This article examines the Senate approved global warming bill and its impact to the Department of Energy (DOE) and the power industry. The bill requires stabilization or reduction of the greenhouse gases produced by the United States by the year 2005. DOE is required to develop a least-cost national energy strategy. A similar bill has been introduced into the House
This article reports on House and Senate response to the NRC's policy statement that would permit the deregulation of radioactive waste deemed below regulatory concern (BRC). Legislation has been introduced that would prevent the NRC from implementing the policy. The Environmental Protection Agency, and environmental and antinuclear activists support the legislation.
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 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
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.
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
Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNFs) for FY 2016, SNF Value-Based Purchasing Program, SNF Quality Reporting Program, and Staffing Data Collection. Final Rule.
This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2016. In addition, it specifies a SNF all-cause all-condition hospital readmission measure, as well as adopts that measure for a new SNF Value-Based Purchasing (VBP) Program, and includes a discussion of SNF VBP Program policies we are considering for future rulemaking to promote higher quality and more efficient health care for Medicare beneficiaries. Additionally, this final rule will implement a new quality reporting program for SNFs as specified in the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). It also amends the requirements that a long-term care (LTC) facility must meet to qualify to participate as a skilled nursing facility (SNF) in the Medicare program, or a nursing facility (NF) in the Medicaid program, by establishing requirements that implement the provision in the Affordable Care Act regarding the submission of staffing information based on payroll data.
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.
... Staffing, Insight Global Staffing, and Technisource, Scarborough, ME; Amended Certification Regarding..., Inc., including on-site leased workers from Balance Staffing, Insight Global Staffing, and... from Balance Staffing, Insight Global Staffing, and Technisource, Scarborough, Maine, who became...
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.
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.
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.
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
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)
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
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. 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
... medlineplus.gov/ency/patientinstructions/000881.htm Understanding your hospital bill To use the sharing features on this ... help you save money. Charges Listed on Your Hospital Bill A hospital bill will list the major ...
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
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
Examines current technology staffing in school districts and compares technology-related roles with a similar study conducted in 1997. Discusses job titles; responsibilities; career paths; lack of technology support in schools; district-level support; teacher training; peer assistance; student roles; collaboration with library media specialists;…
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
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
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
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)
H.R. 1133: a bill to prohibit the export or other transfer to the Republic of South Africa of nuclear material, equipment, and technology. Introduced in the House of Representatives, Ninety-Ninth Congress, First Session, February 19, 1985
A bill to prohibit nuclear trade or the transfer of nuclear technology to the Republic of South Africa cites that country's failure to sign the Non-Proliferation Treaty or to agree with safeguards and inspection standards set by the International Atomic Energy Agency (IAEA) as justification for the restrictions set out in H.R. 1133. Other concerns are South Africa's intention to build and use nuclear weapons, its position as the only Sub-Saharan country with a nuclear capability, and US interests in containing nuclear weapons
Butler, Graham; Rock, Noel
Private Members' Bill (legislation) introduced in Dáil Éireann (House of Deputies), Houses of the Oireachtas (Irish Parliament). An Act to amend sections 49 and 51 of the Central Bank (Supervision and Enforcement) Act 2013 to ensure the powers exercised by the Central Bank of Ireland to make...... regulations, conferred by the Central Bank (Supervision and Enforcement) Act 2013 are fit for purpose; and to provide for related matters....
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
... injuries, and decrease the number of hospital visits. The Army does not have standardized staffing guidelines or models while the mechanisms to determine requirements are fragmented and inconsistent...
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.
I N S T I T U T E F O R D E F E N S E A N A L Y S E S Staffing for Cyberspace Operations: Summary of Analysis Thomas H. Barth Jerome J. Burke...7013 (a)(16) [Jun 2013]. Staffing for Cyberspace Operations: Summary of Analysis Thomas H. Barth Jerome J. Burke Stanley A. Horowitz Mark F. Kaye...civilian employment. 1 Thomas H. Barth et al., “(U) Staffing for Cyberspace Operations,” IDA Paper P
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
Examines how book publishers are staffing for multimedia developments. Discussion includes competition from software developers, costs, partnerships, professional organizations as the most innovative electronic publishers, cultural problems, human resource polices, hiring, conflict between print and technology staff, marketing, outside…
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
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
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.
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.)
Klein, Eric E
Justification of clinical physics staffing levels is difficult due to the lack of direction as how to equate clinical needs with the staffing levels and competency required. When a physicist negotiates staffing requests to administration, she/he often refers to American College of Radiology staffing level suggestions, and resources such as the Abt studies. This approach is often met with questions as to how to fairly derive the time it takes to perform tasks. The result is often insufficient and/or inexperienced staff handling complex and cumbersome tasks. We undertook development of a staffing justification grid to equate the clinical needs to the quantity and quality of staffing required. The first step is using the Abt study, customized to the clinical setting, to derive time per task multiplied by the anticipated number of such tasks. Inclusion of vacation, meeting, and developmental time may be incorporated along with allocated time for education and administration. This is followed by mapping the tasks to the level of competency/experience needed. For example, in an academic setting the faculty appointment levels correlate with experience. Non-staff personnel, such as IMRT QA technicians or clerical staff, should also be part of the equation. By using the staffing justification grid, we derived strong documentation to justify a substantial budget increase. The grid also proved useful when our clinical demands changed. Justification for physics staffing can be significantly strengthened with a properly developed data-based time and work analysis. A staffing grid is presented, along with a development methodology that facilitated our justification. Though our grid is for a large academic facility, the methodology can be extended to a non-academic setting, and to a smaller scale. This grid method not only equates the clinical needs with the quantity of staffing, but can also help generate the personnel budget, based on the type of staff and personnel required
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
Butler, Graham; Hunt, Brian; Doyle, Andrew
Private Members' Bill (legislation) introduced in Dáil Éireann (House of Deputies), Houses of the Oireachtas (Parliament of Ireland). An Act to set voting hours for Dáil Elections, Dáil Bye-Elections, Presidential Elections, European Parliament Elections, Local Government Elections and Referenda ...
This article features Congressman Edward Rees's bill. Congressman Edward Rees of Kansas introduced a bill (H.R. 7786) in the U.S. House of Representatives on February 8, 1954, to create a national holiday that would honor the nation's veterans. He said in a speech on the floor of the House that he did it so that "a grateful nation may pay…
Fellow Profile. Elected: 2000 Honorary. Sutherland, Prof. Bill. Date of birth: 1942. Address: Department of Physics, University of Utah, 115 S 1400 E Rm 201, Salt Lake City, UT 8412-0830, U.S.A.. Contact: Office: (+1-801) 581 6424. Residence: (+1-801) 355 8342. Fax: (+1-801) 581 4801. Email: email@example.com, ...
van Amelsvoort, H.W.C.H.; Hendriks, Maria A.; Scheerens, Jaap
International comparisons of indicators on staffing are regarded as a useful information base to policymakers. Politically relevant staffing indicators in relation to the costs, planning and quality of education deal with training, working conditions, staff characteristics, and stability and
... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR... of the activities and chimpanzee population of the sanctuary. The level of staffing shall be adequate... issues related to captive nonhuman primates. Experience in these areas dealing specifically with...
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…
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.
The world is changing. Where before you needed to purchase and install big and expensive programs on your computer in order to create stunning images, you can now do it all online for free using Aviary. Aviary is an online collection of applications that enable you to upload and modify your own photographs and images, and create new imagery from scratch. It includes a powerful photo-manipulation tool called Phoenix, a vector-drawing application called Raven, an effects suite for creating eye-watering image effects called Peacock, and much more. Introducing Aviary takes you through all of these
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
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
Pereira, Irene Mari; Gaidzinski, Raquel Rapone; Fugulin, Fernanda Maria Togeiro; Peres, Heloísa Helena Ciqueto; Lima, Antônio Fernandes Costa; Castilho, Valéria; Mira, Vera Lúcia; Massarollo, Maria Cristina Komatsu Braga
The complexity involved in operationalizing the method for nursing staffing, in view of the uncountable variable related to identifying the workload, the effective working time of the staff, and the Technical Security Index (TSI) revealed the need to develop a software program named: Computerized Nursing Staffing (DIPE, in Portuguese acronyms). This exploratory, descriptive study was performed with the objective to evaluate the technical quality and functional performance of DIPE. Participants were eighteen evaluators, ten of whom where nurse faculty or nurse hospital unit managers, and eight health informatics experts. The software evaluation was performed according to norm NBR ISO/IEC 9126-1, considering the features functionality, reliability, usability, efficiency, and maintainability. The software evaluation reached positive results and agreement among the evaluators for all the evaluated features. The reported suggestions are important for proposing further improving and enhancing the DIPE.
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
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
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.
Smith, Myra Kay Davis
TO BILL OR NOT TO BILL: MEDICAID BILLING FOR SPECIAL EDUCATION RELATED SERVICES IN ARKANSAS PUBLIC SCHOOLS Myra Kay Davis Smith (ABSTRACT) Medicaid is a complicated system for educators to access. LEAs can access Medicaid funds by: billing through a contracted service, establishing their own billing system, or may choose not billing Medicaid. The purpose of this study was to investigate the Medicaid billing processes used in Arkansas public schools. The study ...
Spicer, M.; Barron, K.; Lloyd, I.
The main purpose of the Bill is to raise the financial limit imposed on BNFL from Pound 1,500 million to Pound 2000 million. Other clauses deal with the costs of nuclear safety research, technical amendments to the rules on insurance cover for third party compensation claims in the event of a nuclear incident. Clause 5 makes the necessary changes to enable the United Kingdom to ratify the international convention on assistance in the case of a nuclear incident (mutual assistance convention). The debate, which lasted over 2 hours and is reported verbatim, was mainly about BNFL funding and the increased cost of building the Thermal Oxide Reprocessing Plant at Sellafield. However the general problems of radioactive waste disposal, reprocessing, the privatisation of the electricity supply industry and the disposal of nuclear submarines were also discussed. (U.K.)
ED coding and billing are challenging additions to the responsibilities of emergency physicians. Assurances that each is performed in the most efficient and accurate manner possible is an essential component of today's emergency medicine practice. Minimizing the risk for submitting fraudulent claims is critical, because it assures the efficient and timely billing of all ED services. For the practice to thrive, each is necessary.
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
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…
U.S. President Bill Clinton has signed into law a measure to establish a commission to identify and address problems associated with the recruitment, retention, and advancement of women, minorities, and persons with disabilities in science and engineering fields."Today, we have taken a positive step forward to strengthen and expand our high-tech workforce by ensuring that women, minorities, and persons with disabilities have the skills necessary to compete in the Information Age," said U.S. Rep. Connie Morella (R.-Md.), who introduced the measure.
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
Montgomery County of Maryland — The Council enacts local public laws for the ‘peace, good government, health, and welfare of the county’. The bills dataset contains all legislation considered by...
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...
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.
Butler, Graham; Hunt, Brian; Flanagan, Terence
Private Members' Bill (legislation) introduced in Dáil Éireann (House of Deputies), Houses of the Oireachtas (Irish Parliament). An Act to reinforce the Common Travel Area by providing for passport-free travel for persons who are entitled to travel within the Common Travel Area without a passport...
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.
The work describes the legal and technical background of the electronic billing. The core of the work is in the cost-benefit analysis, with focus on the comparison of the fully electronic billing with manual billing and the modern billing composed of several incremental technologies.
... 49 Transportation 5 2010-10-01 2010-10-01 false Expense bills. 373.103 Section 373.103... Carrier Receipts and Bills § 373.103 Expense bills. (a) Property. Every motor common carrier shall issue a freight or expense bill for each shipment transported containing the following information: (1) Names of...
Bordoloi, S K; Weatherby, E J
A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, Alaska. We also indicate several managerial implications on how our results and their sensitivity analyses can be used effectively in decision making in a variety of categories.
Bordoloi, S K; Weatherby, E J
A critical managerial decision in health care organizations is the staffing decision. We offer a model to derive an optimum mix of different staff categories that minimizes total cost subject to constraints imposed by the patient acuity system and minimum staffing policies in a medical unit of Fairbanks Memorial Hospital, Alaska. We also indicate several managerial implications on how our results and their sensitivity analyses can be used effectively in decision making in a variety of categories.
Ersek, Mary; Sefcik, Justine S; Lin, Feng-Chang; Lee, Tae Joon; Gilliam, Robin; Hanson, Laura C
This study examined the association between Nurse Practitioner (NP) and Physician Assistant (PA) staffing in nursing homes and the effect of a decision aid regarding feeding options in dementia on the frequency of surrogate-provider discussions and on surrogates' decisional conflict. We compared these outcomes for facilities that had no NPs/PAs, part-time-only NP/PA staffing, and full-time NP/PA staffing. The sample included 256 surrogate decision makers from 24 nursing homes. The decision aid was associated with significant increases in discussion rates in facilities with part-time or no NP/PA staffing (26% vs. 51%, p vs. 41%, p vs. -0.047, p = .008, and -0.30 vs. -0.68, p = .014, respectively). Sites with full-time NP/PA staffing had high baseline rates of discussions (41%). These findings suggest that the decision aid and full-time NP/PA staffing can enhance surrogate decision making in nursing homes.
Hooper, Baroness; Williams, Lord; Ezra, Lord.
The Bill contains a number of unrelated proposals. The first would increase the financial limit imposed on British Nuclear Fuels plc by Acts of Parliament to Pound 2,000 million in line with current investment plans. The second would enable the Health and Safety Executive to recover the costs of nuclear safety research which it sponsors, from nuclear site licensees and applicants for licences. The next two proposals make minor technical amendments to the rules on insurance cover for meeting third party compensation claims in the event of nuclear incidents. Finally, the Bill would enable the United Kingdom to ratify the International Convention on Assistance in the case of nuclear accident or radiological emergency (mutual assistance convention). The Bill was debated for half an hour and is reported verbatim. In particular the financing of the Thermal Oxide Reprocessing Plant at BNFL's Sellafield site was discussed. Questions on vitrification of radioactive wastes were raised. (U.K.)
S. 2073: a bill to encourage the standardization of nuclear powerplants, to improve the nuclear licensing and regulatory process, to amend the Atomic Energy Act of 1954, and for other purposes. Introduced in the Senate of the United States, Ninety-Ninth Congress, Second Session, February 18, 1986
The Nuclear Facility Standardization Act of 1986 (S. 2073) seeks more efficient licensing and regulation through standardization of design and technology as a way to shorten the lead time for the siting, construction, and operation of new nuclear power plant facilities. Standardization would improve personnel training and performance, encourage more public participation in the regulatory process and decision making, and reduce costs as well. The Bill outlines new procedures for approving standardized designs, with an emphasis on early site approval and more efficient procedures for granting permits and licenses. The Act also amends Section 187 of the Atomic Energy Act dealing with design and construction modifications to require that they result in significant safety improvement
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.
Thompson, Nathan H.
Summarizes the 10-year accomplishments of Students for Environmental Quality from Bellport High School, New York, including successful halting of local waste oil pollution, instigating state laws to prohibit seal killing and protect the Carmans River wetlands, and details current efforts to assist in passage of a state "bottle bill."…
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.
The audit objectives were to evaluate the process of submitting bills for household goods accessorial charges for payment, and to evaluate procedures used to conduct prepayment reviews of billed accessorial charges...
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
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...
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.
... 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...
... CONTRACT ADMINISTRATION AND AUDIT SERVICES Indirect Cost Rates 42.704 Billing rates. (a) The contracting... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Billing rates. 42.704... final indirect cost rates also shall be responsible for determining the billing rates. (b) The...
... 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...
Belaia Nataliia Vladimirovna
Full Text Available The state of agricultural sector influences every person, determines the potential of national economy and politics. That is why the development of agricultural sector has always been one of the most urgent tasks for Russia and its regions. For the last few years the large-scale government support of the agricultural sector has been maintained which made the problem of peopleware of agricultural sector to be very significant. Staffing is known as fundamental principle of peopleware. Altai region is one of the farm production leaders, and problems of agricultural staffing are becoming more and more important.
Alikani, Mina; Go, Kathryn J; McCaffrey, Caroline; McCulloh, David H
To consider how staffing requirements have changed with evolving and increasingly more complex assisted reproduction technology (ART) laboratory practice. Analysis by four laboratory directors from three different ART programs of the level of complexity and time requirements for contemporary ART laboratory activities to determine adequate staffing levels. University-based and private ART programs. None. None. Human resource requirements for ART procedures. Both complexity and time required for completion of a contemporary ART cycle have increased significantly compared with the same requirements for the "traditional cycle" of the past. The latter required roughly 9 personnel hours, but a contemporary cycle can require up to 20 hours for completion. Consistent with this increase, a quantitative analysis shows that the number of embryologists required for safe and efficient operation of the ART laboratory has also increased. This number depends on not only the volume but also the types of procedures performed: the higher the number of complex procedures, the more personnel required. An interactive Personnel Calculator is introduced that can help determine staffing needs. The increased complexity of the contemporary ART laboratory requires a new look at the allocation of human resources. Our work provides laboratory directors with a practical, individualized tool to determine their staffing requirements with a view to increasing the safety and efficiency of operations. The work could serve as the basis for revision of the 2008 American Society for Reproductive Medicine (ASRM) staffing guidelines. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
... Insight Global Stone Staffing, and Randstad Formerly Known as Sapphire Technologies, Watertown, MA... workers from Insight Global, Stone Staffing, Randstad formerly known as Sapphire Technologies, Watertown... telecommunication services. The company reports that workers leased from Insight Global, Stone Staffing, Randstad...
Findings showed that, there was a gross under-utilization of special collections by users in the libraries studied. A further analysis revealed that significant relationships between staffing with utilization of special collections information resources existed. Based on the findings, the study concluded that, there was gross ...
... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Special Payments § 9701.363 Special... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special staffing payments. 9701.363 Section 9701.363 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT...
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…
Munnich, Elizabeth L
In 2004, California became the first state to implement statewide minimum nurse-to-patient ratios in general hospitals. In spite of years of work to establish statewide staffing regulations, there is little evidence that the law was effective in attracting more nurses to the hospital workforce or improving patient outcomes. This paper examines the effects of this legislation on employment and wages of registered nurses. By using annual financial data from California hospitals, I show that nurse-to-patient ratios in medical/surgical units increased substantially following the staffing mandate. However, survey data from two nationally representative datasets indicate that the law had no effect on the aggregate number of registered nurses or the hours they worked in California hospitals, and at most a modest effect on wages. My findings suggest that offsetting changes in labor demand due to hospital closures, combined with reclassification of workers within hospitals, and mitigated the employment effects of California's staffing regulation. This paper cautions that California's experience with minimum nurse staffing legislation may not be generalizable to states considering similar policies in very different hospital markets. Copyright © 2013 John Wiley & Sons, Ltd.
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.
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
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
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.,…
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
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
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.
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.
Faller, Marcia; Gogek, Jim
The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.
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...
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.
Louis F. Wilson
The introduced pine, sawfly (Diprion similis (Hartig)) in North America was first discovered in 1914 in a nursery in New Haven, Conn. This insect might have been introduced in the cocoon stage on nursery stock or packing material from Holland. Since its arrival, it has advanced steadily westward, reaching Pennsylvania before 1920 and Ontario by 1931. The present range...
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.
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.
... 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...
Oppel, Eva-Maria; Young, Gary J
To examine the relationship between nurse staffing patterns and patients' experience of care in hospitals with a particular focus on staffing flexibility. The study sample comprised U.S. general hospitals between 2010 and 2012. Nurse staffing data came from the American Hospital Association Annual Survey, and patient experience data came from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems. An observational research design was used entailing a pooled, cross-sectional data set. Regression models were estimated using generalized estimating equation (GEE) and hospital fixed effects. Nurse staffing patterns were assessed based on both levels (i.e., ratio of full-time equivalent nurses per 1,000 patient days) and composition (i.e., skill mix-percentage of registered nurses; staffing flexibility-percentage of part-time nurses). All three staffing variables were significantly associated with patient experience in the GEE analysis, but only staffing flexibility was significant in the fixed-effects analysis. A higher percentage of part-time nurses was positively associated with patient experience. Multiplicative and nonlinear effects for the staffing variables were also observed. Among three staffing variables, flexibility was found to be the most important relative to patient experience. Unobserved hospital characteristics appear to underlie patient experience as well as certain nurse staffing patterns. © Health Research and Educational Trust.
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.
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...
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.
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.
Pediatric radiologists (both SPR and ESPR) are a family growing in numbers. When founders such as John Caffey, Ed Neuhauser and Jacques Le Febvre died, we grieved while remembering them fondly. The death of Bill McSweeney from acute airway obstruction in August 1998 came as a shock. Yet Bill had been ill for many years. His once promising effects of been cut short by the inexorable; devastating effects of Parkinson disease and the complications of this therapy. Most current SPR and ESPR members never knew Bill McSweeney. These remembrances are designed to correct that
Muecke, Michael; Hamester, Ralf [Muecke, Sturm and Company, Muenchen (Germany)
To date many companies in the energy sector use software with classical licensing models for billing their customers. These systems are associated with high costs of procurement and maintenance. Here new billing systems based on the Software-as-a-service (SaaS) concept pose a serious alternative to the classical licensing model. Not only do they offer price advantages, they are also attractive for their flexibility.
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
Gershengorn, Hayley B; Wunsch, Hannah; Wahab, Romina; Leaf, David; Brodie, Daniel; Li, Guohua; Factor, Phillip
As the number of ICU beds and demand for intensivists increase, alternative solutions are needed to provide coverage for critically ill patients. The impact of different staffing models on the outcomes of patients in the medical ICU (MICU) remains unknown. In our study, we compare outcomes of nonphysician provider-based teams to those of medical house staff-based teams in the MICU. We conducted a retrospective review of 590 daytime (7:00 am-7:00 pm) admissions to two MICUs at one hospital. In one MICU staffed by nurse practitioners and physician assistants (MICU-NP/PA) there were nonphysicians (nurse practitioners and physicians assistants) during the day (7:00 am-7:00 pm) with attending physician coverage overnight. In the other MICU, there were medicine residents (MICU-RES) (24 h/d). The outcomes investigated were hospital mortality, length of stay (LOS) (ICU, hospital), and posthospital discharge destination. Three hundred two patients were admitted to the MICU-NP/PA and 288 to the MICU-RES. Mortality probability model III (MPM(0)-III) predicted mortality was similar (P = .14). There was no significant difference in hospital mortality (32.1% for MICU-NP/PA vs 32.3% for MICU-RES, P = .96), MICU LOS (4.22 ± 2.51 days for MICU-NP/PA vs 4.44 ± 3.10 days for MICU-RES, P = .59), or hospital LOS (14.01 ± 2.92 days for MICU-NP/PA vs 13.74 ± 2.94 days for MICU-RES, P = .86). Discharge to a skilled care facility (vs home) was similar (37.1% for MICU-NP/PA vs 32.5% for MICU-RES, P = .34). After multivariate adjustment, MICU staffing type was not associated with hospital mortality (P = .26), MICU LOS (P = .29), hospital LOS (P = .19), or posthospital discharge destination (P = .90). Staffing models including daytime use of nonphysician providers appear to be a safe and effective alternative to the traditional house staff-based team in a high-acuity, adult ICU.
Response to a column on caring and staffing struck a cord with Nursing Economic$ readers worldwide. Measuring caring is complicated and a healthy debate exists over how exactly to do it. The extraordinary work of Dr. Jean Watson is an excellent resource for understanding how to measure and monitor caring. Beneath the instruments for measuring caring sits foundational work that can help us clarify and understand the topic of caring and just where it sits in our philosophies, intentions, patient care models, and care delivery systems.
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.
Hu, Ben Yu-Kuang
I describe an elementary way of introducing electromagnetic field momentum. By considering a system of a long solenoid and line charge, the dependence of the field momentum on the electric and magnetic fields can be deduced. I obtain the electromagnetic angular momentum for a point charge and magnetic monopole pair partially through dimensional…
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
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.)
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.
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)
Reinfuss, Marian; Byrski, Edward; Malicki, Julian
Background and purpose To evaluate the current status of radiotherapy facilities, staffing, and equipment, treatment and patients in Poland for the years 2005–2011 following implementation of the National Cancer Programme. Methods A survey was sent to the radiotherapy centres in Poland to collect data on available equipment, staffing, and treatments in the years 2005–2011. Results In 2011, 76,000 patients were treated with radiotherapy at 32 centres vs. 63,000 patients at 23 centres in 2005. Number of patients increased by 21%. In 2011, there were 453 radiation oncologists – specialists (1 in 168 patients), 325 medical physicists (1 in 215 patients), and 883 radiotherapy technicians (1 in 86 patients) vs. 320, 188, and 652, respectively, in 2005. The number of linear accelerators increased by 60%, from 70 units in 2005 to 112 in 2011. The current linac/patient ratio in Poland is 1 linac per 678 patients. Waiting times from diagnosis to the start of treatment has decreased. Conclusion Compared to 2005, there are more treatment facilities, more and better equipment (linacs), and more cancer care specialists. There are still large differences between the 16 Polish provinces in terms of equipment availability and ease of access to treatment. However, radiotherapy services in Poland have improved dramatically since the year 2005. PMID:24416548
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
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.
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)
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,…
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…
Hyer, Kathryn; Thomas, Kali S.; Branch, Laurence G.; Harman, Jeffrey S.; Johnson, Christopher E.; Weech-Maldonado, Robert
Objective: This study examines the relationship between increasing certified nursing assistants (CNAs) and licensed nurse staffing ratios and deficiencies in Florida nursing homes over a 4-year period. Methods: Data from Florida staffing reports and the Online Survey Certification and Reporting database examine the relationship among staffing…
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...
... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Billing and payment of fees... EMERGENCY PREPAREDNESS PROGRAM § 354.6 Billing and payment of fees. (a) Electronic billing and payment. We... statutory authority. Working with the Department of the Treasury we now provide for payment of bills by...
... 42 Public Health 2 2010-10-01 2010-10-01 false Initial and subsequent billings. 408.62 Section 408... MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Individual Payment § 408.62 Initial and subsequent billings. (a) Monthly billing. (1) The first premium bill is for the period...
... 42 Public Health 4 2010-10-01 2010-10-01 false Bill of rights. 460.110 Section 460.110 Public...) Participant Rights § 460.110 Bill of rights. (a) Written bill of rights. A PACE organization must have a written participant bill of rights designed to protect and promote the rights of each participant. Those...
Pappas, Sharon; Davidson, Nan; Woodard, Jim; Davis, Jennifer; Welton, John M
The presence of hospital-acquired conditions, infections, or other adverse events are a reflection of inadequate patient safety and can have short and long-term impacts of quality of life for patients as well as financial implications for the hospital. Using unit-level information to develop a tool, the Patient Risk Assessment Profile, nurses on an inpatient surgical unit proactively assessed patient risk to guide staffing decisions and nurse-patient assignment with the goal to improve patient value, reduce adverse events, and avoid unnecessary hospital costs. Findings showed decreased adverse event rates for patient falls, catheter-acquired urinary tract infection, central line-acquired blood stream infection, and pressure ulcer prevalence after the intervention was implemented. In addition, end-of-shift over-time and patient cost per case decreased as well yielding an operational impact in hospital financial performance.
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.
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.
Acharya, B. S.; Actis, M.; Aghajani, T.; Agnetta, G.; Aguilar, J.; Aharonian, F.; Ajello, M.; Akhperjanian, A.; Alcubierre, M.; Aleksić, J.; Alfaro, R.; Aliu, E.; Allafort, A. J.; Allan, D.; Allekotte, I.; Amato, E.; Anderson, J.; Angüner, E. O.; Antonelli, L. A.; Antoranz, P.; Aravantinos, A.; Arlen, T.; Armstrong, T.; Arnaldi, H.; Arrabito, L.; Asano, K.; Ashton, T.; Asorey, H. G.; Awane, Y.; Baba, H.; Babic, A.; Baby, N.; Bähr, J.; Bais, A.; Baixeras, C.; Bajtlik, S.; Balbo, M.; Balis, D.; Balkowski, C.; Bamba, A.; Bandiera, R.; Barber, A.; Barbier, C.; Barceló, M.; Barnacka, A.; Barnstedt, J.; Barres de Almeida, U.; Barrio, J. A.; Basili, A.; Basso, S.; Bastieri, D.; Bauer, C.; Baushev, A.; Becerra, J.; Becherini, Y.; Bechtol, K. C.; Becker Tjus, J.; Beckmann, V.; Bednarek, W.; Behera, B.; Belluso, M.; Benbow, W.; Berdugo, J.; Berger, K.; Bernard, F.; Bernardino, T.; Bernlöhr, K.; Bhat, N.; Bhattacharyya, S.; Bigongiari, C.; Biland, A.; Billotta, S.; Bird, T.; Birsin, E.; Bissaldi, E.; Biteau, J.; Bitossi, M.; Blake, S.; Blanch Bigas, O.; Blasi, P.; Bobkov, A.; Boccone, V.; Boettcher, M.; Bogacz, L.; Bogart, J.; Bogdan, M.; Boisson, C.; Boix Gargallo, J.; Bolmont, J.; Bonanno, G.; Bonardi, A.; Bonev, T.; Bonifacio, P.; Bonnoli, G.; Bordas, P.; Borgland, A.; Borkowski, J.; Bose, R.; Botner, O.; Bottani, A.; Bouchet, L.; Bourgeat, M.; Boutonnet, C.; Bouvier, A.; Brau-Nogué, S.; Braun, I.; Bretz, T.; Briggs, M.; Bringmann, T.; Brook, P.; Brun, P.; Brunetti, L.; Buanes, T.; Buckley, J.; Buehler, R.; Bugaev, V.; Bulgarelli, A.; Bulik, T.; Busetto, G.; Buson, S.; Byrum, K.; Cailles, M.; Cameron, R.; Camprecios, J.; Canestrari, R.; Cantu, S.; Capalbi, M.; Caraveo, P.; Carmona, E.; Carosi, A.; Carr, J.; Carton, P.-H.; Casanova, S.; Casiraghi, M.; Catalano, O.; Cavazzani, S.; Cazaux, S.; Cerruti, M.; Chabanne, E.; Chadwick, P.; Champion, C.; Chen, A.; Chiang, J.; Chiappetti, L.; Chikawa, M.; Chitnis, V. R.; Chollet, F.; Chudoba, J.; Cieślar, M.; Cillis, A.; Cohen-Tanugi, J.; Colafrancesco, S.; Colin, P.; Colome, J.; Colonges, S.; Compin, M.; Conconi, P.; Conforti, V.; Connaughton, V.; Conrad, J.; Contreras, J. L.; Coppi, P.; Corona, P.; Corti, D.; Cortina, J.; Cossio, L.; Costantini, H.; Cotter, G.; Courty, B.; Couturier, S.; Covino, S.; Crimi, G.; Criswell, S. J.; Croston, J.; Cusumano, G.; Dafonseca, M.; Dale, O.; Daniel, M.; Darling, J.; Davids, I.; Dazzi, F.; De Angelis, A.; De Caprio, V.; De Frondat, F.; de Gouveia Dal Pino, E. M.; de la Calle, I.; De La Vega, G. A.; de los Reyes Lopez, R.; De Lotto, B.; De Luca, A.; de Mello Neto, J. R. T.; de Naurois, M.; de Oliveira, Y.; de Oña Wilhelmi, E.; de Souza, V.; Decerprit, G.; Decock, G.; Deil, C.; Delagnes, E.; Deleglise, G.; Delgado, C.; Della Volpe, D.; Demange, P.; Depaola, G.; Dettlaff, A.; Di Paola, A.; Di Pierro, F.; Díaz, C.; Dick, J.; Dickherber, R.; Dickinson, H.; Diez-Blanco, V.; Digel, S.; Dimitrov, D.; Disset, G.; Djannati-Ataï, A.; Doert, M.; Dohmke, M.; Domainko, W.; Dominis Prester, D.; Donat, A.; Dorner, D.; Doro, M.; Dournaux, J.-L.; Drake, G.; Dravins, D.; Drury, L.; Dubois, F.; Dubois, R.; Dubus, G.; Dufour, C.; Dumas, D.; Dumm, J.; Durand, D.; Dyks, J.; Dyrda, M.; Ebr, J.; Edy, E.; Egberts, K.; Eger, P.; Einecke, S.; Eleftheriadis, C.; Elles, S.; Emmanoulopoulos, D.; Engelhaupt, D.; Enomoto, R.; Ernenwein, J.-P.; Errando, M.; Etchegoyen, A.; Evans, P.; Falcone, A.; Fantinel, D.; Farakos, K.; Farnier, C.; Fasola, G.; Favill, B.; Fede, E.; Federici, S.; Fegan, S.; Feinstein, F.; Ferenc, D.; Ferrando, P.; Fesquet, M.; Fiasson, A.; Fillin-Martino, E.; Fink, D.; Finley, C.; Finley, J. P.; Fiorini, M.; Firpo Curcoll, R.; Flores, H.; Florin, D.; Focke, W.; Föhr, C.; Fokitis, E.; Font, L.; Fontaine, G.; Fornasa, M.; Förster, A.; Fortson, L.; Fouque, N.; Franckowiak, A.; Fransson, C.; Fraser, G.; Frei, R.; Albuquerque, I. F. M.; Fresnillo, L.; Fruck, C.; Fujita, Y.; Fukazawa, Y.; Fukui, Y.; Funk, S.; Gäbele, W.; Gabici, S.; Gabriele, R.; Gadola, A.; Galante, N.; Gall, D.; Gallant, Y.; Gámez-García, J.; García, B.; Garcia López, R.; Gardiol, D.; Garrido, D.; Garrido, L.; Gascon, D.; Gaug, M.; Gaweda, J.; Gebremedhin, L.; Geffroy, N.; Gerard, L.; Ghedina, A.; Ghigo, M.; Giannakaki, E.; Gianotti, F.; Giarrusso, S.; Giavitto, G.; Giebels, B.; Gika, V.; Giommi, P.; Girard, N.; Giro, E.; Giuliani, A.; Glanzman, T.; Glicenstein, J.-F.; Godinovic, N.; Golev, V.; Gomez Berisso, M.; Gómez-Ortega, J.; Gonzalez, M. M.; González, A.; González, F.; González Muñoz, A.; Gothe, K. S.; Gougerot, M.; Graciani, R.; Grandi, P.; Grañena, F.; Granot, J.; Grasseau, G.; Gredig, R.; Green, A.; Greenshaw, T.; Grégoire, T.; Grimm, O.; Grube, J.; Grudzinska, M.; Gruev, V.; Grünewald, S.; Grygorczuk, J.; Guarino, V.; Gunji, S.; Gyuk, G.; Hadasch, D.; Hagiwara, R.; Hahn, J.; Hakansson, N.; Hallgren, A.; Hamer Heras, N.; Hara, S.; Hardcastle, M. J.; Harris, J.; Hassan, T.; Hatanaka, K.; Haubold, T.; Haupt, A.; Hayakawa, T.; Hayashida, M.; Heller, R.; Henault, F.; Henri, G.; Hermann, G.; Hermel, R.; Herrero, A.; Hidaka, N.; Hinton, J.; Hoffmann, D.; Hofmann, W.; Hofverberg, P.; Holder, J.; Horns, D.; Horville, D.; Houles, J.; Hrabovsky, M.; Hrupec, D.; Huan, H.; Huber, B.; Huet, J.-M.; Hughes, G.; Humensky, T. B.; Huovelin, J.; Ibarra, A.; Illa, J. M.; Impiombato, D.; Incorvaia, S.; Inoue, S.; Inoue, Y.; Ioka, K.; Ismailova, E.; Jablonski, C.; Jacholkowska, A.; Jamrozy, M.; Janiak, M.; Jean, P.; Jeanney, C.; Jimenez, J. J.; Jogler, T.; Johnson, T.; Journet, L.; Juffroy, C.; Jung, I.; Kaaret, P.; Kabuki, S.; Kagaya, M.; Kakuwa, J.; Kalkuhl, C.; Kankanyan, R.; Karastergiou, A.; Kärcher, K.; Karczewski, M.; Karkar, S.; Kasperek, J.; Kastana, D.; Katagiri, H.; Kataoka, J.; Katarzyński, K.; Katz, U.; Kawanaka, N.; Kellner-Leidel, B.; Kelly, H.; Kendziorra, E.; Khélifi, B.; Kieda, D. B.; Kifune, T.; Kihm, T.; Kishimoto, T.; Kitamoto, K.; Kluźniak, W.; Knapic, C.; Knapp, J.; Knödlseder, J.; Köck, F.; Kocot, J.; Kodani, K.; Köhne, J.-H.; Kohri, K.; Kokkotas, K.; Kolitzus, D.; Komin, N.; Kominis, I.; Konno, Y.; Köppel, H.; Korohoda, P.; Kosack, K.; Koss, G.; Kossakowski, R.; Kostka, P.; Koul, R.; Kowal, G.; Koyama, S.; Kozioł, J.; Krähenbühl, T.; Krause, J.; Krawzcynski, H.; Krennrich, F.; Krepps, A.; Kretzschmann, A.; Krobot, R.; Krueger, P.; Kubo, H.; Kudryavtsev, V. A.; Kushida, J.; Kuznetsov, A.; La Barbera, A.; La Palombara, N.; La Parola, V.; La Rosa, G.; Lacombe, K.; Lamanna, G.; Lande, J.; Languignon, D.; Lapington, J.; Laporte, P.; Lavalley, C.; Le Flour, T.; Le Padellec, A.; Lee, S.-H.; Lee, W. H.; Leigui de Oliveira, M. A.; Lelas, D.; Lenain, J.-P.; Leopold, D. J.; Lerch, T.; Lessio, L.; Lieunard, B.; Lindfors, E.; Liolios, A.; Lipniacka, A.; Lockart, H.; Lohse, T.; Lombardi, S.; Lopatin, A.; Lopez, M.; López-Coto, R.; López-Oramas, A.; Lorca, A.; Lorenz, E.; Lubinski, P.; Lucarelli, F.; Lüdecke, H.; Ludwin, J.; Luque-Escamilla, P. L.; Lustermann, W.; Luz, O.; Lyard, E.; Maccarone, M. C.; Maccarone, T. J.; Madejski, G. M.; Madhavan, A.; Mahabir, M.; Maier, G.; Majumdar, P.; Malaguti, G.; Maltezos, S.; Manalaysay, A.; Mancilla, A.; Mandat, D.; Maneva, G.; Mangano, A.; Manigot, P.; Mannheim, K.; Manthos, I.; Maragos, N.; Marcowith, A.; Mariotti, M.; Marisaldi, M.; Markoff, S.; Marszałek, A.; Martens, C.; Martí, J.; Martin, J.-M.; Martin, P.; Martínez, G.; Martínez, F.; Martínez, M.; Masserot, A.; Mastichiadis, A.; Mathieu, A.; Matsumoto, H.; Mattana, F.; Mattiazzo, S.; Maurin, G.; Maxfield, S.; Maya, J.; Mazin, D.; Mc Comb, L.; McCubbin, N.; McHardy, I.; McKay, R.; Medina, C.; Melioli, C.; Melkumyan, D.; Mereghetti, S.; Mertsch, P.; Meucci, M.; Michałowski, J.; Micolon, P.; Mihailidis, A.; Mineo, T.; Minuti, M.; Mirabal, N.; Mirabel, F.; Miranda, J. M.; Mirzoyan, R.; Mizuno, T.; Moal, B.; Moderski, R.; Mognet, I.; Molinari, E.; Molinaro, M.; Montaruli, T.; Monteiro, I.; Moore, P.; Moralejo Olaizola, A.; Mordalska, M.; Morello, C.; Mori, K.; Mottez, F.; Moudden, Y.; Moulin, E.; Mrusek, I.; Mukherjee, R.; Munar-Adrover, P.; Muraishi, H.; Murase, K.; Murphy, A.; Nagataki, S.; Naito, T.; Nakajima, D.; Nakamori, T.; Nakayama, K.; Naumann, C.; Naumann, D.; Naumann-Godo, M.; Nayman, P.; Nedbal, D.; Neise, D.; Nellen, L.; Neustroev, V.; Neyroud, N.; Nicastro, L.; Nicolau-Kukliński, J.; Niedźwiecki, A.; Niemiec, J.; Nieto, D.; Nikolaidis, A.; Nishijima, K.; Nolan, S.; Northrop, R.; Nosek, D.; Nowak, N.; Nozato, A.; O'Brien, P.; Ohira, Y.; Ohishi, M.; Ohm, S.; Ohoka, H.; Okuda, T.; Okumura, A.; Olive, J.-F.; Ong, R. A.; Orito, R.; Orr, M.; Osborne, J.; Ostrowski, M.; Otero, L. A.; Otte, N.; Ovcharov, E.; Oya, I.; Ozieblo, A.; Padilla, L.; Paiano, S.; Paillot, D.; Paizis, A.; Palanque, S.; Palatka, M.; Pallota, J.; Panagiotidis, K.; Panazol, J.-L.; Paneque, D.; Panter, M.; Paoletti, R.; Papayannis, A.; Papyan, G.; Paredes, J. M.; Pareschi, G.; Parks, G.; Parraud, J.-M.; Parsons, D.; Paz Arribas, M.; Pech, M.; Pedaletti, G.; Pelassa, V.; Pelat, D.; Perez, M. d. C.; Persic, M.; Petrucci, P.-O.; Peyaud, B.; Pichel, A.; Pita, S.; Pizzolato, F.; Platos, Ł.; Platzer, R.; Pogosyan, L.; Pohl, M.; Pojmanski, G.; Ponz, J. D.; Potter, W.; Poutanen, J.; Prandini, E.; Prast, J.; Preece, R.; Profeti, F.; Prokoph, H.; Prouza, M.; Proyetti, M.; Puerto-Gimenez, I.; Pühlhofer, G.; Puljak, I.; Punch, M.; Pyzioł, R.; Quel, E. J.; Quinn, J.; Quirrenbach, A.; Racero, E.; Rajda, P. J.; Ramon, P.; Rando, R.; Rannot, R. C.; Rataj, M.; Raue, M.; Reardon, P.; Reimann, O.; Reimer, A.; Reimer, O.; Reitberger, K.; Renaud, M.; Renner, S.; Reville, B.; Rhode, W.; Ribó, M.; Ribordy, M.; Richer, M. G.; Rico, J.; Ridky, J.; Rieger, F.; Ringegni, P.; Ripken, J.; Ristori, P. R.; Riviére, A.; Rivoire, S.; Rob, L.; Roeser, U.; Rohlfs, R.; Rojas, G.; Romano, P.; Romaszkan, W.; Romero, G. E.; Rosen, S.; Rosier Lees, S.; Ross, D.; Rouaix, G.; Rousselle, J.; Rousselle, S.; Rovero, A. C.; Roy, F.; Royer, S.; Rudak, B.; Rulten, C.; Rupiński, M.; Russo, F.; Ryde, F.; Sacco, B.; Saemann, E. O.; Saggion, A.; Sahakian, V.; Saito, K.; Saito, T.; Saito, Y.; Sakaki, N.; Sakonaka, R.; Salini, A.; Sanchez, F.; Sanchez-Conde, M.; Sandoval, A.; Sandaker, H.; Sant'Ambrogio, E.; Santangelo, A.; Santos, E. M.; Sanuy, A.; Sapozhnikov, L.; Sarkar, S.; Sartore, N.; Sasaki, H.; Satalecka, K.; Sawada, M.; Scalzotto, V.; Scapin, V.; Scarcioffolo, M.; Schafer, J.; Schanz, T.; Schlenstedt, S.; Schlickeiser, R.; Schmidt, T.; Schmoll, J.; Schovanek, P.; Schroedter, M.; Schultz, C.; Schultze, J.; Schulz, A.; Schure, K.; Schwab, T.; Schwanke, U.; Schwarz, J.; Schwarzburg, S.; Schweizer, T.; Schwemmer, S.; Segreto, A.; Seiradakis, J.-H.; Sembroski, G. H.; Seweryn, K.; Sharma, M.; Shayduk, M.; Shellard, R. C.; Shi, J.; Shibata, T.; Shibuya, A.; Shum, E.; Sidoli, L.; Sidz, M.; Sieiro, J.; Sikora, M.; Silk, J.; Sillanpää, A.; Singh, B. B.; Sitarek, J.; Skole, C.; Smareglia, R.; Smith, A.; Smith, D.; Smith, J.; Smith, N.; Sobczyńska, D.; Sol, H.; Sottile, G.; Sowiński, M.; Spanier, F.; Spiga, D.; Spyrou, S.; Stamatescu, V.; Stamerra, A.; Starling, R.; Stawarz, Ł.; Steenkamp, R.; Stegmann, C.; Steiner, S.; Stergioulas, N.; Sternberger, R.; Sterzel, M.; Stinzing, F.; Stodulski, M.; Straumann, U.; Strazzeri, E.; Stringhetti, L.; Suarez, A.; Suchenek, M.; Sugawara, R.; Sulanke, K.-H.; Sun, S.; Supanitsky, A. D.; Suric, T.; Sutcliffe, P.; Sykes, J.; Szanecki, M.; Szepieniec, T.; Szostek, A.; Tagliaferri, G.; Tajima, H.; Takahashi, H.; Takahashi, K.; Takalo, L.; Takami, H.; Talbot, G.; Tammi, J.; Tanaka, M.; Tanaka, S.; Tasan, J.; Tavani, M.; Tavernet, J.-P.; Tejedor, L. A.; Telezhinsky, I.; Temnikov, P.; Tenzer, C.; Terada, Y.; Terrier, R.; Teshima, M.; Testa, V.; Tezier, D.; Thuermann, D.; Tibaldo, L.; Tibolla, O.; Tiengo, A.; Tluczykont, M.; Todero Peixoto, C. J.; Tokanai, F.; Tokarz, M.; Toma, K.; Torii, K.; Tornikoski, M.; Torres, D. F.; Torres, M.; Tosti, G.; Totani, T.; Toussenel, F.; Tovmassian, G.; Travnicek, P.; Trifoglio, M.; Troyano, I.; Tsinganos, K.; Ueno, H.; Umehara, K.; Upadhya, S. S.; Usher, T.; Uslenghi, M.; Valdes-Galicia, J. F.; Vallania, P.; Vallejo, G.; van Driel, W.; van Eldik, C.; Vandenbrouke, J.; Vanderwalt, J.; Vankov, H.; Vasileiadis, G.; Vassiliev, V.; Veberic, D.; Vegas, I.; Vercellone, S.; Vergani, S.; Veyssiére, C.; Vialle, J. P.; Viana, A.; Videla, M.; Vincent, P.; Vincent, S.; Vink, J.; Vlahakis, N.; Vlahos, L.; Vogler, P.; Vollhardt, A.; von Gunten, H.-P.; Vorobiov, S.; Vuerli, C.; Waegebaert, V.; Wagner, R.; Wagner, R. G.; Wagner, S.; Wakely, S. P.; Walter, R.; Walther, T.; Warda, K.; Warwick, R.; Wawer, P.; Wawrzaszek, R.; Webb, N.; Wegner, P.; Weinstein, A.; Weitzel, Q.; Welsing, R.; Werner, M.; Wetteskind, H.; White, R.; Wierzcholska, A.; Wiesand, S.; Wilkinson, M.; Williams, D. A.; Willingale, R.; Winiarski, K.; Wischnewski, R.; Wiśniewski, Ł.; Wood, M.; Wörnlein, A.; Xiong, Q.; Yadav, K. K.; Yamamoto, H.; Yamamoto, T.; Yamazaki, R.; Yanagita, S.; Yebras, J. M.; Yelos, D.; Yoshida, A.; Yoshida, T.; Yoshikoshi, T.; Zabalza, V.; Zacharias, M.; Zajczyk, A.; Zanin, R.; Zdziarski, A.; Zech, A.; Zhao, A.; Zhou, X.; Ziętara, K.; Ziolkowski, J.; Ziółkowski, P.; Zitelli, V.; Zurbach, C.; Żychowski, P.; CTA Consortium
The Cherenkov Telescope Array (CTA) is a new observatory for very high-energy (VHE) gamma rays. CTA has ambitions science goals, for which it is necessary to achieve full-sky coverage, to improve the sensitivity by about an order of magnitude, to span about four decades of energy, from a few tens of GeV to above 100 TeV with enhanced angular and energy resolutions over existing VHE gamma-ray observatories. An international collaboration has formed with more than 1000 members from 27 countries in Europe, Asia, Africa and North and South America. In 2010 the CTA Consortium completed a Design Study and started a three-year Preparatory Phase which leads to production readiness of CTA in 2014. In this paper we introduce the science goals and the concept of CTA, and provide an overview of the project.
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.
Male, Timothy D.; Fancy, Steven G.; Ralph, C. John
Known in the cage bird trade as the Japanese Hill-Robin, Peking Robin, or Peking Nightingale, the Red-billed Leiothrix was first imported into the Hawaiian Islands in 1911 ( Fisher and Baldwin 1947 ), with intentional releases to the wild occurring after 1918 ( Caum 1933 ). A native of Southeast Asia, southern China, and the Himalayan regions of India, this species is a medium-sized, green and yellow babbler with a conspicuous red bill and strongly notched tail. The species is extremely active, but individuals are somewhat secretive and difficult to see as they flit around in the understory, often in small groups. The Red-billed Leiothrix is found in a wide variety of habitats in the Hawaiian Islands, including both native and exotic forests from sea level to near mountain summits exceeding 4,000 m elevation.
Schmitz, R B
Global fees for episodes of care is perhaps one of the most progressive risk-based contracting techniques to emerge in managed care. Although global fees are theoretically a far more advanced and efficient payment technique than either fee-for-service or capitation, the chief obstacle preventing their implementation is the archaic billing and claims transaction systems operating in most "modern" health plans, hospitals, and physician offices. This article discusses various billing techniques available to interested parties who desire to enter into episode of care contracting venues.
Schwartz, Kevin L; Tu, Karen; Wing, Laura; Campitelli, Michael A; Crowcroft, Natasha S; Deeks, Shelley L; Wilson, Sarah E; Wilson, Kumanan; Gemmill, Ian; Kwong, Jeffrey C
Ontario has a single payer provincial health insurance program. Administrative data may provide a potentially robust source of information for post-marketing vaccine studies. Vaccine-specific immunization billing codes were introduced in 2011. Our objective was to validate Ontario's universal health care administrative datasets to assess infant immunization status. Electronic medical record data from the Electronic Medical Record Administrative data Linked Database (EMRALD) was used as the reference standard to calculate performance characteristics of the Ontario Health Insurance Plan (OHIP) database vaccine-specific and general immunization codes for 4 primary infant immunizations: diphtheria, tetanus, acellular pertussis, inactivated polio, Haemophilus influenzae type B (DTaP-IPV-Hib) combination vaccine, pneumococcal conjugate vaccine, measles, mumps, rubella (MMR) vaccine, and meningococcal conjugate serogroup C vaccine. OHIP billing claims had specificity ranging from 81% to 92%, sensitivity 70% to 83%, positive predictive value (PPV) 97% to 99%, and negative predictive value (NPV) 13% to 46% for identifying the various specific vaccines in administrative data. For cohorts vaccinated in the new code introduction phase, using both the vaccine-specific and general codes had higher sensitivity than the vaccine-specific codes alone. In conclusion, immunization billing claims from administrative data in Ontario had high specificity and PPV, moderate sensitivity, and low NPV. This study identifies some of the applications of utilizing administrative data for post-marketing vaccine studies. However, limitations of these data decrease their utility for measuring vaccine coverage and effectiveness. Therefore, the establishment of a comprehensive and linkable immunization registry should be a provincial priority.
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 ...
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
Roberts, Amy Restorick; Bowblis, John R
Social service departments in nursing homes (NHs) are staffed by qualified social workers (QSWs) and paraprofessionals. Due to greater workforce challenges in rural areas, this article aims to describe the staffing levels and composition of these departments by rurality. Certification and Survey Provider Enhanced Reports data from 2009 to 2015 are used to examine the effect of rurality on social service staffing using random-effects linear panel regressions. The average NH employed 1.8 full-time equivalents (FTEs), with approximately two thirds of social services staffed by QSWs. Large NHs had more staff, but employed fewer staff hours per resident day. Staffing levels were lower and QSWs made up a smaller percentage of staff in rural areas. National trends indicate variability in staffing by NH size and degree of rurality. Very low staffing within rural NHs is a concern, as staff may have less time to respond to residents' needs and these NHs may utilize fewer QSWs. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
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.
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
Battista, Jerry J; Clark, Brenda G; 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.
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
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.)
... 7 Agriculture 3 2010-01-01 2010-01-01 false Billing. 91.42 Section 91.42 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) COMMODITY LABORATORY TESTING PROGRAMS SERVICES...
Many foreigners apply for visas to visit or live in Australia. A small proportion of these applications are refused, however, because they are judged to be of bad character and a danger to Australian society. Some have their visas canceled after they have been issued. Australia's executive branch and judiciary have been struggling for a decade and a half to see who should have the final say on questions of immigration control. The Character Bill is the most recent development in this struggle. The Bill aims to protect communities from non-citizens who may be of bad character, especially those who may be criminals, when they apply for visas. It does this by making such people prove that they are of good character, by limiting their capacity to seek review of character-based decisions to deny them visas or to cancel already issued visas, and by restricting their access to information about them provided by law enforcement agencies. In some cases, non-citizens who are refused or deprived of visas on the basis of character will not have access to proper justice. The political and legal backgrounds to the Character Bill are described, as well as the substance and status of, and responses to the new bill.
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
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.
Jones, Emily B; Zur, Julia; Rosenbaum, Sara
Community health centers provide co-located medical, behavioral, and case management services to meet the unique and complex needs of the underserved, including homeless individuals. Multivariate analysis of staffing patterns in health centers serving high homeless caseloads highlights above-average behavioral and case management staffing, regardless of Health Care for the Homeless funding status. Rural health centers and those in the South had lower behavioral health and enabling services staffing. Implications include the need to monitor disparities, link health centers with available technical assistance, and emphasize integrating co-located behavioral health, enabling, and medical services through grant oversight mechanisms.
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...
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.
Full Text Available Two of the issues facing the South African Health Care System are the shortage of nursing staff and a lack of adequate skills to provide quality patient care. The hospital under study experienced a critical shortage of applications from professional registered nurses, consequently a staffing strategy was implemented to overcome the shortage of nurses and to maintain quality patient care. The strategy introduced encouraged nurses to voluntarily work an additional ten hours per week with remuneration. A non-experimental, descriptive design with a quantitative approach was applied to investigate the effect of a staffing strategy aimed at improving the quality of care in a hospital in Kwa-Zulu Natal based on voluntarily increasing staff working hours. The investigation compared the quality of nursing care before and after the implementation of the staffing strategy through retrospective audits of randomly selected patient files 372 (11% of the total population of 400 files were audited. A random sample of 4 boxes each containing a 100 patient files, of a total of 34 boxes, was selected from the hospital filing system. Descriptive statistical analyses were performed and correlations between various variables using the Chi-square test. No statistically significant differences (p<0.05 were found between the quality of nursing care before and after the implementation of the management strategy, even though deterioration of results after the implementation was observed. The study shows that the quality of nursing care in most wards deteriorated after implementation. The staffing strategy failed to improve or maintain the quality of nursing care.
Best, Michele L
Workforce issues, especially recruitment and retention of qualified laboratory staff, are major strategic issues that will continue to face laboratory managers over the next 10 years. Major factors affecting the laboratory labor market in the next decade include increased health-care and laboratory testing needs of an aging population, the graying of the laboratory workforce as baby boomers retire, and new technology development. At least two of these factors will increase the demand for qualified laboratory professionals. Vacancy rates for laboratory professionals are increasing at a significant rate and will continue over the next 10 years. Planning will require creativity in staff recruitment and retention strategies and in human resources. Laboratorians no longer will have the luxury of using medical technologists for nonspecialized testing assignments and will need to develop more creative recruiting approaches using fewer highly qualified testing personnel. This article proposes a staffing deployment model that will use medical technologist education and skills more appropriately, will improve retention of medical technologists, and will alleviate the shortage of medical technologists by reducing dependence on them as routine laboratory testing personnel.
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
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.
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.
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...
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.
fatigue attributed to work-related stressors .19 On the other hand, research has shown that the 48/96 schedule exacerbates sleep deprivation issues...health and wellness initiatives, brown-out, fire department funding, peak-usage staffing, four-person staffing, schedule modification, sleep deprivation ...to a significant sleep deprivation risk that impacts the employee’s ability to function at peak levels.7 The 10/14-hour schedule produces better
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.
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...
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.)
Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A
Objective To estimate the effect of minimum nurse staffing ratios on California acute care hospitals’ financial performance. Data Sources/Study Setting Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. Study Design The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1 = lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Data Collection/Extraction Methods Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Principal Findings Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Conclusions Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. PMID:22150627
Stafseth, Siv K; Tønnessen, Tor Inge; Fagerström, Lisbeth
Nurse staffing costs represent approximately 60% of total intensive care unit costs. In order to analyse resource allocation in intensive care, we examined the association between nurse staffing costs and two patient classification systems: the nursing activities score (NAS) and nine equivalents of nursing manpower use score (NEMS). A retrospective descriptive correlational analysis of nurse staffing costs and data of 6390 patients extracted from a data warehouse. Three intensive care units in a university hospital and one in a regional hospital in Norway. Nurse staffing costs, NAS and NEMS. For merged data from all units, the NAS was more strongly correlated with monthly nurse staffing costs than was the NEMS. On separate analyses of each ICU, correlations were present for the NAS on basic costs and external overtime costs but were not significant. The annual mean nurse staffing cost for 1% of NAS was 20.9-23.1 euros in the units, which was comparable to 53.3-81.5 euros for 1 NEMS point. A significant association was found between monthly costs, NAS, and NEMS. Cost of care should be based on individual patients' nursing care needs. The NAS makes nurses' workload visible and may be a helpful classification system in future planning and budgeting of intensive care resources. Copyright © 2018 Elsevier Ltd. All rights reserved.
Park, Bohyun; Seo, Sukyung; Lee, Taejin
To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.
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
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.
Reiter, Kristin L; Harless, David W; Pink, George H; Mark, Barbara A
To estimate the effect of minimum nurse staffing ratios on California acute care hospitals' financial performance. Secondary data from Medicare cost reports, the American Hospital Association's (AHA) Annual Survey, and the California Office of Statewide Health Planning and Development (OSHPD) are combined from 2000 to 2006 for 203 hospitals in California and 407 hospitals in 12 comparison states. The study employs a difference-in-difference analytical approach. Hospitals are grouped into quartiles based on pre-regulation nurse staffing levels in adult medical-surgical and pediatric units (quartile 1=lowest staffing). Differences in operating margin, operating expenses per day, and inpatient operating expenses per discharge for California hospitals within a staffing quartile during the period of regulation are compared to differences at hospitals in comparison states during the same period. Hospital data from Medicare cost reports are merged with nurse staffing measures obtained from AHA and from OSPHD. Relative to hospitals in comparison states, operating margins declined significantly for California hospitals in quartiles 2 and 3. Operating expenses increased significantly in quartiles 1, 2, and 3. Implementation of minimum nurse staffing legislation in California put substantial financial pressure on some hospitals. © Health Research and Educational Trust.
Ku, Leighton; Frogner, Bianca K; Steinmetz, Erika; Pittman, Patricia
Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served. Project HOPE—The People-to-People Health Foundation, Inc.
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
... conspicuous disclosure of inquiry contacts. Telephone bills must contain clear and conspicuous disclosure of any information that the subscriber may need to make inquiries about, or contest, charges on the bill. Common carriers must prominently display on each bill a toll-free number or numbers by which subscribers...
... Provisions And Clauses 252.204-7006 Billing Instructions. As prescribed in 204.7109, use the following clause: Billing Instructions (OCT 2005) When submitting a request for payment, the Contractor shall— (a) Identify... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Billing Instructions. 252...
... 42 Public Health 2 2010-10-01 2010-10-01 false Termination of group billing arrangement. 408.90... SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Group Payment § 408.90 Termination of group billing arrangement. (a) A group billing arrangement may be terminated...
... 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...
... 46 Shipping 8 2010-10-01 2010-10-01 false Subsidy billing procedures. 282.31 Section 282.31... OPERATORS OPERATING-DIFFERENTIAL SUBSIDY FOR LINER VESSELS ENGAGED IN ESSENTIAL SERVICES IN THE FOREIGN COMMERCE OF THE UNITED STATES Subsidy Payment and Billing Procedures § 282.31 Subsidy billing procedures...
... 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 8 2010-10-01 2010-10-01 false Subsidy billing procedures. 252.41 Section 252.41... OPERATORS OPERATING-DIFFERENTIAL SUBSIDY FOR BULK CARGO VESSELS ENGAGED IN WORLDWIDE SERVICES Subsidy Payment and Billing Procedures § 252.41 Subsidy billing procedures. (a) Subsidy voucher—(1) Form. Requests...
... 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...
Urs Buehlmann; D. Earl Kline; Janice K. Wiedenbeck; R., Jr. Noble
This research validated the framework for the standardized and simplified cutting bill presented in an earlier paper. The cutting bill validation was carried out in two ways. First, all 20 of the cutting bill's part groups were examined to determine if significant yield influences resulted from changing specific part sizes within the boundaries of a given part...
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)
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
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 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 (2006-2016) 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. 75% 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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…
Martsolf, Grant R; Auerbach, David; Benevent, Richele; Stocks, Carol; Jiang, H Joanna; Pearson, Marjorie L; Ehrlich, Emily D; Gibson, Teresa B
Inpatient quality deficits have important implications for the health and well-being of patients. They also have important financial implications for payers and hospitals by leading to longer lengths of stay and higher intensity of treatment. Many of these costly quality deficits are particularly sensitive to nursing care. To assess the effect of nurse staffing on quality of care and inpatient care costs. Longitudinal analysis using hospital nurse staffing data and the Healthcare Cost and Utilization Project State Inpatient Databases from 2008 through 2011. Hospital discharges from California, Nevada, and Maryland (n=18,474,860). A longitudinal, hospital-fixed effect model was estimated to assess the effect of nurse staffing levels and skill mix on patient care costs, length of stay, and adverse events, adjusting for patient clinical and demographic characteristics. Increases in nurse staffing levels were associated with reductions in nursing-sensitive adverse events and length of stay, but did not lead to increases in patient care costs. Changing skill mix by increasing the number of registered nurses, as a proportion of licensed nursing staff, led to reductions in costs. The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix can lead to improved quality and reduced length of stay at no additional cost.
Kunkel, Elisabeth J S; Del Busto, Elena; Kathol, Roger; Stern, Theodore A; Wise, Thomas N; Stoddard, Frederick R; Straus, Joshua; Saravay, Stephen M; Muskin, Philip R; Dresner, Nehama; Harrington, Colin J; Weiner, Joseph; Barnhill, John; Becker, Madeleine; Joseph, Robert C; Oyesanmi, Olugbenga; Fann, Jesse R; Colon, Eduardo; Epstein, Steven; Weinrieb, Robert
The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients. The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services. Program directors of seven academic Psychosomatic Medicine (PM) programs in the Northeast were surveyed to establish current staffing patterns and patient volumes. Survey data were reviewed and analyzed along with data from the literature and The Academy of Psychosomatic Medicine (APM) fellowship directory. Staffing patterns varied widely, both in terms of the number and disciplines of staff providing care for medical and surgical inpatients. The ratio of initial consultations performed per hospital bed varied from 1.6 to 4.6. Although staffing patterns vary, below a minimum staffing level, there is likely to be significant human and financial cost. Efficient sizing of a PM staff must be accomplished in the context of a given institution's patient population, the experience of providers, the presence/absence and needs of trainees, and the financial constraints of the department and institution. National survey data are needed to provide benchmarks for both academic and nonacademic PM services.
Im, Jinwoo J; Shachter, Ross D; Finney, John W; Trafton, Jodie A
In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically. We used a stepwise method to derive prediction functions for benefits and costs based on patients' treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping. Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients' outcomes, and improved net benefits are estimated from $1472 to $17,743 per patient.
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
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
Brewer, David; Morgan, Bill
In this session, INDOT auditors address common billing errors for different contract payment methodologies. Attendees responsible for preparing bills and submitting invoices will gain a better understanding of how contracts are designed and what is accepted for payment. Local agencies will understand how to review a consultant’s billing before making payment, thus avoiding citations. This presentation should be of particular interest to both engineering consulting firms and local agencies who...
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...
Unit billed services are those services provided internally by project to other projects, except for those services furnished by Lockheed Martin Services,Inc., an Enterprise Company. These services are billed when the actual work is performed, based on a published rate for the service. Examples of this would be crane and rigging, duplicating, or lab analysis. The providers of these services collect their costs in a pool. The pool is then liquidated by the billings.
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
Tattersall, Glenn J; Arnaout, Bassel; Symonds, Matthew R E
The avian bill is a textbook example of how evolution shapes morphology in response to changing environments. Bills of seed-specialist finches in particular have been the focus of intense study demonstrating how climatic fluctuations acting on food availability drive bill size and shape. The avian bill also plays an important but under-appreciated role in body temperature regulation, and therefore in energetics. Birds are endothermic and rely on numerous mechanisms for balancing internal heat production with biophysical constraints of the environment. The bill is highly vascularised and heat exchange with the environment can vary substantially, ranging from around 2% to as high as 400% of basal heat production in certain species. This heat exchange may impact how birds respond to heat stress, substitute for evaporative water loss at elevated temperatures or environments of altered water availability, or be an energetic liability at low environmental temperatures. As a result, in numerous taxa, there is evidence for a positive association between bill size and environmental temperatures, both within and among species. Therefore, bill size is both developmentally flexible and evolutionarily adaptive in response to temperature. Understanding the evolution of variation in bill size however, requires explanations of all potential mechanisms. The purpose of this review, therefore, is to promote a greater understanding of the role of temperature on shaping bill size over spatial gradients as well as developmental, seasonal, and evolutionary timescales. © 2016 Cambridge Philosophical Society.
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.
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)
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...
Suresh Bada Math
Full Text Available Mental capacity refers to the ability of an individual to make one's own decisions. Decision-making capacity has been described as the “key to autonomy” and an important ingredient of informed consent. Limited or impaired mental capacity embarks on a minefield of ethical and legal issues, which doctors need to be aware of while dealing with a particular patient. The objective of this article is to critically analyze the provisions of “capacity to consent” in Mental Health Care Bill (MHC Bill 2013, under the framework of the United Nations Convention on the Rights of Person with Disabilities (UNCRPD 2006. This article also attempts to offer a practical legal framework and some concrete suggestions, for psychiatrists operating in an ethically and legally challenging area of mental capacity. Some of the highlights include attempts to translate aspirations of the UNCRPD into MHC Bill 2013, which were out of context given the available resources, the family structure of our society, and inadequate research inputs. However, there is a need to introduce the capacity to consent to the MHC Bill 2013 after comprehensive research and to study the impact of such a revolutionary idea on the family aspects of our society. There is an urgent need to formulate and validate a capacity assessment tool for our population. The MHC Bill needs to consider the repercussion and impact of capacity to consent, thereby making room for the compulsory community treatment order empowering affected family members in providing much needed treatment for persons with mental illness.
Stearns, Sally C.; Park, Jeongyoung; Zimmerman, Sheryl; Gruber-Baldini, Ann L.; Konrad, Thomas R.; Sloane, Philip D.
Purpose: Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes.…
... 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...
Commandant of the Marine Corps submits updated force projections and the Secretary of Defense submits a master plan to Congress. Guam Realignment...are responsible for medical personnel assets. 5 NMW personnel used the following formula to determine physician staffing requirements...Okinawa discussed staffing requirements for multiple specialties, including pediatrics , psychiatry, psychology, and emergency room care. NMW
... 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...
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…
Tuck, Kathy D.; Holmes, Dwight R.
This study analyzes data collected between 2000 and 2013 from the annual National Center for Education Statistics (NCES) Common Core of Data (CCD) Local Education Agency (School District) Universe Survey; the NCES Schools and Staffing Survey (SASS); and the U.S. Census Bureau Small Area Income and Poverty Estimates Survey (SAIPE). The findings…
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
... Furniture Group, Inc., Including On-Site Leased Workers From Staffing Solutions; Morristown, TN; Commercial Furniture Group, Inc., Chicago, IL; Amended Certification Regarding Eligibility To Apply for Worker... Adjustment Assistance on May 5, 2010, applicable to workers of Commercial Furniture Group, Inc., including on...
Williams, Thomas O., Jr.; Ernst, Jeremy V.
This study investigated physical attacks as reported by public school teachers on the most recent Schools and Staffing Survey (SASS) from the National Center for Education Statistics administered by the Institute of Educational Sciences. For this study, characteristics of teachers who responded affirmatively to having been physically attacked in…
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,…
Lowry, Glenn R.
Reports results of survey of United States online database producers designed to determine number of personnel employed in intellectual production of databases and provide basis for generation of people employed in frequently recurring staff categories. Implications for education based on needs suggested by staffing patterns are examined.…
... 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...
... 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…
Kim, Hongsoo; Harrington, Charlene; Greene, William H.
Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…
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…
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
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA Form 10-3567-State Home Inspection Staffing Profile. 58.10 Section 58.10 Pensions, Bonuses, and Veterans' Relief... Profile. ER06JA00.000 ER06JA00.001 ER06JA00.002 ...
... 45 Public Welfare 4 2010-10-01 2010-10-01 false Organization and staffing of the State agency. 1321.9 Section 1321.9 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... PROGRAMS GRANTS TO STATE AND COMMUNITY PROGRAMS ON AGING State Agency Responsibilities § 1321.9...
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…
Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur
Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…
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…
Meyer, Anke Sofia; Kalkum, Bernd
Market-based reforms in China's urban centralized heating sector are essential to addressing the perpetual inefficiency of a sector built on welfare based principles. The reform of heat pricing and billing is a crucial part of overall heat reform, since it will commodity heat and thus create economic incentives to provide and use heat much more efficiently. Heat pricing and billing reform ...
The study also revealed poor and unreliable power supply and most often the bills issued for the electricity consumption are based on estimates, thus contributing to poor consumers' response to payments of electricity bills. Some suggestions that can facilitate the improvements of the operation of the Distribution Company ...
... Payment § 408.86 Responsibilities under group billing arrangement. (a) Enrollee responsibilities. (1) The enrollee is still responsible for premium payments; the group payer simply acts as his agent. If the agent... 42 Public Health 2 2010-10-01 2010-10-01 false Responsibilities under group billing arrangement...
... 42 Public Health 2 2010-10-01 2010-10-01 false Billing and payment procedures. 408.207 Section 408... Surcharge Agreements § 408.207 Billing and payment procedures. (a) Adding and removing enrollees. The State... terminates, or the month of the enrollee's death, whichever comes first. (b) Payment and grace period...
... 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...
... 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...
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.
...) UNIFORM SYSTEM OF ACCOUNTS FOR MUTUAL SERVICE COMPANIES AND SUBSIDIARY SERVICE COMPANIES, PUBLIC UTILITY HOLDING COMPANY ACT OF 1935 General Instructions § 256.01-10 Billing procedures. All invoices for services... 17 Commodity and Securities Exchanges 3 2010-04-01 2010-04-01 false Billing procedures. 256.01-10...
... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Billing policy and procedures. 206.3... SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE MANAGEMENT OF FEDERAL AGENCY RECEIPTS, DISBURSEMENTS, AND OPERATION OF THE CASH MANAGEMENT IMPROVEMENTS FUND § 206.3 Billing policy and procedures. The...
The paper revealed the genesis of Freedom of Information (FOI) Bill in Nigeria and the organizations instrumental to its enactment. The Bill is to ensure free flow of information and to protect Public Officers for giving out information in their possession. It also mandates organizations to preserve its information in such manner ...
monopoly of National Electric Power Authority (NEPA) to Power Holding ... amount of electric energy supplied to consumers. The most common ..... drive. In Table 9, 45.7% of respondent agreed to be getting bills on time and 35.8% disagreed while. 18.5% were indifferent. The mean of 2.45 shows that bills are distributed on ...
... the case may be, and (5) The total quantity in wine gallons or liters, (b) As to beer: (1) The name of... bill of lading), and (3) The number and size of containers. Where a copy of an export bill of lading or...
... 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...
... 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...
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 ...
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
Reed, R Lawrence; Davis, Kimberly A; Silver, Geoffrey M; Esposito, Thomas J; Tsitlik, Victoria; O'Hern, Timothy; Gamelli, Richard L
Trauma care demands constant physician availability, resulting in rotational coverage systems. Third-party payors consider separate trauma surgeon bills as originating from the same individual. Trauma surgeons may be unaware of their colleagues' billing history on jointly managed patients. Not all postoperative procedures and evaluation and management services are denied by global surgical package rules. We investigated whether a networked billing program designed to crosscheck for global package coding concerns would reduce payment denials. A networked relational database was created for trauma surgeons to enter billable encounters, displaying global periods and operative diagnoses while prompting for postoperative modifiers. Denials were compared for equivalent time periods before and after program initiation. Payment denials fell from 361 to 16 for "bundled" evaluation and management services and from 55 to 13 for bundled postoperative procedures. Time spent on billing decreased and legibility improved. Overall savings totaled $183,404. Collaborative billing can improve payments for professional trauma care.
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
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...
Beck, Charles R.
Describes how to introduce opera to students through the use of prompting strategies. Explains that these strategies encourage active participation by students and help to improve listening skills. Focuses on prompting strategies, such as matching characters to songs, identifying, and sequencing songs. (CMK)
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,…
A brief and breezy guide to the various philosophies of happiness—from Zhuangzi to the world of Positive Psychology and from Epicurus to the Buddha—packed with entertaining and fun exercises. Introducing Happiness is also a very intense shade of yellow.
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
Corkern, Sheree M.; Morgan, Mark I.
This paper informs business instructors and educators about XBRL (Extensible Business Reporting Language) so that they can introduce it to their students and expand their students' understanding of how it relates to the accounting profession. Even though the financial community has entered a new age with this standardized reporting language, many…
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.)
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).
... 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...
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.
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 training staffing and facilities. The results (1) suggest that the ATs were satisfied with their facilities and (2) highlight the differences in resources among competition levels.
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
This paper reports on omnibus energy legislation which went down to the wire in the closing days of the 102nd U.S. Congress. The House adjourned after approving the compromise energy bill, 363-60. The Senate planned to resume debate on the wide-ranging legislation late last week. Proponents of the bill also faced the problem of getting enough senators to return from a recess and vote to override the filibuster. Sixty senators would have to vote to limit debate on the energy bill, a vote that energy lobbyists the could be close
... & Services, Inc., Billing and Collections Department, Including Workers Whose Unemployment Insurance (UI... Solutions & Services, Inc., Billing and Collections Department, Mason, Ohio. The workers are engaged in... of ATOS IT Solutions & Services, Inc., Billing and Collections Department, including workers whose...
Pagad, Shyama; Genovesi, Piero; Carnevali, Lucilla; Schigel, Dmitry; McGeoch, Melodie A.
Harmonised, representative data on the state of biological invasions remain inadequate at country and global scales, particularly for taxa that affect biodiversity and ecosystems. Information is not readily available in a form suitable for policy and reporting. The Global Register of Introduced and Invasive Species (GRIIS) provides the first country-wise checklists of introduced (naturalised) and invasive species. GRIIS was conceived to provide a sustainable platform for information delivery to support national governments. We outline the rationale and methods underpinning GRIIS, to facilitate transparent, repeatable analysis and reporting. Twenty country checklists are presented as exemplars; GRIIS Checklists for close to all countries globally will be submitted through the same process shortly. Over 11000 species records are currently in the 20 country exemplars alone, with environmental impact evidence for just over 20% of these. GRIIS provides significant support for countries to identify and prioritise invasive alien species, and establishes national and global baselines. In future this will enable a global system for sustainable monitoring of trends in biological invasions that affect the environment. PMID:29360103
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
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.
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
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.
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.
Dunscombe, Peter; Grau, Cai; Defourny, Noémie
BACKGROUND AND PURPOSE: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project...... changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed...... guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. CONCLUSION: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon...
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
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
...) The amount of the total bill assessed as a franchise fee and the identity of the franchising authority... imposed on the cable operator by the franchise agreement to support public, educational, or governmental...
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
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")
This report describes the staffing plans of each industrial team member during final design and construction of the IFGDP. The internal organization of each team member, including the delegation of authority and responsibility within the structure, is discussed. The primary function of the various organizational units are also identified. In addition, a brief summary of the Phase II role of each industrial partner is included. The overall Phase II organization chart is attached.
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)
Himmel, Konrad; Schneider, Udo
The ambulatory physician payment system in the German Social Health Insurance (SHI) offers incentives to reduce practice activity at the end of a billing period. Most services within a period are reimbursed at full cost only up to a certain threshold. Furthermore, capitated payments make follow-up treatments within a billing period less profitable. Using claims data from Germany's largest sickness fund with about nine million members, we find a decrease of all services limited by a threshold ...
Bing Pao; Myles Riner; Theodore C. Chan
Introduction: The objective of this study was to examine reimbursement trends for emergency provider professional services following the balance billing ban in California.Methods: We conducted a blinded web-based survey to collect claims data from emergency providers and billing companies. Members of the California Chapter of the American College of Emergency Physicians (California ACEP) reimbursement committee were invited to participate in the survey. We used a convenience sample of claims ...
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.
authority were made available in: (1) the Agriculture, Rural Development , Food and Drug Administration, and Related Agencies Appropriations Act, 2010...appropriations bills for the entire U.S. government . This report is a research aid that lists the DOD authorization bills (Table 1) and...2) the Energy and Water Development and Related Agencies Appropriations Act, 2010; (3) the Department of Homeland Security Appropriations Act, 2010
This project proposed to develop, implement, and evaluate a peer-staffed toll-free hotline for individuals at high risk of developing hereditary breast cancer, either through family history or known BRCA1/2 mutations...
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.
Petrucci, Cristina; Calandro, Maria Teresa; Tresulti, Federica; Baldacchini, Antonio; Lancia, Loreto
The measurement of nursing sensitive outcomes represents a fundamental element in "Health Management" in order to assess the suitability and quality of care given, particoulaly in hospitals for the acutely ill. To highlight how some variables connected with nurse-staffing can determine the quality of processes and the care outcomes. A narrative review of international literature has been carried out on investigating possible correlation between nurse-staffing characteristics and care outcomes regarding patients, taking into account primary and secondary sources, written either in English or Italian, without time limits. The bibliographical research strategies used, have brought about the restitution of no. 4244 articles were retrived, of these 56 were analyzed. Articles were categorized into 3 specific areas: 1) Which aspects determine the efficacy and quality of nursing care; 2) The direct effects of nursing care on care outcomes; 3) The indirect effects of nursing care on care outcomes. Results confirm the existence of a noticeable relationship between the main components of nurse-staffing and the direct and indirect outcomes on patients health. Longitudinal studies shound be carried out highlighting the results obtained up till now even more and assist in accurately measuring the importance of possible predictive variables on care outcomes correlated to nursing care.
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.
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
Pao, Bing; Riner, Myles; Chan, Theodore C
The objective of this study was to examine reimbursement trends for emergency provider professional services following the balance billing ban in California. We conducted a blinded web-based survey to collect claims data from emergency providers and billing companies. Members of the California Chapter of the American College of Emergency Physicians (California ACEP) reimbursement committee were invited to participate in the survey. We used a convenience sample of claims to determine payment rates before and after the balance billing ban. We examined a total of 55,243 claims to determine the percentage of charges paid before and after the balance billing ban took effect on October 15, 2008. The overall reduction in percentage of charges paid was 13% in the first year and 19% in the second year following the balance billing ban. The average percentage of charges paid by health plans decreased from 91% to 86% from 2008 to 2010. Payments by risk-bearing organizations decreased from 72% to 46% of charges during the same time frame. Payment rates by subcontracted risk-bearing organizations for non-contracted emergency department professional services declined significantly following the balanced billing ban whereas payment rates by health plans remained relatively stable.
Full Text Available Introduction: The objective of this study was to examine reimbursement trends for emergency provider professional services following the balance billing ban in California. Methods: We conducted a blinded web-based survey to collect claims data from emergency providers and billing companies. Members of the California Chapter of the American College of Emergency Physicians (California ACEP reimbursement committee were invited to participate in the survey. We used a convenience sample of claims to determine payment rates before and after the balance billing ban. Results: We examined a total of 55,243 claims to determine the percentage of charges paid before and after the balance billing ban took effect on October 15, 2008. The overall reduction in percentage of charges paid was 13% in the first year and 19% in the second year following the balance billing ban. The average percentage of charges paid by health plans decreased from 91% to 86% from 2008 to 2010. Payments by risk-bearing organizations decreased from 72% to 46% of charges during the same time frame. Conclusion: Payment rates by subcontracted risk-bearing organizations for non-contracted emergency department professional services declined significantly following the balanced billing ban whereas payment rates by health plans remained relatively stable.
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 …
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 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.
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".
Jose V. Nable
Full Text Available Introduction: There is scant literature regarding the optimal resident physician staffing model of academic emergency departments (ED that maximizes learning opportunities. A department of emergency medicine at a large inner-city academic hospital initiated a team-based staffing model. Its pre-interventional staffing model consisted of residents and attending physicians being separately assigned patients, resulting in residents working with two different faculty providers in the same shift. This study aimed to determine if the post-interventional team-based system, in which residents were paired with a single attending on each shift, would result in improved residents’ learning and clinical experiences as manifested by resident evaluations and the number of patients seen. Methods: This retrospective before-and-after study at an academic ED with an annual volume of 52,000 patients examined the mean differences in five-point Likert-scale evaluations completed by residents assessing their ED rotation experiences in both the original and team-based staffing models. The residents were queried on their perceptions of feeling part of the team, decision-making autonomy, clinical experience, amount of supervision, quality of teaching, and overall rotational experience. We also analyzed the number of patients seen per hour by residents. Paired sample t-tests were performed. Residents who were in the program in the year preceding and proceeding the intervention were eligible for inclusion. Results: 34 of 38 eligible residents were included (4 excluded for lack of evaluations in either the pre- or post-intervention period. There was a statistically significant improvement in resident perception of the quality and amount of teaching, 4.03 to 4.27 (mean difference=0.24, p=0.03. There were non-statistically significant trends toward improved mean scores for all other queries. Residents also saw more patients following the initiation of the team-based model
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.
I present a novel way to introduce the lunar orbital eccentricity in introductory astronomy courses. The Moon is perhaps the clearest illustration of the general orbital elements such as inclination, ascending node, eccentricity, perigee, and so on. Furthermore, I like the students to discover astronomical phenomena for themselves, by means of a guided exercise, rather than just telling them the facts.1 The inclination and nodes may be found by direct observation, monitoring carefully the position of the Moon among the stars. Even the regression of the nodes may be discovered in this way2 To find the eccentricity from students' observations is also possible,3 but that requires considerable time and effort. if a whole class should discover it in a short time, here is a method more suitable for a one-day class or home assignment. The level I aim at is, more or less, advanced high school or first-year college students. I assume them to be acquainted with celestial coordinates and the lunar phases, and to be able to use algebra and trigonometry.
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.
Griffiths, Peter; Maben, Jill; Murrells, Trevor
An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient
... the supply of medical billing services. On September 5, 2013, the Department issued a negative... workers of Apria-Billing was based on the Department's findings that neither increased of billing services like or directly competitive with the medical billing services supplied by the subject workers, a shift...
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.
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.
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.)
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.
Pakkanen, Toni; Virkkunen, Ilkka; Kämäräinen, Antti; Huhtala, Heini; Silfvast, Tom; Virta, Janne; Randell, Tarja; Yli-Hankala, Arvi
Traumatic brain injury (TBI) is one of the leading causes of death and permanent disability. Emergency Medical Services (EMS) personnel are often the first healthcare providers attending patients with TBI. The level of available care varies, which may have an impact on the patient's outcome. The aim of this study was to evaluate mortality and neurological outcome of TBI patients in two regions with differently structured EMS systems. A 6-year period (2005 - 2010) observational data on pre-hospital TBI management in paramedic-staffed EMS and physician-staffed EMS systems were retrospectively analysed. Inclusion criteria for the study were severe isolated TBI presenting with unconsciousness defined as Glasgow coma scale (GCS) score ≤ 8 occurring either on-scene, during transportation or verified by an on-call neurosurgeon at admission to the hospital. For assessment of one-year neurological outcome, a modified Glasgow Outcome Score (GOS) was used. During the 6-year study period a total of 458 patients met the inclusion criteria. One-year mortality was higher in the paramedic-staffed EMS group: 57 % vs. 42 %. Also good neurological outcome was less common in patients treated in the paramedic-staffed EMS group. We found no significant difference between the study groups when considering the secondary brain injury associated vital signs on-scene. Also on arrival to ED, the proportion of hypotensive patients was similar in both groups. However, hypoxia was common in the patients treated by the paramedic-staffed EMS on arrival to the ED, while in the physician-staffed EMS almost none of the patients were hypoxic. Pre-hospital intubation by EMS physicians probably explains this finding. The results suggest to an outcome benefit from physician-staffed EMS treating TBI patients. ClinicalTrials.gov ID NCT01454648.
Echevarria, Kelly; Groppi, Julie; Kelly, Allison A; Morreale, Anthony P; Neuhauser, Melinda M; Roselle, Gary A
The development and validation of a staffing calculator and its use in creating staffing guidance for antimicrobial stewardship programs (ASPs) in Veterans Health Administration (VHA) facilities are described. The Tools and Resources Work Group of the Antimicrobial Stewardship Task Force and PBM Clinical Pharmacy Practice Office of the Department of Veterans Affairs developed, tested, and validated a staffing calculator to track patient care and ASP management activities needed to maintain a comprehensive ASP. Time spent on activities was based on time-in-motion tracking studies and input from experienced antimicrobial stewards. The staffing calculator was validated across VHA facilities of varying sizes and complexities to determine the number of needed clinical pharmacist full-time equivalents (FTEs) to implement and maintain ASPs per 100 occupied beds. A total of 12 facilities completed the staffing calculator for 1 calendar week. The median number of occupied beds was 226. Most facilities had at least 100 occupied beds, and 6 of the 12 were considered high complexity facilities. The median calculated FTE personnel requirement was 2.62, or 1.01 per 100 occupied beds. The majority of FTE time (70%) was spent on patient care activities and 30% on program management activities, including infectious diseases or ASP rounds. The final recommendations indicated that in order to implement and manage a robust ASP, a pharmacist FTE investment of 1.0 per 100 occupied beds would be needed. A staffing calculator to account for the time needed to implement ASP activities and provide staffing guidance across a large health-care system was validated. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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.
Domenici, P.; Wilson, A.D.M.; Kurvers, R.H.J.M.
The istiophorid family of billfishes is characterized by an extended rostrum or ‘bill’. While various functions (e.g. foraging and hydrodynamic benefits) have been proposed for this structure, until now no study has directly investigated the mechanisms by which billfishes use their rostrum to feed...... on prey. Here, we present the first unequivocal evidence of how the bill is used by Atlantic sailfish (Istiophorus albicans) to attack schooling sardines in the open ocean. Using high-speed video-analysis, we show that (i) sailfish manage to insert their bill into sardine schools without eliciting...... an evasive response and (ii) subsequently use their bill to either tap on individual prey targets or to slash through the school with powerful lateral motions characterized by one of the highest accelerations ever recorded in an aquatic vertebrate. Our results demonstrate that the combination of stealth...
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.
... handle supplemental billings from the TSP after payment of the original bill? 102-118.155 Section 102-118...) FEDERAL MANAGEMENT REGULATION TRANSPORTATION 118-TRANSPORTATION PAYMENT AND AUDIT Ordering and Paying for Transportation and Transportation Services § 102-118.155 How does my agency handle supplemental billings from the...
Han, Kihye; Trinkoff, Alison M; Storr, Carla L; Lerner, Nancy; Yang, Bo Kyum
Though more people in the United States currently reside in assisted living facilities (ALFs) than nursing homes, little is known about ALF admission policies, resident care needs, and staffing characteristics. We therefore conducted this study using a nationwide sample of ALFs to examine these factors, along with comparison of ALFs by size. Cross-sectional secondary data analysis using data from the 2010 National Survey of Residential Care Facilities. Measures included nine admission policy items, seven items on the proportion of residents with selected conditions or care needs, and six items on staffing characteristics (e.g., access to licensed nurse, aide training). Facilities (n = 2,301) were divided into three categories by size: small, 4 to 10 beds; medium, 11 to 25 beds; and large, 26 or more beds. Analyses took complex sampling design effects into account to project national U.S. estimates. More than half of ALFs admitted residents with considerable healthcare needs and served populations that required nursing care, such as for transfers, medications, and eating or dressing. Staffing was largely composed of patient care aides, and fewer than half of ALFs had licensed care provider (registered nurse, licensed practical nurse) hours. Smaller facilities tended to have more inclusive admission policies and residents with more complex care needs (more mobility, eating and medication assistance required, short-term memory issues, p < .01) and less access to licensed nurses than larger ALFs (p < .01). This study suggests ALFs are caring for and admitting residents with considerable care needs, indicating potential overlap with nursing home populations. Despite this finding, ALF regulations lag far behind those in effect for nursing homes. In addition, measurement of care outcomes is critically needed to ensure appropriate ALF care quality. As more people choose ALFs, outcome measures for ALFs, which are now unavailable, should be developed to allow for oversight
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)
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.
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.
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
Mackenhauer, Julie; Møller, Cecilie; Fjældstad, Alexander; Østervig, Rebecca; Kole, Ayhan Al; Folkestad, Lars; Hallas, Peter; Brabrand, Mikkel; Møllekær, Anders; Kirkegaard, Hans
The Danish health care system is undergoing a major reorganisation, resulting in fewer emergency departments (ED) with consultants in attendance 24/7. This questionnaire-based study evaluates the status of the reorganisation with emphasis on physician attendance and recruitment. 76% of the EDs are not staffed by consultants 24/7, 51% report difficulties in recruiting qualified personnel and 33% report problems connected to retaining them. 71% believe that a specialty in emergency medicine could help solve these problems. Danish EDs do not comply with the visions of the reorganisation plan.
McKenna, Erin; Clement, Kristina; Thompson, Elizabeth; Haas, Kathy; Weber, William; Wallace, Michelle; Stauffer, Cindy; Frailey, Jan; Anderson, Aimee; Deascenti, Missy; Hershiser, Lisa; Roda, Patricia Inama
Challenged by rising costs, higher registered nurse vacancy rates and declining staff morale, a Nursing Productivity Committee was formed to analyze productive and nonproductive hours and seek improvements in our staffing models and scheduling processes. The changes implemented led to lower nurse to patient ratios, better control of labor costs, elimination of agency staff, greater staff satisfaction, and introduction of new technologies. Nurse managers, nursing supervisors, and frontline staff are now more knowledgeable and empowered to use creative solutions to manage their budgets and schedules in these times of fluctuating census and varying vacancy rates.
Full Text Available In 2008, the Traditional Courts Bill (TCB was introduced in South Africa’s Parliament to regulate customary courts in place of the apartheid-era Black Administration Act. The TCB has come under wide ranging attack from civil society across the country, including from people based in the former homelands where the Bill would have effect, for its perpetuation of colonial and apartheid distortions of customary law, and its continuation of the oppressions justified through these distortions. In this article, I examine some of the major epistemic developments in customary law in South Africa, from colonialism to the present, to highlight key logics and genealogies of power that form the foundation and framework for ‘official customary law’. This examination provides the context for analysing the epistemological de-linking from colonial frameworks represented in women’s claims to land, and reveals how changes in women’s access to land over the years allows for a reading of epistemological shifts and contestations in customary law. I read these developments alongside the content of the TCB to examine different references for custom represented in both colonially rooted knowledges and de-colonial knowledges that challenge the premises of the former.
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…
Since the first draft in 2004, the Bill was subjected to scrutiny and refinement by the respective Health Committees of the Senate and House of Representatives. It was finally passed on 19th May 2011. It has 64 sections divided into seven parts which include establishment of National health system, health establishments, ...
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.
Thereafter the Draft Domestic Partnership Bill is investigated to determine the intended future marriage law system of South Africa. It is clear from the discussion that a hierarchy of personal relationships exist. Such a hierarchy does not promote diversity and a meassure of deregulation of marriage is proposed as a more ...
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
Maynes, J. O. "Rocky", Jr.
As an evaluation report, this 1970 document summarizes information from 13 Arizona school districts involved in special English classes under House Bill No. 1. Program emphasis was on oral language development, vocabulary, and comprehension. Each district used its own method of evaluating progress; therefore, in synthesizing the information, each…
...., United Parcel Service, Federal Express, or United States Postal Service small package shipments), no VA employee may issue a bill of lading or otherwise procure transportation services for goods unless the... Officer Certification Program (ref. 801.690). All transportation services for goods, other than for small...
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 ...
Vladimir A. Polyakov
Full Text Available The article gives a concept of the billing as a developing means of marketing promotion. Examples of comparative analysis for a rating are considered. The author presents technology of two-factor rating of trade marks on the basis of expert and comparative analysis.
Blue-billed Weaver dis- played a seven~month breeding season from March to September with a peak lying between April and July. The long breeding period showed the efﬁciency with which the species may have utilized different food resources and hence occupy broad feeding niches. The clutch size was between 1 to.
Beyond the Traditional Courts Bill: Regulating customary courts in line with living customary law and the Constitution. ... Customary courts are not professional institutions but community-based discussion forums, thus participation in them is inclusive of the broad community membership, and their accountability is partly ...
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...
Bangalore N Gangadhar
Full Text Available Electroconvulsive therapy (ECT is one of the oldest medical treatments in psychiatry. The practice has evolved over the years, and the indications have become better defined now. Notwithstanding these, it remains a highly regulated and scrutinized practice. Indian laws specifically related to ECT do not exist till date though this would change if the purported mental health care bill 2013 becomes the law of the land. ECT gets both direct and indirect mention at various places in the bill with far-reaching consequences impacting patients, families, and the professionals. Ban on “ECT as an emergency treatment option” and on “unmodified ECT” is being sought. In addition, ECT in minors is slated to come under stricter regulation. ECT could also get implicated under the “advance directives” provisions of the bill. This naturally has triggered vociferous debates throughout the country between the supporters as well as detractors of ECT. A number of ethical, professional, logistic, and clinical concerns are being discussed. In this background, we attempt to critically evaluate the bill with regard to ECT in the background of the existent scientific and legal literature. We provide possible future directions with regard to ECT practice and its regulation.
...: Billings County, North Dakota AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Revised Notice of...- of-Way Engineer, Federal Highway Administration, 1471 Interstate Loop, Bismarck, North Dakota 58503, Telephone: (701) 250-4343 Extension 111. Bryon Fuchs, Local Government Division, North Dakota Department of...
... 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...
Helminths, Arthropods and Protozoa of Domesticated Animals. 6th Edn. Bailliere,. Tindall and Cassell Ltd; London. pp. 1-824. Todd, K.S. and Worley, D.E. (1967). Helminth parasites of the Black-billed magpie Pica pica hudsonia from South Western Montana. J. Parasit. 53: pp. 354-367. Vincent, A.L. (1972). Parasites of the ...
A bill to alleviate the threat of a significant shortage of helium was set to be debated in the US House of Representatives as Physics World went to press with the House's Natural Resources Committee putting the finished touches to the motion.
Urs Buehlmann; Janice K. Wiedenbeck; R., Jr. Noble; D. Earl Kline
From an analytical viewpoint, the relationship between rough mill cutting bill part requirements and lumber yield is highly complex. Part requirements can have almost any length, width, and quantity distribution within the boundaries set by physical limitations, such as maximum length and width of parts. This complexity makes it difficult to understand the specific...
... 47 Telecommunication 2 2010-10-01 2010-10-01 false Other billing and collecting expense. 36.380 Section 36.380 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES JURISDICTIONAL SEPARATIONS PROCEDURES; STANDARD PROCEDURES FOR SEPARATING TELECOMMUNICATIONS PROPERTY COSTS...
evaluation of the role played by the red-billed oxpecker Buphagus erythrorhynchus in the biological control of ticks. Onderstepoort J. Vet. Res. HOWELL, C.J., WALKER, J.B. & NEVILL, E.M. 1978. Ticks, mites and insects infesting domestic animals in South Africa. Part I. Descriptions and biology. Sci. Bull. Dep. Agric. tech.
Constitutional Rights Foundation, Los Angeles, CA.
The biannual Newsletter, directed to secondary school teachers, now has a supplement, Bill of Rights Today, for student use. The student newsletter contains materials intended to stimulate discussion and class work on the subject of change in the school, community, and nation. In this issue articles on Common Cause, National Rifle Association, and…
Mitchell, Christine C; Ashley, Stanley W; Zinner, Michael J; Moore, Francis D
To develop a model to predict future staffing for the surgery service at a teaching hospital. Tertiary hospital. A computer model with potential future variables was constructed. Some of the variables were distribution of resident staff, fellows, and physician extenders; salary/wages; work hours; educational value of rotations; work units, inpatient wards, and clinics; future volume growth; and efficiency savings. Outcomes Number of staff to be hired, staffing expense, and educational impact. On a busy general surgery service, we estimated the impact of changes in resident work hours, service growth, and workflow efficiency in the next 5 years. Projecting a reduction in resident duty hours to 60 hours per week will require the hiring of 10 physician assistants at a cost of $1 134 000, a cost that is increased by $441 000 when hiring hospitalists instead. Implementing a day of didactic and simulator time (10 hours) will further increase the costs by $568 000. A 10% improvement in the efficiency of floor care, as might be gained by advanced information technology capability or by regionalization of patients, can mitigate these expenses by as much as 21%. On the other hand, a modest annual growth of 2% will increase the costs by $715 000 to $2 417 000. To simply replace residents with alternative providers requires large amounts of human and fiscal capital. The potential for simple efficiencies to mitigate some of this expense suggests that traditional patterns of care in teaching hospitals will have to change in response to educational mandates.
Morita, Kojiro; Matsui, Hiroki; Fushimi, Kiyohide; Yasunaga, Hideo
To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. We conducted a retrospective cohort study to examine the association of inpatient nurse-to-occupied bed ratio (NBR) with in-hospital fractures. Multivariable logistic regression with generalized estimating equations was performed, adjusting for patient characteristics and hospital characteristics. We identified 770,373 patients aged 50 years or older who underwent planned major surgery for some forms of cancer or cardiovascular diseases. We used ICD-10 codes and postoperative procedure codes to identify patients with in-hospital fractures. Hospital characteristics were obtained from the "Survey of Medical Institutions and Hospital Report" and "Annual Report for Functions of Medical Institutions." Overall, 662 (0.09 percent) in-hospital fractures were identified. Logistic regression analysis showed that the proportion of in-hospital fractures in the group with the highest NBR was significantly lower than that in the group with the lowest NBR (adjusted odd ratios, 0.67; 95 percent confidence interval, 0.44-0.99; p = .048). Sufficient nurse staffing may be important to reduce postsurgical in-hospital fractures in acute care hospitals. © Health Research and Educational Trust.
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)
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.
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)
Schubert, Maria; Schaffert-Witvliet, Bianca; De Geest, Sabina
The effects of cost saving strategies and changes in staffing levels and skill mix in the inpatient care setting on patient and nurse outcomes have not yet been examined in Switzerland. In 2002 the Swiss Federal Office of Health mandated the Institute of Nursing Science at the University of Basel to conduct a literature review to examine the evidence available on this topic. The literature research and analysis cover the period from 1991 to 2003. Sixty publications out of a total of 260 reviewed abstracts were included and analyzed. The results show that in the inpatient care settings in Switzerland as well as in other countries positions for registered nurses have been reduced and/or the qualification and skill mix in care teams have been downgraded. Given the present health care situation where the intensity and complexity of caring for hospitalized patients is increasing, an imbalance occurs between the need for high quality care and the possibilities to offer this care. This affects patients' and nurses outcomes. The international results show a significant relationship between lower staffing levels and skill mix in care teams and higher complication, "failure-to-rescue", and mortality rates in patients, as well as a lower job satisfaction, and higher fluctuation, burnout and work-related injury rates in nursing personnel. Thus, nursing care within hospitals represents not only a cost factor but also an important quality factor which is essential in order to be able to realize good patient's outcomes.
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.
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.
Although the details are not even written for forthcoming legislation to reauthorize the U.S. federal Water Resources Development Act (WRDA), three broad themes emerged during a 20 September hearing by the U.S. Senate Committee on Environment and Public Works (EPW). First, passage of the WRDA bill, which would authorize water projects around the country, already appears to have bipartisan support, as well as support from conservation, industry, and labor groups. WRDA was last reauthorized in 2007 when the Senate voted 79-14 in broad bipartisan support to override President George W. Bush's veto of the $23 billion bill. Second, although the U.S. Army Corps of Engineers—which manages, operates, and maintains a vast water resources infrastructure including more than 600 dams, 926 harbors, and 12,000 miles of commercial inland navigation channels—received some praise for its projects, it was also criticized as being a bureaucracy in need of repair. Third, WRDA legislation is operating under different ground rules than in the past. EPW committee chair Barbara Boxer (D-Calif.) said that she has been working with Republicans on WRDA legislation and that she hopes to move forward with a bill later this year—possibly bringing it up for a markup during Congress's lame duck session following the national election in November. She said that would be a way to set a marker for leadership on both sides of the congressional aisle to move forward with the bill. Boxer said she would "get my dream bill in place" and then provide it to committee ranking member James Inhofe (R-Okla.) and other Republicans for their comments.
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....
Belletti, S; Dutreix, A; Garavaglia, G; Gfirtner, H; Haywood, J; Jessen, K A; Lamm, I L; Mijnheer, B; Noël, A; Nüsslin, F; Rosenow, U; Schneider, P; Seelentag, W; Sheriff, S; Svensson, H; Thwaites, D
The safe application of ionising radiation for diagnosis and therapy requires a high level of knowledge of the underlying processes and of quality assurance. Sophisticated modern equipment can be used effectively for complicated diagnostic and therapeutic techniques only with adequate physics support. In the light of recent analyses and recommendations by national and international societies a joint working group of representatives from ESTRO (European Society for Therapeutic Radiology and Oncology) and from EFOMP (European Federation of Organisations for Medical Physics) was set up to assess the necessary staffing levels for physics support to radiotherapy. The method used to assess the staffing levels, the resulting recommendations and examples of their practical application are described.
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.)
The Ugandan Anti-Homosexuality Bill of October 2009 caused an international outcry and sparked intense debate in the local and international media. Particularly contentious was its proposal to impose the death penalty for acts of 'aggravated homosexuality'. Through a quantitative content analysis of 176 items from two main daily newspapers, the government-owned New Vision and the privately-owned Daily Monitor, over the period October 2009-June 2010, combined with qualitative interviews with human rights defenders in Uganda, this study explores attempts made by local human rights advocates to influence the media's coverage of the Bill and the extent to which these attempts were successful. The study finds that while there are significant differences between the frequency of reporting on the Bill in the two newspapers, both papers devoted little editorial space to the public health and human rights concerns put forward by local human rights organizations. Despite Uganda's recent and often lauded history of openly addressing HIV/AIDS, human right organizations' attempts to highlight the Bill's potentially adverse effects on the country's ability to tackle the epidemic effectively were only partially successful and, interestingly, awarded much less attention than the potential human rights implications of the proposed change in legislation.
.... 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...
... DEPARTMENT OF AGRICULTURE Forest Service Kaibab National Forest, Williams Ranger District; Arizona; Bill Williams Mountain Restoration Project AGENCY: Forest Service, USDA. ACTION: Notice of intent to... health and sustainability of forested conditions on and surrounding Bill Williams Mountain by reducing...
... Billing for Skilled Nursing Facilities for FY 2014; Correction AGENCY: Centers for Medicare & Medicaid...; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2014.'' DATES: These...
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
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.
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.
Berro, Elizabeth A; Knoesel, Joanne M
The current limited number of nurse faculty and available clinical sites requires innovative strategies to provide education to current and future nurses. Simulation centers and clinical education laboratories can meet this need, but staffing issues can be problematic. This article describes how an urban university developed a cost-effective model to staff its clinical education laboratory. After two faculty members proposed a pilot program to fully integrate simulation into both the accelerated and traditional undergraduate nursing programs on two campuses, a need was identified for more nursing staff dedicated to the simulation program. Knowing that many recent nurse graduates were available while waiting to obtain their first nursing position, these new nurses were recruited to serve in a volunteer capacity, supporting nursing faculty in the simulation program. The new nurse graduate volunteer position quickly evolved into a paid nurse intern position and has proven to benefit students, faculty, and new nurse graduates. Copyright 2016, SLACK Incorporated.
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
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...
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.
Stearns, Sally C; Park, Jeongyoung; Zimmerman, Sheryl; Gruber-Baldini, Ann L; Konrad, Thomas R; Sloane, Philip D
Residential care/assisted living facilities have become an alternative to nursing homes for many individuals, yet little information exists about staffing in these settings and the effect of staffing. This study analyzed the intensity and skill mix of nursing staff using data from a four-state study, and their relationship to outcomes. We obtained longitudinal data for 1,894 residents of 170 residential care/assisted living facilities participating in the Collaborative Studies of Long-Term Care. Descriptive statistics assessed the levels of direct care staff (registered nurse, licensed practical nurse, personal care aide). Regression analyses evaluated the relationship between two staffing measures (intensity measured as care hours per resident and skill mix measured as the percentage of total care hours by licensed nurses), facility characteristics, and four health outcomes (mortality, nursing home transfer, hospitalization, and incident morbidity). Care hours per resident decreased with facility size (economies of scale) only for very small facilities and increased with dementia prevalence (case-mix effect). Licensed staff accounted for a greater proportion of total hours in nonprofit settings. Health outcomes did not vary by total care hours per resident, but hospitalization rates were significantly lower in facilities with higher proportions of skilled staff hours; this effect was stronger as dementia case mix increased. Current staffing levels for the outcomes analyzed meet most residents' needs. Reduced hospitalization in relation to greater use of licensed staff suggests that increased use of these workers might result in reductions in acute care expenditures.
... 288 4 4 2 289 to 316 5 4 2 317 to 343 5 5 2 (3) Swine Inspection. The following inspection staffing standards are applicable to swine slaughter configurations. The inspection standards for all slaughter lines..., liver, heart, lungs, and mediastinal lymph nodes. In addition, for one- and two-inspector lines, the...
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-73,756] Progressive Furniture, Inc., Including On-Site Leased Workers From Onin Staffing, a Subsidiary of Sauder Furniture, Claremont, NC; Notice of Affirmative Determination Regarding Application for Reconsideration On July 19, 2010...
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-81,067] Johnson Controls, Inc... workers of Johnson Controls, Inc., including on-site leased workers from Valley Staffing, Hudson... subject firm. The company reports that workers leased from AZ Quality were employed on-site at the Hudson...
... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-74,593] Whirlpool Corporation... Staffing, Fort Smith, Arkansas. The workers are engaged in the production of refrigerators and trash... trash compactors to Mexico. The amended notice applicable to TA-W-74,593 is hereby issued as follows...
... 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...
Salvucci, Sameena; And Others
This user's manual summarizes the results and use of design effects and generalized variance functions (GVF) to approximate standard errors for the 1990-91 Schools and Staffing Survey (SASS). It is Volume I of a two-volume publication that is part of the Technical Report series of the National Center for Education Statistics (NCES). The SASS is a…
Goodrich, Elizabeth A.
The study examined impact of office automation on the roles and staffing patterns of office employees at the National Institute of Neurological and Communicative Disorders and Stroke. Results of an interview study indicate that automation has had a favorable impact on the way work is accomplished and on the work environment. (Author/CH)
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.
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.
... 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...
Rhode Island Governor Lincoln Almond vetoed legislation allowing State prison guards to learn the names of adult inmates infected with HIV. The bill was brought before the governor for two consecutive years. Almond stated that the disclosure requirement, supported by the Brotherhood of Correctional Officers, is not medically necessary, nor would it prevent transmission of the virus to guards or other inmates. Use of universal precautions will prevent transmission far better than any disclosure program, according to the governor.
Arini Saraswati; Damerianta P. Sahni, SKom, MMSI
At this writing the author took the title "Draft Billing System In Front Office Hotel Genggong Cimanggis", as an enterprise which is engaged in the hospitality, the required increase in forward speed performance and reliable.Information processing stillusing manual method is not reliable. Yet in today's era of information processing problems increasingly needed because of the complexity of the problem more and more.It is expected that the existing computerized technology to be used as optimal...
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.
Full Text Available Context: There have been few reports investigating the effects of air transportation on patients with decompression illness (DCI. Aims: To investigate the influence of air transportation on patients with DCI transported via physician-staffed emergency helicopters (HEMS: Emergency medical system of physician-staffed emergency helicopters. Settings and Design: A retrospective medical chart review in a single hospital. Materials and Methods: A medical chart review was retrospectively performed in all patients with DCI transported via HEMS between July 2009 and June 2013. The exclusion criteria included cardiopulmonary arrest on surfacing. Statistical analysis used: The paired Student′s t-test. Results: A total of 28 patients were treated as subjects. Male and middle-aged subjects were predominant. The number of patients who suddenly surfaced was 15/28. All patients underwent oxygen therapy during flight, and all but one patient received the administration of lactate Ringer fluid. The subjective symptoms of eight of 28 subjects improved after the flight. The range of all flights under 300 m above sea level. There were no significant differences between the values obtained before and after the flight for Glasgow coma scale, blood pressure, and heart rate. Concerning the SpO 2 , statistically significant improvements were noted after the flight (96.2 ± 0.9% versus 97.3 ± 0.7%. There were no relationships between an improvement in subjective symptoms and the SpO 2 . Conclusion: Improvements in the subjective symptoms and/or SpO 2 of patients with DCI may be observed when the patient is transported via HEMS under flights less than 300 m in height with the administration of oxygen and fluids.
... for Unauthorized Charges (``Cramming''); Consumer Information and Disclosure; Truth-in-Billing Format... unauthorized charges on their telephone bills, an unlawful and fraudulent practice commonly referred to as... charges and place third-party charges in a separate bill section from all telephone company charges. The...
... 42 Public Health 3 2010-10-01 2010-10-01 false Effective date of Medicare billing privileges. 424... HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Requirements for Establishing and Maintaining Medicare Billing Privileges § 424.520 Effective date of Medicare billing...
... billing agents that prepare or submit claims presented to TRICARE for payment. DATES: Written comments... billing agents that prepare or submit claims presented to TRICARE for payment. TRICARE program policy.... This rule will allow TRICARE to sanction third-party billing agents to prevent the payment of false or...
... Inspection; Overtime and Holiday Service; Billing Establishments § 381.39 Basis of billing for overtime and... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Basis of billing for overtime and holiday services. 381.39 Section 381.39 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE...
... provider of services or supplies as specified in Sec. 199.6 of this part.'' Third-party billing agents do...-party billing agent. As long as the provider of services has not been sanctioned and remains an... 0720-AB49 TRICARE; TRICARE Sanction Authority for Third-Party Billing Agents AGENCY: Office of the...
... 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...
... 49 Transportation 8 2010-10-01 2010-10-01 false Uniform Straight Bill of Lading A Appendix A to Part 1035 Transportation Other Regulations Relating to Transportation (Continued) SURFACE... Appendix A to Part 1035—Uniform Straight Bill of Lading Uniform Straight Bill of Lading Original—Not...
... Billings/Laurel Area. 52.1392 Section 52.1392 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 52.1392 Federal Implementation Plan for the Billings/Laurel Area. (a) Applicability. This section... in ownership or operation, of the following facilities in the Billings/Laurel, Montana area: CHS Inc...
... Quality Control Regions § 81.88 Billings Intrastate Air Quality Control Region. The Metropolitan Billings Intrastate Air Quality Control Region (Montana) has been renamed the Billings Intrastate Air Quality Control... to by Montana authorities as follows: Sec. 481.168Great Falls Intrastate Air Quality Control Region...
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
Comparing macrophyte herbivory by introduced Louisiana crayfish ( Procambarus clarkii ) (Crustacea: Cambaridae) and native Dytiscid beetles ( Cybister tripunctatus ) (Coleoptera: Dytiscidae), in Kenya.
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.
Adams, Diane L; Norman, Helen; Burroughs, Valentine J
Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction
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.
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.
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
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.
On November 16, 1993, the US Senate voted approval, by 69 to 30 members, to impose stiff penalties on those obstructing access to abortion clinics. The penalties include up to 1 year in jail and a $100,000 fine for first violent offenses. Obstruction without violence would lead to a fine of $10,000 and 6 months in jail. The legislation was deemed necessary after the murder of a doctor in Florida and the wounding of another doctor in Kansas. Democratic Senator Edward Kennedy said that those who do not obstruct access have nothing to fear. Support came not only from abortion rights advocates, but from those against lawlessness in the pro-life movement. Maryland's Democratic Senators Mikulski and Sarbanes and California's Democratic Senator Barbara Boxes supported the bill, as well as Attorney General Janet Reno and President Clinton. House Speaker Thomas S. Foley announced that the House would consider its version of the bill on November 18, 1993. The original version was changed to reduce fines for nonviolent offenders from $100,000 to $10,000. Opponents argued that the legislation treated peaceful protesters as felons, and was directed in a singular=sided way with no regard to civil disobedience by animal rights activists, antinuclear protesters, and AIDS activists. North Carolina Republican Senator Jesse Helms thought that the Supreme Court would find the bill unconstitutional. Other arguments were that civil disobedience should be allowed for anti-abortion protesters, as it was allowed for civil rights protesters such as Dr. Martin Luther King, Jr. Senator Kennedy pointed out the Dr. King was trying to secure a constitutional right, unlike anti-abortion protesters who were trying to deny a constitutional right.
Thomas, Megan D.
Did the World War II (WWII) GI Bill increase the probability of completing high school and further affect the probability of poverty and employment for the cohorts for whom it benefited? This paper studies whether the GI Bill, one of the largest public financial aid policies for education, affected low education levels in addition to its…
Den korte og følelsesladede debatten mellom den tyske typografen og designeren Jan Tschichold og den sveitsiske arkitekten og designeren Max Bill fra 1946 berører noen sentrale estetiske og funksjonelle aspekter ved typografi og grafisk design. Foranledningen for debatten var at Tschichold i løpet av krigsårene 1940–45 hadde vendt seg mot sine tidligere standpunkter og gått til angrep på funksjonalismen og «den nye typografien». Isteden tok han den tradisjonelle, symmetriske typografien i for...
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
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
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.
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.
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.
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.
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.
Bonfield, Christopher M; Kondziolka, Douglas
Bill Masterton is the only man to die of injuries sustained in a National Hockey League (NHL) game. He remains the last fatality in any professional team sport involving a direct in-game injury in North America. While Masterton was originally thought to have suffered a fatal brain injury while being checked on the ice, later analysis of the case revealed evidence of second-impact syndrome and the effects of prior concussions. Masterton's death sparked both an immediate debate in the NHL on whether helmets should be compulsory and the NHL's first vote on mandatory helmet use. Although the subject of mandated helmet use met with resistance in the 10 years after Masterton's death, especially from hockey owners and coaches, the NHL finally legislated helmet use by all players entering the league beginning in the 1979-1980 season. Several awards, including one recognizing the NHL player who best exemplifies the qualities of perseverance, sportsmanship, and dedication to hockey, have been created in memory of Masterton. However, his legacy extends far beyond the awards that bear his name. His death was the seminal event bringing head safety to the forefront of a game that was both unready and unwilling to accept change. An increase in mainstream media attention in recent years has led to unprecedented public awareness of brain injury and concussion in hockey and other sports. Advances in the diagnosis and treatment of head injury in sports have occurred recently, the impetus for which started over 45 years ago, when Bill Masterton died.
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.
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
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 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
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)
Full Text Available Context: There have been no reports that have studied the characteristics specific to bodyboard injuries. Aims: To clarify characteristics to bodyboard injuries. Settings and Design: A retrospective medical chart review. Materials and Methods: A medical chart review was retrospectively performed for all patients with spinal cord injuries transported via physician-staffed emergency helicopters between January 2009 and October 2013. The subjects were divided into two groups based on whether they had a spinal cord injury induced by bodyboarding (Bodyboard group, n = 14 or not (Control group, n = 14. Statistical Analysis Used: Using a χ2 -test, Mann-Whitney U-test and non-paired Student′s t-test. Results: All but one of the subjects had spinal canal stenosis. The age of the patients in the Bodyboard group was younger than that of the Control group. The ratio of males and Glasgow Coma Scale of the Bodyboard group were higher than those on the Control group. The spinal cord injury induced by bodyboarding typically occurred after impacts of the head or face with the sea bottom while the subject was being buffeted by the waves. The severity of the spinal cord injury in the Bodyboard group was lower than that in the Control group. Conclusion: Bodyboarding tended to induce spinal cord injuries after the head or face collided with the sea bottom, and was more common in middle-aged males during the summer season, and was associated with a favorable outcome.
Moore, U; Durham, J; Corbett, I; Thomson, P
Competence based education is becoming more important in dentistry and medicine. In dentistry clinical skills are assessed using longitudinal assessments or structured objective clinical tests. We have previously presented the assessment of competence in surgical extractions however the success rate for this was poor. The opportunity to alter staffing levels and timetabling arose and we present the influence of this on the achievement of competence. The competence assessments and portfolios of two consecutive years of dental undergraduates were examined after completing their surgical extraction course. The first cohort received 9 sessions of teaching spread over 2 years with one staff supervisor per session. The second cohort received 10 sessions with varying numbers of staff supervisors. The first cohort required 210 staff sessions and performed 275 surgical extractions (mean 4), and 23% achieved competence. The second cohort required 240 staff sessions and performed 403 surgical extractions (mean 6), and 66% achieved competence. Thirty six extra sessions were provided for students in the second cohort who failed to complete their competence during the allocated blocks and following this 99% of the second cohort achieved competence. These differences are significant (P timetabling changes which focus student experience and learning.
Full Text Available In the article the staffing problems of transport complex in the period of its fundamental technical change and intensive development of 1960–1980-ies are described. The main purpose of this article is to analyze the peculiarities of personnel potential development of transport complex of the Ukrainian SSR in the years of the intensive development of transport sectors, figure out the social component of the measures to improve the efficiency of transport networks. Methodology. In this article we used the method of analysis. The qualitative personnel structure, training of skilled workers in the educational institutions and other forms of improvement of personal skills of transport workers are analyzed. The causes of staff turnover and low labour discipline are studied. Practical implementation. This article shows the possible opportunities for the modern transport complex of Ukraine, how to be successful and competitive in the market. The historical background of this article can be very useful for present managers of the transport complex. Results. The author makes a general conclusion that the main causes of personnel fluctuation in transport brunches are low wages, pour conditions of work and lack of accomodations for the staff. The social and practical measures to improve effectiveness of work with personnel of all brunches of transport system are characterized.
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.
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.
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.
... 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...
Dunscombe, Peter; Grau, Cai; Defourny, Noémie; Malicki, Julian; Borras, Josep M.; Coffey, Mary; Bogusz, Marta; Gasparotto, Chiara; Slotman, Ben; Lievens, Yolande; Kokobobo, Arianit; Sedlmayer, Felix; Slobina, Elena; De Hertogh, Olivier; Hadjieva, Tatiana; Petera, Jiri; Eriksen, Jesper Grau; Jaal, Jana; Bly, Ritva; Azria, David
Background and purpose: In planning to meet evidence based needs for radiotherapy, guidelines for the provision of capital and human resources are central if access, quality and safety are not to be compromised. A component of the ESTRO-HERO (Health Economics in Radiation Oncology) project is to document the current availability and content of guidelines for radiotherapy in Europe. Materials and methods: An 84 part questionnaire was distributed to the European countries through their national scientific and professional radiotherapy societies with 30 items relating to the availability of guidelines for equipment and staffing and selected operational issues. Twenty-nine countries provided full or partial evaluable responses. Results: The availability of guidelines across Europe is far from uniform. The metrics used for capital and human resources are variable. There seem to have been no major changes in the availability or specifics of guidelines over the ten-year period since the QUARTS study with the exception of the recent expansion of RTT staffing models. Where comparison is possible it appears that staffing for radiation oncologists, medical physicists and particularly RTTs tend to exceed guidelines suggesting developments in clinical radiotherapy are moving faster than guideline updating. Conclusion: The efficient provision of safe, high quality radiotherapy services would benefit from the availability of well-structured guidelines for capital and human resources, based on agreed upon metrics, which could be linked to detailed estimates of need
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
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.
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.
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
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...
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Hlotov Yevhen O.
Full Text Available The article conducts an analysis of the existing methodological framework for assessment of bill, which is one of the most complicated categories of securities. This arises from the variety of functions that a bill can perform during the process of treatment. In this publication, bill refers to securities based on statutory form and containing an unconditional obligation to pay a specified sum within a stipulated time frame, it is also specified that the Ukrainian exchange law is still in a formative stage. Simulations of calculations of bills, which differ in agreements and payers, are considered. The focus of the work is given to simulation of calculations related to common operations with bills, as well as to technology of automation of bills' accounting computation in the Libre Calc environment, using the built-in functions: ACCRINTM(, PRICEDISC(, YIELDDISC(, DISC(, INTRATE(, RECEIVED(. An electronic worksheet in the environment of the table processor LibreOffice Calc has been developed, which is a tool to automate the analysis of accounting operations with bills and may be supplemented and adapted to the analysis of operations in more complex terms. Thus, the analyzed methodological framework of bills and the developed electronic worksheet provide to analyze accounting operations with bills, and to develop a program for their analysis in a high-level language that is useful both in practice and in the educational process
Reid, William H
Forensic practice fees, billing, and collection procedures are quite different from those in general psychiatry. Most forensic practices have far fewer "clients," and individual bills are usually larger. Collections are usually better (and less frequently discounted) in forensic practice, and resolving billing disputes is far more straightforward. Medicare, Medicaid, other insurance coverage, provider networks and agreements, procedure codes, and diagnosis-related groups (DRGs) are all largely irrelevant in forensic work (although sometimes important to direct clinical services in correctional psychiatry or forensic treatment clinics). An understanding of the practicalities and ethics of charging and billing for forensic services greatly simplifies practice management.
Saunders, G.B.; Clark, E.
On 20 May 1961 an immature female tiger shark (Galeocerdo cuvier), 2.3 meters in length and weighing 52 kg, was caught in the Gulf of Mexico several miles offshore from Sarasota, Florida, by personnel of the Cape Haze Marine Laboratory. The contents of its stomach included a leg and some feathers of a land bird. The leg was sent to the Bird and Mammal Laboratories, Bureau of Sport Fisheries and Wildlife, Washington, D.C., where it was identified by Mrs. R. C. Laybourne as that of a Yellow-billed Cuckoo (Coccyzus americanus). In addition to this bird, the stomach contained a blue crab, several sea catfishes (Galeichthys felis), and part of a black nose shark (Carcharhinus acronatus).
Full Text Available Den korte og følelsesladede debatten mellom den tyske typografen og designeren Jan Tschichold og den sveitsiske arkitekten og designeren Max Bill fra 1946 berører noen sentrale estetiske og funksjonelle aspekter ved typografi og grafisk design. Foranledningen for debatten var at Tschichold i løpet av krigsårene 1940–45 hadde vendt seg mot sine tidligere standpunkter og gått til angrep på funksjonalismen og «den nye typografien». Isteden tok han den tradisjonelle, symmetriske typografien i forsvar og gav den en fornyelse og en kvalitetsheving. Artikkelen tar for seg debatten og kommenterer de ulike standpunktene i lys av den senere faghistorien, og fokuserer spesielt på hvordan ideologi og tidsavhengig tankegods kan påvirke argumenter om funksjonalitet og estetikk.
Pomeroy, Robert W.
Designed to be a "road map," this guide introduces an approach to producing "electronic reports," documents that fuse computer-based methods with traditional research techniques. The guide emphasizes four stages--planning, inquiry, analysis, and expression. The chapter on planning discusses defining objectives, flowcharting,…
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 ...
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 ...
Wagner, Stefan Rahr; Toftegaard, Thomas Skjødeberg; Bertelsen, Olav W.
resulting in reduced data quality and suboptimal treatment. Objectives: The aim of this paper is to introduce the Adherence Strategy Engineering Framework (ASEF) as a method for developing novel technology-based adherence strategies to assess and improve patient adherence levels in the unsupervised setting...
Jensen, Jens Højgaard
Many aspects of fluid dynamics can be introduced using dimensional analysis, combined with some basic physical principles. This approach is concise and allows exploration of both the laminar and turbulent limits—including important phenomena that are not normally dealt with when fluid dynamics...
Introducing new agricultural technologies and marketing strategies: A means for increasing income and nutrition of farm households in Ethiopia. ... Both the treatment of the nutritional deficits and the decision making criteria defined by farmers are expected to be useful techniques in other developing country technology ...
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 ...
Wiggins, Enrique R.
Introducing technology education students to the field of home inspection gives them a great opportunity to learn about and apply construction technology content. In working with his 8th-grade students, the author covers the purpose of a home inspection, the dynamic of home inspections, the process involved in inspecting schools and homes and…
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…
English, Lyn D.
Children live in a highly sophisticated world composed of interlocking complex systems. An appreciation and understanding of such systems is critical for making effective decisions about everyone's lives as individuals and as community members. This article addresses one approach to introducing children of all achievement levels to introductory…
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...
Sorrels, Barbara; Norris, Deborah; Sheeran, Linda
Constructivist education, based on the theories of Piaget and Vygotsky, advocates an approach to curriculum and teaching that is student centered, inquiry based, integrated and intellectually engaging. One teaching strategy that provides such an experience is the Project Approach, reflective of the pedagogy of John Dewey and introduced as a model…
Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Shah, Avantika S; Schnelle, John F
To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care. Supervisory staff used a standardized observational method to measure ADL care quality and the staff time to provide care during the morning and evening across 12 consecutive months. Staff were given individual feedback about the quality of their care provision following each observation. The average staff time to provide ADL care averaged 35 (± 11) minutes per resident per care episode with bathing and 18 (± 6) minutes/resident/care episode without bathing. Morning ADL care required significantly more staff time than evening care. There was not a significant relationship between residents' levels of cognitive impairment or ADL dependency and the staff time to provide ADL care. Quality ADL care was maintained for 12 months. This study provides novel data related to the amount of staff time necessary to provide quality ADL care for persons with dementia in an assisted living care setting. This study also describes a standardized approach to staff management that was effective in maintaining quality ADL care provision. Assisted living facilities should consider these data when determining the necessary unlicensed staffing level to provide person-centered ADL care and how to effectively manage direct care providers. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Kyeremanteng, Kwadwo; Hendin, Ariel; Bhardwaj, Kalpana; Thavorn, Kednapa; Neilipovitz, Dave; Kubelik, Dalibour; D'Egidio, Gianni; Stotts, Grant; Rosenberg, Erin
With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units. This retrospective study assessed clinical and cost-related outcomes in an intermediate-level neurosciences acute care unit (NACU) before and after the addition of an intensivist to the unit's care team. Starting in October 2011, an intensivist-led model was adopted in a 16-bed NACU unit, including daytime coverage by a dedicated intensivist. Data were obtained from all patients admitted 1 year prior to and 2 years after this intervention. Primary outcomes were LOS and hospital costs. Safety outcomes included mortality and readmissions. Descriptive and analytic statistics were calculated. Individual and total patient costs were calculated based on per-day NACU and ward cost estimates and significance measured using bootstrapping. A total of 2931 patients were included over the study period. Patients were on average 59.5 years and 53% male. The most common reasons for admission were central nervous system (CNS) tumor (27.6%), ischemic stroke (27%), and subarachnoid hemorrhage (11%). Following the introduction of an intensivist, there was a significant reduction in NACU and hospital LOS, by 1 day and 3 days, respectively. There were no differences in readmissions or mortality. Adding an intensivist produced an individual cost savings of US$963 in NACU and US$2687 per patient total hospital stay. An intensivist-led model of intermediate-level neurointensive care staffed by intensivists is safe, decreases LOS, and produces cost savings in a system increasingly strained to provide quality
Christie, A.; Robertson, I.
Aim: To supplement previous surveys analysing provision of interventional radiology (IR), in-hours (IH) and out-of-hours (OOH), by specifically surveying the level of nursing support provided. Materials and methods: A web-based questionnaire was distributed to all British Society of Interventional Radiology (BSIR) members. This addressed several aspects of radiology nursing support for IR procedures, both IH and OOH. Results: Sixty percent of respondents indicated that they have a formal OOH service. Of these, all have a dedicated nursing rota, with the vast majority operating with one nurse. IH, 77% of respondents always have a scrubbed nurse assistant, but this reduces to 40% OOH. IH, 4% never have a scrubbed radiology nurse assistant, which rises to 25% OOH. IH, 75% of respondents always have a radiology nurse dedicated to patient monitoring, but this reduces to 20% OOH. IH, 3% never have a radiology nurse dedicated to patient monitoring, which rises to 42% OOH. Conclusion: A significant disparity exists in the level of IR nursing support between IH and OOH. The majority of sites provide a single nurse with ad hoc additional support. This is potentially putting patients at increased risk. Radiology nurses are integral to the safe and sustainable provision of IR OOH services and a greater focus is required to ensure adequate and safe staffing levels for 24/7 IR services. - Highlights: • A significant disparity exists between the level of nursing support provided in-hours and OOH. • This applies to both the availability of a nurse to scrub and to monitor the patient. • Having a dedicated 24/7 nursing rota is mandatory to providing a deliverable OOH service.
Lorenzo, N. de; Borsani, R.C.
Integrated Logistics Support (ILS) is the managerial organisation that co-ordinates the activities of many disciplines to develop the supporting resources (training, staffing, designing aids, equipment removal routes, etc) required by technologically complex systems. The application of an ILS methodology in defence projects is described in several places, but it is infrequently illustrated for other areas; therefore the present paper deals with applying this approach to research reactors under design or already in operation. Although better results are obtained when applied since the very beginning of a project, it can be applied successfully in facilities already in operation to improve their capability in a cost-effective way. In applying this methodology, the key objectives shall be previously identified in order to tailor the whole approach. Generally in high power multipurpose reactors, obtaining maximum profit at the lowest possible cost without reducing the safety levels are key issues, while in others the goal is to minimise drawbacks like spurious shutdowns, low quality experimental results or even to reduce staff dose to ALARA values. These items need to be quantified for establishing a system status base line in order to trace the process evolution. Thereafter, specific logistics analyses should be performed in the different areas composing the system. RAMS (Reliability, Availability, Maintainability and Supportability), Manning, Training Needs, Supplying Needs are some examples of these special logistic assessments. The following paragraphs summarise the different areas, encompassed by this ILS methodology. Plant design is influenced focussing the designers? attention on the objectives already identified. Careful design reviews are performed only in an early design stage, being useless a later application. In this paper is presented a methodology including appropriate tools for ensuring the designers abide to ILS issues and key objectives through the
Cramer, Ryan; Loosier, Penny S; Krasner, Andee; Kawatu, Jennifer
Health departments (HDs) cite state laws as barriers to billing third parties for sexually transmitted disease (STD) services, but the association between legal/policy barriers and third party HD billing has not been examined. This study investigates the relationship between laws that may limit HDs' ability to bill, clinic perceptions of billing barriers, and billing practices. Two surveys (1) clinic managers [N=246], 2) STD program managers [N=63]) conducted via a multi-regional needs assessment of federally funded HD clinics' capacity to bill for STD services, billing/reimbursement practices, and perceived barriers were combined with an analysis of state laws regarding third party billing for STD services. Statistical analyses examined relationships between laws that may limit HDs' ability to bill, clinic perceptions, and billing practices. Clinic managers reported clinics were less likely to bill Medicaid and other third parties in jurisdictions with a state law limiting their ability to bill compared to respondents who billed neither or one payer (OR=0.31, CI=0.10,0.97) and cited practical concerns as a primary barrier to billing (OR=2.83 CI=1.50,5.37). STD program managers' reports that staff believed STD services should be free (OR=0.34, CI=0.13, 0.90) was associated with not billing (not sure versus no resistance to billing); confidentiality concerns was not a reported barrier to billing among either sample. Practical concerns and clinic staff beliefs that STD services should be free emerged as possible barriers to billing, and laws less so. Attempts to initiate HD billing for STD services may benefit from staff education as well as addressing perceived legal barriers and staff concerns.
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.
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.
Masiga, Clet Wandui
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.
Madsen, Vibeke Thøis
Purpose – The purpose of this paper is to explore the challenges associated with introducing internal social media (ISM) into organizations in order to help them reap the benefits of coworker communication on ISM. Design/methodology/approach – The paper is based on an exploratory study in ten...... facilitators and sense-givers. Keywords Organizational communication, Internal communication, Coworker, Internal social media Paper type Research paper...
Karen Grierson; Andrew Allen
Introducing the new business demography statisticsA new National Statistics series waspublished on 28 November 2008 bythe Offi ce for National Statistics (ONS),providing data on business births,deaths and survival rates, called BusinessDemography: Enterprise Births andDeaths. The Department for Business,Enterprise & Regulatory Reform (BERR)also published its series Business start upsand closures: VAT registrations andde-registrations in 2007 on the sameday. The year 2008 is the final update t...
Alton, Theresa; Arndt, Channing; Davies, Rob; Hartley, Faaiqa; Makrelov, Konstantin; Thurlow, James; Ubogu, Dumebi
Highlights: • South Africa is considering introducing a carbon tax to reduce greenhouse gas emissions. • A phased-in tax of US$30 per ton can achieve national emissions reductions targets set for 2025. • Ignoring all potential benefits, the tax reduces national welfare by about 1.2 percent in 2025. • Border carbon adjustments reduce welfare losses while maintaining emissions reductions. • The mode for recycling carbon tax revenues strongly influences distributional outcomes. - Abstract: South Africa is considering introducing a carbon tax to reduce greenhouse gas emissions. Following a discussion of the motivations for considering a carbon tax, we evaluate potential impacts using a dynamic economywide model linked to an energy sector model including a detailed evaluation of border carbon adjustments. Results indicate that a phased-in carbon tax of US$30 per ton of CO 2 can achieve national emissions reductions targets set for 2025. Relative to a baseline with free disposal of CO 2 , constant world prices and no change in trading partner behavior, the preferred tax scenario reduces national welfare and employment by about 1.2 and 0.6 percent, respectively. However, if trading partners unilaterally impose a carbon consumption tax on South African exports, then welfare/employment losses exceed those from a domestic carbon tax. South Africa can lessen welfare/employment losses by introducing its own border carbon adjustments. The mode for recycling carbon tax revenues strongly influences distributional outcomes, with tradeoffs between growth and equity
Ping, Liang; Xie, Zong-Qiang
Eucalyptus is well-known as an effective reforestation tree species, due to its fast growth and high adaptability to various environments. However, the introduction of Eucalyptus could have negative effects on the local environment, e. g., inducing soil degradation, decline of groundwater level, and decrease of biodiversity, and especially, there still have controversies on the effects of introduced Eucalyptus on the understory biodiversity of indigenous plant communities and related mechanisms. Based on a detailed analysis of the literatures at home and abroad, it was considered that the indigenous plant species in the majority of introduced Eucalyptus plantations were lesser than those in natural forests and indigenous species plantations but more than those in other exotic species plantations, mainly due to the unique eco-physiological characteristics of Eucalyptus and the irrational plantation design and harvesting techniques, among which, anthropogenic factors played leading roles. Be that as it may, the negative effects of introducing Eucalyptus on local plant biodiversity could be minimized via more rigorous scientific plantation design and management based on local plant community characteristics. To mitigate the negative effects of Eucalyptus introduction, the native trees and understory vegetation in plantations should be kept intact during reforestation with Eucalyptus to favor the normal development of plant community and regeneration. At the same time, human disturbance should be minimized to facilitate the natural regeneration of native species.
James C. Russell
Full Text Available The diversity of introduced mammals and their introduction history varies greatly across the Western Indian Ocean (WIO islands, from ancient introductions in the past millennia on islands off the East coast of Africa where extant terrestrial native mammal communities exist, to very recent invasions in the past decades on islands in the Mascarene archipelago. We compile the distribution of 16 introduced mammal taxa on 28 island groups comprising almost 2000 islands. Through an exhaustive literature review and expert consultation process we recorded all mammal eradications, and species recoveries which could be attributed to introduced mammal eradication or control. All island groups have been invaded by mammals, and invasive cats and rats in particular are ubiquitous, but cultural contingency has also led to regional invasions by other mammals such as lemurs, civets and tenrecs. Mammal eradications have been attempted on 45 islands in the WIO, the majority in the Seychelles and Mauritius, and where successful have resulted in spectacular recovery of species and ecosystems. Invasive mammalian predator eradication or control in association with habitat management has led to improved conservation prospects for at least 24 species, and IUCN red-list down-listing of eight species, in the Mascarene Islands. Future island conservation prioritisation in the region will need to take account of global climate change and predicted sea-level rises and coastal inundation. Greater investment and prioritisation in island conservation in the region is warranted, given its high biodiversity values and the extent of invasions.
Kong, F; Cook, D; Paterson, D L; Whitby, M; Clements, A C A
Staffing deficits and workload have may a bearing on transmission of meticillin-resistant Staphylococcus aureus (MRSA) within intensive care units (ICUs). New MRSA acquistions may provide a clearer picture of the relationship between MRSA acquisition and staffing in the ICU setting. To determine whether staffing and bed occupancy rates had an immediate or delayed impact on the number of new MRSA acquisitions in a well-staffed ICU, and whether these variables could be used as predictors of future MRSA acquisitions. Data on new MRSA acquisitions in the ICU of a 796-bed metropolitan Australian hospital between January 2003 and December 2006 were used to build a model to predict the probabilility of actual new MRSA acquisitions in 2007. Cross validation was performed using receiver operator characteristic analysis. Sixty-one new MRSA acquisitions (21 infections, 40 colonizations) were identified in 51 individual weeks over the study period. The number of non-permanent staffing hours was relatively small. The area under the curve in the cross-validation analysis was 0.46 [95% CI 0.25-0.67] which suggests that the model, built on data from 2003-2006, was not able to predict weeks in which new MRSA acquisitions occurred in 2007. The risks posed by high workloads may have been mitigated by good compliance with infection control measures, nurse training and adequate staffing ratios in the ICU. Consequently, staffing policies and the infection control practices in the ICU do not need to be modified to address the rate of new MRSA acquisitions. Copyright Â© 2011 The Healthcare Infection Society. All rights reserved.
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…
This article provides information related to organizing a grassroots lobbying effort within a state association and working for the passage of a bill. This information resulted from experience working for the successful passage of the pay parity bill for nationally certified school psychologists in West Virginia during the 2008 legislative…
... From the Federal Register Online via the Government Publishing Office FEDERAL COMMUNICATIONS COMMISSION 47 CFR Part 64 Empowering Consumers To Prevent and Detect Billing for Unauthorized Charges... placement of unauthorized charges on their telephone bills, an unlawful and fraudulent practice commonly...
... 42 Public Health 3 2010-10-01 2010-10-01 false Prohibitions on the sale or transfer of billing... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Requirements for Establishing and Maintaining Medicare Billing Privileges § 424.550 Prohibitions on the sale or transfer of...
... Financial Matters: Assessments, Billing, and Collections § 171.525 How do I pay my bill? (a) You can pay... your payment during normal business hours; (2) Depositing your payment in an authorized drop box, if available, at the local office of the irrigation facility; or (3) Mailing your payment to the address...
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...
Hachfeld, Gary A.; Mahnken, Curtis L.; Holcomb, C. Robert; Bau, Dave B.; Berning, Elizabeth R.
The Agricultural Act of 2014 (Farm Bill) is a critical part of the economic safety net for U.S. crop and dairy producers through 2018. Passage of the Farm Bill marked a change in philosophy regarding producer and landowner decisions about program choices. The shift was away from nearly 20 years of fixed annual payments based on historical…
... 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
.... 98-170; FCC 12-42] Empowering Consumers to Prevent and Detect Billing for Unauthorized Charges (``Cramming''); Consumer Information and Disclosure; Truth-in-Billing Format AGENCY: Federal Communications... Commercial Mobile Radio Service (CMRS) and Voice over Internet Protocol (VoIP) service. The Commission seeks...
... 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...
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Basis of billing for overtime and holiday services. 307.6 Section 307.6 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE... AND VOLUNTARY INSPECTION AND CERTIFICATION FACILITIES FOR INSPECTION § 307.6 Basis of billing for...
Andrews, Donald S.
College football became a popular spectator sport after World War II with the return of veterans to college. Financial help was provided by the G. I. Bill, which led to older, more experienced students playing football. This article explores how the G. I. Bill helped make college football the popular sport it is today. (DF)
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.
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)
Specific provisions in the bill that may have effect on the provision of library and information services to disabled students in Kenya are identified and interpretations given where possible. The paper concludes that the bill is likely to open up educational opportunities for the visual handicapped by lessening previous existing ...
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.
... 0938-AP87 Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing... Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2011.'' DATES: Effective... illustrate the skilled nursing facility (SNF) prospective payment system (PPS) payment rate computations for...
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
The bill shape of foliage-gleaning birds in temperate and tropical new world forests is dissimilar. Tropical species have longer and narrower bills than their temperate zone counterparts. In addition, their bills are longer for a given body size. These differences cannot be readily explained as phylogenetic artifacts. I suggest that the distinct bill morphology of the two assemblages is determined by the type of insects that comprise the largest size classes of potential prey. These large insects are particularly important since they generally comprise the bulk of the nestling diet for insectivorous birds. In tropical forests Orthoptera are probably the most abundant large soft-bodied arthropods; they form an important resource for foliage-gleaning birds during the breeding (rainy) seasons. Most temperate zone foliage-gleaning birds rely almost entirely upon caterpillars when breeding. Long, narrow bills are thought to close more rapidly than shorter, broader bills. These long, "fast" bills may be required to efficiently harvest active Orthoptera. Migrant warblers may face morphological constraints from breeding successfully in lowland tropical forests. While the short-billed temperate zone birds can survive the tropical dry season by foraging on small arthropods, they may be inefficient at handling large Orthoptera to feed to nestlings.
Full Text Available Although it is widely held that campaign contributions influence support for legislation, the impact of contributions is unclear. Despite lack of a tobacco growing or manufacturing constituency, many members of Congress (MOC in the Southwest support the pro-tobacco Traditional Cigar Manufacturing and Small Business Jobs Preservation Act of 2015 (HR 662/S 441, aka the "Cigar Bill". The association between campaign contributions from tobacco companies (2006-16 with cosponsor for the Cigar Bill were examined. There was a highly significant correlation with 92% of Southwest MOC who cosponsored the Cigar Bill having received campaign contributions. In contrast, 31% of those who did not cosponsoring the bill had received tobacco company campaign contributions (p<0.001 by Fisher's Exact Test. These data demonstrates a highly significant correlation between campaign contributions and legislative support for the "Cigar Bill".
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. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background The Ministry of Health (MOH in Zambia is currently operating with fewer than half of the health workers required to deliver basic health services. The MOH has developed a human resources for health (HRH strategic plan to address the crisis through improved training, hiring, and retention. However, the projected success of each strategy or combination of strategies is unclear. Methods We developed a model to forecast the size of the public sector health workforce in Zambia over the next ten years to identify a combination of interventions that would expand the workforce to meet staffing targets. The key forecasting variables are training enrolment, graduation rates, public sector entry rates for graduates, and attrition of workforce staff. We model, using Excel (Office, Microsoft; 2007, the effects of changes in these variables on the projected number of doctors, clinical officers, nurses and midwives in the public sector workforce in 2018. Results With no changes to current training, hiring, and attrition conditions, the total number of doctors, clinical officers, nurses, and midwives will increase from 44% to 59% of the minimum necessary staff by 2018. No combination of changes in staff retention, graduation rates, and public sector entry rates of graduates by 2010, without including training expansion, is sufficient to meet staffing targets by 2018 for any cadre except midwives. Training enrolment needs to increase by a factor of between three and thirteen for doctors, three and four for clinical officers, two and three for nurses, and one and two for midwives by 2010 to reach staffing targets by 2018. Necessary enrolment increases can be held to a minimum if the rates of retention, graduation, and public sector entry increase to 100% by 2010, but will need to increase if these rates remain at 2008 levels. Conclusions Meeting the minimum need for health workers in Zambia this decade will require an increase in health