass index (BMI) among nursing home residents affects the amount of staffing assistance needed for activities of daily living (ADL). We analyzed 1,627,141 US nursing home residents reported in the 2013 Minimum Data Set in seven BMI categories, from underweight (BMI < 18.5 kg/m 2 ) to obesity Class IIIB (≥50 kg/m 2 ). Logistic regression models estimated the odds of nursing home-reported need for extensive (≥2 staff member) assistance needed for ADLs. The adjusted odds increased from 1.07 (95% Confidence Interval (95%CI) 1.06-1.08) for Class I, 1.16 (95%CI 1.14-1.17) for Class II, 1.33 (95%CI 1.31-1.35) for Class IIIA, and 1.90 (95%CI 1.86-1.95) for Class IIIB obesity residents compared to residents of normal weight. As a nursing home resident's BMI increases, especially for BMI ≥40 kg/m 2 , the need for extensive staffing assistance with ADLs also increases substantially. Copyright © 2018 Elsevier Inc. All rights reserved.
... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Billings. 101-26.607 Section 101-26.607 Public Contracts and Property Management Federal Property Management Regulations System FEDERAL PROPERTY MANAGEMENT REGULATIONS SUPPLY AND PROCUREMENT 26-PROCUREMENT SOURCES AND PROGRAM 26.6...
The paper discusses the concept and philosophy of copyright. It also discusses copyright infringement with special reference to ICT. Furthermore, the paper examines international provisions related to copyright and reviews the Copyright Law Model. The paper also identifies gaps in the Uganda Copyright Bill, 2002 and ...
The Typical Electric Bills report is prepared by the Electric Power Division; Office of Coal, Nuclear, Electric and Alternate Fuels; Energy Information Administration; Department of Energy. The publication is geared to a variety of applications by electric utilities, industry, consumes, educational institutions, and government in recognition of the growing importance of energy planning in contemporary society. 19 figs., 18 tabs
This document analyzes the energy bill in France (28,35 milliards of euros), which increased of 24,1 % in 2004. This increase is due to the net imports and especially the fossil fuels. Statistical data and the presentation of Patrick Devedjian, delegated ministry for the Industry, illustrate this economic analysis. (A.L.B.)
Combination vaccines have been introduced in Mexico. The national immunization program has incorporated the measles-mumps-rubella (MMR) vaccines in 1998, and the pentavalent vaccine in 1999. The two categories of antigen composition in combination vaccines are: 1) multiple different antigenic types of a single pathogen, such as the 23 valent pneumococcal polysaccharide vaccine, and 2) antigens from different pathogens causing different diseases, such as the DPT and MMR vaccines. Pentavalent vaccines are included in the second category. The vaccine protects against diphtheria, tetanus, pertussis, hepatitis B, and other diseases produced by Haemophilus influenzae type b (Hib). Combined diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b (DTP-HB/Hib) vaccine has been distributed to 87% of Mexican children under 1 year of age. Over 800,000 doses of pentavalent vaccine have been administered.
CIVINS (Civilian Institutions) Thesis document This report was generated by accepting a report topic contained in a list of topics on the Civil Engineer Corps Graduate School Information web page. The topic request and description is noted as follows: Topic. How to Measure Staffing Requirements in ROICC offices and Other Acquisition Functions with a description. Description: We base current staffing requirements on history and only adjust from what we have used in the past years. It is sus...
Steach, John C.
This mixed methods study explored how high school principals prioritize their work and utilize available human resources to adjust to inadequate administrative staffing. Analysis of staffing levels across the state of Washington and specifically inside two eastern Washington districts framed interview questions for central office administration…
Houseman, Susan N.
Use of flexible staffing arrangements--including temporary help agency, short-term, on-call, regular part-time, and contract workers--is widespread and two-thirds of employers believe this trend will increase in the near future. A study examined which employers use flexible staffing arrangements, why they use these arrangements, and their…
Background Understanding the quality loss implications of short staffing is essential in maintaining service quality on a limited budget. Objectives For elaborate financial control on staffing decisions, it is necessary to quantify the cost of the incidental quality loss that a given workload and
Whitebook, Marcy; Howes, Carollee; Phillips, Deborah
In 1988, the National Child Care Staffing Study first gathered information on staffing and quality from a sample of child care centers in five metropolitan areas--Atlanta, Boston, Detroit, Phoenix, and Seattle--and returned for updated information in 1992. In 1997, directors of the original sample of centers still in operation were contacted again…
Krüger, A J; Lossius, H M; Mikkelsen, S
All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...
National Institutes of Health (DHEW), Bethesda, MD. Resources Analysis Branch.
This summary report of staffing patterns in 6 medical schools established between 1952 and 1960 is the first phase of a proposed study of biomedical staffing requirements in institutions of higher education, 1965-1975. The 6 schools are: the University of Miami, Albert Einstein College of medicine at Yeshiva University, the University of Florida,…
.... The Department has determined that workers from Spherion Staffing were sufficiently under the control..., Including On-Site Leased Workers From Manpower and Spherion Staffing, Including On-Site Workers From Hagemeyer North America, Lake Mills, IA; Amended Certification Regarding Eligibility To Apply for Worker...
The staffing for a single-unit AP600 is estimated to require a staff for operation and maintenance about 32% smaller than current generation power plants of similar size. These staffing reductions are driven primarily by various features incorporated into the AP600 plant design. (author)
Geneva is variously known as the city of peace, the world’s smallest metropolis and a place where great ideas have taken form. It has been the home to philosophers such as Rousseau and Voltaire. It was the centre of the Calvinist reformation and birthplace of the Red Cross. I hardly need to tell you that it is also a city of great international collaboration in science. Little wonder, then, that over the years, Geneva has developed into the world’s capital of internationalism in the broadest sense of the word. Yet while we all know of the existence of modern day International Geneva, how many of us really know what it does? Here at CERN, we’re about to find out. Next week sees the first in a series of talks at the Laboratory from the heads of some of the institutions that make up International Geneva. On Friday, 20 February, it will be my pleasure to introduce you to Michael Møller, Acting Director-General of the United Nations Office at Geneva (UNO...
The EDMS Team
We are very pleased to announce the arrival of a brand new EDMS: EDMS 6. The CERN Engineering and Equipment Data Management Service just got better than ever! EDMS is the de facto interface for all engineering related data and more. Currently there are more than 1.2 million documents and nearly 2 million files stored in EDMS. What’s new? The first thing you will notice is the look and feel of EDMS 6; the new design not only makes it more modern but also more intuitive, so that the system is easier to use, regardless of your experience with EDMS. Whilst we have kept the key concepts, we have introduced more functionality and improved navigation within the interface, allowing for better performance to help you in your daily work. We have also added a personal slant to EDMS 6 so that you can now customise your list of favourite objects. Modifying data in EDMS is much simpler, allowing you to view all object data in a single window. More functionality will be added in the ...
Bowblis, John R; Roberts, Amy Restorick
Health care providers face fixed reimbursement rates from government sources and need to carefully adjust staffing to achieve the highest quality within a given cost structure. With data from the Certification and Survey Provider Enhanced Reports (1999-2015), this study holistically examined how staffing levels affect two publicly reported measures of quality in the nursing home industry, the number of deficiency citations and the deficiency score. While higher staffing consistently yielded better quality, the largest quality improvements resulted from increasing administrative registered nurses and social service staffing. After adjusting for wages, the most cost-effective investment for improving overall deficiency outcomes was increasing social services. Deficiencies related to quality of care were improved most by increasing administrative nursing and social service staff. Quality of life deficiencies were improved most by increasing social service and activities staff. Approaches to improve quality through staffing adjustments should target specific types of staff to maximize return on investment.
Waugh, Jeff L
The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees. © 2014 American Academy of Neurology.
The tariff agreement signed by CERN (and other international organisations) with Hôpital de La Tour specifies that all bills paid within 30 days of the date of the invoice will enjoy a discount, to be deducted by the payer. The bills are labelled with a message to this effect.Physicians' fees, personal expenses as well as services from outside providers (e.g. ambulance companies or external laboratories) are however not part of the discount agreement. Bills for hospitalisation (i.e. with a stay in hospital longer than 28h) are normally directly paid by AUSTRIA, acting as a third-party payer.In May this year, Hôpital de La Tour introduced a new (Y2K compliant) accounting and invoicing system. This implementation did not go as smoothly as planned and delayed the issuing of bills by two months. During the summer period, a special team of temporary staff was put in place to catch up on the delay. As a result of this, some bills were produced that contained errors and the sticky label mentionin...
Debora L. Madsen
Full Text Available Institutional repositories (IRs have become established components of many academic libraries. As an IR matures it will face the challenge of how to scale up its operations to increase the amount and types of content archived. These challenges involve staffing, systems, workflows, and promotion. In the past eight years, Kansas State University's IR (K-REx has grown from a platform for student theses, dissertations, and reports to also include faculty works. The initial workforce of a single faculty member was expanded as a part of a library-wide reorganization, resulting in a cross-departmental team that is better able to accommodate the expansion of the IR. The resultant need to define staff responsibilities and develop resources to manage the workflows has led to the innovations described here, which may prove useful to the greater library community as other IRs mature.
Bilibino NPP has four 12 MW(e) water cooled graphite moderated channel reactors. The plant has been in operation since 1973 in conditions of isolated local energy system in a remote area with extreme climatic conditions. The plant accounts for almost 70 per cent of energy produced in the region, it also provides heating to the regional centre. The plant's organisational structure is on the whole consistent with the standard structure of other NPPs of ex-USSR. At the same time there are some specific features due to high cost of personnel in the prime cost of the generated energy. As a result a need arises to broaden the task of catering for each worker and, therefore, to extend and increase the level of training. The number of high-quality personnel is on the increase. A method of step-by-step training is widely used at all work areas for training operations personnel. At the end of each step a worker is engaged in independent activities at this work area. When a plant is located in a remote area efficient and effective maintenance becomes highly instrumental. The engineering and design support on the part of the utility and equipment manufacturer begins to play a greater role. Activities to optimise the plant organisational structure were mostly characterised by merging of subdivisions and by some change in the proportion of different categories of personnel. It would be an optimum decision to put all supporting services, namely, logistics, book-keeping and staffing departments, within the utility's authority. Operations experience of the Bilibino plant will certainly be valuable for projection, location choice and staffing of plants with small and medium reactors. (author)
Huang, Sean Shenghsiu; Bowblis, John R
Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes. We use a unique panel dataset of Ohio NHs (2005-2010) to empirically examine the relationship between managerial equity ownership and NH staffing, quality, and financial performance. We identify facility administrators as owner-managers if they have more than 5% of the equity stakes or are relatives of the owners. The statistical analysis is based on the pooled ordinary least squares and NH-fixed effect models. We find that owner-managed NHs are associated with higher nursing staff levels compared to other FP NHs. Surprisingly, despite higher staffing levels, owner-managed NHs are not associated with better quality and we find no statistically significant difference in financial performance between owner-managed and nonowner-managed FP NHs. Our results do not support the principal-agent model and we offer alternative explanations for future research. Our findings provide empirical evidence that NH ownership structures are more nuanced than simply broadly categorizing facilities as FP or NFP, and our results do not fully align with the standard principal-agent model. The role of managerial ownership should be considered in future NH research and policy discussions. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Full Text Available The contribution critically reflects on the proposed amendments to the Unemployment Insurance Act Act 63 of 2001 (the UIA / the Act, introduced via the provisions of the Unemployment Insurance Amendment Bill of 2015 (B25-2015. Several shortcomings and deficiencies are addressed and improvements introduced by the proposed amending legislation, including the extension of coverage to a wider range of beneficiaries, the extension of the period of benefits (to a maximum of 365 days, the increase of the rate of maternity benefits of a (female contributor's earnings, the adjustment of the accrual rate of a contributor's duration of benefits from 1 day for every 6 days of employment to 1 day for every 5 days of employment, and some attempt to provide for employment retention and the re-entry of unemployed contributors into the labour market. And yet, despite these important contributions to the development of unemployment insurance in South Africa, several matters appearing from the Bill point towards inconsistent, inadequate and inappropriate treatment of core elements of the unemployment insurance system. Recommendations have been made to address these matters, which among others relate to: •\tThe insufficient alignment of the UIA with ILO, UN and SADC standards in key areas of concern; •\tUnclear or absent provisions in relation to the coverage and/or application of the UIA in relation to public servants, migrant workers, and the self- and informally employed; •\tInadequate provision for employment promotion, the prevention, combating and reduction of unemployment, and reintegration into employment; •\tInappropriate provisions relating to benefit rates and periods, among others concerning the Minister's power to set/amend the Income Replacement Rate and to vary the benefit period by regulation; •\tInconsistent and discriminatory provisions requiring a 13-week qualifying period for accessing maternity benefits; •\tInappropriate provisions
Orenstein, Gil C; Kaye, Alan David; Fox, Charles J; Urman, Richard D
The field of medical billing and collections continues to evolve along with current developments in U.S. healthcare reform. Although there has been a significant shift of payment responsibility from third-party payers to patients, many practices are not equipped to handle this change. As patients' financial obligations increase, the physician's ability to collect from patients will become increasingly important. Inability to collect bills receivable can adversely affect the revenue cycle of the practice. Solutions include improvement of the point-of-service collection processes, properly trained office staff, written financial policies, and the use of technology to facilitate online payments. Patients should fully understand their financial responsibilities and options available to them for payment of services rendered.
Bill Viola videoretrospektiiv Stedelijk Museumis, Rijksmuseumis, New Metropolises jm. Amsterdamis 29. novembrini. H. Liivrand Bill Violast ja tema loomingust. B. Viola oma videokunstist praegu ja 25 aastat tagasi, mil tema alustas, mõjutustest loomingule.
The paper describes 21 principles of the draft Energy Conservation Bill. The principles lay down fundamental responsibilities of the government, the municipalities, business entities, citizens and power plants in the field of economical energy management. Included are principles to minimize energy consumption and to stimulate a reasonable energy management, the role of the energy distribution network, responsibilities of the central load dispatching center, and power plant output regulation schemes. (J.B.)
In the debate in the House of Commons on the second reading of the Atomic Energy Bill, the objective of which is to put the finances of the Authority on to a trading fund basis, the discussion included the following: proposed changes in method of financing the Authority; safety; underlying research; customer relations; accountability; personnel; public relations; radioactive waste management; energy research; parliamentary scrutiny; energy policy; nuclear power; fast reactors; fusion research; government policy. (U.K.)
Pursuant to a judgement passed by the Lower Court of Hamburg, the author discusses probable legal arguments justifying the refusal to pay one's electricity bill, the so-called electricity bill boycott. Following an analysis of the power supply contract and of the content and the limits of the fundamental right of freedom of conscience, as well as of the concept of free enterprise and of the legal effect of licenses under the nuclear law, his point of view stated in the article is to agree with the decision of the court saying that the operation of a nuclear power plant licensed under the nuclear law does not mean an infringement of the right of freedom of conscience. It can further not be accepted to let people refuse to pay their electricity bill by referring to the right of freedom of speech, by alleging conduct against public policy on the part of the public utilities, or by referring to the right of opposition. (HSCH) [de
Effective billing and collection systems are a critical component for ensuring the viability of a service provider. Improving billing and collection activities has an immediate impact on the revenue streams of a service provider that can, in turn, help the service provider in improving services. However, while effective billing and collection practices depend on many internal factors (including customer databases, the extent of metered and unmetered service provision, tariff and billing struc...
Full Text Available Recently an online electric vehicle (OLEV concept has been introduced, where vehicles are propelled by the wirelessly transmitted electrical power from the infrastructure installed under the road while moving. The absence of secure-and-fair billing is one of the main hurdles to widely adopt this promising technology. This paper introduces a new secure and privacy-aware fair billing framework for OLEV on the move through the charging plates installed under the road. We first propose two extreme lightweight mutual authentication mechanisms, a direct authentication and a hash chain-based authentication between vehicles and the charging plates that can be used for different vehicular speeds on the road. Second, we propose a secure and privacy-aware wireless power transfer on move for the vehicles with bidirectional auditability guarantee by leveraging game theoretic approach. Each charging plate transfers a fixed amount of energy to the vehicle and bills the vehicle in a privacy-aware way accordingly. Our protocol guarantees secure, privacy-aware, and fair billing mechanism for the OLEVs while receiving electric power from the infrastructure installed under the road. Moreover, our proposed framework can play a vital role in eliminating the security and privacy challenges in the deployment of power transfer technology to the OLEVs.
... Resources, Inc., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc...., Doepker Group, Inc., D.B.A. Time Staffing, Inc., Personnel Management Group, Inc., Select Staffing, and... follows: ''All workers of Alternative Management Resources, Inc., Doepker Group, Inc., D.B.A. Time...
..., Inc., Including On-Site Leased Workers From Insight Global Stone Staffing, and Randstad Formerly Known..., Massachusetts, including on-site leased workers from Insight Global, Stone Staffing, Randstad formerly known as... Insight Global, Stone Staffing, Randstad, formerly known as Sapphire Technologies, were employed on-site...
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Basis of billing plants. 590.130... of Service § 590.130 Basis of billing plants. Overtime and/or holiday services shall be billed to the official plant on the basis of each 15 minutes of overtime and/or holiday service performed by each...
... is applicable toward TDRSS operational services. (b) The procedure for billing and payment of... billings as the actual service time is tabulated. Amounts due to the user will be credited to the next... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Payment and billing. 1215.115 Section 1215...
... 46 Shipping 1 2010-10-01 2010-10-01 false Billing for services. 9.16 Section 9.16 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC EXTRA COMPENSATION FOR OVERTIME SERVICES § 9.16 Billing for services. Overtime services shall be billed to the steamship companies...
... 42 Public Health 2 2010-10-01 2010-10-01 false Conditions for group billing. 408.82 Section 408.82 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE... for group billing. CMS agrees to a group billing arrangement only if the following conditions are met...
Hughes, Ronda G; Bobay, Kathleen L; Jolly, Nicholas A; Suby, Chrysmarie
This analysis compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn in staffing allocation impacts nurse workload and may result in adverse patient outcomes. Secondary data analysis of unit-level data from 32 hospitals, where nursing units are grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Use of the discharges and transfers adjustment to midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements. © 2013 John Wiley & Sons Ltd.
Kim, Yunmi; You, Sunju; Kim, Jinhyun
This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future. © 2017 Korean Society of Nursing Science
Mobley, Lee R; Magnussen, Jon
The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.
Melber, B.; Roussel, A.; Baker, K.; Durbin, N.; Hunt, P.; Hauth, J.; Forslund, C.; Terrill, E.; Gore, B.
The objective of this report is to identify how decisions are made regarding staffing levels and positions for a sample of U.S. nuclear power plants. In this report, a framework is provided for understanding the major forces driving staffing and the implications of staffing decisions for plant safety. The focus of this report is on driving forces that have led to changes in staffing levels and to the establishment of new positions between the mid-1980s and the early 1990s. Processes used at utilities and nuclear power plants to make and implement these staffing decisions are also discussed in the report. While general trends affecting the plant as a whole are presented, the major emphasis of this report is on staffing changes and practices in the operations department, including the operations shift crew. The findings in this report are based on interviews conducted at seven nuclear power plants and their parent utilities. A discussion of the key findings is followed by a summary of the implications of staffing issues for plant safety
Mukamel, Dana B; Kang, Taewoon; Collier, Eric; Harrington, Charlene
Policy initiatives at the Federal and state level are aimed at increasing staffing in nursing homes. These include direct staffing standards, public reporting, and financial incentives. To examine the impact of California's Medicaid reimbursement for nursing homes which includes incentives directed at staffing. Two-stage limited-information maximum-likelihood regressions were used to model the relationship between staffing [registered nurses (RNs), licensed practical nurses, and certified nursing assistants hours per resident day] and the Medicaid payment rate, accounting for the specific structure of the payment system, endogeneity of payment and case-mix, and controlling for facility and market characteristics. A total of 927 California free-standing nursing homes in 2006. The model included facility characteristics (case-mix, size, ownership, and chain affiliation), market competition and excess demand, labor supply and wages, unemployment, and female employment. The instrumental variable for Medicaid reimbursement was the peer group payment rate for 7 geographical market areas, and the instrumental variables for resident case-mix were the average county revenues for professional therapy establishments and the percent of county population aged 65 and over. Consistent with the rate incentives and rational expectation behavior, expected nursing home reimbursement rates in 2008 were associated with increased RN staffing levels in 2006 but had no relationship with licensed practical nurse and certified nursing assistant staffing. The effect was estimated at 2 minutes per $10 increase in rate. The incentives in the Medicaid system impacted only RN staffing suggesting the need to improve the state's rate setting methodology.
Battista, Jerry J.; Patterson, Michael S.; Beaulieu, Luc; Sharpe, Michael B.; Schreiner, L. John; MacPherson, Miller S.; Van Dyk, Jacob
The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center‐specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We calculate requirements for each staffing type based on caseload, equipment inventory, quality assurance, educational programs, and administration. Average per‐case staffing ratios were also determined for larger‐scale human resource planning and used to model staffing needs for Ontario, Canada over the next 10 years. The workload specific algorithm was tested through a survey of Canadian cancer centers. For center‐specific human resource planning, we propose a grid of coefficients addressing specific workload factors for each staff group. For larger scale forecasting of human resource requirements, values of 260, 700, 300, 600, 1200, and 2000 treated cases per full‐time equivalent (FTE) were determined for medical physicists, physics assistants, dosimetrists, electronics technologists, mechanical technologists, and information technology specialists, respectively. PACS numbers: 87.55.N‐, 87.55.Qr PMID:22231223
Park, Claire Su-Yeon
To propose a new theory pinpointing the optimal nurse staffing threshold delivering the maximum quality of care relative to attendant costs in home health care. Little knowledge exists on the theoretical foundation addressing the inter-relationship among quality of care, nurse staffing, and cost. Theory synthesis. Cochrane Library, PubMed, CINAHL, EBSCOhost Web and Web of Science (25 February - 26 April 2013; 20 January - 22 March 2015). Most of the existing theories/models lacked the detail necessary to explain the relationship among quality of care, nurse staffing and cost. Two notable exceptions are: 'Production Function for Staffing and Quality in Nursing Homes,' which describes an S-shaped trajectory between quality of care and nurse staffing and 'Thirty-day Survival Isoquant and Estimated Costs According to the Nurse Staff Mix,' which depicts a positive quadric relationship between nurse staffing and cost according to quality of care. A synthesis of these theories led to an innovative multi-dimensional econometric theory helping to determine the maximum quality of care for patients while simultaneously delivering nurse staffing in the most cost-effective way. The theory-driven threshold, navigated by Mathematical Programming based on the Duality Theorem in Mathematical Economics, will help nurse executives defend sufficient nurse staffing with scientific justification to ensure optimal patient care; help stakeholders set an evidence-based reasonable economical goal; and facilitate patient-centred decision-making in choosing the institution which delivers the best quality of care. A new theory to determine the optimum nurse staffing maximizing quality of care relative to cost was proposed. © 2017 The Author. Journal of Advanced Nursing © John Wiley & Sons Ltd.
Mark, Barbara A; Harless, David W; McCue, Michael
While there are a number of studies examining the relationship between nurse staffing and quality, none has examined structural differences in the relationship between nurse staffing and quality contingent upon the level of managed care penetration. We used administrative data, and a dynamic panel data model to examine this relationship in a panel of 422 acute care hospitals from 1990 to 1995. We found that there were significant differences in the relationship between nurse staffing and both mortality and length of stay depending upon the level of HMO penetration in the hospital's market.
This report contains the modifications introduced by the French Senate in a bill project voted by the National Assembly which addresses a new organization of the electricity market. Several aspects are treated in this text: the freedom of choice of the electricity provider, the sale and the conditions of sale of electricity by EDF to other electricity providers, the maximum volume a provider can buy and its evaluation, the electricity price determination, the provider obligations, and so on
Bizon, M M
If a healthcare facility's accounts receivable operation is experiencing problems, the patient accounts manager should survey all areas of his or her responsibility to determine the best method of resolving the difficulties. One effective technique to reduce billing problems is to take a proactive--not reactive--approach. If mistakes can be corrected before they get out of control, and if the patient accounts manager can ensure that claims will not be denied, a healthcare facility's accounts receivable should remain in good condition.
Maass, Kayse Lee; Liu, Boying; Daskin, Mark S; Duck, Mary; Wang, Zhehui; Mwenesi, Rama; Schapiro, Hannah
Increased nurse-to-patient ratios are associated negatively with increased costs and positively with improved patient care and reduced nurse burnout rates. Thus, it is critical from a cost, patient safety, and nurse satisfaction perspective that nurses be utilized efficiently and effectively. To address this, we propose a stochastic programming formulation for nurse staffing that accounts for variability in the patient census and nurse absenteeism, day-to-day correlations among the patient census levels, and costs associated with three different classes of nursing personnel: unit, pool, and temporary nurses. The decisions to be made include: how many unit nurses to employ, how large a pool of cross-trained nurses to maintain, how to allocate the pool nurses on a daily basis, and how many temporary nurses to utilize daily. A genetic algorithm is developed to solve the resulting model. Preliminary results using data from a large university hospital suggest that the proposed model can save a four-unit pool hundreds of thousands of dollars annually as opposed to the crude heuristics the hospital currently employs.
Sonne, Asger; Wulffeld, Sandra; Steinmetz, Jacob
INTRODUCTION: Implementation of a physician-staffed helicopter emergency medical service (HEMS) in eastern Denmark was associated with increased survival for severely injured patients. This study aimed to assess the potential impact of advanced prehospital interventions by comparing the proportion...
Trinkoff, Alison M; Han, Kihye; Storr, Carla L; Lerner, Nancy; Johantgen, Meg; Gartrell, Kyungsook
The authors examined the relationship of staff turnover to selected nursing home quality outcomes, in the context of staffing and skill mix. Staff turnover is a serious concern in nursing homes as it has been found to adversely affect care. When employee turnover is minimized, better care quality is more likely in nursing homes. Data from the National Nursing Home Survey, a nationally representative sample of US nursing homes, were linked to Nursing Home Compare quality outcomes and analyzed using logistic regression. Nursing homes with high certified nursing assistant turnover had significantly higher odds of pressure ulcers, pain, and urinary tract infections even after controlling for staffing, skill mix, bed size, and ownership. Nurse turnover was associated with twice the odds of pressure ulcers, although this was attenuated when staffing was controlled. This study suggests turnover may be more important in explaining nursing home (NH) outcomes than staffing and skill mix and should therefore be given greater emphasis.
This research provides a synthesis of practices in organizational structuring and professional staffing of the innovative delivery units in several state DOTs across the nation that are actively utilizing alternative project delivery. Several major c...
Donna R. Gillespie
Full Text Available In response to budget cuts in 2002, 4-H staffing models were restructured. The response by University of Idaho Extension was intended to continue meeting the needs of Idaho’s citizens with fewer UI Extension faculty. This staffing reorganization led to the formation of the District III 4-H Team who united to bring stronger 4-H programs to south central Idaho and expand programs to underserved audiences. Information from surveys and interviews over the past seven years reflects the effectiveness, challenges and successes of the District III 4-H Team. In Making the Best Better: 4-H Staffing Patterns and Trends in the Largest Professional Network in the Nation (2007, author Kirk A. Astroth notes a nationwide change in 4-H leadership at the county level from 4-H faculty to program assistants or coordinators. The information gathered in our research may help other states determine staffing models to meet the needs of clientele in these changing times.
Using a Resource-Based Theory/View of the firm, this study examined if increased inpatient staffing levels at military hospitals can generate a competitive advantage based on better patient quality outcomes...
Full Text Available Motivated by call center practice, we study the optimal staffing of many-server queues with impatient and repeat-calling customers. A call center is modeled as an M/M/s+M queue, which is developed to a behavioral queuing model in which customers come and go based on their satisfaction with waiting time. We explicitly take into account customer repeat behavior, which implies that satisfied customers might return and have an impact on the arrival rate. Optimality is defined as the number of agents that maximize revenues net of staffing costs, and we account for the characteristic that revenues are a direct function of staffing. Finally, we use numerical experiments to make certain comparisons with traditional models that do not consider customer repeat behavior. Furthermore, we indicate how managers might allocate staffing optimally with various customer behavior mechanisms.
Church, J.; Rosehart, W.; MacCormack, J.
Plans developed by the Alberta Electric System Operator (AESO) have determined that Alberta's electrical transmission system needs to be expanded. However, there are complex issues that must be considered in order to assess the nature and extent of the needed expansion. Various new amendments to the system were proposed in the Alberta government's Bill 50, including the construction of new transmission lines; the installation of a double circuit 500 kV alternating current line between Edmonton and the Gibbons-Redwater region; the construction of a new 240 kV substation in southeast Calgary; and the installation of 2 single circuit 500 kV alternating current lines between Edmonton and Fort McMurray. This study provided a review of the institutional framework instituted by the government's transmission policy and compared the costs and benefits of 2 large capacity high voltage DC (HVDC) transmission lines proposed for the Edmonton-Calgary corridor relative to the various other transmission system amendment suggestions. An evaluation of Alberta's proposed regulatory process under Bill 50 was also conducted. Results of the study indicated that the addition of the HVDC lines is an inefficient response to concerns over adequate supply and reliability. 72 refs., 18 tabs.
Suurbritannia üks kogenumaid ärikonsultante firmade ärikasvumudelist, mis aitab ettevõttel järgmisesse etappi üle minna. Mida peaks ettevõtja enne äri alustamist läbi mõtlema ning millised eesmärgid ja ülesanded enda jaoks paika panema. Lisad: Bill Barbour; Universaalne kriisimudel
Bloom, Jennifer, Ed.
The 36 lessons collected in this publication are designed to introduce students to the rights of the accused and provide a scholarly study of these rights, exploring historical development as well as current application. Lessons are provided for all grade levels. The topics covered include the Bill of Rights, criminal rights amendments, juvenile…
Japan has managed to provide universal coverage at relatively low cost by containing prices and restricting the conditions for which services can be billed in the compulsory social health insurance (SHI) program. However, decline in Japan's economic growth ushered in new actors backed by the prime minister who proposed that the providers should be allowed to extra bill for services not covered by the SHI. In 2004 they took the strategy of drawing the attention of the public to areas where the rigidity of the current prohibition appeared to be unfair and ridiculous. They were opposed by the Ministry of Health, Labor, and Welfare and the Japan Medical Association, who strongly objected on the grounds of safety and equity. The compromise reached by the two ministers in charge led to a clarification of the services that are to be covered and of the process for extending coverage to new procedures and drugs. The prohibition on extra billing has remained essentially unchanged, but the momentum for deregulation has been lost. In 2005 an alternate proposal was made to contain SHI expenditures by introducing a global cap on health expenditures and increasing out-of-pocket payment. Although this proposal was not fully adopted, the gradual decline in SHI benefit levels could lead to a renewed move to allow extra billing.
Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert
Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing-related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result of better financial performance, particularly in more competitive markets. In this study, we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Nurse staffing levels had a positive association with financial performance (β = 3.3, p = .02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost-cutting measures may be inefficient and negatively affect financial performance.
Lu, Minmin; Ruan, Hui; Xing, Weijie; Hu, Yan
The investigators examined how nurse staffing affects nurse job satisfaction and quality of care. Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China. A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care. The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82). Nurse staffing is associated with job dissatisfaction and quality of care. Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects. © 2013 John Wiley & Sons Ltd.
Everhart, Damian; Neff, Donna; Al-Amin, Mona; Nogle, June; Weech-Maldonado, Robert
Background Hospitals facing financial uncertainty have sought to reduce nurse staffing as a way to increase profitability. However, nurse staffing has been found to be important in terms of quality of patient care and nursing related outcomes. Nurse staffing can provide a competitive advantage to hospitals and as a result better financial performance, particularly in more competitive markets Purpose In this study we build on the Resource-Based View of the Firm to determine the effect of nurse staffing on total profit margin in more competitive and less competitive hospital markets in Florida. Methodology/Approach By combining a Florida statewide nursing survey with the American Hospital Association Annual Survey and the Area Resource File, three separate multivariate linear regression models were conducted to determine the effect of nurse staffing on financial performance while accounting for market competitiveness. The analysis was limited to acute care hospitals. Findings Nurse staffing levels had a positive association with financial performance (β=3.3; p=0.02) in competitive hospital markets, but no significant association was found in less competitive hospital markets. Practice Implications Hospitals in more competitive hospital markets should reconsider reducing nursing staff, as these cost cutting measures may be inefficient and negatively affect financial performance. PMID:22543824
As power generators around the world grapple with the challenges of the environment, deregulation, competitions and changing prices of fuels, the economics of running a future power plant are influenced significantly by the component of labour costs. These costs, from plant staff, corporate support and purchased services, will affect the overall plant economics. To achieve improved efficiency and effectiveness of organization structures and staff, vendors and utilities are working jointly to apply lessons learned for future designs. This paper will examine the experience gained to date with Canadian CANDU 6 type reactors both in Canada and abroad. The strategies which have been very successful will be reviewed, together with the results of collaboration between Atomic Energy of Canada and the utilities. An assessment of the staffing numbers is provided as a comparison between current number at a Canadian utility and the projected number from a future plant with the improvements in the design. The influence to the overall plant economics are discussed with some broad generalities that look at the effects of increasing and reducing staff levels showing the probable impact on capacity factor. The lessons from other plants can contribute significantly to the performance improvement process. The paper points to the need for a balanced approach in the future for the distribution of operating maintenance and administration (OM and A) cost between nuclear safety studies; maintenance programs and staff training. In the future, utilities, together with the designers, will have to greatly improve plant maintenance and training. The improved design features detailed in the paper will support this strategy by utilizing operational experience. (author)
Lin, Chiuhsiang Joe; Hsieh, Tsung-Ling; Lin, Shiau-Feng
Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed
Simpson, Kathleen Rice; Lyndon, Audrey; Wilson, Jane; Ruhl, Catherine
To solicit input from registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) on critical considerations for review and revision of existing nurse staffing guidelines. Thematic analysis of responses to a cross-sectional on-line survey question: "Please give the staffing task force your input on what they should consider in the development of recommendations for staffing of perinatal units." Members of AWHONN (N = 884). Descriptions of staffing concerns that should be considered when evaluating and revising existing perinatal nurse staffing guidelines. Consistent themes identified included the need for revision of nurse staffing guidelines due to requirements for safe care, increases in patient acuity and complexity, invisibility of the fetus and newborn as separate and distinct patients, difficulties in providing comprehensive care during labor and for mother-baby couplets under current conditions, challenges in staffing small volume units, and the negative effect of inadequate staffing on nurse satisfaction and retention. Participants overwhelmingly indicated current nurse staffing guidelines were inadequate to meet the needs of contemporary perinatal clinical practice and required revision based on significant changes that had occurred since 1983 when the original staffing guidelines were published. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Lin, Chiuhsiang Joe, E-mail: email@example.com [Department of Industrial Management, National Taiwan University of Science and Technology, 43, Section 4, Keelung Road, Taipei 10607, Taiwan (China); Hsieh, Tsung-Ling, E-mail: firstname.lastname@example.org [Institute of Nuclear Energy Research, 1000, Wenhua Road, Chiaan Village, Lungtan 32546, Taiwan (China); Lin, Shiau-Feng, E-mail: email@example.com [Department of Industrial Engineering, Chung-Yuan Christian University, 200, Chung Pei Road, Chung-Li 32023, Taiwan (China)
Highlights: • A staffing evaluation principle was developed for the advanced main control room. • The principle proposed to improve situation awareness and mental workload. • The principle has good validity that was examined by experimental design. - Abstract: Situation awareness and mental workload, both of which influence operator performance in the advanced main control room of a nuclear power plant, can be affected by staffing level. The key goal of staffing is to ensure the proper number of personnel to support plant operations and events. If the staffing level is not adaptive, the operators may have low situation awareness and an excessive mental workload, which lead to human error. Accordingly, this study developed a staffing evaluation principle based on CPM-GOMS modeling for operations in the advanced main control room. A within-subject experiment was designed to examine the validity of the staffing evaluation principle. The results indicated that the situation awareness, mental workload, and operating performance of the staffing level determined by the staffing evaluation principle was significantly better than that of the non-evaluated staffing level; thus, the validity of the staffing evaluation technique is acceptable. The implications of the findings of this study on managerial practice are discussed.
Diploma is a description of a programming solution for preparing billing invoices of Mikrocop services. Developed system can easily manage billing invoices specifications for all customers and set schedules for generating invoices. These settings are than used by the service module generating invoices on schedule. Generated invoices can be seen and managed with help of Windows Reporting Services technology. First chapter describes services billing in general. Second chapter shortly de...
This paper reports that the House of Representatives has approved a plan to limit U.S. gas prorationing by the states but rejected a move to require petroleum refiners and importers to place 1% of their oil or products volumes into the Strategic Petroleum Reserve. The oil industry lobbied heavily against the SPR provision, which went down 263-135. The House then passed its omnibus energy bill 381-37. It is designed to facilitate all types of energy production while promoting conservation. The legislation also imposes bans on offshore leasing but gives independent producers limited relief from the alternative minimum tax (AMT) and does not include a mandate for use of ethanol in gasoline
Fishburn, D.; Walley, J.; Currie, E.
This is a private members Bill which will enable new rules to be set out that will govern the way in the which nearly 500,000 shipments of radioactive and nuclear material go by road in the United Kingdom every year. It would give the Department of Transport, which would become the enforcing authority, the powers of entry and inspection and allows penalties to be exacted from those breaking the rules. The present regulations for transport by road are those set out in 1947 and these need to be updated to comply with International Atomic Energy Authority Standards. The debate which lasted over one and a half hours is reported verbatim. The main points raised were about which emergency services if any should be notified on the transport of nuclear materials, with particular reference to Derbyshire. Nuclear power in general was also discussed. (UK)
Gabbay, Uri; Bukchin, Michael
Nurse shortage and rising healthcare resource burdens mean that appropriate workforce use is imperative. This paper aims to evaluate whether daily nursing staffing meets ward workload needs. Nurse attendance and daily nurses' workload capacity in three hospitals were evaluated. Statistical process control was used to evaluate intra-ward nurse workload capacity and day-to-day variations. Statistical process control is a statistics-based method for process monitoring that uses charts with predefined target measure and control limits. Standardization was performed for inter-ward analysis by converting ward-specific crude measures to ward-specific relative measures by dividing observed/expected. Two charts: acceptable and tolerable daily nurse workload intensity, were defined. Appropriate staffing indicators were defined as those exceeding predefined rates within acceptable and tolerable limits (50 percent and 80 percent respectively). A total of 42 percent of the overall days fell within acceptable control limits and 71 percent within tolerable control limits. Appropriate staffing indicators were met in only 33 percent of wards regarding acceptable nurse workload intensity and in only 45 percent of wards regarding tolerable workloads. The study work did not differentiate crude nurse attendance and it did not take into account patient severity since crude bed occupancy was used. Double statistical process control charts and certain staffing indicators were used, which is open to debate. Wards that met appropriate staffing indicators prove the method's feasibility. Wards that did not meet appropriate staffing indicators prove the importance and the need for process evaluations and monitoring. Methods presented for monitoring daily staffing appropriateness are simple to implement either for intra-ward day-to-day variation by using nurse workload capacity statistical process control charts or for inter-ward evaluation using standardized measure of nurse workload intensity
Felipe Prata Mendes
Full Text Available This work aims to analyze in which way the bill 4330/2004 affects the union representativeness of outsourced workers. In order to accomplish the settled purpose, it is necessary firstly to frame the outsourcing phenomena in the context of the evolution of capitalism. In relation to the main problem of the work, it’s necessary to investigate if the bill 4330/2004 implies an offense to the union representativeness of outsourced workers. The conclusions obtained show that bill 4330/2004 compounds the representativeness trouble, since this bill proposes the agglutination of workers pertained to very different realities, what stunts the collective protection of interests.
Griffiths, Peter; Recio-Saucedo, Alejandra; Dall'Ora, Chiara; Briggs, Jim; Maruotti, Antonello; Meredith, Paul; Smith, Gary B; Ball, Jane
To identify nursing care most frequently missed in acute adult inpatient wards and to determine evidence for the association of missed care with nurse staffing. Research has established associations between nurse staffing levels and adverse patient outcomes including in-hospital mortality. However, the causal nature of this relationship is uncertain and omissions of nursing care (referred as missed care, care left undone or rationed care) have been proposed as a factor which may provide a more direct indicator of nurse staffing adequacy. Systematic review. We searched the Cochrane Library, CINAHL, Embase and Medline for quantitative studies of associations between staffing and missed care. We searched key journals, personal libraries and reference lists of articles. Two reviewers independently selected studies. Quality appraisal was based on the National Institute for Health and Care Excellence quality appraisal checklist for studies reporting correlations and associations. Data were abstracted on study design, missed care prevalence and measures of association. Synthesis was narrative. Eighteen studies gave subjective reports of missed care. Seventy-five per cent or more nurses reported omitting some care. Fourteen studies found low nurse staffing levels were significantly associated with higher reports of missed care. There was little evidence that adding support workers to the team reduced missed care. Low Registered Nurse staffing is associated with reports of missed nursing care in hospitals. Missed care is a promising indicator of nurse staffing adequacy. The extent to which the relationships observed represent actual failures, is yet to be investigated. © 2018 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.
... 47 Telecommunication 4 2010-10-01 2010-10-01 false Negative option billing. 76.981 Section 76.981 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Cable Rate Regulation § 76.981 Negative option billing. (a) A cable operator...
... shipments for the account of DOE shall include the following statement on all commercial bills of lading: This shipment is for the account of the U.S. Government which will assume the freight charges and is... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Commercial bills of...
... 42 Public Health 1 2010-10-01 2010-10-01 false Bills of health. 71.11 Section 71.11 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES QUARANTINE, INSPECTION, LICENSING FOREIGN QUARANTINE Measures at Foreign Ports § 71.11 Bills of health. A carrier at any foreign port clearing or...
an online system and window driven and can be used for the purpose of e- billing (Advalorem, 2009). ... Source: Billing Operation Unit, Customer Services Department KED Plc, (2002). Kilowatt hour is equal to the amount of energy ..... but reaction of the respondent confirmed the conclusion of poor consumers' response to ...
... 42 Public Health 2 2010-10-01 2010-10-01 false Billing and payment procedures. 408.84 Section 408.84 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Billing and payment procedures. (a) Initial premium notice. (1) CMS or its agent always sends the initial...
... change in practice location, a change of any managing employee, and a change in billing services. A... 42 Public Health 3 2010-10-01 2010-10-01 false Deactivation of Medicare billing privileges. 424.540 Section 424.540 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...
Sugar, William A.
This paper presents a potential solution to encourage technology adoption and integration within schools by proposing a human-centered technology "bill of rights" for educators. The intention of this bill of rights it to influence educators' beliefs towards technology and to enable educators to confront with confidence the seemingly…
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Delinquent payment of Customs bills. 142.14 Section 142.14 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... of Customs bills. The following procedure shall be followed if an importer is substantially or...
... 19 Customs Duties 2 2010-04-01 2010-04-01 false Delinquent payment of Customs bills. 142.26 Section 142.26 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... Delinquent payment of Customs bills. The following procedures shall be followed if an importer is...
Linear regression analysis has been employed to develop a model for predicting accurately the electricity billing for commercial consumers in Ogun State (Nigeria) at faster rate. The electricity billing model was implement-ed, executed and tested using embedded MATLAB function blocks. The correlations between the ...
... 64.2401 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES... provider. (3) The telephone bill must clearly and conspicuously identify any change in service provider... content so that customers can accurately assess that the services for which they are billed correspond to...
Full Text Available In the recent years, mobile operators have provided many billing alternatives such as limited and unlimited billing plans, and shared and non-shared data plans for the users with different needs. A non-shared data plan is designed for a single user with a limited monthly data allowance. On the other hand, the monthly data allowance of a shared data plan is shared by a group of users with multiple devices. The mobile operators often conduct the primary price study to compare their billing plans, which shows the relationship between the prices of the billing plans against the fixed amounts of data usage. Although the primary price study can easily and quickly draw the conclusions, it only provides rough billing plan suggestions. In reality, the amounts of data usage are not fixed, and therefore should be measured from commercial mobile networks to reflect the user behaviors on data usage. This paper proposes an analytical approach by using the measured data of Chunghwa Telecom Co., Ltd. (CHT, the largest telecommunications company in Taiwan, to derive the expected payments of various billing plans. The results of the analytical model are more accurate than those of the primary price study, and therefore provide better suggestions for billing plan selection. Other mobile operators can easily use our model to analyze the billing alternatives with their measured data.
This article examines the possible financial impacts of the 1990 amendments to the Clean Air Act. Topics include an overview of the bill, impact on utility companies, and implications for utility investors. The author feels the bill has important implications for investors who own utility stocks, particularly the stocks of coal-burning utilities in the Midwest and Appalachia
Kirby, Esther; Hurst, Keith
This major community, workload, staffing and quality study is thought to be the most comprehensive community staffing project in England. It involved over 400 staff from 46 teams in 6 localities and is unique because it ties community staffing activity to workload and quality. Scotland was used to benchmark since the same evidence-based Safer Nursing Care Tool methodology developed by the second-named author was used (apart from quality) and took into account population and geographical similarities. The data collection method tested quality standards, acuity, dependency and nursing interventions by looking at caseloads, staff activity and service quality and funded, actual, temporary and recommended staffing. Key findings showed that 4 out of 6 localities had a heavy workload index that stretched staffing numbers and time spent with patients. The acuity and dependency of patients leaned heavily towards the most dependent and acute categories requiring more face-to-face care. Some areas across the localities had high levels of temporary staff, which affected quality and increased cost. Skill and competency shortages meant that a small number of staff had to travel significantly across the county to deliver complex care to some patients.
Yoo, E J; Damaghi, N; Shakespeare, W G; Sherman, M S
Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care. Copyright © 2015 Elsevier Inc. All rights reserved.
Patrician, Patricia A; Loan, Lori A; McCarthy, Mary S; Swiger, Pauline; Breckenridge-Sproat, Sara; Brosch, Laura Ruse; Jennings, Bonnie Mowinski
Two decades ago, findings from an Institute of Medicine (IOM) report sparked the urgent need for evidence supporting relationships between nurse staffing and patient outcomes. This article provides an overview of nurse staffing, practice environment, and patient outcomes research, with an emphasis on findings from military studies. Lessons learned also are enumerated. This study is a review of the entire Military Nursing Outcomes Database (MilNOD) program of research. The MilNOD, in combination with evidence from other health care studies, provides nurses and leaders with information about the associations between staffing, patient outcomes, and the professional practice environment of nursing in the military. Leaders, therefore, have useful empirical evidence to make data-driven decisions. The MilNOD studies are the basis for the current Army nursing dashboard, and care delivery framework, called the Patent CaringTouch System. Future research is needed to identify ideal staffing based on workload demands, and provide leaders with factors to consider when operationalizing staffing recommendations. Copyright © 2017 Elsevier Inc. All rights reserved.
U.S. Environmental Protection Agency — These data represent predicted current distributions of all introduced fish in the Middle-Atlantic region. These data are available for both 8-digit HUCs and EMAP...
The rover Sojourner's first target for measurement by the Alpha-Proton-Xray Spectrometer (APXS) was the rock named Barnacle Bill, located close to the ramp down which the rover made its egress from the lander. The full spectral capability of the Imager for Mars Pathfinder (IMP), consisting of 13 wavelength filters, was used to characterize the rock's surface. The measured area is relatively dark, and is shown in blue. Nearby on the rock surface, soil material is trapped in pits (shown in red).Mars Pathfinder is the second in NASA's Discovery program of low-cost spacecraft with highly focused science goals. The Jet Propulsion Laboratory, Pasadena, CA, developed and manages the Mars Pathfinder mission for NASA's Office of Space Science, Washington, D.C. The Imager for Mars Pathfinder (IMP) was developed by the University of Arizona Lunar and Planetary Laboratory under contract to JPL. Peter Smith is the Principal Investigator. JPL is an operating division of the California Institute of Technology (Caltech).
Manheim, L M; Shortell, S M; McFall, S
Much concern has been raised about the effect of "corporatization" of health through the expansion of investor-owned hospital chains. One method of expansion is through hospital acquisition. At issue is the question of the effect of acquisitions on expenses and on such patient care inputs as staffing levels. In this article, we examine the effect of acquisition by one investor-owned chain on hospital costs and staffing. Subsequent to acquisition, hospital costs increase and staffing decreases, relative to competitor hospitals. However, since investor-owned hospitals not recently acquired do not have higher cost levels than their competitors, the increase in costs appears to be due to factors associated with the acquisition itself rather than factors associated with being an investor-owned hospital. Under the retrospective payment system in effect at the time, revenues also were higher for acquired hospitals. Under prospective payment, increasing revenues has been more difficult, decreasing acquisition incentives. PMID:2807933
Personnel Division + CHISB
The tariff agreement signed by CERN (and other international organisations) with Hospital de La Tour specifies that all bills paid within 30 days of the date of the invoice will enjoy a discount, to be deducted by the payer. The bills are labelled with a message to this effect.Physicians' fees, personal expenses as well as services from outside providers (e.g. ambulance companies or external laboratories) are however not part of the discount agreement. Bills for hospitalisation (i.e. with a stay in hospital longer than 28h) are normally directly paid by AUSTRIA, acting as a third-party payer.In May this year, Hospital de La Tour introduced a new (Y2K compliant) accounting and invoicing system. This implementation did not go as smoothly as planned and delayed the issuing of bills by two months. During the summer period, a special team of temporary staff was put in place to catch up on the delay. As a result of this, some bills were produced that contained errors and the sticky label mentioning the discount agr...
S.210: A Bill to establish the United States Enrichment Corporation to operate the Federal uranium enrichment program on a profitable and efficient basis in order to maximize the long term economic value to the United States, to provide assistance to the domestic uranium industry and to provide a Federal contribution for the reclamation of mill tailings generated pursuant to Federal defense contracts at active uranium and thorium processing sites, introduced in the Senate of the United States, One Hundred Second Congress, First Session, January 15, 1991
The bill would amend the Atomic Energy Act of 1954 to establish the US Enrichment Corporation to operate the Federal uranium enrichment program on a profitable and efficient basis in order to maximize the long term economic value to the US, would provide a Federal contribution for the reclamation of mill tailings generated as a result of Federal defense contracts at active uranium and thorium processing sites, and would provide assistance to the domestic uranium industry
... responsibility for receiving and responding to billing error complaints or inquiries. (2) Billing error means any... or other toll free telephone number. (v) The failure to reflect properly on a billing statement a... billing error complaint or inquiry. (6) Telephone-billed purchase means any purchase that is completed...
the reactor facility. Because of this the CNSC has stated publicly in a variety of presentations and meetings that it is prepared now to license small reactor projects and that they expect that SMRs can be licensed in Canada in less time than would be required in the U.S. They have urged SMR vendors to bring their designs to Canada and to engage with them in the rather unique pre-licensing Vendor Design Review process that is available in Canada. Notwithstanding the rather 'promotional' licensing stance being taken by the CNSC, there remains a significant level of uncertainty around the many other issues that need to be addressed to successfully introduce an SMR into Canada. These include, among other things and in no particular order: safety; risk (licensing, economic, schedule, public perception); economics (is economy of scale offset by modular fabrication, serial introduction); siting (remote or industrial complex); design and engineering (FOAK or prototype); manufacturing/construction (central fabrication facility, who gets 'construction' license); staffing (number, training); operations (who owns, who operates); maintenance and refuelling (on-site refuelling allowed or at central facility, what level of maintenance required); and decommissioning (on-site or centralized storage of waste, decommissioning funds). Addressing these and other infrastructure issues will need to be a key part of any considerations given to the possible introduction of Small Modular Reactors into Canada.
Hallbert, B.P.; Sebok, A.; Haugset, K.
Differences in the ways in which vendors expect the operations staff to interact with advanced passive plants by vendors have led to a need for reconsideration of the minimum shift staffing requirements of licensed Reactor Operators and Senior Reactor Operators contained in current federal regulations (i.e., 10 CFR 50.54(m)). A research project is being carried out to evaluate the impact(s) of advanced passive plant design and staffing of control room crews on operator and team performance. The purpose of the project is to contribute to the understanding of potential safety issues and provide data to support the development of design review guidance. Two factors are being evaluated across a range of plant operating conditions: control room crew staffing; and characteristics of the operating facility itself, whether it employs conventional or advanced, passive features. This paper presents the results of the first phase of the study conducted at the Loviisa nuclear power station earlier this year. Loviisa served as the conventional plant in this study. Data collection from four crews were collected from a series of design basis scenarios, each crew serving in either a normal or minimum staffing configuration. Results of data analyses show that crews participating in the minimum shift staffing configuration experienced significantly higher workload, had lower situation awareness, demonstrated significantly less effective team performance, and performed more poorly as a crew than the crews participating in the normal shift staffing configuration. The baseline data on crew configurations from the conventional plant setting will be compared with similar data to be collected from the advanced plant setting, and a report prepared providing the results of the entire study
Shin, Juh Hyun; Hyun, Ta Kyung
To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea. We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately
Melber, B.; Hauth, J.; Terrill, E.; Berk, B.; Gore, B.
In this report an international review of regulatory and industry practices is provided in the area of nuclear power plant staffing during the 1980s in Canada, France, Germany, Japan, Sweden, and the United Kingdom. The objective of this review is to highlight trends in staffing regulatory approaches, industry practices, and issues of concern in other countries that have potential relevance to nuclear power plant staffing issues in the United States. The decade of the 1980s was marked by a great deal of growth in nuclear power operations internationally; however, growth of nuclear power is not expected to continue in the 1990s except in France and Japan. A continuum of regulatory approaches to staffing was identified, ranging from prescribed regulations that are applied to all licensees (Germany is most similar to the United States in this regard), to indirect staffing regulations where the regulatory authority oversees plant operating practices that are agreed to in the plant operating license (most notably, France and the United Kingdom). Most of the changes observed in staffing regulations and practices in the early 1980s were made in response to the accident at the Three Mile Island Unit 2 nuclear power plant (TMI) in 1979. These changes included the widespread issuance of new operator and licensing requirements and the establishment of national training centers. After the post-TMI changes were implemented, a period of relative stability followed. Changes in the latter half of the 1980s have focused on continuing improvements and additions to training curricula and methods, most notably increased reliance on simulator training
Konetzka, R Tamara; Yi, Deokhee; Norton, Edward C; Kilpatrick, Kerry E
To investigate the effects of Medicare's Prospective Payment System (PPS) for skilled nursing facilities (SNFs) and associated rate changes on quality of care as represented by staffing ratios and regulatory deficiencies. Online Survey, Certification and Reporting (OSCAR) data from 1996-2000 were linked with Area Resource File (ARF) and Medicare Cost Report data to form a panel dataset. A difference-in-differences model was used to assess effects of the PPS and the BBRA (Balanced Budget Refinement Act) on staffing and deficiencies, a design that allows the separation of the effects of the policies from general trends. Ordinary least squares and negative binomial models were used. The OSCAR and Medicare Cost Report data are self-reported by nursing facilities; ARF data are publicly available. Data were linked by provider ID and county. We find that professional staffing decreased and regulatory deficiencies increased with PPS, and that both effects were mitigated with the BBRA rate increases. The effects appear to increase with the percent of Medicare residents in the facility except, in some cases, at the highest percentage of Medicare. The findings on staffing are statistically significant. The effects on deficiencies, though exhibiting consistent signs and magnitudes with the staffing results, are largely insignificant. Medicare's PPS system and associated rate cuts for SNFs have had a negative effect on staffing and regulatory compliance. Further research is necessary to determine whether these changes are associated with worse outcomes. Findings from this investigation could help guide policy modifications that support the provision of quality nursing home care.
Robinson, Claire H; Annis, Ann M; Forman, Jane; Krein, Sarah L; Yankey, Nicholas; Duffy, Sonia A; Taylor, Beth; Sales, Anne E
To assess implementation of the Veterans Health Administration staffing methodology directive. In 2010 the Veterans Health Administration promulgated a staffing methodology directive for inpatient nursing units to address staffing and budget forecasting. A qualitative multi-case evaluation approach assessed staffing methodology implementation. Semi-structured telephone interviews were conducted from March - June 2014 with Nurse Executives and their teams at 21 facilities. Interviews focused on the budgeting process, implementation experiences, use of data, leadership support, and training. An implementation score was created for each facility using a 4-point rating scale. The scores were used to select three facilities (low, medium and high implementation) for more detailed case studies. After analysing interview summaries, the evaluation team developed a four domain scoring structure: (1) integration of staffing methodology into budget development; (2) implementation of the Directive elements; (3) engagement of leadership and staff; and (4) use of data to support the staffing methodology process. The high implementation facility had leadership understanding and endorsement of staffing methodology, confidence in and ability to work with data, and integration of staffing methodology results into the budgeting process. The low implementation facility reported poor leadership engagement and little understanding of data sources and interpretation. Implementation varies widely across facilities. Implementing staffing methodology in facilities with complex and changing staffing needs requires substantial commitment at all organizational levels especially for facilities that have traditionally relied on historical levels to budget for staffing. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
Hesselfeldt, R; Steinmetz, J; Jans, H
This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients.......This study aims to compare the trauma system before and after implementing a physician-staffed helicopter emergency medical service (PS-HEMS). Our hypothesis was that PS-HEMS would reduce time from injury to definitive care for severely injured patients....
Funder, Kamilia S; Rasmussen, L.S.; Hesselfeldt, R
BACKGROUND: Implementation of a physician-staffed helicopter emergency medical service (PS-HEMS) in Denmark was associated with lower 30-day mortality in severely injured trauma patients and less time on social subsidy. However, the reduced 30-day mortality in severely injured patients might...... be at the expense of a worse functional outcome and quality of life (QoL) in those who survive. The aim of this study was to investigate the effect of a physician-staffed helicopter on long-term QoL in trauma patients. METHODS: Prospective, observational study including trauma patients who survived at least 3 years...
Nims, Julia K; Stevens, Robert
Reference service remains a core function of modern libraries. However, how and where we provide assistance has evolved with changing technologies and the shifting habits and preferences of our users. One way libraries can provide the on-demand, in-person assistance while managing and developing new services and resources that will benefit current and future users is to reconsider how their reference points and services are staffed and adopt a staff-based reference model. In Implementing an Inclusive Staffing Model for Today's Reference Services, Nims, Storm, and Stevens describe step-by-step
The purpose of this safety guide is to provide recommendations for national authorities on the appropriate management system, organization and staffing for the regulatory body responsible for the regulation of nuclear facilities in order to achieve compliance with the applicable safety requirements. This safety guide covers the organization and staffing in relation to nuclear facilities such as: enrichment and fuel manufacturing plants. Nuclear power plants. Other reactors such as research reactors and critical assemblies. Spent fuel reprocessing plants. And radioactive waste management facilities such as treatment, storage and disposal facilities. This safety guide also covers issues related to the decommissioning of nuclear facilities, the closure of waste disposal facilities and site rehabilitation
Bricknell, Roseanna; Faunce, Thomas
In 2013, Liberal MP Chris Spence introduced a Private Member's Bill to the New South Wales Parliament, reinvigorating an earlier Bill introduced by Christian Democrat MP Fred Nile. If passed, the Bill would have bestowed legal personhood on fetuses of 20 weeks or more for the purpose of grievous bodily harm offences in the Crimes Act 1900 (NSW). The Bill had the potential to undermine freedom of choice for women in relation to abortions prior to the point of viability (capacity for fetal existence outside the womb) as well as other decisions concerning pregnancy and childbirth. One hypothesis is that legislative measures such as this that support the rights of the fetus are well intentioned initiatives by those for whom the fetus is an essentially independent entity or symbol of innocence and moral purity whose existence must be protected over and above the interests and independent decision-making capacity of the mother. This column explores this hypothesis in the context of the paradoxical negative commercial implications of such legislation on multiple areas involving fetal-maternal interaction including surrogacy.
... organization table, including: (a) The structure and composition of the Board of Directors of the RLF; (b) The... 45 Public Welfare 4 2010-10-01 2010-10-01 false Staffing and organization of the Revolving Loan... Hawaiian Revolving Loan Fund Demonstration Project § 1336.65 Staffing and organization of the Revolving...
New research needs, global developments and local shifts in emphasis are demanding a broader range of interactions by librarians with researchers and are challenging previous staffing structures. Research has a higher institutional profile and academic libraries have responded by creating new roles and staffing models, with stronger linkage across…
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-71,014] Jeld-Wen, Inc., Hawkins Window Division, Including On-Site Leased Workers of Nicolet Staffing, Hawkins, WI; Notice of Negative...., Hawkins Window Division, including on-site leased workers of Nicolet Staffing, Hawkins, Wisconsin. Signed...
Kanda, Katsuya; Mezey, Mathy
Examined changes in resident acuity and registered nurse staffing in all nursing homes in Pennsylvania before and after introduction of Medicare Prospective Payment System (PPS) in 1983. Found that acuity of nursing home residents increased significantly since introduction of PPS, full-time registered nurse staffing remained unchanged, and…
Full Text Available Introduction of animals from an early age can make children to love animals, especially pets. Children are the easiest group to receive stimulation, such as for example the stimulation of introducing children to the pet. Various media are used by parents to introduce pet. For examplle, by the media of books, multimedia, etc. One of the interesting media to introduce pet is with game. Of these problems then need to know how to make concept and design game to introduced pets for children age 3-6 years. In this paper, author formulate how to make pet game design include game genre, user interface design, image model selection, game characters, and game engine. The expected design of this game can be formulation of learning through proper game as a learning tool children. Game design derived from this writing by using model 2-dimensional images are funny and interesting coloring. And combines several game genres into one, or use the mini games that children do not get bored quickly. Design of GUI (Graphical User Interface is made as simple as possible so that children easily understand in playing this game, but also must use an interesting image
MacIntyre, Peter D.; Mercer, Sarah
Positive psychology is a rapidly expanding subfield in psychology that has important implications for the field of second language acquisition (SLA). This paper introduces positive psychology to the study of language by describing its key tenets. The potential contributions of positive psychology are contextualized with reference to prior work,…
Seier, Edith; Liu, Yali
In introductory statistics courses, the concept of power is usually presented in the context of testing hypotheses about the population mean. We instead propose an exercise that uses a binomial probability table to introduce the idea of power in the context of testing a population proportion. (Contains 2 tables, and 2 figures.)
Johnson, Craig M.
The central ideas of postcalculus mathematics courses offered in college are difficult to introduce in middle and secondary schools, especially through the engineering and sciences examples traditionally used in algebra, geometry, and trigonometry textbooks. However, certain concepts in music theory can be used to expose students to interesting…
Wareham, David; Elefsiniotis, Takis P.; Elms, David
This paper describes a method of introducing ethics to a second-year class of civil engineering students. The method, known as a "structured controversy", takes the form of a workshop where the students assume the identity of stakeholders having an interest in a proposed development in an environmentally sensitive region. The instructor…
Tillinghast, B. S., Jr.
Suggests that the works of Ernest Hemingway can introduce young readers to (1) an intense expression of the joy of life, (2) heroic models, (3) original use of language, (4) a sharp sense of time and place, and (5) literature that can be understood at many levels. (MM)
Schnelle, John F; Schroyer, L Dale; Saraf, Avantika A; Simmons, Sandra F
Nursing aides provide most of the labor-intensive activities of daily living (ADL) care to nursing home (NH) residents. Currently, most NHs do not determine nurse aide staffing requirements based on the time to provide ADL care for their unique resident population. The lack of an objective method to determine nurse aide staffing requirements suggests that many NHs could be understaffed in their capacity to provide consistent ADL care to all residents in need. Discrete event simulation (DES) mathematically models key work parameters (eg, time to provide an episode of care and available staff) to predict the ability of the work setting to provide care over time and offers an objective method to determine nurse aide staffing needs in NHs. This study had 2 primary objectives: (1) to describe the relationship between ADL workload and the level of nurse aide staffing reported by NHs; and, (2) to use a DES model to determine the relationship between ADL workload and nurse aide staffing necessary for consistent, timely ADL care. Minimum Data Set data related to the level of dependency on staff for ADL care for residents in over 13,500 NHs nationwide were converted into 7 workload categories that captured 98% of all residents. In addition, data related to the time to provide care for the ADLs within each workload category was used to calculate a workload score for each facility. The correlation between workload and reported nurse aide staffing levels was calculated to determine the association between staffing reported by NHs and workload. Simulations to project staffing requirements necessary to provide ADL care were then conducted for 65 different workload scenarios, which included 13 different nurse aide staffing levels (ranging from 1.6 to 4.0 total hours per resident day) and 5 different workload percentiles (ranging from the 5th to the 95th percentile). The purpose of the simulation model was to determine the staffing necessary to provide care within each workload
Dr. William (Bill) Nelson is playing an integral role in advancing our understanding of cancer health disparities and helping to foster the interests of young students from underrepresented backgrounds in cancer/cancer health disparities research.
... with only micro-purchase authority may not issue bills of lading or otherwise procure transportation... for goods only shall comply with the Education, Experience, and Training requirements, if any, in Part...
Schiratti, A. [Sunoco, Toronto, ON (Canada)
This presentation focused on timely issues regarding marketer consolidated billing (MCB). MCB allows energy marketers to directly bill customers for both gas and electric commodities and distribution services. MCB is mandated by the Ontario Energy Board (OEB) in the electricity sector through the Retail Settlements Task Force and is proposed by the OEB in the Gas Distributor Access Rule. The main topics discussed in this paper were the new relationship under MCB, benefits for customers and challenges for marketers. The major obstacles for a successful MCB model were also proposed. The new MCB approach strengthens the relationship between the marketer and the customer. The MCB will allow both electricity and natural gas customers to choose marketers who bill for both delivery and gas on one bill.
ABSTRACT. This paper assesses the perception of billing consumers via analogue meter in Kano Electricity ... the successor companies of Power Holding Company ... Nassarawa computer center was established in 1991. .... The value 7.2 is.
Tuumalu, Tiit, 1971-
19.-23. nov. toimuvast animafilmide festivalist "Animated Dreams". Pikemalt USA tuntuimast sõltumatust animaatorist Bill Plymtonist, kes näitab festivalil oma täispikka joonisfilmi "Idioodid ja inglid" ("Idiots and Angels")
...) The amount of the total bill assessed as a franchise fee and the identity of the franchising authority... fees and costs itemized pursuant to this section. (c) Local franchising authorities may adopt...
A first text discusses the motivations of this bill project: to guarantee French supply security, to contribute to France economical competitiveness, to protect the environment, to give everybody access to energy, and to comply with the European energy market. It also comments the bill project content, the objectives aimed at through the different bill articles. These articles settle a regulated access to electricity and a regulatory frame for pricing, define provider responsibilities, deal with installation dismantling expenses. This presentation is followed by the bill text and by the report of an impact study of the implementation of a regulated access to electricity, of a capacity obligation, and of the evolution of regulated selling prices
Senate Bill 1080 (2008 Special Session) tightened documentation and identity verification requirements for the issuance, replacement and renewal of Oregon driver licenses, driver permits and identification cards. The law was signed by the Governor on...
This presentation focused on timely issues regarding marketer consolidated billing (MCB). MCB allows energy marketers to directly bill customers for both gas and electric commodities and distribution services. MCB is mandated by the Ontario Energy Board (OEB) in the electricity sector through the Retail Settlements Task Force and is proposed by the OEB in the Gas Distributor Access Rule. The main topics discussed in this paper were the new relationship under MCB, benefits for customers and challenges for marketers. The major obstacles for a successful MCB model were also proposed. The new MCB approach strengthens the relationship between the marketer and the customer. The MCB will allow both electricity and natural gas customers to choose marketers who bill for both delivery and gas on one bill
The Soulbop Bandi rajajad Randy Becker ja Bill Evans ning meie Evelin Samuel gospeli ja rhytmblues'i juurtega soulist. Lk. 72-73 Inessa Josingu ja Ande Kaalepi souliteemaline fotolavastusega ruumikujundus
Keywords: Electricity Distribution, Consumers, Analogue Meter, Billing, Nigeria. INTRODUCTION. Electricity ... the energy usage of a typical electricity consumer in one month is several ..... improve on distribution network. In addition it should.
Houseman, Susan N.
Workers in flexible staffing arrangementsincluding temporary agency, direct-hire temporary, on-call, and contract workersare much less likely than regular, direct-hire employees to be covered by laws mandating or regulating workplace benefits. They are also much less likely to receive pension, health insurance, and other benefits on the job.…
Liao, S.; van Delft, C.; Jouini, O.; Koole, G.M.
We consider a multi-period staffing problem in a single-shift call center. The call center handles inbound calls, as well as some alternative back-office jobs. The call arrival process is assumed to follow a doubly non-stationary stochastic process with a random mean arrival rate. The inbound calls
The article presents the goals, methods, and case examples of The Nutury, a predominantly male-staffed child care center serving single-parent children. The primary goal is to provide consistent relationships with men for children without a male model in their home. Clinical observations reveal positive life-styles and attitudes. (LPG)
Au, M.L.; DiSalvo, R.; Merschoff, E.
The report is a compilation of the data obtained from a survey of foreign nuclear power plant operator requirements. Included among the considerations are: (1) shift staffing; (2) operator eligibility; (3) operator training programs; (4) operator licensing or certification; and (5) operator retraining. The data obtained from this survey are presented in matrix form and contrasted with U.S. requirements
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... refrigerators and trash compactors. The notice was published in the Federal Register on October 25, 2010 (75 FR...
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation Including On-Site Leased Workers From Career Solutions TEC Staffing, Andrews International, IBM Corporation... workers are engaged in the production of refrigerators and trash compactors. The notice was published in...
Experience from well operated nuclear power plants (NPPs) around the world indicates that an organizational structure which efficiently supports plant operation is essential in economically achieving both high level of safety and operational performance. At the same time energy markets are being opened to competition in many Member States. It is in consideration of this new competitive energy market that the overall objective of this document is to provide NPP managers information on lessons learned on improving the organization and staffing of NPP activities. Within this overall objective, specific objectives are to: Identify organisational design and staffing principles, Provide examples of how NPPs implement these principles, Identify typical NPP staffing levels, Factors affecting these levels, and staffing trends among various NPP types. Although it is not expected that any particular utility or NPP manager would consider all of the suggestions provided here to be appropriate, it is anticipated that nearly every NPP manager in IAEA Member States would find some ideas useful in improving the efficiency and effectiveness of NPP activities
Safety of public, occupational workers and the protection of environment should be assured while activities for economic and social progress are pursued. These activities include the establishment and utilisation of nuclear facilities and the use of radioactive sources. This safety guide provides guidance on the aspects of staffing, recruitment, training, qualification and certification of operating personnel of nuclear power plants
Felce, D.; Perry, J.
Background: There is little evidence to guide the commissioning of residential provision for adults with autistic spectrum disorder (ASD) in the UK. We aim to explore the degree and impact of diagnostic congregation among adults with intellectual disabilities (ID) and ASD living in staffed housing. Methods: One hundred and fifty-seven adults with…
North, Nicola; Leung, William; Ashton, Toni; Rasmussen, Erling; Hughes, Frances; Finlayson, Mary
To determine the rates and costs of nurse turnover, the relationships with staffing practises, and the impacts on outcomes for nurses and patients. In the context of nursing shortages, information on the rates and costs of nursing turnover can improve nursing staff management and quality of care. Quantitative and qualitative data were collected prospectively for 12 months. A re-analysis of these data used descriptive statistics and correlational analysis techniques. The cost per registered nurse turnover represents half an average salary. The highest costs were related to temporary cover, followed by productivity loss. Both are associated with adverse patient events. Flexible management of nursing resources (staffing below budgeted levels and reliance on temporary cover), and a reliance on new graduates and international recruitment to replace nurses who left, contributed to turnover and costs. Nurse turnover is embedded in staffing levels and practises, with costs attributable to both. A culture of turnover was found that is inconsistent with nursing as a knowledge workforce. Nurse managers did not challenge flexible staffing practices and high turnover rates. Information on turnover and costs is needed to develop strategies that retain nurses as knowledge-based workers. © 2012 Blackwell Publishing Ltd.
In fall of 2011 the University at Buffalo Libraries circulation department undertook Six Sigma training for the purpose of overhauling its student scheduling process. The department was able to mitigate significant staffing budgetary reductions and resource reallocations and to overcome the unique challenges of scheduling student labor for a…
Kamis-Gould, Edna; And Others
A model for quality assurance (QA) in psychiatric hospitals is described. Its functions (general QA, utilization review, clinical records, evaluation, management information systems, risk management, and infection control), subfunctions, and corresponding staffing requirements are reviewed. This model was designed to foster standardization in QA…
Christopher E. Pelt, MD
Conclusions: A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.
Felce, David; Perry, Jonathan; Romeo, Renee; Robertson, Janet; Meek, Andrea; Emerson, Eric; Knapp, Martin
In a matched-groups design, costs and quality of life outcomes for adults with intellectual disabilities with relatively low support needs were compared between those in fully staffed group homes (n = 35) and in semi-independent living (n = 35). Data were collected on participant characteristics, setting organization, various lifestyle outcomes,…
... Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., Working On-Site at Tyler Pipe... MDS Industrial Resources, Inc., working on-site at Tyler Pipe Company, Waterworks Division, South... Staffing Agency, Willstaff Crystal, Inc., and MDS Industrial Resources, Inc., working on-site at Tyler Pipe...
Tuck, Kathy D.; Holmes, Dwight R.
At the request of New Business Item: 89 (NBI: 89) adopted at the 2015 NEA Representative Assembly, this study examines the extent to which students have access to public school library/media centers with qualified staff and up-to-date resources. The study explores trends in library/media center openings and closings as well as staffing patterns…
Roberts, Amy Restorick; Bowblis, John R
Although nurse staffing has been extensively studied within nursing homes (NHs), social services has received less attention. The study describes how social service departments are organized in NHs and examines the structural characteristics of NHs and other macro-focused contextual factors that explain differences in social service staffing patterns using longitudinal national data (Certification and Survey Provider Enhanced Reports, 2009-2012). NHs have three patterns of staffing for social services, using qualified social workers (QSWs); paraprofessional social service staff; and interprofessional teams, consisting of both QSWs and paraprofessionals. Although most NHs employ a QSW (89 percent), nearly half provide social services through interprofessional teams, and 11 percent rely exclusively on paraprofessionals. Along with state and federal regulations that depend on facility size, other contextual and structural factors within NHs also influence staffing. NHs most likely to hire QSWs are large facilities in urban areas within a health care complex, owned by nonprofit organizations, with more payer mixes associated with more profitable reimbursement. QSWs are least likely to be hired in small facilities in rural areas. The influence of policy in supporting the professionalization of social service staff and the need for QSWs with expertise in gerontology, especially in rural NHs, are discussed. © 2016 National Association of Social Workers.
American Federation of Teachers (NJ), 2008
Over the last generation, the instructional staffing system in American higher education has experienced a significant reduction in the proportion of jobs for full-time tenured and tenure-track faculty members and a dramatic growth in fixed-term full- and part-time instructional jobs without tenure. About 70 percent of the people teaching in…
A big telephone bill--possibly in six figures--can be a painful way for a hospital to find out its phone system isn't secure. When unusually large long-distance bills start to show up, chances are a professional telephone hacker has broken in. According to experts, one in 15 businesses has been victimized by long-distance toll fraud, and loss estimates range from $900 million to $4 billion a year.
Ben Gilbert; Joshua S. Graff Zivin
Digital tracking and the proliferation of automated payments have made intermittent billing more commonplace, and the frequency at which consumers receive price, quantity, or total expenditure signals may distort their choices. This category of goods has expanded from household utilities, toll road access and software downloads to standard consumption goods paid by credit card or other "bill-me-later"-type systems. Yet we know surprisingly little about how these payment patterns affect decisi...
Abubakar Sanni Aliyu
Full Text Available Nigeria has absolutely no privacy and personal information laws. This lacuna is even more material in an internet world where information published on the web is open to a global audience. It is in this regard that the Data Protection Bill was sponsored by Hon. Yakubu Dogara, member of the Federal House of Representatives, representing Bogoro/Dass/Tafawa Balewa Bauchi State, Nigeria. This paper has two key aims, firstly to find out the major issues address by the proposed Data Protection Bill 2010, secondly, to determine the significance and the challenges of the Bill to Nigeria environment. The study utilized secondary source of data from the Data Protection Bill, 2010 and other documentary sources for analysis. The study finds out that the Bill protect parties in regard to publication of market survey details and information, ensure that unauthorised processing of personal information is reduce, and use of personal data and information without the prior consent of the data is subjected to scrutiny. The paper recommends that the Federal Government of Nigeria and the policy makers should hasten the process of passing the Bill into law in order to strengthen the activities of ecommerce in Nigeria through the following benefits: Improved customer relations; Improved ability to market lawfully; Improved data quality; Improved data security among others.
Iyer, Maithili; Kempton, Willett; Payne, Christopher
A program called ``Innovative Billing?? has been developed to provide individualized energy information for a mass audience?the entireresidential customer base of an electric or gas utility. Customers receive a graph on the bill that compares that customer?s consumption with othersimilar customers for the same month. The program aims to stimulate customers to make ef?ciency improvements. To group as many as severalmillion customers into small ``comparison groups??, an automated method must be developed drawing solely from the data available to the utility.This paper develops and applies methods to compare the quality of resulting comparison groups.A data base of 114,000 customers from a utility billing system was used to evaluate Innovative Billing comparison groups, comparing fouralternative criteria: house characteristics (?oor area, housing type, and heating fuel); street; meter read route; billing cycle. Also, customers wereinterviewed to see what forms of comparison graphs made most sense and led to fewest errors of interpretation. We ?nd that good qualitycomparison groups result from using street name, meter book, or multiple house characteristics. Other criteria we tested, such as entire cycle, entiremeter book, or single house characteristics such as ?oor area, resulted in poor quality comparison groups. This analysis provides a basis forchoosing comparison groups based on extensive user testing and statistical analysis. The result is a practical set of guidelines that can be used toimplement realistic, inexpensive innovative billing for the entire customer base of an electric or gas utility.
Full Text Available No abstract available. Article truncated after first 150 words. Today, the Senate Republican leadership released a revised version of a bill to repeal and replace the Affordable Care Act (ACA. The new bill draft includes an amendment sponsored by Sen. Cruz (R-TX that permits insurers to offer health insurance plans on the ACA exchanges that do not cover the ACA’s 10 essential health benefits (EHB as long as they offer at least one other plan that provides full coverage of EHB’s. The bill also includes more funding for opioid addiction and for state initiatives to reduce insurance premiums and additionally, some flexibility for state Medicaid funding in the event of a public health crisis. The bill must still receive a cost estimate from the Congressional Budget Office (CBO, which will include the impact of the bill on insurance coverage levels, expected out Monday. The ATS remains deeply concerned about the bill because under the Cruz proposal, insurance coverage costs …
Krogh, Paul; Ernster, Jason; Knoer, Scott
The creation and implementation of data-driven staffing-to-demand models at two institutions are described. Predictive workload tools provide a guideline for pharmacy managers to adjust staffing needs based on hospital volume metrics. At Abbott Northwestern Hospital, management worked with the department's staff and labor management committee to clearly outline the productivity monitoring system and the process for reducing hours. Reference charts describing the process for reducing hours and a form to track the hours of involuntary reductions for each employee were created to further enhance communication, explain the rationale behind the new process, and promote transparency. The University of Minnesota Medical Center-Fairview, found a strong correlation between measured pharmacy workload and an adjusted census formula. If the daily census and admission report indicate that the adjusted census will provide enough workload for the fully staffed department, no further action is needed. If the census report indicates the adjusted census is less than the breakeven point, staff members are asked to leave work, either voluntarily or involuntarily. The opposite holds true for days when the adjusted census is higher than the breakeven point, at which time additional staff are required to synchronize worked hours with predicted workload. Successful staffing-to- demand models were implemented in two hospital pharmacies. Financial savings, as indicated by decreased labor costs secondary to reduction of staffed shifts, were approximately $42,000 and $45,500 over a three-month period for Abbott Northwestern Hospital and the University of Minnesota Medical Center-Fairview, respectively. Maintenance of 100% productively allowed the departments to continue to replace vacant positions and avoid permanent staff reductions.
Clet Wandui Masiga
Full Text Available The Cartagena Protocol on Biosafety to the Convention on Biological Diversity is an internationally binding instrument addressing issues of biosafety. Biosafety refers to the need to protect human health and the environment from the possible adverse effects of the products of modern biotechnology. Accordingly all countries to the convention are required to put in place regulatory mechanisms to enhance the safety of biotechnology in the context of the Convention’s overall goal of reducing all potential threats to biological diversity, while taking into account the risks to human health. Therefore each country party to the convention has its own procedures to enact laws to guide the safe use of biotechnology. In Uganda the process involves the drafting of the bill by the first parliamentary counsel, approval by cabinet, first reading at the parliament, committal to the responsible parliamentary sessional committee, tabling of the bill for public hearing, consultations, and final approval. In Uganda, the Committee on Science and Technology is responsible for the Biosafety Bill. In March 2013, the Committee tabled the bill for public hearing and submissions from public institutions. There were comments supporting the passage of the Bill and comments in objection.The reasons for objection are mainly due to precaution, speculation, lack of knowledge about biotechnology and biosafety, and alleged influence from biosafety entrepreneurs. This article reviews these public views, revealing controversy and possible consensus to pass the bill.
Learn ZBrush inside and out with this updated new edition Get totally comfortable sculpting in a digital environment with the latest edition of this bestselling beginner's guide to ZBrush. Fully updated for the newest version of the software, ZBrush 4R3, this book dispels any fears you might have about the difficulty of using ZBrush and soon has you creating realistic, cartoon, and organic models with flair. Learn all the essentials, as you complete fun tutorials on painting, meshes, organic scripting, hard surface sculpting, lighting, rendering, and more. Introduces you to ZBrush, the sculpt
What is time? The 5th-century philosopher St Augustine famously said that he knew what time was, so long as no one asked him. Is time a fourth dimension similar to space or does it flow in some sense? And if it flows, does it make sense to say how fast? Does the future exist? Is time travel possible? Why does time seem to pass in only one direction?These questions and others are among the deepest and most subtle that one can ask, but "Introducing Time" presents them - many for the first time - in an easily accessible, lucid and engaging manner, wittily illustrated by Ralph Edney.
Schlaepfer, Martin A.; Sherman, P.W.; Blossey, B.; Runge, M.C.
Invasive species can alter environments in such a way that normal behavioural decision-making rules of native species are no longer adaptive. The evolutionary trap concept provides a useful framework for predicting and managing the impact of harmful invasive species. We discuss how native species can respond to changes in their selective regime via evolution or learning. We also propose novel management strategies to promote the long-term co-existence of native and introduced species in cases where the eradication of the latter is either economically or biologically unrealistic.
Introducing Character Animation with Blender, 2nd Edition is written in a friendly but professional tone, with clear descriptions and numerous illustrative screenshots. Throughout the book, tutorials focus on how to accomplish actual animation goals, while illustrating the necessary technical methods along the way. These are reinforced by clear descriptions of how each specific aspect of Blender works and fits together with the rest of the package. By following all the tutorials, the reader will gain all the skills necessary to build and animate a well-modeled, fully-rigged character of their
Merrick, Allison; Green, Rochelle; Cunningham, Thomas V; Eisenberg, Leah R; Hester, D Micah
Although ethics is an essential component of undergraduate medical education, research suggests that current medical ethics curricula face considerable challenges in improving students' ethical reasoning. This article discusses these challenges and introduces a promising new mode of graduate and professional ethics instruction for overcoming them. We begin by describing common ethics curricula, focusing in particular on established problems with current approaches. Next, we describe a novel method of ethics education and assessment for medical students that we have devised: the Medical Ethics Bowl (MEB). Finally, we suggest the pedagogical advantages of the MEB when compared to other ethics curricula.
Kim, Youngsang; Ployhart, Robert E
This study integrates research from strategy, economics, and applied psychology to examine how organizations may leverage their human resources to enhance firm performance and competitive advantage. Staffing and training are key human resource management practices used to achieve firm performance through acquiring and developing human capital resources. However, little research has examined whether and why staffing and training influence firm-level financial performance (profit) growth under different environmental (economic) conditions. Using 359 firms with over 12 years of longitudinal firm-level profit data, we suggest that selective staffing and internal training directly and interactively influence firm profit growth through their effects on firm labor productivity, implying that staffing and training contribute to the generation of slack resources that help buffer and then recover from the effects of the Great Recession. Further, internal training that creates specific human capital resources is more beneficial for prerecession profitability, but staffing is more beneficial for postrecession recovery, apparently because staffing creates generic human capital resources that enable firm flexibility and adaptation. Thus, the theory and findings presented in this article have implications for the way staffing and training may be used strategically to weather economic uncertainty (recession effects). They also have important practical implications by demonstrating that firms that more effectively staff and train will outperform competitors throughout all pre- and postrecessionary periods, even after controlling for prior profitability. (c) 2014 APA, all rights reserved.
The field of critical care has changed markedly in recent years to accommodate a growing population of chronically critically ill patients. New administrative structures have evolved to include divisions, departments, and sections devoted exclusively to the practice of critical care medicine. On an individual level, the ability to manage complex multisystem critical illnesses and to introduce invasive monitoring devices defines the intensivist. On a systems level, critical care services managed by an intensivist-led multidisciplinary team are now recognized by their ability to efficiently utilize hospital resources and improve patient outcomes. Due to the numerous cost and quality issues related to the delivery of critical care medicine, intensive care unit physician staffing (IPS) has become a charged subject in recent years. Although the federal government has played a large role in regulating best practices by physicians, other third parties have entered the arena. Perhaps the most influential of these has been The Leapfrog Group, a consortium representing 130 employers and 65 Fortune 500 companies that purchase health care for their employees. This group has proposed specific regulatory guidelines for IPS that are purported to result in substantial cost containment and improved quality of care. This narrative review examines the impact of The Leapfrog Group's recommendations on critical care delivery in the United States. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Sonia Maria Gomes Ferreira
Full Text Available Arising at a time of unprecedented growth of interest in fostering critical thinking, Introducing Reading offers a clear introduction and thorough account of contemporary developments in the field of reading. While overtly focusing on the special demands of social and human aspects of the reading practice, the issues raised have crucial resonance in the sphere of critical reading. Explicitly addressed to teachers of mother tongue and foreign language contexts, the book claims to elaborate on aspects of reading which have received meager attention to date: individual readers engaged in different real-world reading tasks, the social contexts where such readers engage and interact with texts, and the nature and variety of texts, here regarded as “participants” in the interaction between reader and writer. To this extent, the book successfully reaches the ambitious aim of “socializing and humanizing reading and the teaching of reading” (p. xi. Arising at a time of unprecedented growth of interest in fostering critical thinking, Introducing Reading offers a clear introduction and thorough account of contemporary developments in the field of reading. While overtly focusing on the special demands of social and human aspects of the reading practice, the issues raised have crucial resonance in the sphere of critical reading. Explicitly addressed to teachers of mother tongue and foreign language contexts, the book claims to elaborate on aspects of reading which have received meager attention to date: individual readers engaged in different real-world reading tasks, the social contexts where such readers engage and interact with texts, and the nature and variety of texts, here regarded as “participants” in the interaction between reader and writer. To this extent, the book successfully reaches the ambitious aim of “socializing and humanizing reading and the teaching of reading” (p. xi.
Ms, Suzie Aparicio; Welch Bacon, Cailee E; Parsons, John T; Bay, R Curtis; Cohen, Randy P; DeZeeuw, Terry; McLeod, Tamara C Valovich
The "Appropriate Medical Coverage for Intercollegiate Athletics" (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Cross-sectional study. Web-based survey. Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1-3 FTE athletic trainers for football would change their compliance status. A uniform definition of the term FTE within collegiate athletics is needed to allow for structured
Gallucci, Andrew R; Petersen, Jeffrey C
Athletic training facilities have been described in terms of general design concepts and from operational perspectives. However, the size and scope of athletic training facilities, along with staffing at different levels of intercollegiate competition, have not been quantified. To define the size and scope of athletic training facilities and staffing levels at various levels of intercollegiate competition. To determine if differences existed in facilities (eg, number of facilities, size of facilities) and staffing (eg, full time, part time) based on the level of intercollegiate competition. Cross-sectional study. Web-based survey. Athletic trainers (ATs) who were knowledgeable about the size and scope of athletic training programs. Athletic training facility size in square footage; the AT's overall facility satisfaction; athletic training facility component spaces, including satellite facilities, game-day facilities, offices, and storage areas; and staffing levels, including full-time ATs, part-time ATs, and undergraduate students. The survey was completed by 478 ATs (response rate = 38.7%) from all levels of competition. Sample means for facilities were 3124.7 ± 4425 ft 2 (290.3 ± 411 m 2 ) for the central athletic training facility, 1013 ± 1521 ft 2 (94 ± 141 m 2 ) for satellite athletic training facilities, 1272 ± 1334 ft 2 (118 ± 124 m 2 ) for game-day athletic training facilities, 388 ± 575 ft 2 (36 ± 53 m 2 ) for athletic training offices, and 424 ± 884 ft 2 (39 ± 82 m 2 ) for storage space. Sample staffing means were 3.8 ± 2.5 full-time ATs, 1.6 ± 2.5 part-time ATs, 25 ± 17.6 athletic training students, and 6.8 ± 7.2 work-study students. Division I schools had greater resources in multiple categories (P facilities in recent years was common, and almost half of ATs reported that upgrades have been approved for the near future. This study provides benchmark descriptive data on athletic training staffing and
MS, Suzie Aparicio; Welch Bacon, Cailee E.; Parsons, John T.; Bay, R. Curtis; Cohen, Randy P.; DeZeeuw, Terry; McLeod, Tamara C. Valovich
Context The “Appropriate Medical Coverage for Intercollegiate Athletics” (AMCIA) document was created to support assessment and calculation of athletic training personnel requirements. However, little is known regarding disparities between current and recommended staffing practices. Objective To identify the staffing and employment characteristics of athletic health care services at Football Bowl Subdivision-level institutions. Design Cross-sectional study. Setting Web-based survey. Patients or Other Participants Head athletic trainers and athletic training staff members who were knowledgeable about budget and staff. Main Outcome Measure(s) The survey, Assessment of Staffing Levels at National Collegiate Athletic Association Football Bowl Subdivision-Level Institutions, was used to evaluate personal, university, and staff demographics; staffing and employment topics; and AMCIA variables and use. Results The survey was accessed and partially completed by 104 individuals (response rate = 84.6%). A total of 79 athletic trainers (response rate = 76%) completed the entire survey. One-third of the respondents (34.2%, n = 26) met the recommended number of full-time equivalents (FTEs) for football, two-thirds of the respondents (65.7%, n = 50) failed to meet the recommendation, and 26.2% (n = 27) were missing data needed for FTE calculation. Among those who did not meet the recommended FTEs (n = 50), 38.0% (n = 19) were within 1 FTE of being compliant, 26.0% (n = 13) were within 2 FTEs, and 24.0% (n = 12) were within 3 FTEs. About one-third of respondents (35.9%, n = 37) reported not using the AMCIA, citing lack of funding (29.7%, n = 11), lack of administrative support (21.6%, n = 8), and other reasons (37.8%, n = 14). Conclusions The majority of institutions that used the AMCIA were able to provide justification for staffing. For most of the institutions that failed to meet their recommendation, adding 1–3 FTE athletic trainers for football would change their
... (b) Billing method (1)(i) Government issued agency charge card, (1) Bill from charge card company (may be electronic). (ii) Centrally billed travel account citation. (2)(i) Purchase order, (2) Bill from TSP (may be electronic). (ii) Bill of lading, (iii) Government Bill of Lading, (iv) Government...
The bill asserting the French national commitment for the environment (also named 'Grenelle 2') is considered as the juridical tool-box of the French environmental policy. It confirms, strengthens, and concretizes the objectives defined by the Grenelle 1 law. The main dispositions of the bill concern the following domains: settlement and urbanism with the improvement of the energy efficiency, energy conservation and life-cycle of buildings; transports with the development of sustainable transportation systems; energy with the creation of regional climate, air and energy schemes with the aim of developing renewable energies (with some restrictions concerning wind power) and reducing CO 2 emissions; biodiversity with the creation of ecological pathways between protected areas for the migration of flora and fauna species; environment and waste management with the reinforcement of measures for the abatement of environmental pollutant effects. Among the numerous dispositions involving more than 20 codes (urbanism, environment, buildings etc..) one concerns the progressive implementation of a 'carbon price' index taking into account the greenhouse gas emission costs during the whole life cycle of a product, another one concerns the monitoring of indoor air quality in public buildings. This document is made of three parts. Part 1 is the exposition of the intentions of each article of the bill, part 2 is the bill itself and part 3 is the impact study of the bill in terms of economical, social and environmental impact. (J.S.)
Higgerson, N J; Van Slyck, A
The advantages of variable billing for nursing care that: It identifies revenue nursing cost centers. It facilitates systematic control of revenue and expenses, improving budget planning and management. It generates a tremendous amount of data that can be used in administrative planning and decision making. It is more equitable than past billing practices for the patient, the third-party payer, and the hospital, making it a public relations asset. The disadvantages of variable billing are that: Charges at one hospital are not easily compared with those at another. The mix of patients at varying classification levels has a significant effect on revenue, thus increasing the possibility of lower revenue. More accountability and in some cases more work is required of nursing administrators. In this article, the practical application of variable billing in acute care settings has been discussed. It is hoped that the information provided here will stimulate nursing administrators to assess the feasibility of implementing varible billing for nursing services as a fiscal practice in their own institutions.
O'Connor, Katherine M; Zipes, David G; Schaffzin, Joshua K; Rosenberg, Rebecca
Surgical comanagement is an increasingly common practice in pediatric hospital medicine. Information about the structure and financing of such care is limited. The aim of the researchers for this study was to investigate pediatric hospitalist surgical comanagement models and to assess pediatric hospitalist familiarity with and patterns of billing for surgical patients. We conducted a cross-sectional cohort web-based survey of pediatric hospitalists using the American Academy of Pediatrics' Section on Hospital Medicine listserv. In our study ( N = 133), we found wide variation in our cohort in surgical patient practice management, including program structure, individual billing practices, and knowledge regarding billing practices. Even for pediatric hospitalists with comanagement service agreements between surgeons and pediatric hospitalists, there was no increased awareness or knowledge about reimbursement or billing for surgical patients. This global lack of knowledge in our small but diverse sample suggests that billing resources and training for pediatric hospitalists practicing comanagement of surgical patients are needed. Copyright © 2017 by the American Academy of Pediatrics.
Vawdrey, David K; Walsh, Colin; Stetson, Peter D
Between 2008 and 2010, our academic medical center transitioned to electronic provider documentation using a commercial electronic health record system. For attending physicians, one of the most frustrating aspects of this experience was the system's failure to support their existing electronic billing workflow. Because of poor system integration, it was difficult to verify the supporting documentation for each bill and impractical to track whether billable notes had corresponding charges. We developed and deployed in 2011 an integrated billing application called "iCharge" that streamlines clinicians' documentation and billing workflow, and simultaneously populates the inpatient problem list using billing diagnosis codes. Each month, over 550 physicians use iCharge to submit approximately 23,000 professional service charges for over 4,200 patients. On average, about 2.5 new problems are added to each patient's problem list. This paper describes the challenges and benefits of workflow integration across disparate applications and presents an example of innovative software development within a commercial EHR framework.
The rainbow, the moon, a spinning top, a comet, the ebb and flood of the oceans ...a falling apple. There is only one universe and it fell to Isaac Newton to discover its secrets. Newton was arguably the greatest scientific genius of all time, and yet he remains a mysterious figure. Written and illustrated by William Rankin, "Introducting Newton and Classical Physics" explains the extraordinary ideas of a man who sifted through the accumulated knowledge of centuries, tossed out mistaken beliefs, and single-handedly made enormous advances in mathematics, mechanics and optics. By the age of 25, entirely self-taught, he had sketched out a system of the world. Einstein's theories are unthinkable without Newton's founding system. He was also a secret heretic, a mystic and an alchemist, the man of whom Edmund Halley said "Nearer to the gods may no man approach!". This is an ideal companion volume to "Introducing Einstein".
Full Text Available Positive psychology is a rapidly expanding subfield in psychology that has important implications for the field of second language acquisition (SLA. This paper introduces positive psychology to the study of language by describing its key tenets. The potential contributions of positive psychology are contextualized with reference to prior work, including the humanistic movement in language teaching, models of motivation, the concept of an affective filter, studies of the good language learner, and the concepts related to the self. There are reasons for both encouragement and caution as studies inspired by positive psychology are undertaken. Papers in this special issue of SSLLT cover a range of quantitative and qualitative methods with implications for theory, research, and teaching practice. The special issue serves as a springboard for future research in SLA under the umbrella of positive psychology.
Haas, Sheila A; Vlasses, Frances; Havey, Julia
There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.
Isambert, Aurelie; Valero, Marc; Rousse, Carole; Blanchard, Vincent; Le Du, Dominique; Guilhem, Marie-Therese; Dieudonne, Arnaud; Pierrat, Noelle; Salvat, Cecile
The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. (authors)
Isambert, Aurélie; Le Du, Dominique; Valéro, Marc; Guilhem, Marie-Thérèse; Rousse, Carole; Dieudonné, Arnaud; Blanchard, Vincent; Pierrat, Noëlle; Salvat, Cécile
The French regulations concerning the involvement of medical physicists in medical imaging procedures are relatively vague. In May 2013, the ASN and the SFPM issued recommendations regarding Medical Physics Personnel for Medical Imaging: Requirements, Conditions of Involvement and Staffing Levels. In these recommendations, the various areas of activity of medical physicists in radiology and nuclear medicine have been identified and described, and the time required to perform each task has been evaluated. Criteria for defining medical physics staffing levels are thus proposed. These criteria are defined according to the technical platform, the procedures and techniques practised on it, the number of patients treated and the number of persons in the medical and paramedical teams requiring periodic training. The result of this work is an aid available to each medical establishment to determine their own needs in terms of medical physics. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Full Text Available Resource allocation could be influenced by various dynamic elements, such as the skills of engineers and the growth of skills, which requires managers to find an effective and efficient tool to support their staffing decision-making processes. Rescheduling happens commonly and frequently during the project execution. Control options have to be made when new resources are added or tasks are changed. In this paper we propose a software project staffing model considering dynamic elements of staff productivity with a Genetic Algorithm (GA and Hill Climbing (HC based optimizer. Since a newly generated reschedule dramatically different from the initial schedule could cause an obvious shifting cost increase, our rescheduling strategies consider both efficiency and stability. The results of real world case studies and extensive simulation experiments show that our proposed method is effective and could achieve comparable performance to other heuristic algorithms in most cases.
McCue, Michael J; Nayar, Preethy
Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.
Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.
Goryakin, Yevgeniy; Griffiths, Peter; Maben, Jill
Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provided care. Therefore, we conducted a scoping literature review of economic evaluation studies which consider the link between nurse staffing, skill mix within the nursing team and between nurses and other medical staff to determine the nature of the available economic evidence. Scoping literature review. English-language manuscripts, published between 1989 and 2009, focussing on the relationship between costs and effects of care and the level of registered nurse staffing or nurse-physician substitution/nursing skill mix in the clinical team, using cost-effectiveness, cost-utility, or cost-benefit analysis. Articles selected for the review were identified through Medline, CINAHL, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Google Scholar database searches. After selecting 17 articles representing 16 unique studies for review, we summarized their main findings, and assessed their methodological quality using criteria derived from recommendations from the guidelines proposed by the Panel on Cost-Effectiveness in Health Care. In general, it was found that nurses can provide cost effective care, compared to other health professionals. On the other hand, more intensive nurse staffing was associated with both better outcomes and more expensive care, and therefore cost effectiveness was not easy to assess. Although considerable progress in economic evaluation studies has been reached in recent years, a number of methodological issues remain. In the future
Griffiths, P; Goryakin, Y.; Maben, J.
OBJECTIVE: Several systematic reviews have suggested that greater nurse staffing as well as a greater proportion of registered nurses in the health workforce is associated with better patient outcomes. Others have found that nurses can substitute for doctors safely and effectively in a variety of settings. However, these reviews do not generally consider the effect of nurse staff on both patient outcomes and costs of care, and therefore say little about the cost-effectiveness of nurse-provide...
Dolinska, Nina; Hrlovic, Dzenita; Swane, Katarina
Increasing production costs and high pressure from the consumers are leading Swedish companies towards an expansion to China. Since more and more companies are moving their production, we found it interesting to study the problems they might encounter while employing personnel. The purpose of this dissertation is to analyse what staffing policies companies choose and variables that influence the decision at Swedish production plants in China. Ethnocentric, polycentric and geocentric polic...
Cho, Eunhee; Sloane, Douglas M; Kim, Eun-Young; Kim, Sera; Choi, Miyoung; Yoo, Il Young; Lee, Hye Sun; Aiken, Linda H
While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. To examine the effects of nurse staffing, work environment, and education on patient mortality. This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths. Copyright © 2014 Elsevier Ltd. All rights reserved.
Shipanga, A.N.; Ellmann, A.
Full text: Introduction: Nuclear medicine in South Africa is developing fast. Much has changed since the constitution of a scientific model for determining an optimum number of radiographer posts in a Nuclear Medicine department in the late 1980's. Aim: The aim of this study was to ascertain whether the number of radiographers required by a Nuclear Medicine department can still be determined according to the norms established in 1988. Methods: A quantitative study using non-experimental evaluation design was conducted to determine the ratios between current radiographer workload and staffing norms. The workload ratios were analysed using the procedures statistics of the Nuclear Medicine department at Tygerberg Hospital. Radiographers provided data about their activities related to patient procedures, including information about the condition of the patients, activities in the radiopharmaceutical laboratory, and patient related administrative tasks. These were factored into an equation relating this data to working hours, including vacation and sick leave. The calculation of Activity Standards and an annual Standard Workload was used to finally calculate the staffing requirements for a Nuclear Medicine department. Results: Preliminary data confirmed that old staffing norms cannot be used in a modern Nuclear Medicine department. Protocols for several types of study have changed, including the additional acquisition of tomographic studies. Interest in the use of time-consuming non-imaging studies has been revived and should be factored Into the equation. Conclusions: All Nuclear Medicine departments In South Africa, where the types of studies performed have changed over the past years, should look carefully at their radiographer staffing ratio to ascertain whether the number of radiographers needed is adequate for the current workload. (author)
Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H
To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.
Full Text Available Complex billing practices cost the US healthcare system billions of dollars annually. Coding for outpatient office visits [known as Evaluation & Management (E&M services] is commonly particularly fraught with errors. The best way to insure proper billing and coding by practicing physicians is to teach this as part of the medical school curriculum. Here, in a pilot study, we show that medical students can learn well the basic principles from lectures. This approach is easy to implement into a medical school curriculum.
Today Italy is the only G8 member to have no nuclear power plants in operation. In 1987 as a consequence of a referendum Italy decided to shut down its nuclear power plants and to forbid the construction of new ones. Italy relies on oil and gas imports for 80% of its energy needs. The Italian parliament has recently passed a bill for a renaissance of nuclear power. The bill gives 6 months to the government to set the rules and conditions for the come-back of nuclear energy. (A.C.)
Doris, Elizabeth [National Renewable Energy Lab. (NREL), Golden, CO (United States); Stout, Sherry [National Renewable Energy Lab. (NREL), Golden, CO (United States); Peterson, Kimberly [National Renewable Energy Lab. (NREL), Golden, CO (United States)
This technical report discusses the effectiveness of the Jamaica Public Service Company Limited Net-Billing Pilot Program. The National Renewable Energy Laboratory (NREL) collected and analyzed data from a wide range of stakeholders, conducted in-country research, and compared program elements to common interconnection practices to form programmatic recommendations for the Jamaica context. NREL finds that the net-billing pilot program has successfully contributed to the support of the emerging solar market in Jamaica with the interconnection of 80 systems under the program for a total of 1.38 megawatts (MW) at the time of original analysis.
The French house of commons has adopted this bill which allows to adapt the French legislation to the new requirements defined by the program law relative to the implementation of the French road-mad in favor of ecology and sustainable development ('Grenelle de l'environnement'). The bill covers 6 main domains: settlement and urbanism, transports, energy, biodiversity, environment and waste management, and governance and information. Its aim is to encourage the development of renewable energy sources, to reduce the greenhouse gas emissions, and to protect the environment thanks to new legal and technical means at the disposal of actors with practical experience, in particular the local authorities. (J.S.)
Folmer, Erwin Johan Albert; van Bekkum, Michael; Verhoosel, Jack
This paper will discuss strategies for using international domain standards within a national context. The various strategies are illustrated by means of a case study of the temporary staffing industry.
Halm, Margo; Peterson, Michelle; Kandels, Mary; Sabo, Julie; Blalock, Miriam; Braden, Rebecca; Gryczman, Anna; Krisko-Hagel, Kathryn; Larson, Dave; Lemay, Diane; Sisler, Bette; Strom, Linda; Topham, Debra
To conduct an investigation similar to a landmark study that investigated the association between nurse-to-patient ratio and patient mortality, failure-to-rescue, emotional exhaustion and job satisfaction of nurses. Cross-sectional analysis of 2709 general, orthopedic, and vascular surgery patients, and 140 staff nurses (42% response rate) caring for these patients in a large Midwestern institution. The main outcome measures were mortality, failure-to-rescue, emotional exhaustion, and job dissatisfaction. Staffing was not a significant predictor of mortality or failure-to-rescue, nor did clinical specialty predict emotional exhaustion or job dissatisfaction. Although these findings reinforce adequate staffing ratios at this institution, programs that support nurses in their daily practice and positively impact job satisfaction need to be explored. The Nursing Research Council not only has heightened awareness of how staffing ratios affect patient and nurse outcomes, but also a broader understanding of how the research process can be used to effectively shape nurse's practice and work environments.
At the time of this study there were about 160 small and medium sized nuclear power reactors (referred to as SMRs) in operation worldwide, and about 25 more under construction. Operation and maintenance costs for operating SMRs represent a substantial portion of the cost of electricity produced. Of these costs, the direct and indirect cost of staff represents the major cost component. In recent years, particularly since 1990, there has been increased interest in SMRs by many developing countries wishing to take advantage of nuclear power and several small and medium reactor designs are in various stages of development. To enhance the economic competitive position of SMRs relative to alternative methods of electricity generation, it is essential to ensure that new SMRs can be operated reliably and efficiently using the optimum number of staff. This publication reviews the lessons learned from the reactor operation, and the insights gained through the design of new SMRs, with a view to optimizing staffing in order to improve overall plant economics without compromising safety.This publication is intended to evaluate the estimated staffing size of various SMRs, the staff qualification and training required for the operation of future SMRs. and the key issues which impact the staffing requirements that should be considered in the development and deployment of future SMRs
Full Text Available The Affordable Care Act signed into law by President Obama, with its value-based purchasing program, is designed to link payment to quality processes and outcomes. Treatment of critically ill patients represents nearly 1% of the gross domestic product and 25% of a typical hospital budget. Data suggest that high-intensity staffing patterns in the intensive care unit (ICU are associated with cost savings and improved outcomes. We evaluate the literature investigating the cost-effectiveness and clinical outcomes of high-intensity ICU physician staffing as recommended by The Leapfrog Group (a consortium of companies that purchase health care for their employees and identify ways to overcome barriers to nationwide implementation of these standards. Hospitals that have implemented the Leapfrog initiative have demonstrated reductions in mortality and length of stay and increased cost savings. High-intensity staffing models appear to be an immediate cost-effective way for hospitals to meet the challenges of health care reform.
Leetz, Hans-Karl; Eipper, Hermann Hans; Gfirtner, Hans; Schneider, Peter; Welker, Klaus
To get a general idea of the actual staffing level situation in medical radiation physics in 1999 a survey was carried out by the task-group "Personalbedarf" of Deutsche Gesellschaft für Medizinische Physik (DGMP) among all DGMP-members who are active in this field. Main components for equipment and activities are defined in Report 8 and 10 of DGMP for staffing requirements in medical radiation physics. 322 forms were sent out, 173 of them have been evaluated. From the answers regarding equipment and activities numbers for staff are calculated by the methods given in Report 8 and 10 for this spot check target and compared with effective staffing levels. The data of the spot check are then extrapolated on total Germany. The result is a calculated deficit of 865 medical physicists for the whole physics staff, 166 of them in radiation therapy. From the age distribution of DGMP-members and the calculated deficit resulted a training capacity of about 100 medical physicists at all per year (19 in radiation therapy) if the deficit shall be cut back in 10 years.
Full Text Available In 2006, the Ontario Ministry of Health and Long-Term Care (MOHLTC introduced Physician Assistants (PAs through the announcement of demonstration projects, education and training programs, and subsequent funding. PAs are directly supervised by physicians and act as physician extenders by performing acts as delegated to them by their supervising physicians. PAs were proposed as a potential solution to help improve access to health care and reduce wait times throughout the province. Prior to the 2006 Ministry announcement, there was little public discussion regarding the acceptance of the PA role or its sustainability. Opposition from nursing and other groups emerged in response to the 2006 announcement and flared again when stakeholder comments were solicited in 2012 as part of the PA application for status as regulated health professionals. As a health reform, the introduction of PAs has neither succeeded nor failed. In 2013, the majority of PA funding continues to be provided by the MOHLTC, and it is unknown whether the PA role will be sustainable when the MOHTLC withdraws salary funding and health system employers must decide whether or not to continue employing PAs at their own expense.
Ivinger, Linnea; Lindvetter, Lisa
Theory suggests that there is a linkage between strategies and human resource staffing policies. Our aim with the dissertation was to test if such a linkage could be proven in Swedish MNCs. Also, indications spoke for ethnocentric tendencies in MNCs. We wanted to test if this was the reality for Swedish companies. In order to test the linkage we had to categorise the companies’ strategies and human resource staffing policies. By a survey we concluded that there was not full consistency in the...
P. Avila Jr
Full Text Available The knowledge of scientific method provides stimulus and development of critical thinking and logical analysis of information besides the training of continuous formulation of hypothesis to be applied in formal scientific issues as well as in everyday facts. The scientific education, useful for all people, is indispensable for the experimental science students. Aiming at the possibility to offer a systematic learning of the scientific principles, we developed a undergraduate course designed to approximate the students to the procedures of scientific production and publication. The course was developed in a 40 hours, containing two modules: I. Introducing Scientific Articles (papers and II. Writing Research Project. The first module deals with: (1 the difference between scientific knowledge and common sense; (2 scientific methodology; (3 scientific publishing categories; (4 logical principles; (5 deduction and induction approach and (6 paper analysis. The second module includes (1 selection of problem to be solved by experimental procedures; (2 bibliography revision; (3 support agencies; (4 project writing and presentation and (5 critical analysis of experimental results. The course used a Collaborative Learning strategy with each topic being developed through activities performed by the students. Qualitative and quantitative (through Likert questionnaires evaluation were carried out in each step of the course, the results showing great appreciation by the students. This is also the opinion of the staff responsible for the planning and development of the course, which is now in its second and improved version.
Professor Bill Reynolds (1933-2004) inspired many students and colleagues with his never-ending curiosity and thought-provoking ideas. Bill's relentless energy, together with his hallmark can-do character and do-it-yourself attitude, led to many seminal contributions to mechanical engineering in general, and fluid mechanics in particular. He has left a lasting impact on many of us, especially for those who had the privilege of working closely with him. Some of my current work on boundary-layer control, the use of neural networks in particular, were inspired by many discussions with Bill. He was among the first to see the potential of control-theoretic approaches for flow control, which has become the main thrust of my current research. Without his continued encouragement, I would not have been deeply involved in this line of research; and perhaps, we would not have seen the current flurry of research activities in applying modern control theories to flow control. In memory of Bill Reynolds, who himself has contributed much to flow control, an analysis of boundary-layer control from a linear system perspective will be presented.
... questions of citizenship and human rights, driving progress in the American mind. We learned that our Nation... anniversary of the Bill of Rights, let us reach for a day when we all may enjoy the basic truths of liberty... of Rights Day, 2013 By the President of the United States of America A Proclamation When America's...
Matthew Moskwik; Theresa Thom; Laurel M. Barnhill; Craig Watson; Jennifer Koches; John Kilgo; Bill Hulslander; Colette Degarady; Gary. Peters
Following the reported rediscovery of Campephilus principalis (Ivory-billed Woodpecker) in Arkansas, we initiated searches in South Carolina in February 2006, with additional searches in the winter and spring of 2006â2007 and 2007â2008, concentrating in the Congaree, Santee, and Pee Dee river basins. We accrued a cumulative total of 8893 survey hours...
..., REVENUES, EXPENSES, TAXES AND RESERVES FOR TELECOMMUNICATIONS COMPANIES 1 Operating Expenses and Taxes... statistical work, controlling record work and the preparation of revenue reports. (b) Local exchange carriers... balance of Account 6620-Services to the Other billing and collecting expense classification based on the...
... particular species. Species' History Historically the thick-billed parrot's range extended from Mexico into... and the Secretary of the Interior. This species is currently found in Mexico but has not been detected... included southern Arizona and possibly southwestern New Mexico. The recovery plan addendum includes...
Murphy, Garrett; Spangenberg, Gail
In this essay Garrett Murphy and Gail Spangenberg report on the need for understanding better than in the past, the number of undocumented immigrants likely to need adult education services under provisions of Senate Immigration Bill S.744. The essay looks at why the issues of "size and flow" are important for planners, providers, and…
This study provides a critical and close reading of "The Dreamkeepers" (1994), by Gloria Ladson-Billings. The paper focuses primarily on the gendered nature of "being a teacher" and "being a student" as revealed in the dreamkeeper text, while maintaining its engagement with race and culture as it is manifested in the United States context. It…
The postpaid and prepaid billing systems currently in operation in Telecommunications have some problems that show a win-loss situation. In postpaid the problem is mostly due to fraudulent activities by some employees that costs a telecommunications company a loss of between 5% and 15% of its total revenue as shown ...
Hanson, Martin, 1984-
Bill Gates loobub Microsofti juhi kohast ning jätkab vaid nõustajana. Vt. samas: Elulugu; Tasub teada; Miljardär, kes hoiab oma eraelu kiivalt saladuses. Kommenteerivad Microsoft Eesti esinduse juht Rain Laane ja IBM Eesti juht Valdo Randpere
The National Health Bill was developed in 2004 as an instrument for correcting ... in the 1999 constitution of Federal Republic of Nigeria as it relates to the health sector. ... Its provisions have effects on all three levels of care and subsystems ...
The Dutch company Gasunie Trade and Supply will replace the Commodity Services System (CDS, abbreviated in Dutch) January 1, 2004. This will result in a higher gas bill for almost all their clients that are expected to use more than 1 million m 3 natural gas per year. An overview is given of the principles of the old and the new pricing system [nl
Spaller, Kathy Dye; Thomas, Stephen B.
Federal allocations for special education programs are below 10% whereas the federal contribution to state medicaid programs ranges from 50-80%. Third-party billing provides a more equitable distribution of the costs among federal, state, and local governments, in addition to including private-sector contributions. (MLF)
Rumph, F. J.; Kruithof, G. H.; Huitema, G. B.
Services delivered to an end user can be composed of numerous subservices and form chains of composed services. These service composition chains traditionally consist of a static set of business entities. However, in order to increase business agility, dynamic service composition chains can be used by leveraging techniques of service publishing and discovery, and consist of more short-lived relations between the various business entities. This chapter focuses on issues concerning accounting, charging and billing of such dynamic service composition chains. In this type of service delivery, several traditional settlement models are not applicable since existing architectures lack support of automated negotiation of settlement parameters. Examples of such parameters are what the service consumer will be charged for and how much, how and when the consumer will be billed. In this chapter, the requirements that have to be fulfilled with respect to accounting, charging and billing in dynamic service composition chains are explored. Based on these requirements, a framework architecture for accounting charging and billing is described.
Ottley, Alford H.
The 2008 GI Bill offers college funds for veterans. Yet Black male vets are not taking advantage of these benefits. This chapter examines personal and societal problems that hinder access to higher education for Black vets, and suggests some ways adult educators can advocate for these young men.
Induced abortion has been a universal phenomenon in the history of humanity. The first recorded evidence was found in an Egyptian papyrus from 1550 BC. The debate on the proposed Termination of Pregnancy Bill is mired in misconception. Many, including the Christian doctors' group, make the assumption that the ...
... 49 Transportation 5 2010-10-01 2010-10-01 false Motor carrier bills of lading. 373.101 Section 373.101 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL MOTOR CARRIER SAFETY REGULATIONS RECEIPTS AND...
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Billing policy and procedures. 206.3 Section 206.3 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE MANAGEMENT OF FEDERAL AGENCY RECEIPTS...
Fowkes, F G; Roberts, C J
the impetus for the College to develop guidelines for the use of pre-operative chest X-rays in hospitals in the United Kingdom. Creating a change in clinical practice through the introduction of guidelines is a three stage process: Stage I: introducing the idea of a change in practice. Stage II: introduction of guidelines into clinical practice. Stage III: sustained implementation of guidelines in clinical practice.(ABSTRACT TRUNCATED AT 400 WORDS)
The US House of Representatives which has traditionally been wary of measures that would allow nuclear power to expand, came down strongly on the side of nuclear when it approved a much-amended omnibus energy bill on May 27 by a vote of 381 to 37. The key for the nuclear industry is the presence in the bill (H.R. 776) of language on one-step power plant licensing that was taken directly from the Senate energy bill (S. 2166) that passed in February. This means that when the House and Senate work out a compromise version of the legislation, one-step licensing is almost certain to be carried through--and become law once the final bill is signed by President George Bush, which is expected later this year. The House's endorsement of nuclear power--both as it exists now, and as it could be with the introduction of new plant designs and an end to the long hiatus in plant orders by utilities--went beyond one-step licensing. Debate on the House floor prior to Memorial Day totally transformed the nuclear-related part of the energy bill. H.R. 776 was reported to the floor by the Rules Committee with language by the Interior and Insular Affairs Committee that would have created a nominal one-step system, with a full evidentiary hearing prior to plant construction but also allowing an intervenor who later presents new information on the plant to get another full evidentiary hearing after construction but before operation. This would effectively duplicate the two-step process that existed for all plants now in service, and which utilities no longer want to endure
McCullough, J Mac
A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes.
This document provides information on the petroleum products taxation in the framework of the appropriation bills. The following aspects are presented : the utilization of fuels more respectful of the environment, the taxation lightening measures, measures in favor of the transportation sector, the juridical references and elements for the economic situation. (A.L.B.)
Teranishi, Masaru; Omatu, Sigeru; Kosaka, Toshihisa
Fatigued bills have harmful influence on daily operation of Automated Teller Machine(ATM). To make the fatigued bills classification more efficient, development of an automatic fatigued bill classification method is desired. We propose a new method to estimate bending rigidity of bill from acoustic signal feature of banking machines. The estimated bending rigidities are used as continuous fatigue level for classification of fatigued bill. By using the supervised Self-Organizing Map(supervised SOM), we estimate the bending rigidity from only the acoustic energy pattern effectively. The experimental result with real bill samples shows the effectiveness of the proposed method.
Анатолій Іванович Гулей
Full Text Available In this article the measures directed on counteraction to laundering of criminal incomes are considered about the financial transaction with using bills of exchange and promissory notes. A study and analysis of the development process of bills of exchange and promissory notes in different countries of the world, the nature of bills as payment document, securities, commercial and bank credit, and process of immobilization of bills. Also, the problems of the legal framework relating to bill circulation in Ukraine are investigated and some recommendations for reduce the risks of bill circulation are given
Leary, Alison; Cook, Rob; Jones, Sarahjane; Smith, Judith; Gough, Malcolm; Maxwell, Elaine; Punshon, Geoffrey; Radford, Mark
Nursing is a safety critical activity but not easily quantified. This makes the building of predictive staffing models a challenge. The aim of this study was to determine if relationships between registered and non-registered nurse staffing levels and clinical outcomes could be discovered through the mining of routinely collected clinical data. The secondary aim was to examine the feasibility and develop the use of 'big data' techniques commonly used in industry for this area of healthcare and examine future uses. The data were obtained from 1 large acute National Health Service hospital trust in England. Routinely collected physiological, signs and symptom data from a clinical database were extracted, imported and mined alongside a bespoke staffing and outcomes database using Mathmatica V.10. The physiological data consisted of 120 million patient entries over 6 years, the bespoke database consisted of 9 years of daily data on staffing levels and safety factors such as falls. To discover patterns in these data or non-linear relationships that would contribute to modelling. To examine feasibility of this technique in this field. After mining, 40 correlations (pdata (such as the presence or absence of nausea) and staffing factors. Several inter-related factors demonstrated step changes where registered nurse availability appeared to relate to physiological parameters or outcomes such as falls and the management of symptoms. Data extraction proved challenging as some commercial databases were not built for extraction of the massive data sets they contain. The relationship between staffing and outcomes appears to exist. It appears to be non-linear but calculable and a data-driven model appears possible. These findings could be used to build an initial mathematical model for acute staffing which could be further tested. 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/.
Helfrich, Christian D; Simonetti, Joseph A; Clinton, Walter L; Wood, Gordon B; Taylor, Leslie; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Fihn, Stephan D; Nelson, Karin M
Work-related burnout is common in primary care and is associated with worse patient safety, patient satisfaction, and employee mental health. Workload, staffing stability, and team completeness may be drivers of burnout. However, few studies have assessed these associations at the team level, and fewer still include members of the team beyond physicians. To study the associations of burnout among primary care providers (PCPs), nurse care managers, clinical associates (MAs, LPNs), and administrative clerks with the staffing and workload on their teams. We conducted an individual-level cross-sectional analysis of survey and administrative data in 2014. Primary care personnel at VA clinics responding to a national survey. Burnout was measured with a validated single-item survey measure dichotomized to indicate the presence of burnout. The independent variables were survey measures of team staffing (having a fully staffed team, serving on multiple teams, and turnover on the team), and workload both from survey items (working extended hours), and administrative data (patient panel overcapacity and average panel comorbidity). There were 4610 respondents (estimated response rate of 20.9%). The overall prevalence of burnout was 41%. In adjusted analyses, the strongest associations with burnout were having a fully staffed team (odds ratio [OR] = 0.55, 95% CI 0.47-0.65), having turnover on the team (OR = 1.67, 95% CI 1.43-1.94), and having patient panel overcapacity (OR = 1.19, 95% CI 1.01-1.40). The observed burnout prevalence was 30.1% lower (28.5% vs. 58.6%) for respondents working on fully staffed teams with no turnover and caring for a panel within capacity, relative to respondents in the inverse condition. Complete team staffing, turnover among team members, and panel overcapacity had strong, cumulative associations with burnout. Further research is needed to understand whether improvements in these factors would lower burnout.
Clark, Ann B.
Business and industry leaders do not flinch at the idea of placing top talent in struggling departments and divisions. This is not always the case in public education. The Charlotte-Mecklenburg Schools made a bold statement to its community in its strategic plan by identifying two key reform levers--(1) an effective principal leading each school;…
Fram, Nancy; Morgan, Beverley
Research shows that nurses want to provide more input into assessing patient acuity, changes in patient needs and staffing requirements. The Dashboard Project involved the further development and application of an electronic monitoring tool that offers a single source of nursing, patient and organizational information. It is designed to help inform nurse staffing decisions within a hospital setting. The Dashboard access link was installed in computers in eight nursing units within the Hamilton Health Sciences (HHS) network. The Dashboard indicators are populated from existing information/patient databases within the Decision Support Department at HHS. Committees composed of the unit manager, staff nurses, project coordinator, financial controller and an information controller met regularly to review the Dashboard indicators. Participants discussed the ability of the indicators to reflect their patients' needs and the feasibility of using the indicators to inform their clinical staffing plans. Project findings suggest that the Dashboard is a work in progress. Many of the indicators that had originally been incorporated were refined and will continue to be revised based on suggestions from project participants and further testing across HHS. Participants suggested the need for additional data, such as the time that nurses are off the unit (for code blue response, patient transfers and accompanying patients for tests); internal transfers/bed moves to accommodate patient-specific issues and particularly to address infection control issues; deaths and specific unit-centred data in addition to the generic indicators. The collaborative nature of the project enabled staff nurses and management to work together on a matter of high importance to both, providing valuable recommendations for shared nursing and interprofessional planning, further Dashboard development and project management.
Three decades of operating experience in India has led to sustained high performance of NPPs. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. Specific qualification levels apply to each position - six at management positions, five licensed positions with the rest qualified through an equivalent training scheme. Practically all O and M activities are carried out on-site by the utility manpower with minimum involvement of contractors. The entire process of human resource development is in-house - with each NPP organisation comprised of 30% experienced staff transferred from older NPPs and 70% totally developed out of fresh recruits. Four to eight years lead time goes to qualify fresh recruits depending on the position. This optimisation of manpower is a result of continuous learning - through operating experience and regulatory feed back and self assessment for (i) optimising quantum of work load and (ii) improving productivity. For the first category, design improvements over older NPP's increased reliability, operability, maintainability and human factors are described separately in the companion paper. In this paper the organisation factors are discussed, starting with the initial lessons that demanded improved management and enhanced quality programmes and caused temporarily, high demand of staffing for bringing out new systems, e.g., (i) attaining maturity of units; (ii) standardising training, retraining and cross training and qualifications; (in) job rotations, (iv) in service inspection of reactor components; (v) quality audits. The experiences on subsequent optimisation of staffing levels are outlined. (author)
Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R
The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.
Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I
Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able
Kucharski, Adam J; Camacho, Anton; Checchi, Francesco; Waldman, Ron; Grais, Rebecca F; Cabrol, Jean-Clement; Briand, Sylvie; Baguelin, Marc; Flasche, Stefan; Funk, Sebastian; Edmunds, W John
In some parts of western Africa, Ebola treatment centers (ETCs) have reached capacity. Unless capacity is rapidly scaled up, the chance to avoid a generalized Ebola epidemic will soon diminish. The World Health Organization and partners are considering additional Ebola patient care options, including community care centers (CCCs), small, lightly staffed units that could be used to isolate patients outside the home and get them into care sooner than otherwise possible. Using a transmission model, we evaluated the benefits and risks of introducing CCCs into Sierra Leone's Western Area, where most ETCs are at capacity. We found that use of CCCs could lead to a decline in cases, even if virus transmission occurs between CCC patients and the community. However, to prevent CCC amplification of the epidemic, the risk of Ebola virus-negative persons being exposed to virus within CCCs would have to be offset by a reduction in community transmission resulting from CCC use.
An application of algorithmic exploration of billing data is examined for fault detection, diagnosis (FDD) based on evaluation of present state and detection of unexpected changes in energy efficiency of buildings. Large data sets from district heating (DH) billing systems are used for construction of feature space, diagnostic rules and classification of the buildings according to their energy efficiency properties. The algorithmic approach automates discovering knowledge about common, thus accepted changes in buildings’ properties, in equipment and in habitants’ behavior reflecting progress in technology and life style. In this article implementation of Data Mining and Knowledge Discovery (DMKD) method in supervision system with exemplary results based on real data is presented. Crucial steps of data processing influencing diagnostic results are described in details.
Ameerika Föderaalse Juurdlusbüroo (FBI) endine eriagent Bill Moschella hakkab treenima siinseid kriminaalpolitseinikke, õpetab, kuidas paremini tööd organiseerida ja kurjategijate paljastamiseks varioperatsioone korraldada. Lisa: Bill Moschella
.... Beginning in October 2002, outpatient itemized billing was mandated for use in the AMEDD. This system shifted the process of billing for outpatient services from an allinclusive rate to one based on the actual care provided...
Offers a retrospective view of organizational factors affecting the redesign of the Midwest Bell Telephone Bill. Shows how financial considerations, organizational time frame, and employee training and experience influenced the bill's development process. (MM)
Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol
This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.
Ade-Oshifogun, Jochebed Bosede; Dufelmeier, Thaddeus
This article describes a quality improvement process for "do not return" (DNR) notices for healthcare supplemental staffing agencies and healthcare facilities that use them. It is imperative that supplemental staffing agencies partner with healthcare facilities in assuring the quality of supplemental staff. Although supplemental staffing agencies attempt to ensure quality staffing, supplemental staff are sometimes subjectively evaluated by healthcare facilities as "DNR." The objective of this article is to describe a quality improvement process to prevent and manage "DNR" within healthcare organizations. We developed a curriculum and accompanying evaluation tool by adapting Rampersad's problem-solving discipline approach: (a) definition of area(s) for improvement; (b) identification of all possible causes; (c) development of an action plan; (d) implementation of the action plan; (e) evaluation for program improvement; and (f) standardization of the process. Face and content validity of the evaluation tool was ascertained by input from a panel of experienced supplemental staff and nursing faculty. This curriculum and its evaluation tool will have practical implications for supplemental staffing agencies and healthcare facilities in reducing "DNR" rates and in meeting certification/accreditation requirements. Further work is needed to translate this process into future research. © 2012 Wiley Periodicals, Inc.
Purpose: The purpose of this study was to explore and describe nurses' experiences regarding staffing patterns in the surgical wards of a private hospital in Gauteng in order to develop recommendations for staffing patterns in these wards. Methodology: A qualitative, exploratory, descriptive and contextual research design was used. Data was collected by means of in-depth semi structured individual interviews from a purposive sample of professional nurses working in the surgical wards of this hospital. Data was analysed using Tesch's method of qualitative thematic analysis. Principles of trustworthiness and ethical principles to ensure the protection of human rights were applied throughout the study. Results: The findings of the study revealed one central theme which reflected that participants experienced the staffing patterns of the surgical wards negatively. Two main themes emerged as, nurses had negative experiences in the surgical wards as well as negative emotional experiences related to the staffing patterns. Conclusion: It is evident from the findings of the study that nurses are experiencing staffing patterns negatively.
textbooks on legislative procedure. Tracking DOD authorization or appropriation bills can be confusing and time-consuming. This has been particularly...by the President through the White House Office of Management and Budget) to the defense authorizing and appropriations committees. Then, for...maintain operations . 3 This might be considered a “line of credit” against the enactment of the relevant appropriations for the new fiscal year
Le, V.M.; van Beijnum, Bernhard J.F.; Nieuwenhuis, Lambertus Johannes Maria; Huitema, G.B.
The technological developments in networking solutions, information and communication services create the basis for the provisioning of complex, realtime services. This paper addresses the charging and billing of such advanced services. Advanced services will be composed of services provided by various 3rd party providers residing in different domains. Hence, charging and billing of advanced services requires a billing system capable of composing charging and billing information from provider...
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... holiday services. 381.39 Section 381.39 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... Inspection; Overtime and Holiday Service; Billing Establishments § 381.39 Basis of billing for overtime and holiday services. (a) Each recipient of overtime or holiday inspection service, or both, shall be billed...
... interstate telecommunications services. (3) The term authorized billing agent means a third party hired by a telecommunications service provider to perform billing and collection services for the telecommunications service... billing name and address information to any party other than a telecommunications service provider or an...
Ayrault, Jean-Marc; Fabius, Laurent
This document contains the brief text of the bill project and the text of the amendment to the Convention on physical protection of nuclear material which has been adopted in Vienna in August 2005 to amend the Convention adopted in October 1979. This amendment introduces the following measures: extension of the scope of application of the Convention to nuclear materials used for peaceful purposes, definition of the objectives of the Convention, articulation of the Convention with other international instruments, definition of the main principles of physical protection, strengthened international cooperation, legal issues concerning extradition and legal cooperation
Bird, Lori [National Renewable Energy Lab. (NREL), Golden, CO (United States); Davidson, Carolyn [National Renewable Energy Lab. (NREL), Golden, CO (United States); McLaren, Joyce [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, John [National Renewable Energy Lab. (NREL), Golden, CO (United States)
With rapid growth in energy efficiency and distributed generation, electric utilities are anticipating stagnant or decreasing electricity sales, particularly in the residential sector. Utilities are increasingly considering alternative rates structures that are designed to recover fixed costs from residential solar photovoltaic (PV) customers with low net electricity consumption. Proposed structures have included fixed charge increases, minimum bills, and increasingly, demand rates - for net metered customers and all customers. This study examines the electricity bill implications of various residential rate alternatives for multiple locations within the United States. For the locations analyzed, the results suggest that residential PV customers offset, on average, between 60% and 99% of their annual load. However, roughly 65% of a typical customer's electricity demand is non-coincidental with PV generation, so the typical PV customer is generally highly reliant on the grid for pooling services.
Morrison, Aileen P; Tanasijevic, Milenko J; Torrence-Hill, Joi N; Goonan, Ellen M; Gustafson, Michael L; Melanson, Stacy E F
The timely availability of inpatient test results is a key to physician satisfaction with the clinical laboratory, and in an institution with a phlebotomy service may depend on the timeliness of blood collections. In response to safety reports filed for delayed phlebotomy collections, we applied Lean principles to the inpatient phlebotomy service at our institution. Our goal was to improve service without using additional resources by optimizing our staffing model. To evaluate the effect of a new phlebotomy staffing model on the timeliness of inpatient phlebotomy collections. We compared the median time of morning blood collections and average number of safety reports filed for delayed phlebotomy collections during a 6-month preimplementation period and 5-month postimplementation period. The median time of morning collections was 17 minutes earlier after implementation (7:42 am preimplementation; interquartile range, 6:27-8:48 am; versus 7:25 am postimplementation; interquartile range, 6:20-8:26 am). The frequency of safety reports filed for delayed collections decreased 80% from 10.6 per 30 days to 2.2 per 30 days. Reallocating staff to match the pattern of demand for phlebotomy collections throughout the day represents a strategy for improving the performance of an inpatient phlebotomy service.
This paper discusses lessons learned from the operation of the Gen II fleet of existing nuclear power plants (NPPs), in terms of staffing, that can be applied to the final design, deployment, and operation of new reactor designs. The most significant of these lessons is the need to appropriately staff the facility, having the right number of people with the required skills and experience. This begs the question of how to identify those personnel requirements. For NPPs, there are five key factors that ultimately will determine the effectiveness and costs of operating nuclear power plants (NPPs): 1) The Nuclear Steam Supply System (NSSS) and the layout of the plant site; 2) The processes which the operating organization applies; 3) The organizational structure of the operating organization; 4) The organizational culture of the operating organization, and 5) The regulatory framework under which the licensee must operate. In summary, this paper identifies opportunities to minimize staffing and costs learned from Gen II NPPs that may be applicable for new nuclear plants. (author)
Agus Arianto Toly
Full Text Available The high level of turnover intentions by accountant staffs had raised the potential cost for public accountant firms. The prior research done by Suwandi and Indriantoro (1999 had succesfully identified the process of turnover intentions, which related to the antecedents and consequences of job insecurity. The responses of 30 accountant staffs from some public accountant firms to a questionnaire designed to measure variables were analyzed using a Pearson's correlation coefficient. The result of this study was not generally consistent with Suwandi and Indriantoro (1999 because some hypotheses were rejected. This study identified that public accountant firm must be noticed organizational factors, such as organizational commitment, role conflict, role ambiguity, and organizational change. Abstract in Bahasa Indonesia : Tingkat keinginan berpindah yang tinggi para staf akuntan telah menimbulkan biaya potensial untuk Kantor Akuntan Publik (KAP. Penelitian sebelumnya yang dilakukan oleh Suwandi dan Indriantoro (1999 telah berhasil mengidentifikasi proses keinginan berpindah, yang berhubungan dengan anteseden dan konsekuensi dari ketidakamanan kerja. Respon 30 staf akuntan dari beberapa KAP terhadap kuesioner yang dibuat untuk mengukur berbagai variabel, dianalisis menggunakan kofisien korelasi Pearson. Hasil dari studi ini secara umum tidak konsisten dengan Suwandi dan Indriantoro (1999 karena ditolaknya beberapa hipotesis. Studi ini mengidentifikasi bahwa KAP harus memberi perhatian terhadap beberapa faktor organisasional, seperti komitmen organisasional, konflik peran, ketidakjelasan peran, dan perubahan organisasional. Kata kunci: konflik peran; ketidakjelasan peran; perubahan organisasional; ketidakamanan kerja; komitmen organisasional; keinginan berpindah.
Chapman, Susan A; Mulvihill, Linda; Herrera, Carolina
The Workload and Time Management Survey of Central Cancer Registries was conducted in 2011 to assess the amount of time spent on work activities usually performed by cancer registrars. A survey including 39 multi-item questions,together with a work activities data collection log, was sent by email to the central cancer registry (CCR) manager in each of the 50 states and the District of Columbia. Twenty-four central cancer registries (47%) responded to the survey.Results indicate that registries faced reductions in budgeted staffing from 2008-2009. The number of source records and total cases were important indicators of workload. Four core activities, including abstracting at the registry, visual editing,case consolidation, and resolving edit reports, accounted for about half of registry workload. We estimate an average of 12.4 full-time equivalents (FTEs) are required to perform all cancer registration activities tracked by the survey; however,estimates vary widely by registry size. These findings may be useful for registries as a benchmark for their own registry workload and time-management data and to develop staffing guidelines.
Pelt, Christopher E; Anderson, Mike B; Pendleton, Robert; Foulks, Matthew; Peters, Christopher L; Gililland, Jeremy M
An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours. After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed. Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change ( P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change ( P = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 ( P = .038) and had longer hospital stays ( P < .001). Early mobilization in the entire cohort was associated with a greater cost savings ( P < .001). A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.
Three decades of operating experience in India has led to sustained high performance of NPP's. The staffing modules and policies are standardised. The basic functions of operation, maintenance, technical support and quality assurance are carried out by a team of 727 in-plant persons (for a 2 x 220 MW PHWR station) organised at five levels, for fifty positions in ten job families. The organisational factors that led to optimising of staff are described in the companion paper. This optimisation of manpower is a result of continuous learning - for (i) optimising quantum of workload and (ii) improving productivity. For the first category, design improvements over older Indian NPP's have increased reliability, operability, maintainability and human factors. Few examples: (i) improved man-machine interface in plant controls and on-power refuelling system with operator guidance, logging as well as diagnostic/health monitoring features; (ii) spread out layout for better access and ease of maintenance, separation of plant services for unit-1 from unit-2 and, removal of reactor auxiliaries out to separate buildings; (iii) reduction of maintenance tasks through redesigned equipment and improved condition monitoring means. However, design and procedural improvements also include additional equipment for upgradation of safety measures, e.g. larger number of safety related pumps separate switchyard control room and increased service system equipment. This paper outlines experience of design improvements in optimising staffing and uses a specific case illustration to establish the findings for better use of staff. (author)
Canet, J; Moral, V; Villalonga, A; Pelegrí, D; Gomar, C; Montero, A
Human resources account for a large part of the budgets of anesthesia and post-anesthesia intensive care units and pain clinics (A-PICU-PC). Adequate staffing is a key factor in providing for both effective care and professional staff development. Changes in professional responsibilities have rendered obsolete the concept of one anesthesiologist per operating room. Duties must be analyzed objectively to facilitate understanding between hospital administrators and A-PICU-PC chiefs of service when assigning human resources. The Catalan Society of Anesthesiology, Post-anesthesia Intensive Care and Pain Therapy has developed a model for estimating requirements for A-PICU-PC staffing based on three factors: 1) Definition of staff positions that must be filled and criteria for assigning human resources; 2) Estimation of non-care-related time required by the department for training, teaching, research and internal management, and 3) Estimation of staff required to cover absences from work for vacations, personal leave or illness. The model revealed that the ratio of number of staff positions to number of persons employed by an A-PICU-PC is approximately 1.3. Differences in the nature of services managed by an A-PICU-PC or the type of hospital might change the ratio slightly. The model can be applied universally, independently of differences that might exist among departments. Widespread application would allow adoption of a common language to be used by health care managers and A-PICU-PC departments when discussing a basis for consensus about our specialty.
McNair, Douglas S
In balancing competing priorities, it is essential that nursing staffing provide enough nurses to safely and effectively care for the patients. Mathematical models to predict optimal "safety stocks" have been routine in supply chain management for many years but have up to now not been applied in nursing workforce management. There are various aspects that exhibit similarities between the 2 disciplines, such as an evolving demand forecast according to acuity and the fact that provisioning "stock" to meet demand in a future period has nonzero variable lead time. Under assumptions about the forecasts (eg, the demand process is well fit as an autoregressive process) and about the labor supply process (≥1 shifts' lead time), we show that safety stock over lead time for such systems is effectively equivalent to the corresponding well-studied problem for systems with stationary demand bounds and base stock policies. Hence, we can apply existing models from supply chain analytics to find the optimal safety levels of nurse staffing. We use a case study with real data to demonstrate that there are significant benefits from the inclusion of the forecast process when determining the optimal safety stocks.
de Cordova, Pamela B; Phibbs, Ciaran S; Schmitt, Susan K; Stone, Patricia W
In hospitals, nurses provide patient care around the clock, but the impact of night staff characteristics on patient outcomes is not well understood. The aim of this study was to examine the association between night nurse staffing and workforce characteristics and the length of stay (LOS) in 138 veterans affairs (VA) hospitals using panel data from 2002 through 2006. Staffing in hours per patient day was higher during the day than at night. The day nurse workforce had more educational preparation than the night workforce. Nurses' years of experience at the unit, facility, and VA level were greater at night. In multivariable analyses controlling for confounding variables, higher night staffing and a higher skill mix were associated with reduced LOS. © 2014 Wiley Periodicals, Inc.
Chu, Kuan-Yu; Huang, Chunmin
A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a 'reader'. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits of the smartcard service, there is also scope
Kruger, Andreas J; Lockey, David; Kurola, Jouni
-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....
Raquel Silva Bicalho Zunta
Full Text Available Our study aimed to map, describe and, validate the audit, account billing and billing reports processes in a large, private general hospital. An exploratory, descriptive, case report study. We conducted non-participatory observation moments in Internal Audit Sectors and Billing Reports from the hospital, aiming to map the processes which were the study objects. The data obtained was validated by internal and external audit specialists in hospital bills. The described and illustrated processes in three flow-charts favor professionals to rationalize their activities and the time spent in hospital billing, avoiding or minimizing the occurrence of flaws and, generating more effective financial results. The mapping, the description and the audit validation process and billing and, the billing reports propitiated more visibility and legitimacy to actions developed by auditor nurses.
Iko, William M.; Dusek, Robert J.
During a recent survey for West Nile virus in wild birds around the Sonny Bono Salton Sea National Wildlife Refuge, Imperial County, California (Dusek et al. 2010), we captured a female American Kestrel (Falco sparverius) with a severe bill deformity (Figure 1). The kestrel was captured on 9 March 2006, at 08:45, approximately 0.25 km south of the intersection of Wiest and Lindsey roads (33° 08' 42' N, 115° 26' 59' W) and 6 km east-northeast of Calipatria. It was caught on a bal-chatri trap baited with a domestic mouse (Berger and Mueller 1959), as were all the 208 kestrels captured during this study. The bird was initially perched on a high transmission line running along Wiest Road and was caught within 10 minutes of our setting the trap. In examining the bird, we observed that the maxilla beyond the cere was missing. The upper bill structure from the palatine process, which included part of the maxilla, the entire premaxilla, and the external rhamphotheca (the hardened keratin layer cover ing the premaxilla) was missing rostral to the bird's cere and nares (Threlfall 1968, Lucas and Stettenheim 1972, Proctor and Lynch 1993). The epidermal layer of the cere appeared to have fused over the remaining area between the nares where the upper bill normally would have been. The deformation did not appear to be recent or related to our trapping, as there were no obvious abrasions or open wounds in the region surrounding the nares and oropharynx or signs of recent trauma surrounding the oropharynx area. Both nares were clearly defined, and the tongue protruded from the open oropharynx area. After completing the physical examination, measurements, and obtaining a blood sample for testing for West Nile virus, we released the kestrel at the location of capture. After its release, we monitored the kestrel's behavior for approximately 30 minutes but did not observe any additional hunting.
Full Text Available The bill of exchange is a kind of paper in order that its holder shall entitle the debtor named in the document to pay a certain amount of payments. The bill of exchange represents a means of payment and an instrument of providing the payment. It is an unconditional order given by the drawer to the drawee to pay a certain amount to the payee listed on the bill of exchange. The bill of exchange is generally a paper on the orders but it can be issued as value paper to a name. It is such promissory notes where the issuer becomes a clause not by order. The bill of exchange though it appears as a means of payment and an instrument for securing the payment it also appears as a means of international payment, because the bill of exchange can become a modern instrument of crediting and payment. With the development of the credit market and the bill of exchange becomes a means for the drawer and the drawee. This means that instead of the bill of exchange to be paid after the expiry of a certain deadline for submission of the bill of exchange the holder may sell or discount, or to pay before the deadline for submission. With this the bill of exchange becomes a toll for discount. Based on this we can conclude that the bill of exchange has the following roles: -bill of exchange serves as a means of credit; -bill of exchange serves as means of payment; -bill of exchange serves as a means for discount by.
Running Head: Evaluation of Contract Versus VA-Staffed CBOCs. Evaluating Contract versus VA-Staffed Community Based Outpatient Clinics (CBOCs) Using Patient Satisfaction and Access Measures in the Veterans Health Administration
staffed CBOC, with dependent variables adjusting for SHEP scores and case mix factors. The equation for the null hypothesis is Hho = In (estimated...that the model can be further improved through combining several of the satisfaction scores. The equation for the null hypothesis is that Hho = In
This article uses a strategic foresight tool, megatrends, to examine forces influencing long-term healthcare staffing in the rural United States. Two megatrends-exponential advances in science and technology and the continued evolution of the decentralized global marketplace-will influence and ultimately help shape the future of rural healthcare. Successful health ecosystems of the future will need to be customer-driven, more affordable, and tech-savvy. Successful evolution in an era of continuous change will require a blend of intentional engagement with stakeholders, strategic foresight, and future-focused leadership. More research is needed to fully understand not only the challenges of rural healthcare but also the emerging opportunities.
Dörrenbächer, Christoph; Gammelgaard, Jens; McDonald, Frank
captures the effects of PCN verses HCN managers on key characteristics of subsidiaries. The results of the study indicate that the PCN/HCN dichotomy widely used in the international staffing literature needs to take account of the following issues: First: The study confirms theoretical assumptions based...... on social capital theory that subsidiaries led by HCNs are more embedded in the host country's external environment (by having more frequent relationships with host country customers, suppliers and competitors). However, the study reveals that the assumed advantages PCN led subsidiaries have...... to the local institutional environment (HRM). Our study finds that this is also the case with regard to strategic decisions on financial control as well as on R&D and new product development. Third: On average, HCN led subsidiaries perform significantly better than PCN led subsidiaries with regard to sales...
Sheward, Louisa; Hunt, Jennifer; Hagen, Suzanne; Macleod, Margaret; Ball, Jane
To explore the relationship between nurse outcomes (dissatisfaction and emotional exhaustion) and nurse workload, nurse characteristics and hospital variables. Concern about the impact of restructuring of nurse staffing, and reports of nurse shortages, on nurse and patient outcomes led to the research being reported on in this article. A questionnaire survey of registered nurses in Scotland and England. A questionnaire survey of the hospitals in which these nurses worked. Respondents in the two countries were similar in terms of demographic, work and employment characteristics. Significant relationships were found using the combined English and Scottish data between nurse patient ratios and (1) emotional exhaustion and (2) dissatisfaction with current job reported by nurses. Increasing numbers of patients to nurses was associated with increasing risk of emotional exhaustion and dissatisfaction with current job.
KHNP, as an owner/operator organization, is responsible for all project activities including design, procurement, construction, and commissioning, for Korea's nuclear power plant (NPP) construction projects. Four separate functional offices of KHNP are set up to complete the construction management work. These offices are (1) home office, (2) field construction office, (3) field quality assurance office, and (4) field startup/commissioning office. This paper presents a staffing plan for the field construction office starting initial project implementation to final turnover to operations stages. It is recognized that the plan may not be applicable to other utility situations in terms of project management of site activity depending upon how the overall project contract is structured
Berg Jansson, Anna; Engström, Åsa
The aim of this study is to describe critical care nurses (CCN's) experiences of working with or as temporary agency staff. This explorative qualitative study is based on interviews with five agency CCNs and five regular CCNs, a total of ten interviews, focusing on the interviewees' experiences of daily work and temporary agency staffing. The interviews were analysed manually and thematically following an inductive approach. Four themes that illustrate both similarities and differences between regular and temporary agency CCNs emerged: "working close to patients versus being responsible for everything", "teamwork versus independence", "both groups needed" and "opportunities and challenges". The study findings illustrate the complexity of the working situation for agency and regular staff in terms of the organisation and management of the temporary agency nurses and the opportunities and challenges faced by both groups. Copyright © 2016 Elsevier Ltd. All rights reserved.
Valentine, Nancy M; Nash, Jan; Hughes, Douglas; Douglas, Kathy
Managing costs while retaining qualified nurses and finding workforce solutions that ensure the delivery of high-quality patient care is of primary importance to nurse leaders and executive management. Leading healthcare organizations are using open-shift management technology as a strategy to improve staffing effectiveness and the work environment. In many hospitals, open-shift management technology has become an essential workforce management tool, nursing benefit, and recruitment and retention incentive. In this article, the authors discuss how a successful nursing initiative to apply automation to open-shift scheduling and fulfillment across a 3-hospital system had a broad enterprise-wide impact resulting in dramatic improvements in nurse satisfaction, retention, recruitment, and the bottom line.
Brener, Nancy; Demissie, Zewditu
Schools are in a unique position to meet the mental and behavioral health needs of children and adolescents because approximately 95% of young people aged 7-17 years attend school. Little is known, however, about policies related to counseling, psychological, and social services staffing in school districts. This study analyzed the prevalence of such policies in public school districts in the U.S. Data from four cycles (2000, 2006, 2012, and 2016) of the School Health Policies and Practices Study, a national survey periodically conducted to assess policies and practices for ten components of school health, were analyzed in 2017. The survey collected data related to counseling, psychological, and social services among nationally representative samples of school districts using online or mailed questionnaires. Sampled districts identified respondents responsible for or most knowledgeable about the content of each questionnaire. The percentage of districts with a district-level counseling, psychological, and social services coordinator increased significantly from 62.6% in 2000 to 79.5% in 2016. In 2016, 56.3% of districts required each school to have someone to coordinate counseling, psychological, and social services at the school. Fewer districts required schools at each level to have a specified ratio of counselors to students (16.2% for elementary schools, 16.8% for middle schools, and 19.8% for high schools), and the percentage of districts with these requirements has decreased significantly since 2012. Increases in the prevalence of district-level staffing policies could help increase the quantity and quality of counseling, psychological, and social services staff in schools nationwide, which in turn could improve mental and behavioral health outcomes for students. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration
Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the
Starace, Fabrizio; Mungai, Francesco; Barbui, Corrado
In mental healthcare, one area of major concern identified by health information systems is variability in antipsychotic prescribing. While most studies have investigated patient- and prescriber-related factors as possible reasons for such variability, no studies have investigated facility-level characteristics. The present study ascertained whether staffing level is associated with antipsychotic prescribing in community mental healthcare. A cross-sectional analysis of data extracted from the Italian national mental health information system was carried out. For each Italian region, it collects data on the availability and use of mental health facilities. The rate of individuals exposed to antipsychotic drugs was tested for evidence of association with the rate of mental health staff availability by means of univariate and multivariate analyses. In Italy there were on average nearly 60 mental health professionals per 100,000 inhabitants, with wide regional variations (range 21 to 100). The average rate of individuals prescribed antipsychotic drugs was 2.33%, with wide regional variations (1.04% to 4.01%). Univariate analysis showed that the rate of individuals prescribed antipsychotic drugs was inversely associated with the rate of mental health professionals available in Italian regions (Kendall's tau -0.438, p = 0.006), with lower rates of antipsychotic prescriptions in regions with higher rates of mental health professionals. After adjustment for possible confounders, the total availability of mental health professionals was still inversely associated with the rate of individuals exposed to antipsychotic drugs. The evidence that staffing level was inversely associated with antipsychotic prescribing indicates that any actions aimed at decreasing variability in antipsychotic prescribing need to take into account aspects related to the organization of the mental health system.
The ability to efficiently introduce DNA into cells is essential for many experiments in biology. This is an explanatory chapter providing an overview of the various methods for introducing DNA into bacteria, yeast, and mammalian cells. Copyright © 2013 Elsevier Inc. All rights reserved.
Houseman, Susan N.; Polivka, Anne E.
A study examined the job stability of workers in the following flexible staffing arrangements: agency temporary, direct-hire temporary, on-call, contract company, independent contractor, and regular part-time work. Two data sources were used in the analysis. The first was a nationwide survey of employers on their use of flexible staffing…
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation, Including On-Site Leased Workers From Career Solutions TEC Staffing and Andrews International, Fort Smith... subject firm. The workers are engaged in the production of refrigerators and trash compactors. The company...
Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Kuusio, Hannamaria; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo
Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. Cross-sectional questionnaire study. 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important. 2011 Elsevier Ltd. All rights reserved.
Fitchett, Paul G.; Heafner, Tina L.; Harden, Susan B.
Moonlighting, an employment practice where individuals work outside of their primary job, is popular within the public education sector. Using data from the National Center for Education Statistics Schools and Staffing Survey, this study examined both the characteristics and motivations of public school teachers across moonlighting categories.…
... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson..., Wisconsin location of Johnson Controls, Inc. The Department has determined that these workers were sufficiently under the control of the subject firm to be considered leased workers. Based on these findings...
Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M
(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.
Gross, Betheny; DeArmond, Michael; Goldhaber, Dan
Education reformers routinely call on school districts to stop hiring teachers based on seniority, which they argue interferes with effective staffing, especially in disadvantaged schools. The few researchers who have empirically studied the issue, however, disagree about whether seniority-based hiring is systematically associated with staffing…
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,666] Badger Meter, Inc... of Badger Meter, Inc., including on-site leased workers from Sourcepoint Staffing, Milwaukee... workers are engaged in the production of flow measurement devices and automatic meter reading equipment...
... Division, Including On-Site Leased Workers From Manpower Staffing and Dow Cleaning Services, Malvern, AR..., and components. The company reports that workers from Dow Cleaning Services were employed on-site at... leased from Dow Cleaning Services working on-site at the Malvern, Arkansas location of Kohler Company...
Poirier, S; Buffington, D E; Memoli, G A
To describe the steps pharmacists must complete when seeking compensation from third party payers for pharmaceutical care services. Government publications; professional publications, including manuals and newsletters; authors' personal experience. Pharmacists in increasing numbers are meeting with success in getting reimbursed by third party payers for patient care activities. However, many pharmacists remain reluctant to seek compensation because they do not understand the steps involved. Preparatory steps include obtaining a provider/supplier number, procuring appropriate claim forms, developing data collection and documentation systems, establishing professional fees, creating a marketing plan, and developing an accounting system. To bill for specific patient care services, pharmacists need to collect the patient's insurance information, obtain a statement of medical necessity from the patient's physician, complete the appropriate claim form accurately, and submit the claim with supporting documentation to the insurer. Although many claims from pharmacists are rejected initially, pharmacists who work with third party payers to understand the reasons for denial of payment often receive compensation when claims are resubmitted. Pharmacists who follow these guidelines for billing third party payers for pharmaceutical care services should notice an increase in the number of paid claims.
Rosenthal, Meagen; Austin, Zubin; Tsuyuki, Ross T
In 2010, the Ontario government brought forward Bill 16, which, among other things, removed pharmacists' professional allowances. While many would disagree with this unilateral action by the Ontario government, it also could have served as a crisis for change towards patient-centred care. We sought to examine the response of the pharmacy profession in Ontario to this crisis as it relates to the vision outlined in the Blueprint for Pharmacy. We systematically examined publicly available responses to Schedule 5 of Ontario's Bill 16 during the period from April to June 16, 2010. A rapid textual analysis of the data using tag or word clouds and a qualitative content analysis were performed on all of the data collected. The rapid textual analysis revealed that the most frequently used terms were "pharmacist," "pharmacy" and "professional allowances"; the least used were "layoffs," "service cuts" and "patient care." Content analysis revealed 4 themes: the desire to maintain the status quo of practice, a focus on the business of pharmacy, pharmacy stakeholders' perceptions of government's attitude towards the profession and changes to patient services. It is notable that patient care was almost completely absent from the discussion, a reflection that our profession has not embraced patient-centred care. This also represents a missed opportunity - a crisis that could have been used to move the profession towards the Blueprint's vision. We thought that the Blueprint had already achieved this consensus, but the Ontario experience has shown that this may not be the case.
Full Text Available A significant decrease in water consumption has been achieved in recent years thanks to different campaigns run by different institutions in Spain. However, most citizens do not have a very clear idea about whether or not they are efficiently using water. To solve this situation, this paper aims is to develop two water labels in order to improve the current water billing. These water labels evaluate the total water consumption and the domestic hot water consumption. To make the tags, several research studies were tackled for establishing consumer trends and behavior patterns. Furthermore, a survey and data collection were conducted to obtain updated values to validate information obtained from previous studies. The result are two water labels that establish six different levels to graphically show the efficiency, and they also include a comparison with the average consumption by customers of the same province. To ensure that the benefits of this evaluation are available to citizens, its inclusion on the water bill is proposed.
Gottlieb, Joshua D; Shapiro, Adam Hale; Dunn, Abe
The administrative costs of providing health insurance in the US are very high, but their determinants are poorly understood. We advance the nascent literature in this field by developing new measures of billing complexity for physician care across insurers and over time, and by estimating them using a large sample of detailed insurance "remittance data" for the period 2013-15. We found dramatic variation across different types of insurance. Fee-for-service Medicaid is the most challenging type of insurer to bill, with a claim denial rate that is 17.8 percentage points higher than that for fee-for-service Medicare. The denial rate for Medicaid managed care was 6 percentage points higher than that for fee-for-service Medicare, while the rate for private insurance appeared similar to that of Medicare Advantage. Based on conservative assumptions, we estimated that the health care sector deals with $11 billion in challenged revenue annually, but this number could be as high as $54 billion. These costs have significant implications for analyses of health insurance reforms.
Hendershot, Kimberly M; Bollins, John P; Armen, Scott B; Thomas, Yalaunda M; Steinberg, Steven M; Cook, Charles H
To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (approximately $954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents approximately $530K annually, extrapolating to approximately $220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (approximately $425K billing, approximately $170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify
Full Text Available Research on variation in bill morphology has focused on the role of diet. Bills have other functions, however, including a role in heat and water balance. The role of the bill in heat loss may be particularly important in birds where water is limiting. Song sparrows localized in coastal dunes and salt marsh edge (Melospiza melodia atlantica are similar in size to, but have bills with a 17% greater surface area than, those that live in mesic habitats (M. m. melodia, a pattern shared with other coastal sparrows. We tested the hypotheses that sparrows can use their bills to dissipate "dry" heat, and that heat loss from the bill is higher in M. m. atlantica than M. m. melodia, which would indicate a role of heat loss and water conservation in selection for bill size.Bill, tarsus, and body surface temperatures were measured using thermal imaging of sparrows exposed to temperatures from 15-37°C and combined with surface area and physical modeling to estimate the contribution of each body part to total heat loss. Song sparrow bills averaged 5-10°C hotter than ambient. The bill of M. m atlantica dissipated up to 33% more heat and 38% greater proportion of total heat than that of M. m. melodia. This could potentially reduce water loss requirements by approximately 7.7%.This >30% higher heat loss in the bill of M. m. atlantica is independent of evaporative water loss and thus could play an important role in the water balance of sparrows occupying the hot and exposed dune/salt marsh environments during the summer. Heat loss capacity and water conservation could play an important role in the selection for bill size differences between bird populations and should be considered along with trophic adaptations when studying variation in bill size.
Report on the behalf of the Special Commission in charge of the examination, in the perspective of a final reading, of the bill project related to energy transition for a green growth (T.A. 519). N 3004
Bareigts, Ericka; Battistel, Marie-Noelle; Buis, Sabine; Baupin, Denis; Plisson, Philippe
This report contains the various amendments introduced by the French Senate before the final reading by the French National Assembly of the bill project on energy transition for a green growth. It also reports the discussion of the Commission in charge of the examination of these amendments with, for some of them, a wider discussion about their acceptance or rejection
... electronic billing for payment of transportation services? 102-118.65 Section 102-118.65 Public Contracts and... Transportation Services § 102-118.65 Can my agency receive electronic billing for payment of transportation... to use electronic billing for the procurement and billing of transportation services. ...
... all funds collected by its employees and contractors. (c) If an institution uses a billing service to carry out billing procedures under § 674.43, the institution shall ensure that the service— (1) Provides... paragraph (f) of this section. (e) If an institution uses a billing service to carry out § 674.43 (billing...
Snider, Karen T; Johnson, Jane C
The names of certain counterstrain tender points are incongruent with their physical locations because of an assumption that these points are reflective of dysfunction in neighboring body areas. Because the body area that is physically examined does not always match the body region in which somatic dysfunction is diagnosed for these tender points, it is not always clear which evaluation and management service codes should be used for billing physician services. To assess the attitudes of osteopathic physicians toward the billing and coding of incongruent counterstrain tender points. Physician members of the American Academy of Osteopathy who use counterstrain in clinical practice were surveyed regarding the body area that they would physically examine when assessing for incongruent tender points and, if tender points were present, the body regions to which they would assign somatic dysfunction for billing and coding purposes. Physician responses were categorized as indicating a structural approach (ie, reflective of anatomic location) or a functional approach (ie, reflective of dysfunction in neighboring body areas) to tender point examination and treatment. Associations between sex, specialty, and years in practice with the approach chosen were also examined. Of 175 physicians who responded to the survey, 156 met the study criteria. Respondents were primarily board-certified in neuromusculoskeletal medicine/osteopathic manipulative medicine (98 [63%]), special proficiency in osteopathic manipulative medicine (30 [19%]), or family practice/family practice and osteopathic manipulative treatment (94 [60%]). Ninety percent of physicians predominantly chose responses indicating a structural approach to the physical examination of tender points and 21% predominantly chose responses indicating a functional approach to somatic dysfunction diagnosis. There were inconsistencies among individual respondents regarding the type of approach chosen for a single tender point. For
Hofstra, Patricia S; Hart, Elinor L
In this increasingly complex world of Medicare reimbursement, physicians must constantly review their billing practices to ensure compliance with all Medicare requirements. "Incident-to" billing and provider-based billing are two areas that present unique challenges for providers, especially those practicing in hospital-owned practices such as hospital outpatient departments. Both incident-to and provider-based billing limit providers' abilities to bill for and receive reimbursement in those practice settings. The Office of Inspector General's 2012 Work Plan Report identified both incident-to billing and place-of-service errors as two of the many areas for investigation and compliance efforts in 2012. This article focuses on identifying the unique point-of-service challenges presented by physicians practicing in hospital outpatient departments or hospital-owned clinics.
We present an approach to introducing product lines to companies that lower their initial risk by applying open source tools and a smooth learning curve into the use and creation of domain specific modeling combined with standardized variability modeling.
This article shows how relativity can be introduced in four stages, each building on those before it, but the teacher can choose to stop after whichever stage he/she believes the pupils are capable of tackling.
Ryan, Conor; Donnelly, William; de Leastar, Eamonn; Cloney, James
The proliferation of IP-based services has resulted in a paradigm shift away from traditional flat-rat, single service billing to content and usage based billing for composed service sets. The Information Societies Technology (IST) FORM project has prototyped an accounting and billing solution for IP-based telecommunications services. A key element of the solution is the IPDR Network Data Management - Usage specification. This paper presents the FORM development of a federated accounting and ...
Today, billing is a big challenge for service providers. With a growing number of rich services such as music, mobile TV, Video-on-Demand and eHealth delivered to the mass market, service providers are missing business opportunities because current billing solutions are not fully capable. In particular, the delivery of on-the-fly composite services, composed of many service components provided by different service providers causes many complexities. This book proposes a billing system that de...
Kang, Dongshik; Oshiro, Ayumu; Ozawa, Kenji; Mitsui, Ikugo
Fatigued bills make a trouble such as the paper jam in a bill handling machine. In the discrimination of fatigued bills using an acoustic signal, the variation of an observed bill sound is considered to be one of causes in misclassification. Therefore a technique has demanded in order to make the classification of fatigued bills more efficient. In this paper, we proposed the algorithm that extracted feature quantity of bill sound from acoustic signal using the frequency difference, and carried out discrimination experiment of fatigued bill money by Support Vector Machine(SVM). The feature quantity of frequency difference can represent the frequency components of an acoustic signal is varied by the fatigued degree of bill money. The generalization performance of SVM does not depend on the size of dimensions of the feature space, even in a high dimensional feature space such as bill-acoustic signals. Furthermore, SVM can induce an optimal classifier which considers the combination of features by the virtue of polynomial kernel functions.
Full Text Available A Review of: Moulaison, S. H., & Dykas, F. (2016. High-quality metadata and repository staffing: Perceptions of United States–based OpenDOAR participants. Cataloging & Classification Quarterly, 54(2, 101-116. http://dx.doi.org/10.1080/01639374.2015.1116480 Objective – To investigate the quality of institutional repository metadata, metadata practices, and identify barriers to quality. Design – Survey questionnaire. Setting – The OpenDOAR online registry of worldwide repositories. Subjects – A random sample of 50 from 358 administrators of institutional repositories in the United States of America listed in the OpenDOAR registry. Methods – The authors surveyed a random sample of administrators of American institutional repositories included in the OpenDOAR registry. The survey was distributed electronically. Recipients were asked to forward the email if they felt someone else was better suited to respond. There were questions about the demographics of the repository, the metadata creation environment, metadata quality, standards and practices, and obstacles to quality. Results were analyzed in Excel, and qualitative responses were coded by two researchers together. Main results – There was a 42% (n=21 response rate to the section on metadata quality, a 40% (n=20 response rate to the metadata creation section, and 40% (n=20 to the section on obstacles to quality. The majority of respondents rated their metadata quality as average (65%, n=13 or above average (30%, n=5. No one rated the quality as high or poor, while 10% (n=2 rated the quality as below average. The survey found that the majority of descriptive metadata was created by professional (84%, n=16 or paraprofessional (53%, n=10 library staff. Professional staff were commonly involved in creating administrative metadata, reviewing the metadata, and selecting standards and documentation. Department heads and advisory committees were also involved in standards and documentation
Simon, Michael; Hausner, Elke; Klaus, Susan F; Dunton, Nancy E
The identification of health services research in databases such as PubMed/Medline is a cumbersome task. This task becomes even more difficult if the field of interest involves the use of diverse methods and data sources, as is the case with nurse staffing research. This type of research investigates the association between nurse staffing parameters and nursing and patient outcomes. A comprehensively developed search strategy may help identify nurse staffing research in PubMed/Medline. A set of relevant references in PubMed/Medline was identified by means of three systematic reviews. This development set was used to detect candidate free-text and MeSH terms. The frequency of these terms was compared to a random sample from PubMed/Medline in order to identify terms specific to nurse staffing research, which were then used to develop a sensitive, precise and balanced search strategy. To determine their precision, the newly developed search strategies were tested against a) the pool of relevant references extracted from the systematic reviews, b) a reference set identified from an electronic journal screening, and c) a sample from PubMed/Medline. Finally, all newly developed strategies were compared to PubMed's Health Services Research Queries (PubMed's HSR Queries). The sensitivities of the newly developed search strategies were almost 100% in all of the three test sets applied; precision ranged from 6.1% to 32.0%. PubMed's HSR queries were less sensitive (83.3% to 88.2%) than the new search strategies. Only minor differences in precision were found (5.0% to 32.0%). As with other literature on health services research, nurse staffing studies are difficult to identify in PubMed/Medline. Depending on the purpose of the search, researchers can choose between high sensitivity and retrieval of a large number of references or high precision, i.e. and an increased risk of missing relevant references, respectively. More standardized terminology (e.g. by consistent use of the
Aiken, Linda H; Sloane, Douglas M; Bruyneel, Luk; Van den Heede, Koen; Griffiths, Peter; Busse, Reinhard; Diomidous, Marianna; Kinnunen, Juha; Kózka, Maria; Lesaffre, Emmanuel; McHugh, Matthew D; Moreno-Casbas, M T; Rafferty, Anne Marie; Schwendimann, Rene; Scott, P Anne; Tishelman, Carol; van Achterberg, Theo; Sermeus, Walter
Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared
Lievens, Yolande; Defourny, Noémie; Coffey, Mary; Borras, Josep M; Dunscombe, Peter; Slotman, Ben; Malicki, Julian; Bogusz, Marta; Gasparotto, Chiara; Grau, Cai; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; Coucke, Philippe; Gabrovski, Roumen; Vosmik, Milan; Eriksen, Jesper Grau; Jaal, Jana; Dejean, Catherine; Polgar, Csaba; Johannsson, Jakob; Cunningham, Moya; Atkocius, Vydmantas; Back, Carlo; Pirotta, Martin; Karadjinovic, Vanja; Levernes, Sverre; Maciejewski, Boguslaw; Trigo, Maria Lurdes; Šegedin, Barbara; Palacios, Amalia; Pastoors, Bert; Beardmore, Charlotte; Erridge, Sara; Smyth, Gaile; Cleries Soler, Ramon
The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database. An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO). A large variation between countries was found for most parameters studied. Averages and ranges for personnel numbers per million inhabitants are 12.8 (2.5-30.9) for radiation oncologists, 7.6 (0-19.7) for medical physicists, 3.5 (0-12.6) for dosimetrists, 26.6 (1.9-78) for RTTs and 14.8 (0.4-61.0) for radiotherapy nurses. The combined average for physicists and dosimetrists is 9.8 per million inhabitants and 36.9 for RTT and nurses. Radiation oncologists on average treat 208.9 courses per year (range: 99.9-348.8), physicists and dosimetrists conjointly treat 303.3 courses (range: 85-757.7) and RTT and nurses 76.8 (range: 25.7-156.8). In countries with higher GNI per capita, all personnel categories treat fewer courses per annum than in less affluent countries. This relationship is most evident for RTTs and nurses. Different clusters of countries can be distinguished on the basis of available personnel resources and socio-economic status. The average personnel figures in Europe are now consistent with, or even more favourable than
Farrell, A.E.; Keith, D.W.; Corbett, J.J.
Considerable effort is being expended on research and demonstration projects aimed at introducing hydrogen into the transportation sector as a fuel, generally motivated by concerns about carbon dioxide emissions and petroleum imports (or scarcity). In this paper we focus on one aspect of strategy for introducing hydrogen--the choice of transportation mode. Our analysis suggests that cost of introducing hydrogen can be reduced by selecting a mode that uses a small number of relatively large vehicles that are operated by professional crews along a limited number of point-to-point routes or within a small geographic area. In addition, technological innovation in vehicle design will take place most quickly in modes where individual vehicles are produced to order and each receives significant engineering attention (not those manufactured in vast quantities on assembly lines). The immediate environmental benefits of introducing hydrogen fuel will occur in modes that have relatively less stringent pollution regulations applied to them. These insights, suggest that heavy-duty freight modes would be a less costly way to introduce hydrogen as a transportation fuel and a more effective way to advance hydrogen-related technologies so that they could subsequently be used more widely in light-duty vehicles
Blanco, Guillermo; Lemus, Jesús A; Grande, Javier
The spread of pathogens in the environment due to human activities (pathogen pollution) may be involved in the emergence of many diseases in humans, livestock and wildlife. When manure from medicated livestock and urban effluents is spread onto agricultural land, both residues of antibiotics and bacteria carrying antibiotic resistance may be introduced into the environment. The transmission of bacterial resistance from livestock and humans to wildlife remains poorly understood even while wild animals may act as reservoirs of resistance that may be amplified and spread in the environment. We determined bacterial resistance to antibiotics in wildlife using the red-billed chough Pyrrhocorax pyrrhocorax as a potential bioindicator of soil health, and evaluated the role of agricultural manuring with waste of different origins in the acquisition and characteristics of such resistance. Agricultural manure was found to harbor high levels of bacterial resistance to multiple antibiotics. Choughs from areas where manure landspreading is a common agricultural practice harbor a high bacterial resistance to multiple antibiotics, resembling the resistance profile found in the waste (pig slurry and sewage sludge) used in each area. The transfer of bacterial resistance to wildlife should be considered as an important risk for environmental health when agricultural manuring involves fecal material containing multiresistant enteric bacteria including pathogens from livestock operations and urban areas. The assessment of bacterial resistance in wild animals may be valuable for the monitoring of environmental health and for the management of emergent infectious diseases influenced by the impact of different human activities in the environment.
Sampling and sample preparation are of crucial importance in an analytical procedure, representing quite often a source of errors. The technique chosen for the isolation of analytes greatly affects the success of a chemical determination. On the other hand, growing concerns about environmental and human safety, along with the introduction of international regulations for quality control, have moved the interest of scientists towards specific needs. Newly introduced sample preparation techniques are challenged to meet new criteria: (i) miniaturization, (ii) higher sensitivity and selectivity, and (iii) automation. In this survey, the most recent techniques introduced in the field of sample preparation will be described and discussed, along with many examples of applications.
What really happens at the most fundamental levels of nature? Introducing Particle Physics explores the very frontiers of our knowledge, even showing how particle physicists are now using theory and experiment to probe our very concept of what is real. From the earliest history of the atomic theory through to supersymmetry, micro-black holes, dark matter, the Higgs boson, and the possibly mythical graviton, practising physicist and CERN contributor Tom Whyntie gives us a mind-expanding tour of cutting-edge science. Featuring brilliant illustrations from Oliver Pugh, Introducing Particle Physics is a unique tour through the most astonishing and challenging science being undertaken today.
Roy, Rabindra Nath; Dasgupta, Samir; Bhattacharyya, Krishna Das; Misra, Raghu Nath; Roy, Sima; Saha, Indranil
ABSTRACT Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO—Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel. PMID:25895199
Wogman, Ned A.; Bond, Leonard J.; Waltar, Alan E.; Leber, R E.
The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory were 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of Nuclear Legacies, Global Security, Nonproliferation, Homeland Security and National Defense, Radiobiology and Nuclear Energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. This paper presents the current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs
Ellappan, Vijayan; Ashwini, J.
In programming change organizations from medium to inconceivable scale broadens, the issue of wander orchestrating is amazingly unusual and testing undertaking despite considering it a manual system. Programming wander-organizing requirements to deal with the issue of undertaking arranging and in addition the issue of human resource portion (also called staffing) in light of the way that most of the advantages in programming ventures are individuals. We propose a machine learning approach with finds respond in due order regarding booking by taking in the present arranging courses of action and an event based scheduler revives the endeavour arranging system moulded by the learning computation in perspective of the conformity in event like the begin with the Ander, the instant at what time possessions be free starting to ended errands, and the time when delegates stick together otherwise depart the wander inside the item change plan. The route toward invigorating the timetable structure by the even based scheduler makes the arranging method dynamic. It uses structure components to exhibit the interrelated surges of endeavours, slip-ups and singular all through different progression organizes and is adjusted to mechanical data. It increases past programming wander movement ask about by taking a gander at a survey based process with a one of a kind model, organizing it with the data based system for peril assessment and cost estimation, and using a choice showing stage.
Rauch, Simon; Strapazzon, Giacomo; Brodmann, Monika; Fop, Ernst; Masoner, Christian; Rauch, Lydia; Forti, Alessandro; Pietsch, Urs; Mair, Peter; Brugger, Hermann
In this prospective, observational study we describe the incidence and characteristics of out of hospital cardiac arrest (OHCA) cases who received mechanical CPR, after the implementation of a mechanical CPR device (LUCAS 2; Physio Control, Redmond, WA, USA) in a physician staffed helicopter emergency medical service (HEMS) in South Tyrol, Italy. During the study period (06/2013-04/2016), 525 OHCA cases were registered by the dispatch centre, 271 (51.6%) were assisted by HEMS. LUCAS 2 was applied in 18 (6.6%) of all HEMS-assisted OHCA patients; ten were treated with LUCAS 2 at the scene only, and eight were transported to hospital with ongoing CPR. Two (11.1%) of the 18 patients survived long term with full neurologic recovery. In seven of eight patients transferred to hospital with ongoing CPR, CPR was ceased in the emergency room without further intervention. Retrospectively, all HEMS-assisted OHCA cases were screened for proposed indication criteria for prolonged CPR. Thirteen patients fulfilled these criteria, but only two of them were transported to hospital. Based on these results, we propose a standard operating procedure for HEMS-assisted patients with refractory OHCA in a region without hospitals with ECLS capacity.
Evans, KATE; Taper, JANETTE; Quintal, DEBORAH
The purpose of this study was to examine consumers' attitudes toward a supermarket nutrition centre staffed full time by a registered dietitian. A questionnaire was administered over three consecutive days in that store and in a control store that was similar to the experimental site in every way, except for the absence of a nutrition centre. Participants were chosen randomly at timed intervals in specific areas of the store. Of 428 customers approached, 232 agreed to participate in the survey. At the experimental site, 75% of the participants were extremely satisfied with the registered dietitian's services and 69% ranked having a registered dietitian on staff in any store as extremely important, compared to 31% at the control site (p importance of 13 required and optional services offered by the supermarkets, 15% of participants at the experimental site ranked having a registered dietitian on staff in the top five, compared with 4% at the control site (p service. There may therefore be an expanded role for registered dietitians in the supermarket setting.
Mark, Barbara A; Hughes, Linda C; Belyea, Michael; Chang, Yunkyung; Hofmann, David; Jones, Cheryl B; Bacon, Cynthia T
Hospital nurses have one of the highest work-related injury rates in the United States. Yet, approaches to improving employee safety have generally focused on attempts to modify individual behavior through enforced compliance with safety rules and mandatory participation in safety training. We examined a theoretical model that investigated the impact on nurse injuries (back injuries and needlesticks) of critical structural variables (staffing adequacy, work engagement, and work conditions) and further tested whether safety climate moderated these effects. A longitudinal, non-experimental, organizational study, conducted in 281 medical-surgical units in 143 general acute care hospitals in the United States. Work engagement and work conditions were positively related to safety climate, but not directly to nurse back injuries or needlesticks. Safety climate moderated the relationship between work engagement and needlesticks, while safety climate moderated the effect of work conditions on both needlesticks and back injuries, although in unexpected ways. DISCUSSION AND IMPACT ON INDUSTRY: Our findings suggest that positive work engagement and work conditions contribute to enhanced safety climate and can reduce nurse injuries.
Kisling-Rundgren, Amy; Paul, David P; Coustasse, Alberto
Assisted-living facilities (ALFs), which provide a community for residents who require assistance throughout their day, are an important part of the long-term-care system in the United States. The costs of ALFs are paid either out of pocket, by Medicaid, or by long-term-care insurance. Monthly costs of ALFs have increased over the past 5 years on an average of 4.1%. The purpose of this research was to examine the future trends in ALFs in the United States to determine the impact of health care on costs. The methodology for this study was a literature review, and a total of 32 sources were referenced. Trends in monthly costs of ALFs have increased from 2004 to 2014. Within the past 5 years, there has been an increase on average of 4.1% in assisted-living costs. Medicaid is one payer for residents of ALFs, whereas another alternative is the use of long-term-care insurance. Unfortunately, Medicare does not pay for ALFs. Staffing concerns in ALFs are limited because of each state having different rules and regulations. Turnover and retention rates of nurses in ALFs are suggested to be high, whereas vacancy rate for nurses is suggested to be lower. The baby-boomer generation can be one contribution to the increase in costs. Over the years, there has been an increase in Alzheimer disease, which has had also an effect on cost in ALFs.
Wogman, Ned A.; Bond, Leonard J.; Waltar, Alan E.; Leber, R E.
The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory where 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of Nuclear Legacies, Global Security, Nonproliferation, Homeland Security and National Defense, Radiobiology and Nuclear Energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. This paper presents the current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs
Wogman, N.A.; Bond, L.J.; Waltar, A.E.; Leber, R.E.
The United States, the Department of Energy (DOE) and its National Laboratories, including the Pacific Northwest National Laboratory (PNNL), are facing a serious attrition of nuclear scientists and engineers and their capabilities through the effects of aging staff. Within the DOE laboratories, 75% of nuclear personnel will be eligible to retire by 2010. It is expected that there will be a significant loss of senior nuclear science and technology staff at PNNL within five years. PNNL's nuclear legacy is firmly rooted in the DOE Hanford site, the World War II Manhattan Project, and subsequent programs. Historically, PNNL was a laboratory where 70% of its activities were nuclear/radiological, and now just under 50% of its current business science and technology are nuclear and radiologically oriented. Programs in the areas of nuclear legacies, global security, nonproliferation, homeland security and national defense, radiobiology and nuclear energy still involve more than 1,000 of the 3,800 current laboratory staff, and these include more than 420 staff who are certified as nuclear/radiological scientists and engineers. Current challenges faced by PNNL that require an emerging strategy to solve the nuclear staffing issues through the maintenance and replenishment of the human nuclear capital needed to support PNNL nuclear science and technology programs are presented. (author)
Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F
Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.
McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl
This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.
Dickstein, Y; Nir-Paz, R; Pulcini, C; Cookson, B; Beović, B; Tacconelli, E; Nathwani, D; Vatcheva-Dobrevska, R; Rodríguez-Baño, J; Hell, M; Saenz, H; Leibovici, L; Paul, M
We aimed to assess the current status of infectious diseases (ID), clinical microbiology (CM) and infection control (IC) staffing in hospitals and to analyse modifiers of staffing levels. We conducted an Internet-based survey of European Society of Clinical Microbiology and Infectious Diseases members and affiliates, collecting data on hospital characteristics, ID management infrastructure, ID/IC-related activities and the ratio of physicians per 100 hospital beds. Regression analyses were conducted to examine factors associated with the physician-bed ratio. Five hundred sixty-seven hospital responses were collected between April and June 2015 from 61 countries, 81.2% (384/473) from Europe. A specialized inpatient ward for ID patients was reported in 58.4% (317/543) of hospitals. Rates of antibiotic stewardship programmes (ASP) and surveillance activities in survey hospitals were high, ranging from 88% to 90% for local antibiotic guidelines and 70% to 82% for programmes monitoring hospital-acquired infections. The median ID/CM/IC physician per 100 hospital beds ratio was 1.12 (interquartile range 0.56-2.13). In hospitals performing basic ASP and IC (including local antibiotic guidelines and monitoring device-related or surgical site infections), the ratio was 1.21 (interquartile range 0.57-2.14). Factors independently associated with higher ratios included compliance with European Union of Medical Specialists standards, smaller hospital size, tertiary-care institution, presence of a travel clinic, beds dedicated to ID and a CM unit. More than half of respondents estimated that additional staffing is needed for appropriate IC or ID management. No standard of physician staffing for ID/CM/IC in hospitals is available. A ratio of 1.21/100 beds will serve as an informed point of reference enabling ASP and infection surveillance. Copyright © 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Louch, Gemma; O'Hara, Jane; Gardner, Peter; O'Connor, Daryl B
The association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. To further our understanding of these associations, this paper takes a within-person approach to examine nurses' daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. We recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three-five shifts which collected information on perceptions of staffing, patient-nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. On days when lower patient-nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p=.011) and more favourable perceptions of patient safety (p=workplace cognitive failure (p=personality factors. The findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these
Garri, Myropi; Konstantopoulos, Nikolaos
The research objective of this paper is to examine the staffing procedure of the internationalization department of the company in reference to the origin of the individuals selected to compose it. Subsequently, we endeavour to outline the identity of the individual at the head of internationalization, where a special department doesn’t exist. Additionally, we attempt to recognize the overall responsibilities and authority spaces of the internationalization manager. Results implied the prefer...
Rieder, S.; Schwenkel, Ch.
This comprehensive report for the Swiss Federal Office of Energy (SFOE) discusses the experience gained from the operation of the consumption-dependent billing of heating and hot-water costs (Verbrauchsabhaengigen Heiz- und Warmwasserkostenabrechnung, VHKA), a system introduced in Switzerland as one of the first energy-policy measures in the nineteen-eighties. The study examines the strategic possibilities of the VHKA within the framework of future efficiency strategies. Also, as an operative goal, the study takes a look at the acceptance of the VHKA and its effectiveness. In this way, an indication on how the instrument can be optimised can be obtained. The report consists of five chapters that look at the concept and implementation of the VHKA, its effect on the lessees of apartments and real estate owners and, finally, presents a cost-benefit analysis of the VHKA. The methods used in the study include the analysis of documents, personal and telephone interviews and the evaluation of billing data and other data collected.
Mullen, P D; Leifer, B H
To develop strong health education programs, health educators working in complex medical care organizations must often secure professional cooperation across disciplines, coordination of services, and orientation of policies, procedures, and personnel toward patient preferences and needs. Frequently, they undertake these tasks against the tide, within a problematic organizational structure. The present case study illustrates the difficulties posed by introducing change in medical care organizations in the context of an education program to acquaint employees of a large HMO with a consumer bill of rights mandated by the consumer Board of Trustees. The underlying assumption was that in a bureaucratic institution, an employee-centered and modest system reform strategy would be effective in bringing about client-centered outcomes-in this case, increased recognition of client rights. The case analysis and results of a post-intervention, cross-sectional survey suggest that in units where a threshold level of participation was reached, there were improvements in knowledge about the Bill and employee attitudes. The program was less successful with hospital nurses whose feelings about physicians were not taken into account fully, and with physicians whose relative lack of integration into the policy and managerial domains made them harder to reach.
Discussion of the Library Bill of Rights focuses on paternalism and the dangers of Internet filtering, in response to a previous article that advocated revision of the Bill of Rights. Topics include ethical presuppositions; censorship; philosophical foundations; access; social contract theory; and utilitarianism. (LRW)
De Meulder, Maartje
This article describes and analyses the pathway to the British Sign Language (Scotland) Bill and the strategies used to reach it. Data collection has been done by means of interviews with key players, analysis of official documents, and participant observation. The article discusses the bill in relation to the Gaelic Language (Scotland) Act 2005…
Appoloni, C.R.; Melquiades, F.L.
Several modern techniques have been applied to prevent counterfeiting of money bills. The objective of this study was to demonstrate the potential of Portable X-ray Fluorescence (PXRF) technique and the multivariate analysis method of Principal Component Analysis (PCA) for classification of bills in order to use it in forensic science. Bills of Dollar, Euro and Real (Brazilian currency) were measured directly at different colored regions, without any previous preparation. Spectra interpretation allowed the identification of Ca, Ti, Fe, Cu, Sr, Y, Zr and Pb. PCA analysis separated the bills in three groups and subgroups among Brazilian currency. In conclusion, the samples were classified according to its origin identifying the elements responsible for differentiation and basic pigment composition. PXRF allied to multivariate discriminate methods is a promising technique for rapid and no destructive identification of false bills in forensic science. - Highlights: • The paper is about a direct method for bills discrimination by EDXRF and principal component analysis. • The bills are analyzed directly, without sample preparation and non destructively. • The results demonstrates that the methodology is feasible and could be applied in forensic science for identification of origin and false banknotes. • The novelty is that portable EDXRF is very fast and efficient for bills characterization
Patrick M. Garry
Full Text Available Under the modern view, individual autonomy has become the primary if not exclusive focus of the Bill of Rights. But the Bill of Rights came about not because of a desire to preserve individual autonomy, nor to insulate the individual from the democratic community. The impetus for the Bill of Rights arose from the same set of concerns that motivated the original Constitution. These concerns involved creating the appropriate structures so as to keep the new central government in check. The Bill of Rights sought to further ensure that the federal government would have limited power and operate in a limited role. Not only does this limited government model coincide with the original intent underlying the Bill of Rights, but it also provides for a more objective and manageable application. Under an individual autonomy view of the Bill of Rights, courts must define the ingredients necessary for such autonomy. However, this endeavor is fraught with ambiguity, and courts must constantly pit the individual against democratic society. But under the limited government model, the judicial role is more objective. Instead of trying to define an ambiguous individual autonomy, courts simply need to focus on whether a particular right is needed so as to maintain limited government. In addition, the limited government model does not put the Bill of Rights in conflict with democratic society. Instead, it just uses the Bill of Rights to maintain a check on government, just as the original Constitution seeks to do.
Conclusions: The results showed that the health providers' compliance with the pregnant women's Bill of Rights was not acceptable in the labor room. Therefore, necessary actions are needed to remove the barriers against pregnant women's compliance of Bill of Rights and to facilitate the compliance with it in hospitals.
... a simple-interest money market yield computed on an actual/360 basis, subject to an appropriate... 13-week Treasury bill auction High Rate (stop out rate) converted into a simple actual/360 interest...-week Treasury bill auction High Rate that has been translated into a simple-interest money market yield...
This note documents the first breeding of Red-billed Quelea in the winter rainfall region of South Africa. A colony of 350–600 nests was found, with evidence of recent breeding. Red-billed Quelea numbers were low in this region, but if numbers increase in the future in the Western Cape, winter crops could be under threat.
... that the above bill is correct and just and that payment has not been received. Vouchers, vendors... employee, in which case the voucher may be in the name of the officer or employee who made the payment. (c... 19 Customs Duties 1 2010-04-01 2010-04-01 false Vouchers; vendors' bills of sale; invoices. 24.34...
... 42 Public Health 5 2010-10-01 2010-10-01 false Billing for services of assistant at surgery during..., DEPARTMENT OF HEALTH AND HUMAN SERVICES OIG AUTHORITIES PROGRAM INTEGRITY-MEDICARE AND STATE HEALTH CARE PROGRAMS Permissive Exclusions § 1001.1701 Billing for services of assistant at surgery during cataract...
Today, billing is a big challenge for service providers. With a growing number of rich services such as music, mobile TV, Video-on-Demand and eHealth delivered to the mass market, service providers are missing business opportunities because current billing solutions are not fully capable. In
... and Bladder Care Billing Form) Activity: Comment Request AGENCY: Veterans Health Administration.... This notice solicits comments on the information needed to evaluate the Bowel and Bladder Care Billing Form used by caregivers of eligible Veterans to document time spent providing services related...
... 42 Public Health 2 2010-10-01 2010-10-01 false Reimbursement for clinical laboratory services... Criteria for Determining Reasonable Charges § 405.515 Reimbursement for clinical laboratory services billed... limitation on reimbursement for markups on clinical laboratory services billed by physicians. If a physician...
... [CMS-1351-CN] RIN 0938-AQ29 Medicare Program; Prospective Payment System and Consolidated Billing for... rule entitled ``Medicare Program; Prospective Payment System and Consolidated Billing for Skilled... Payment System (PPS) final rule (76 FR 48486, 48540) inadvertently included several technical errors in...
... responsibilities, and the assertion that the worker's separation was due to outsourcing to ``Emdeon and India... Reconsideration By application dated September 19, 2013, a former worker of Apria Healthcare LLC, Billing...), applicable to workers and former workers of Apria Healthcare LLC, Billing Department, Overland Park, Kansas...
... 19 Customs Duties 1 2010-04-01 2010-04-01 false CBP bills; interest assessment; delinquency; notice to principal and surety. 24.3a Section 24.3a Customs Duties U.S. CUSTOMS AND BORDER PROTECTION....3a CBP bills; interest assessment; delinquency; notice to principal and surety. (a) Due date of CBP...
Robinson, Donald; And Others
Considers how the Bill of Rights originated and has evolved. Reviews the political views of Alexander Hamilton and James Madison and the nature of their support for the Bill of Rights. Explains nineteenth-century classical liberalism and its revolutionary view that political power inhered in the individual rather than in property ownership. (CH)
The case describes the first year of efforts to introduce microfinance as a tool to work with vulnerable groups in Sweden, more particularly ex-convicts, former drug-addicts and longterm unemployed women of immigrant background. The teaching objective is to discuss whether micro-finance can be seen...
Johnson, Arvid C.
While spreadsheet simulation can be a useful method by which to help students to understand some of the more advanced concepts in an introductory statistics course, introducing the simulation methodology at the same time as these concepts can result in student cognitive overload. This article describes a spreadsheet model that has been…
Many school districts are seeing a need to introduce technology education to students at the elementary level. Pennsylvania's Penn Manor School District is one of them. Pennsylvania has updated science and technology standards for grades 3-8, and after several conversations the author had with elementary principals and the assistant superintendent…
The paper proposes a strategy for designing introductory GIS modules at Birkbeck, University of London. Seven design aspects or elements (content, practical exercises, assessment, pace, mode, level of support, and level of difficulty) for tailoring modules at appropriate levels and for diversity are introduced and their application in Birkbeck's…
This article introduces tenets of Grounded Theory into a reception-oriented model for translation studies, in which the basis of comparison (tertium comparationis) between source and target texts is constructed from target audience expectancy norms. The model is primarily designed for projects where conformity to target ...
The omnivorous Louisiana crayfish, Procambarus clarkii, has caused significant changes to macrophyte communities worldwide and may have similar negative effects in Kenya if used as a biological control agent for snails harbouring human schistosomes. Here we examine how herbivory by the introduced Louisiana ...
Optimization of breeding methods when introducing multiple resistance genes from American to Chinese wheat. JN Qi, X Zhang, C Yin, H Li, F Lin. Abstract. Stripe rust is one of the most destructive diseases of wheat worldwide. Growing resistant cultivars with resistance genes is the most effective method to control this ...
The Nile tilapia Oreochromis niloticus has been introduced throughout Africa outside its native range for aquaculture purposes. Hybridisation between escaped O. niloticus and native Oreochromis species is of concern due to potential negative effects on wild genetic resources for conservation, aquaculture and capture ...