Sample records for total hospital solid
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Developing a master plan for hospital solid waste management: A case study
International Nuclear Information System (INIS)
Karamouz, Mohammad; Zahraie, Banafsheh; Kerachian, Reza; Jaafarzadeh, Nemat; Mahjouri, Najmeh
2007-01-01
Disposal of about 1750 tons of solid wastes per day is the result of a rapid population growth in the province of Khuzestan in the south west of Iran. Most of these wastes, especially hospital solid wastes which have contributed to the pollution of the environment in the study area, are not properly managed considering environmental standards and regulations. In this paper, the framework of a master plan for managing hospital solid wastes is proposed considering different criteria which are usually used for evaluating the pollution of hospital solid waste loads. The effectiveness of the management schemes is also evaluated. In order to rank the hospitals and determine the share of each hospital in the total hospital solid waste pollution load, a multiple criteria decision making technique, namely analytical hierarchy process (AHP), is used. A set of projects are proposed for solid waste pollution control and reduction in the proposed framework. It is partially applied for hospital solid waste management in the province of Khuzestan, Iran. The results have shown that the hospitals located near the capital city of the province, Ahvaz, produce more than 43% of the total hospital solid waste pollution load of the province. The results have also shown the importance of improving management techniques rather than building new facilities. The proposed methodology is used to formulate a master plan for hospital solid waste management
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Management, treatment and final disposal of solid hazardous hospital wastes
International Nuclear Information System (INIS)
Sebiani Serrano, T.
2000-01-01
Medical Waste is characterized by its high risk to human health and the environment. The main risk is biological, due to the large amount of biologically contaminated materials present in such waste. However, this does not mean that the chemical and radioactive wastes are less harmful just because they represent a smaller part of the total waste. Hazardous wastes from hospitals can be divided in 3 main categories: Solid Hazardous Hospital Wastes (S.H.H.W.), Liquid Hazardous Hospital Wastes (L.H.H.W.) and Gaseous Hazardous Hospital Wastes (G.H.H.W.) Most gaseous and liquid hazardous wastes are discharged to the environment without treatment. Since this inappropriate disposal practice, however, is not visible to society, there is no societal reaction to such problem. On the contrary, hazardous solid wastes (S.H.H.W.) are visible to society and create worries in the population. As a result, social and political pressures arise, asking for solutions to the disposal problems of such wastes. In response to such pressures and legislation approved by Costa Rica on waste handling and disposal, the Caja Costarricense de Seguro Social developed a plan for the handling, treatment, and disposal of hazardous solid wastes at the hospitals and clinics of its system. The objective of the program is to reduce the risk to society of such wastes. In this thesis a cost-effectiveness analysis was conducted to determine the minimum cost at which it is possible to reach a maximum level of reduction in hazardous wastes, transferring to the environment the least possible volume of solid hazardous wastes, and therefore, reducing risk to a minimum. It was found that at the National Children's Hospital the internal handling of hazard solid wastes is conducted with a high level of effectiveness. However, once out of the hospital area, the handling is not effective, because hazardous and common wastes are all mixed together creating a larger amount of S.H.H.W. and reducing the final efficiency
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Hospital-onset Clostridium difficile infection among solid organ transplant recipients.
Donnelly, J P; Wang, H E; Locke, J E; Mannon, R B; Safford, M M; Baddley, J W
2015-11-01
Clostridium difficile infection (CDI) is a considerable health issue in the United States and represents the most common healthcare-associated infection. Solid organ transplant recipients are at increased risk of CDI, which can affect both graft and patient survival. However, little is known about the impact of CDI on health services utilization posttransplantation. We examined hospital-onset CDI from 2012 to 2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center-affiliated hospitals in the United States. Infection was five times more common among transplant recipients than among general medicine inpatients (209 vs 40 per 10 000 discharges), and factors associated with CDI among transplant recipients included transplant type, risk of mortality, comorbidities, and inpatient complications. Institutional risk-standardized CDI varied more than 3-fold across high-volume hospitals (infection ratio 0.54-1.82, median 1.04, interquartile range 0.78-1.28). CDI was associated with increased 30-day readmission, transplant organ complications, cytomegalovirus infection, inpatient costs, and lengths of stay. Total observed inpatient days and direct costs for those with CDI were substantially higher than risk-standardized expected values (40 094 vs 22 843 days, costs $198 728 368 vs $154 020 528). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
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SEM Model Medical Solid Waste Hospital Management In Medan City
Simarmata, Verawaty; Pandia, Setiaty; Mawengkang, Herman
2018-01-01
In daily activities, hospitals, as one of the important health care unit, generate both medical solid waste and non-medical solid waste. The occurrence of medical solid waste could be from the results of treatment activities, such as, in the treatment room for a hospital inpatient, general clinic, a dental clinic, a mother and child clinic, laboratories and pharmacies. Most of the medical solid waste contains infectious and hazardous materials. Therefore it should be managed properly, otherwise it could be a source of new infectious for the community around the hospital as well as for health workers themselves. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. One of the efforts that need to be done in improving the quality of the environment is to undertake waste management activities, because with proper waste management is the most important in order to achieve an optimal degree of human health. Health development in Indonesian aims to achieve a future in which the Indonesian people live in a healthy environment, its people behave clean and healthy, able to reach quality health services, fair and equitable, so as to have optimal health status, health development paradigm anchored to the healthy. The healthy condition of the individual and society can be influenced by the environment. Poor environmental quality is a cause of various health problems. Efforts surveillance of various environmental factors need to be applied in accordance with the principles of sanitation focuses on environmental cleanliness. This paper proposes a model for managing the medical solid waste in hospitals in Medan city, in order to create healthy environment around hospitals.
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Al-Khatib, Issam A; Abu Fkhidah, Ismail; Khatib, Jumana I; Kontogianni, Stamatia
2016-03-01
Forecasting of hospital solid waste generation is a critical challenge for future planning. The composition and generation rate of hospital solid waste in hospital units was the field where the proposed methodology of the present article was applied in order to validate the results and secure the outcomes of the management plan in national hospitals. A set of three multiple-variable regression models has been derived for estimating the daily total hospital waste, general hospital waste, and total hazardous waste as a function of number of inpatients, number of total patients, and number of beds. The application of several key indicators and validation procedures indicates the high significance and reliability of the developed models in predicting the hospital solid waste of any hospital. Methodology data were drawn from existent scientific literature. Also, useful raw data were retrieved from international organisations and the investigated hospitals' personnel. The primal generation outcomes are compared with other local hospitals and also with hospitals from other countries. The main outcome, which is the developed model results, are presented and analysed thoroughly. The goal is this model to act as leverage in the discussions among governmental authorities on the implementation of a national plan for safe hospital waste management in Palestine. © The Author(s) 2016.
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Total quality management in the hospital setting.
Ernst, D F
1994-01-01
With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.
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Alternatives of Treatment and Final Disposition of the Solid Hospital residuals
International Nuclear Information System (INIS)
Meza Monge, K.
1998-01-01
The current handling, treatment and final disposition of the hospital solid waste in Costa Rica are considered inadequate or at least insufficient. This situation represents a serious danger for the population's health and the environment, because they are exposed to infectious agents, toxic substances and even radioactive products that are generated among the residuals of the centers of health. This work, alternatives propose for the treatment and adequate final disposition of the solid waste produced in the hospitals of the country. They take into consideration the characteristics that present these residuals, the advantages and disadvantages of each one of the existent techniques and the technical and economic possibilities of the country. For this purpose, in first instance, a revision about the properties, the quality and the quantity of the solid waste produced by the national hospital centers was carried out. Also, a diagnostic of the current situation of the treatment and final disposition of these residuals in some of the most important hospitals of the country, as well as of the possibilities of physical space with that they count on was carried out. Then, the existent different treatment techniques and final disposition for the solid waste that comes from the centers of health are described, as well as their advantages and disadvantages and a comparative analysis of the same ones is carried out. The objective is completed, since alternatives of treatment and final disposition that are considered appropriate for this type of residuals are planned. Nevertheless, in the future, more detailed investigations and studies of feasibility, with the purpose of developing handling programs and elimination of the solid waste for each one of the hospital centers in Costa Rica should be carried out. (Author) [es
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LISREL Model Medical Solid Infectious Waste Hazardous Hospital Management In Medan City
Simarmata, Verawaty; Siahaan, Ungkap; Pandia, Setiaty; Mawengkang, Herman
2018-01-01
Hazardous and toxic waste resulting from activities at most hospitals contain various elements of medical solid waste ranging from heavy metals that have the nature of accumulative toxic which are harmful to human health. Medical waste in the form of gas, liquid or solid generally include the category or the nature of the hazard and toxicity waste. The operational in activities of the hospital aims to improve the health and well-being, but it also produces waste as an environmental pollutant waters, soil and gas. From the description of the background of the above in mind that the management of solid waste pollution control medical hospital, is one of the fundamental problems in the city of Medan and application supervision is the main business licensing and control alternatives in accordance with applicable regulations.
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Christensen, Victoria G.; Kieta, Kristen A.
2014-01-01
This study examined conservation easements and their effectiveness at reducing phosphorus and solids transport to streams. The U.S. Geological Survey cooperated with the Minnesota Board of Water and Soil Resources and worked collaboratively with the Hawk Creek Watershed Project to examine the West Fork Beaver Creek Basin in Renville County, which has the largest number of Reinvest In Minnesota land retirement contracts in the State (as of 2013). Among all conservation easement programs, a total of 24,218 acres of agricultural land were retired throughout Renville County, and 2,718 acres were retired in the West Fork Beaver Creek Basin from 1987 through 2012. Total land retirement increased steadily from 1987 until 2000. In 2000, land retirement increased sharply because of the Minnesota River Conservation Reserve Enhancement Program, then leveled off when the program ended in 2002. Streamflow data were collected during 1999 through 2011, and total phosphorus and total suspended solids data were collected during 1999 through 2012. During this period, the highest peak streamflow of 1,320 cubic feet per second was in March 2010. Total phosphorus and total suspended solids are constituents that tend to increase with increases in streamflow. Annual flow-weighted mean total-phosphorus concentrations ranged from 0.140 to 0.759 milligrams per liter, and annual flow-weighted mean total suspended solids concentrations ranged from 21.3 to 217 milligrams per liter. Annual flow-weighted mean total phosphorus and total suspended solids concentrations decreased steadily during the first 4 years of water-quality sample collection. A downward trend in flow-weighted mean total-phosphorus concentrations was significant from 1999 through 2008; however, flow-weighted total-phosphorus concentrations increased substantially in 2009, and the total phosphorus trend was no longer significant. The high annual flow-weighted mean concentrations for total phosphorus and total suspended solids
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Medalie, Laura
2014-01-01
Annual and daily concentrations and fluxes of total and dissolved phosphorus, total nitrogen, chloride, and total suspended solids were estimated for 18 monitored tributaries to Lake Champlain by using the Weighted Regressions on Time, Discharge, and Seasons regression model. Estimates were made for 21 or 23 years, depending on data availability, for the purpose of providing timely and accessible summary reports as stipulated in the 2010 update to the Lake Champlain “Opportunities for Action” management plan. Estimates of concentration and flux were provided for each tributary based on (1) observed daily discharges and (2) a flow-normalizing procedure, which removed the random fluctuations of climate-related variability. The flux bias statistic, an indicator of the ability of the Weighted Regressions on Time, Discharge, and Season regression models to provide accurate representations of flux, showed acceptable bias (less than ±10 percent) for 68 out of 72 models for total and dissolved phosphorus, total nitrogen, and chloride. Six out of 18 models for total suspended solids had moderate bias (between 10 and 30 percent), an expected result given the frequently nonlinear relation between total suspended solids and discharge. One model for total suspended solids with a very high bias was influenced by a single extreme value; however, removal of that value, although reducing the bias substantially, had little effect on annual fluxes.
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Calculations of Total and Differential Solid Angles for a Proton Recoil Solid State Detector
Energy Technology Data Exchange (ETDEWEB)
Konijn, J; Lauber, A; Tollander, B
1963-08-15
The solid angles have been computed for a proton recoil counter consisting of a circular hydrogenous foil viewed by an isotropic neutron point source at different distances from the target foil. Tables are given for the total subtended solid angle as well as the differential energy distribution function of the proton recoil spectrum. The influence of finite foil thickness has also been studied.
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Assessing total and volatile solids in municipal solid waste samples.
Peces, M; Astals, S; Mata-Alvarez, J
2014-01-01
Municipal solid waste is broadly generated in everyday activities and its treatment is a global challenge. Total solids (TS) and volatile solids (VS) are typical control parameters measured in biological treatments. In this study, the TS and VS were determined using the standard methods, as well as introducing some variants: (i) the drying temperature for the TS assays was 105°C, 70°C and 50°C and (ii) the VS were determined using different heating ramps from room tempature to 550°C. TS could be determined at either 105°C or 70°C, but oven residence time was tripled at 70°C, increasing from 48 to 144 h. The VS could be determined by smouldering the sample (where the sample is burnt without a flame), which avoids the release of fumes and odours in the laboratory. However, smouldering can generate undesired pyrolysis products as a consequence of carbonization, which leads to VS being underestimated. Carbonization can be avoided using slow heating ramps to prevent the oxygen limitation. Furthermore, crushing the sample cores decreased the time to reach constant weight and decreased the potential to underestimate VS.
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An inexpensive optical sensor system for monitoring total suspended solids in water
International Nuclear Information System (INIS)
Sami Gumaan Daraigan; Mohd Zubir Matjafri; Khiruddin Abdullah; Azlan Abdul Aziz; Abdul Aziz Tajuddin; Mohd Firdaus Othman
2005-01-01
The objectives of this work are to design and develop an optical transsmissometer sensor for measuring total suspended solids TSS concentrations in water samples. The proposed optical sensor has the advantages of being relatively inexpensive, and easy to make and operate. An optical algorithm has been developed and used for the measurement of total suspended solids concentrations. The developed optical sensor components include light emitting diodes LEDs that are used for measuring transmitted light. The concentrations of total suspended solids TSS are determined from transmitted light through the water samples. The transmitted light is measured in terms of the output voltage of the photodetector of the sensor system. The readings are measured using a digital multimeter. The results indicate that the level of the photocurrent is linearly proportional to the total suspended solids concentration. The proposed algorithm produces a high correlation coefficient and low root mean square error. (Author)
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Total-dielectric-function approach to electron and phonon response in solids
International Nuclear Information System (INIS)
Penn, D.R.; Lewis, S.P.; Cohen, M.L.
1995-01-01
The interaction between two test charges, the response of a solid to an external field, and the normal modes of the solid can be determined from a total dielectric function that includes both electronic and lattice polarizabilities as well as local-field effects. In this paper we examine the relationship between superconductivity and the stability of a solid and derive sum rules for the electronic part of the dielectric function. It is also shown that there are negative eigenvalues of the total static dielectric function, implying the possibility of an attractive interaction between test charges. An attractive interaction is required for superconductivity
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Organics and Suspended Solids Removal from Hospital
Directory of Open Access Journals (Sweden)
Fakhri Y. Hmood
2013-05-01
Full Text Available The Sequencing Batch Reactor (SBR method is used for treating samples of waste water taken from hospitals in Mosul. Many run periods are used (6-24 hours for 6 months. It is found that the organics and suspended solids removal increase with increasing the period of run, it is in the range ( 96-82 % and ( 100-95 % respectively, while the pH values are nearly neutral (7.05 to 7.5. BOD5 and SS concentrations of the effluent are within the limits of Iraqi standards, 40:30 mg/l respectively. Hence, SBR method could be used for treating hospitals, small factories and some residential sectors waste waters.
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Primary total hip replacement versus hip resurfacing - hospital considerations.
Ward, William G; Carter, Christina J; Barone, Marisa; Jinnah, Riyaz
2011-01-01
Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation. All primary hip arthroplasties undertaken over three fiscal years (2008 to 2010) were reviewed, utilizing only hospital business office data and medical records data that had been previously extracted prior for billing purposes. Analysis confirmed differing demographics for two hip arthroplasty populations, with the resurfacing patients (compared to the conventional total hip arthroplasty population) consisting of younger patients (mean age, 50 vs. 61 years), who were more often male (75% vs. 45%), were more likely to have osteoarthritis as their primary diagnosis (83 vs. 67%) and were more often covered by managed care or commercial insurance (83 vs. 34%). They also had shorter hospital stays (mean length of stay, 2.3 vs. 4.1 days) and consequently provided a more favorable financial revenue stream to the hospital on a per patient basis. Several trends appeared during the study periods. There was a steady increase in all procedures in all groups except for the resurfacings, which decreased 26% in males and 53% in females between 2009 and 2010. Differences were observed in the demographics of patients presenting for resurfacing, compared to those presenting for conventional total hip arthroplasty. In addition to the revenue stream considerations, institutions undertaking a resurfacing program must commit the resources and planning in order to rehabilitate these patients more expeditiously than is usually required with conventional hip arthroplasty patients.
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Controlling costs without compromising quality: paying hospitals for total knee replacement.
Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J
2010-10-01
Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P costs ($12,773-$11,512; P costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.
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Cost-identification analysis of total laryngectomy: an itemized approach to hospital costs.
Dedhia, Raj C; Smith, Kenneth J; Weissfeld, Joel L; Saul, Melissa I; Lee, Steve C; Myers, Eugene N; Johnson, Jonas T
2011-02-01
To understand the contribution of intraoperative and postoperative hospital costs to total hospital costs, examine the costs associated with specific hospital services in the postoperative period, and recognize the impact of patient factors on hospital costs. Case series with chart review. Large tertiary care teaching hospital system. Using the Pittsburgh Head and Neck Organ-Specific Database, 119 patients were identified as having total laryngectomy with bilateral selective neck dissection and primary closure from 1999 to 2009. Cost data were obtained for 112 patients. Costs include fixed and variable costs, adjusted to 2010 US dollars using the Consumer Price Index. Mean total hospital costs were $29,563 (range, $10,915 to $120,345). Operating room costs averaged 24% of total hospital costs, whereas room charges, respiratory therapy, laboratory, pharmacy, and radiology accounted for 38%, 14%, 8%, 7%, and 3%, respectively. Median length of stay was 9 days (range, 6-43), and median Charlson comorbidity index score was 8 (2-16). Patients with ≥1 day in the intensive care unit had significantly higher hospital costs ($46,831 vs $24,601, P cost differences with stratification based on previous radiation therapy ($27,598 vs $29,915 with no prior radiation, P = .62) or hospital readmission within 30 days ($29,483 vs $29,609 without readmission, P = .97). This is one of few studies in surgery and the first in otolaryngology to analyze hospital costs for a relatively standardized procedure. Further work will include cost analysis from multiple centers with investigation of global cost drivers.
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Application of life cycle assessment for hospital solid waste management: A case study.
Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz
2016-10-01
This study was meant to determine environmental aspects of hospital waste management scenarios using a life cycle analysis approach. The survey for this study was conducted at the largest hospital in a major city of Pakistan. The hospital was thoroughly analyzed from November 2014 to January 2015 to quantify its wastes by category. The functional unit of the study was selected as 1 tonne of disposable solid hospital waste. System boundaries included transportation of hospital solid waste and its treatment and disposal by landfilling, incineration, composting, and material recycling methods. These methods were evaluated based on their greenhouse gas emissions. Landfilling and incineration turned out to be the worst final disposal alternatives, whereas composting and material recovery displayed savings in emissions. An integrated system (composting, incineration, and material recycling) was found as the best solution among the evaluated scenarios. This study can be used by policymakers for the formulation of an integrated hospital waste management plan. This study deals with environmental aspects of hospital waste management scenarios. It is an increasing area of concern in many developing and resource-constrained countries of the world. The life cycle analysis (LCA) approach is a useful tool for estimation of greenhouse gas emissions from different waste management activities. There is a shortage of information in existing literature regarding LCA of hospital wastes. To the best knowledge of the authors this work is the first attempt at quantifying the environmental footprint of hospital waste in Pakistan.
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Determination of Total Solids and Ash in Algal Biomass: Laboratory Analytical Procedure (LAP)
Energy Technology Data Exchange (ETDEWEB)
Van Wychen, Stefanie; Laurens, Lieve M. L.
2016-01-13
This procedure describes the methods used to determine the amount of moisture or total solids present in a freeze-dried algal biomass sample, as well as the ash content. A traditional convection oven drying procedure is covered for total solids content, and a dry oxidation method at 575 deg. C is covered for ash content.
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A solid-phase-radioimmunoassay for total serum thyroxine
International Nuclear Information System (INIS)
Moedder, G.; Sokolowski, G.
1978-01-01
A new solid phase radioimmunoassay for total serum thyroxine was evaluated over a longer time under clinical routine conditions and compared with an established test system. The results show up that the T 4 values are precise, reliable and reproducible, the is incomplicate to handle and well suitable for semiautomatic pipetting systems. (orig.) 891 MG [de
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Paulson, Anthony J.; Conn, Kathleen E.; DeWild, John F.
2013-01-01
Previous investigations examined sources and sinks of mercury to Sinclair Inlet based on historic and new data. This included an evaluation of mercury concentrations from various sources and mercury loadings from industrial discharges and groundwater flowing from the Bremerton naval complex to Sinclair Inlet. This report provides new data from four potential sources of mercury to Sinclair Inlet: (1) filtered and particulate total mercury concentrations of creek water during the wet season, (2) filtered and particulate total mercury releases from the Navy steam plant following changes in the water softening process and discharge operations, (3) release of mercury from soils to groundwater in two landfill areas at the Bremerton naval complex, and (4) total mercury concentrations of solids in dry dock sumps that were not affected by bias from sequential sampling. The previous estimate of the loading of filtered total mercury from Sinclair Inlet creeks was based solely on dry season samples. Concentrations of filtered total mercury in creek samples collected during wet weather were significantly higher than dry weather concentrations, which increased the estimated loading of filtered total mercury from creek basins from 27.1 to 78.1 grams per year. Changes in the concentrations and loading of filtered and particulate total mercury in the effluent of the steam plant were investigated after the water softening process was changed from ion-exchange to reverse osmosis and the discharge of stack blow-down wash began to be diverted to the municipal water-treatment plant. These changes reduced the concentrations of filtered and particulate total mercury from the steam plant of the Bremerton naval complex, which resulted in reduced loadings of filtered total mercury from 5.9 to 0.15 grams per year. Previous investigations identified three fill areas on the Bremerton naval complex, of which the western fill area is thought to be the largest source of mercury on the base
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Solid waste management in the hospitality industry: a review.
Pirani, Sanaa I; Arafat, Hassan A
2014-12-15
Solid waste management is a key aspect of the environmental management of establishments belonging to the hospitality sector. In this study, we reviewed literature in this area, examining the current status of waste management for the hospitality sector, in general, with a focus on food waste management in particular. We specifically examined the for-profit subdivision of the hospitality sector, comprising primarily of hotels and restaurants. An account is given of the causes of the different types of waste encountered in this sector and what strategies may be used to reduce them. These strategies are further highlighted in terms of initiatives and practices which are already being implemented around the world to facilitate sustainable waste management. We also recommended a general waste management procedure to be followed by properties of the hospitality sector and described how waste mapping, an innovative yet simple strategy, can significantly reduce the waste generation of a hotel. Generally, we found that not many scholarly publications are available in this area of research. More studies need to be carried out on the implementation of sustainable waste management for the hospitality industry in different parts of the world and the challenges and opportunities involved. Copyright © 2014 Elsevier Ltd. All rights reserved.
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Is total lymphocyte count related to nutritional markers in hospitalized older adults?
Directory of Open Access Journals (Sweden)
Vânia Aparecida LEANDRO-MERHI
Full Text Available ABSTRACT BACKGROUND Older patients are commonly malnourished during hospital stay, and a high prevalence of malnutrition is found in hospitalized patients aged more than 65 years. OBJECTIVE To investigate whether total lymphocyte count is related to other nutritional markers in hospitalized older adults. METHODS Hospitalized older adults (N=131 were recruited for a cross-sectional study. Their nutritional status was assessed by the Nutritional Risk Screening (NRS, anthropometry, and total lymphocyte count. The statistical analyses included the chi-square test, Fisher's exact test, and Mann-Whitney test. Spearman's linear correlation coefficient determined whether total lymphocyte count was correlated with the nutritional markers. Multiple linear regression determined the parameters associated with lymphocyte count. The significance level was set at 5%. RESULTS According to the NRS, 41.2% of the patients were at nutritional risk, and 36% had mild or moderate depletion according to total lymphocyte count. Total lymphocyte count was weakly correlated with mid-upper arm circumference (r=0.20507; triceps skinfold thickness (r=0.29036, and length of hospital stay (r= -0.21518. Total lymphocyte count in different NRS categories differed significantly: older adults who were not at nutritional risk had higher mean and median total lymphocyte count ( P =0.0245. Multiple regression analysis showed that higher lymphocyte counts were associated with higher triceps skinfold thicknesses and no nutritional risk according to the NRS. CONCLUSION Total lymphocyte count was correlated with mid-upper arm circumference, triceps skinfold thickness, and nutritional risk according to the NRS. In multiple regression the combined factors that remained associated with lymphocyte count were NRS and triceps skinfold thickness. Therefore, total lymphocyte count may be considered a nutritional marker. Other studies should confirm these findings.
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Directory of Open Access Journals (Sweden)
Aisyah Nurhajah
2016-04-01
Full Text Available ABSTRAK. Penelitian ini bertujuan mengetahui hubungan antara konsumsi serat kasar dan lemak kasar dengan total solid dan lemak susu kambing Peranakan Ettawa. Penelitian ini menggunakan metode survei dan purposive sampling. Sampel yang digunakan pada penelitian ini adalah 35 ekor kambing Peranakan Ettawa dengan kriteria bulan laktasi 4-5, periode laktasi 2-3 dan frekuensi pemerahan 2 kali. Analisis data dilakukan menggunakan analisis regresi linier sederhana dan non linier kuadratik dan korelasi. Variabel bebas (variabel X pada penelitian ini adalah konsumsi serat kasar dan lemak kasar, sedangkan variabel terikat (variabel Y pada penelitian ini adalah total solid dan lemak susu. Hasil penelitian menunjukkan bahwa terdapat hubungan linier positif yang lemah antara konsumsi serat kasar dengan total solid dan lemak susu (r = 0,185 dan r = 0,160. Hubungan antara konsumsi lemak kasar dengan total solid dan lemak susu pada penelitian ini menunjukkan adanya hubungan kuadratik yang lemah (r = 0,316 dan r = 0,320. Kesimpulan dari penelitian ini adalah terdapat hubungan yang lemah antara konsumsi serat kasar dan lemak kasar dengan total solid dan lemak susu. Semakin tinggi konsumsi serat kasar akan meningkatkan kandungan total solid dan lemak susu, tetapi konsumsi lemak kasar yang semakin tinggi tidak selalu meningkatkan kandungan total solid dan lemak susu. (Correlations between crude fiber and crude fat intake with total solid and milk fat contents in ettawa crossbreed goat ABSTRACT. This study was aimed to determine the correlations between crude fiber and crude fat intake with total solid and milk fat contents. Samples used in this study were 35 Ettawa Crossbreed goats with lactation month of 4-5, lactation period of 2-3 and twice daily milking. Simple linear regression and non linear quadratic regression analysis were used in this study with crude fiber and crude fat intake as independent variables (X, meanwhile total solid and milk fat as
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Inter-relationship between major ions, total dissolved solids and ...
African Journals Online (AJOL)
Sulphate and magnesium concentrations were highest in station 7 while other parameters (potassium, chloride, calcium, alkalinity, conductivity and total dissolved solids (T. D. S.)) were highest in station 6. The ponds belong to class 1 of the African waters since they all have electrical conductance of less than 600 s cm-1.
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Decree 135/999 establishing legal norms for the management of solid waste in hospitals
International Nuclear Information System (INIS)
1999-01-01
Presently ordinance regulation norms settle down on the hospital solid residuals. A definition of solid residuals, contaminated, common, the transport, treatment,installation and integral handling of the same ones is presented in normative happiness. For finish a classification of a residuals in: infectious, piercing or sharp and special as well as duties and sanctions [es
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International Nuclear Information System (INIS)
Campos Arrieta, G.; Navarro Blanco, D
1999-01-01
In the Hospital Mexico a program for the handling of the solid waste was implemented. The program consists on placing recipients, in all the corridors, for each type of waste (recyclable, toxic, dangerous, kitchens). However, this measure doesn't eliminate the risk that the waste represents for the community and the environment. The handling of the solid waste includes the selection or classification, the gathering, the transportation, and the temporary storage. While the treatment consists on the application of procedures that reduce the polluting properties of the waste. The planning of the topic is: To diagnose and to redesign of the handling processes and internal treatment of the hospital solid waste (HSW) in the Hospital Mexico. The contribution of the Industrial Engineering is given in the thematic of redesign of processes; the complementary areas are engineering of the human factor, environmental impact and normalization. The current problem that undergoes the Hospital was defined as follows: The Hospital Mexico cannot assure that the handling and current treatment of the solid waste diminish the risk that they represent to the health of the hospital community and the deterioration of the environment. This problem contains the independent variables such as the handling and current treatment of the solid waste, and the dependent variables such as the risk to the health of the community and deterioration of the environment. Based on the problem, the following hypothesis is established: The current conditions of handling and the lack of internal treatment of the solid waste in the Hospital Mexico, causes that the waste is a risk for the health of the hospital community and the deterioration of the environment. The project was structured in three denominated stages: Diagnose, Design and Validation, which respond to different general and specific objectives. In the stage of diagnose, to determine that the waste generated in the centers of health contain
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International Nuclear Information System (INIS)
Nemathaga, Felicia; Maringa, Sally; Chimuka, Luke
2008-01-01
The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%) > medical waste (30.32%) > sharps (8.94%). The mean generation rates were found to be 0.60 kg per patient per day
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SEBARAN TOTAL SUSPENDED SOLID (TSS PADA PROFIL VERTIKAL DI PERAIRAN SELAT MADURA KABUPATEN BANGKALAN
Directory of Open Access Journals (Sweden)
Aries Dwi Siswanto
2015-04-01
Full Text Available Sebaran sedimen tersuspensi (Total Suspended Solid (TSS dapat dipelajari secara horizontal maupun vertikal. Akumulasi sedimen tersuspensi (TSS secara horizontal sangat dipengaruhi oleh arus permukaan maupun gelombang yang dibangkitkan oleh angin. Keterdapatan TSS ini diduga berpengaruh terhadap sebarannya pada profil vertical. Kedua kondisi sebaran sedimen tersuspensi (TSS berpengaruh terhadap optimalisasi penetrasi cahaya matahari di perairan. Sedimen tersuspensi (TSS menjadi salah satu factor fisika yang penting sebagai indicator kondisi perairan. Penelitian ini bertujuan untuk mengetahui sebaran Total Suspended Solid (TSS di perairan Kabupaten Bangkalan. Materi utama yang digunakan dalam penelitian ini adalah contoh air dan data parameter lingkungan (pasang surut dan kecerahan yang diambil pada 7 stasiun pada bulan Agustus-September 2013 di Perairan Selat Madura, Kabupaten Bangkalan. Metode gravimetric (SNI-06-6989.3-2004 digunakan untuk analisa Total Suspended Solid (TSS. Data parameter lingkungan dianalisa secara deskriptif. Analisa TSS menunjukkan nilai yang berbeda pada beberapa stasiun penelitian untuk setiap minggunya. Konsentrasi TSS terendah sebesar 35 mg/L (Stasiun 3, profil permukaan, minggu pertama dan tertinggi sebesar 620 mg/L (Stasiun 4, profil dasar, minggu pertama. Secara umum, konsentrasi TSS secara vertikal (dari permukaan-dasar cenderung semakin besar, diduga dipengaruhi oleh jenis substrat dan parameter arus yang berpeluang untuk menimbulkan pengadukan di profil dasar. Kondisi lingkungan (kecerahan dan arus menunjukkan bahwa daerah dengan konsentrasi TSS yang tinggi cenderung memilki nilai kecerahan yang rendah dengan kecepatan arus yang lebih besar.Kata Kunci: kecerahan, pola arus, Total Suspended Solid (TSS DISTRIBUTION OF TOTAL SUSPENDED SOLID (TSS IN THE VERTICAL PROFILE IN THE MADURA STRAIT WATERS BANGKALAN DISTRICTABSTRACTDistribution of suspended sediment (Total Suspended Solid (TSS can be studied through
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KUALITAS LIMBAH PADAT MEDIS RUMAH SAKIT (Quality of Solid Medical Waste in Hospital
Directory of Open Access Journals (Sweden)
Riris Nainggolan
2012-11-01
Full Text Available Hospital is one of critical and important part of health care chain due to improvement of it. Hospital can cause nosocomial case for example cellulitis at Dr. Sutomo Hospital in Surabaya because the environment of it not fulfil the health requirements. Several studies reported that hospital environmental health not yet fulfil all the health requirements needed. Only 56.5% used incenerator with unperfect result in temperature which is only reached 200°C. The need of waste management recently have taken attention to improve its quality. Important factors such as volume and waste characteristics are major concern. According to measurement result held in Latin America showed that the hospital garbage and waste production every day per bed about 3.6 Kgs while in England approximately 3.3 Kgs. This research aimed to have characteristic information and the medical waste management of several hospital in Jakarta and Medan. The collection of data conducted through research and book reference, interview and laboratory test for 9 (nine parameters. Characteristic and solid medical waste volume in this research are 2.5-53 Kgs of infectious waste. 0.8-60 Kgs of solid material, 0.8-3 Kgs of unused human anatomy, 0.5-3.3 Kgs of chemical side products, 2-6.6 Kgs of plastic waste. Number of patients with one day care per year about 1228 people while for several days care about 4928 people. From the test results showed that Cu, Se, Zn and Cr value over the quality standard requirements based on Government Acts no 18, 1999.Keywords: Medical waste, Waste Quality, Hospital
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Directory of Open Access Journals (Sweden)
Jing Yi
Full Text Available The total solids content of feedstocks affects the performances of anaerobic digestion and the change of total solids content will lead the change of microbial morphology in systems. In order to increase the efficiency of anaerobic digestion, it is necessary to understand the role of the total solids content on the behavior of the microbial communities involved in anaerobic digestion of organic matter from wet to dry technology. The performances of mesophilic anaerobic digestion of food waste with different total solids contents from 5% to 20% were compared and the microbial communities in reactors were investigated using 454 pyrosequencing technology. Three stable anaerobic digestion processes were achieved for food waste biodegradation and methane generation. Better performances mainly including volatile solids reduction and methane yield were obtained in the reactors with higher total solids content. Pyrosequencing results revealed significant shifts in bacterial community with increasing total solids contents. The proportion of phylum Chloroflexi decreased obviously with increasing total solids contents while other functional bacteria showed increasing trend. Methanosarcina absolutely dominated in archaeal communities in three reactors and the relative abundance of this group showed increasing trend with increasing total solids contents. These results revealed the effects of the total solids content on the performance parameters and the behavior of the microbial communities involved in the anaerobic digestion of food waste from wet to dry technologies.
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Jin, Jingwei; Dai, Xiaohu
2014-01-01
The total solids content of feedstocks affects the performances of anaerobic digestion and the change of total solids content will lead the change of microbial morphology in systems. In order to increase the efficiency of anaerobic digestion, it is necessary to understand the role of the total solids content on the behavior of the microbial communities involved in anaerobic digestion of organic matter from wet to dry technology. The performances of mesophilic anaerobic digestion of food waste with different total solids contents from 5% to 20% were compared and the microbial communities in reactors were investigated using 454 pyrosequencing technology. Three stable anaerobic digestion processes were achieved for food waste biodegradation and methane generation. Better performances mainly including volatile solids reduction and methane yield were obtained in the reactors with higher total solids content. Pyrosequencing results revealed significant shifts in bacterial community with increasing total solids contents. The proportion of phylum Chloroflexi decreased obviously with increasing total solids contents while other functional bacteria showed increasing trend. Methanosarcina absolutely dominated in archaeal communities in three reactors and the relative abundance of this group showed increasing trend with increasing total solids contents. These results revealed the effects of the total solids content on the performance parameters and the behavior of the microbial communities involved in the anaerobic digestion of food waste from wet to dry technologies. PMID:25051352
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Yi, Jing; Dong, Bin; Jin, Jingwei; Dai, Xiaohu
2014-01-01
The total solids content of feedstocks affects the performances of anaerobic digestion and the change of total solids content will lead the change of microbial morphology in systems. In order to increase the efficiency of anaerobic digestion, it is necessary to understand the role of the total solids content on the behavior of the microbial communities involved in anaerobic digestion of organic matter from wet to dry technology. The performances of mesophilic anaerobic digestion of food waste with different total solids contents from 5% to 20% were compared and the microbial communities in reactors were investigated using 454 pyrosequencing technology. Three stable anaerobic digestion processes were achieved for food waste biodegradation and methane generation. Better performances mainly including volatile solids reduction and methane yield were obtained in the reactors with higher total solids content. Pyrosequencing results revealed significant shifts in bacterial community with increasing total solids contents. The proportion of phylum Chloroflexi decreased obviously with increasing total solids contents while other functional bacteria showed increasing trend. Methanosarcina absolutely dominated in archaeal communities in three reactors and the relative abundance of this group showed increasing trend with increasing total solids contents. These results revealed the effects of the total solids content on the performance parameters and the behavior of the microbial communities involved in the anaerobic digestion of food waste from wet to dry technologies.
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Trends in hospital labor and total factor productivity, 1981-86
Cromwell, Jerry; Pope, Gregory C.
1989-01-01
The per-case payment rates of Medicare's prospective payment system are annually updated. As one element of the update factor, Congress required consideration of changes in hospital productivity. In this article, calculations of annual changes in labor and total factor productivity during 1981-86 of hospitals eligible for prospective payment are presented using several output and input variants. Generally, productivity has declined since 1980, although the rates of decline have slowed since prospective payment implementation. According to the series of analyses most relevant for policy, significant hospital productivity gains occurred during 1983-86. This may justify a lower update factor. PMID:10313278
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Danz, Mari E.; Corsi, Steven R.; Graczyk, David J.; Bannerman, Roger T.
2010-01-01
Knowledge of the daily, monthly, and yearly distribution of contaminant loadings and streamflow can be critical for the successful implementation and evaluation of water-quality management practices. Loading data for solids (suspended sediment and total suspended solids) and total phosphorus and streamflow data for 23 watersheds were summarized for four ecoregions of Wisconsin: the Driftless Area Ecoregion, the Northern Lakes and Forests Ecoregion, the North Central Hardwoods Ecoregion, and the Southeastern Wisconsin Till Plains Ecoregion. The Northern Lakes and Forests and the North Central Hardwoods Ecoregions were combined into one region for analysis due to a lack of sufficient data in each region. Urban watersheds, all located in the Southeastern Wisconsin Till Plains, were analyzed separately from rural watersheds as the Rural Southeastern Wisconsin Till Plains region and the Urban Southeastern Wisconsin Till Plains region. Results provide information on the distribution of loadings and streamflow between base flow and stormflow, the timing of loadings and streamflow throughout the year, and information regarding the number of days in which the majority of the annual loading is transported. The average contribution to annual solids loading from stormflow periods for the Driftless Area Ecoregion was 84 percent, the Northern Lakes and Forests/North Central Hardwoods region was 71 percent, the Rural Southeastern Wisconsin Till Plains region was 70 percent, and the Urban Southeastern Wisconsin Till Plains region was 90 percent. The average contributions to annual total phosphorus loading from stormflow periods were 72, 49, 61, and 76 percent for each of the respective regions. The average contributions to annual streamflow from stormflow periods are 20, 23, 31, and 50 percent for each of the respective regions. In all regions, the most substantial loading contributions for solids were in the late winter (February through March), spring (April through May), and
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Lessons learned from the total evacuation of a hospital after the 2016 Kumamoto Earthquake.
Yanagawa, Youichi; Kondo, Hisayoshi; Okawa, Takashi; Ochi, Fumio
The 2016 Kumamoto Earthquakes were a series of earthquakes that included a foreshock earthquake (magnitude 6.2) on April 14 and a main shock (magnitude 7.0) on April 16, 2016. A number of hospitals in Kumamoto were severely damaged by the two major earthquakes and required total evacuation. The authors retrospectively analyzed the activity data of the Disaster Medical Assistance Teams using the Emergency Medical Information System records to investigate the cases in which the total evacuation of a hospital was attempted following the 2016 Kumamoto Earthquake. Total evacuation was attempted at 17 hospitals. The evacuation of one of these hospitals was canceled. Most of the hospital buildings were more than 20 years old. The danger of collapse was the most frequent reason for evacuation. Various transportation methods were employed, some of which involved the Japan Ground Self-Defense Force; no preventable deaths occurred during transportation. The hospitals must now be renovated to improve their earthquake resistance. The coordinated and combined use of military and civilian resources is beneficial and can significantly reduce human suffering in large-scale disasters.
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Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E
2017-10-01
Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD
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Development of a field test method for total suspended solids analysis.
2013-11-01
Total suspended solids (TSS) are all particles in water that will not pass through a glass fiber filter with a pore size less : than 2 m, including sediments, algae, nutrients, and metals. TSS is an important water quality parameter because of its ...
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Motte, J-C; Escudié, R; Bernet, N; Delgenes, J-P; Steyer, J-P; Dumas, C
2013-09-01
Among all the process parameters of solid-state anaerobic digestion (SS-AD), total solid content (TS), inoculation (S/X ratio) and size of the organic solid particles can be optimized to improve methane yield and process stability. To evaluate the effects of each parameter and their interactions on methane production, a three level Box-Behnken experimental design was implemented in SS-AD batch tests degrading wheat straw by adjusting: TS content from 15% to 25%, S/X ratio (in volatile solids) between 28 and 47 and particle size with a mean diameter ranging from 0.1 to 1.4mm. A dynamic analysis of the methane production indicates that the S/X ratio has only an effect during the start-up phase of the SS-AD. During the growing phase, TS content becomes the main parameter governing the methane production and its strong interaction with the particle size suggests the important role of water compartmentation on SS-AD. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Sahney, V K
1993-01-01
Industrial engineering applications in the hospital industry first began in 1910. This paper traces the evolution of hospital industrial engineering in five distinct phases. For each of the major phases, this paper presents the contributions made by industrial engineers. Many of the techniques advocated by industrial engineers are now being taught to hospital employees as hospitals introduce total quality management (TQM) within the health-care industry. TQM introduction has meant a new role for industrial engineers, as that of a teacher, coach, and a facilitator. This new role holds much promise for the improvement of quality and productivity in health care.
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David J. Lewis; Kenneth W. Tate; Randy A. Dahlgren; Jacob Newell
2002-01-01
Resource agencies, private landowners, and citizen monitoring programs utilize turbidity (water clarity) measurements as a water quality indicator for total suspended solids (TSS â mass of solids per unit volume) and other constituents in streams and rivers. The dynamics and relationships between turbidity and TSS are functions of watershed-specific factors and...
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Boas, Rebecca; Ensor, Kelsey; Qian, Edward; Hutzler, Lorraine; Slover, James; Bosco, Joseph
2015-05-01
The purpose of this study was to analyze the effect of hospital volume and charges on the rate of surgical site infections for total hip replacements (THRs) in New York State (NYS). In NYS, higher volume hospitals have higher charges after THR. The study team analyzed 93,620 hip replacements performed in NYS between 2008 and 2011. Hospital charges increased significantly from $43,713 in 2008 to $50,652 in 2011 (P<.01). Compared with lower volume hospitals, patients who underwent THR at the highest volume hospitals had significantly lower surgical site infection rates (P=.003) and higher total hospital charges (P<.0001). The study team found that in the highest volume hospitals, preventing one surgical site infection was associated with $1.6 million dollars in increased charges. © 2014 by the American College of Medical Quality.
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Measurement of total dissolved solids using electrical conductivity
International Nuclear Information System (INIS)
Ray, Vinod K.; Jat, J.R.; Reddy, G.B.; Balaji Rao, Y.; Phani Babu, C.; Kalyanakrishnan, G.
2017-01-01
Total dissolved solids (TDS) is an important parameter for the disposal of effluents generated during processing of different raw materials like Magnesium Di-uranate (MDU), Heat Treated Uranium Peroxide (HTUP), Sodium Di-uranate (SDU) in Uranium Extraction plant and Washed and Dried Frit (WDF) in Zirconium Extraction Plant. The present paper describes the use of electrical conductivity for determination of TDS. As electrical conductivity is matrix dependent property, matrix matched standards were prepared for determination of TDS in ammonium nitrate solution (AN) and mixture of ammonium nitrate and ammonium sulphate (AN/AS) and results were found to be in good agreement when compared with evaporation method. (author)
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Solid fat content as a substitute for total polar compound analysis in edible oils
The solid fat contents (SFC) of heated edible oil samples were measured and found to correlate positively with total polar compounds (TPC) and inversely with triglyceride concentration. Traditional methods for determination of total polar compounds require a laboratory setting and are time intensiv...
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Augustijn, Dionysius C.M.; Fares, Ali; Tran, Dai Ngia
2011-01-01
Hawaiian watersheds are small, steep, and receive high intensity rainfall events of non-uniform distribution. These geographic and weather patterns result in flashy streams of strongly variable water quality even within various stream segments. Total suspended solids (TSS) and total dissolved solids
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Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan
2015-12-01
To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
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Yi, Jing; Dong, Bin; Jin, Jingwei; Dai, Xiaohu
2014-01-01
The total solids content of feedstocks affects the performances of anaerobic digestion and the change of total solids content will lead the change of microbial morphology in systems. In order to increase the efficiency of anaerobic digestion, it is necessary to understand the role of the total solids content on the behavior of the microbial communities involved in anaerobic digestion of organic matter from wet to dry technology. The performances of mesophilic anaerobic digestion of food waste...
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COMMUNITY SCALE STREAM TAXA SENSITIVITIES TO DIFFERENT COMPOSITIONS OF EXCESS TOTAL DISSOLVED SOLIDS
Model stream chronic dosing studies (42 d) were conducted with three total dissolved solids (TDS) recipes. The recipes differed in composition of major ions. Community scale emergence was compared with single-species responses conducted simultaneously using the whole effluent tox...
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International Nuclear Information System (INIS)
Conte, L.; Pedroli, G.; Monciardini, M.; Bianchi, L.; Novario, R.; Beretta, A.
1996-01-01
In the Lombardy region some hospitals have recently been reported to the local authorities because of the presence of radioactivity in hospital refuse sent to the municipal tips for incineration. On various occasions the refuse collectors coming from the hospitals had to return with their refuse as traces of radioactivity were detected at the entrance to the tips equipped with monitoring systems. Hospitals administering radioactive substances for diagnostic or therapeutic purposes produce radioactive waste mainly in solid and liquid form. This waste is principally present in patient excreta and in contaminated materials. Radioactive waste present in patient excreta is normally disposed of through the sewage system provided that the concentration limits and annual activity stipulated by law are respected. The contaminated materials coming from the departments that carry out radioisotopic investigations and therapy with unsealed sources can be collected separately and sent to a tip after a period of storage to permit radioactive decay. However, part of the radioactive waste escapes all checks and inevitably mixes with normal refuse or with special hospital refuse that is not considered radioactive. This occurs in the case of: 1. excreta from patients who are not hospitalised after a radioisotopic investigation and materials contaminated by the excreta; 2. excreta from hospitalised patients which are eliminated outside the nuclear medicine and radiotherapy departments; 3. contaminated materials produced with unsealed sources in hospital departments other than those of nuclear medicine and radiotherapy; The waste indicated in point 1 is probably the main problem in ecological terms as the patients who are not hospitalised eliminate radioactive excreta into domestic sewage systems and can also contaminate materials that are disposed of with normal household refuse. In this case any solution to the problem would seriously affect diagnostic activities carried out in the
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Smina, T P; Mathew, J; Janardhanan, K K
2016-04-30
G. lucidum total triterpenes were assessed for its apoptosis-inducing and anti-tumour activities. The ability of the total triterpenes to induce apoptosis was evaluated in Dalton's lymphoma ascites (DLA) and Ehrlich's ascites carcinoma (EAC) cell lines. Total triterpenes were found to be highly cytotoxic to DLA and EAC cell lines with IC50 values 5 ± 0.32 and 7.9 ± 0.2 µg/ml respectively. Total triterpenes induced apoptosis in both cell lines which is evident from the DNA fragmentation assay. Anti-tumour activity was accessed using DLA induced solid and EAC induced ascites tumour models in Swiss albino mice. Administration of 10, 50 and 100 mg/kg b. wt. total triterpenes showed 11.86, 27.27 and 40.57% increase in life span of animals in ascites tumour model. Treatment with 10, 50 and 100 mg/kg b. wt. total triterpenes exhibited 76.86, 85.01 and 91.03% inhibition in tumour volume and 67.96, 72.38 and 77.90% inhibition in tumour weight respectively in the solid tumour model. The study reveals the significant dose-dependent anti-tumour activity of total triterpenes in both models. Total triterpenes were more active against the solid tumour than the ascites tumour. The anti-oxidant potential and ability to induce cell-specific apoptosis could be contributing to its anti-tumour activities.
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Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Huang, Susan S
2013-11-01
Public reporting of surgical site infections (SSIs) by hospitals is largely limited to infections detected during surgical hospitalizations or readmissions to the same facility. SSI rates may be underestimated if patients with SSIs are readmitted to other hospitals. We assessed the impact of readmissions to other facilities on hospitals' SSI rates following primary total hip arthroplasty (THA) or total knee arthroplasty (TKA). This was a retrospective cohort study of all patients who underwent primary THA or TKA at California hospitals between 1 January 2006 and 31 December 2009. SSIs were identified using ICD-9-CM diagnosis codes predictive of SSI assigned at any California hospital within 365 days of surgery using a statewide repository of hospital data that allowed tracking of patients between facilities. We used statewide data to estimate the fraction of each hospital's THA and TKA SSIs identified at the operative hospital versus other hospitals. A total of 91 121 THA and 121 640 TKA procedures were identified. Based on diagnosis codes, SSIs developed following 2214 (2.3%) THAs and 2465 (2.0%) TKAs. Seventeen percent of SSIs would have been missed by operative hospital surveillance alone. The proportion of hospitals' SSIs detected at nonoperative hospitals ranged from 0% to 100%. Including SSIs detected at nonoperative hospitals resulted in better relative ranking for 61% of THA hospitals and 61% of TKA hospitals. Limiting SSI surveillance to the operative hospital caused varying degrees of SSI underestimation and substantially impacted hospitals' relative rankings, suggesting that alternative methods for comprehensive postdischarge surveillance are needed for accurate benchmarking.
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Biomedical solid waste management in an Indian hospital: a case study
International Nuclear Information System (INIS)
Patil, Gayathri V.; Pokhrel, Kamala
2005-01-01
The objectives of this study were: (i) to assess the waste handling and treatment system of hospital bio-medical solid waste and its mandatory compliance with Regulatory Notifications for Bio-medical Waste (Management and Handling) Rules, 1998, under the Environment (Protection Act 1986), Ministry of Environment and Forestry, Govt. of India, at the chosen KLE Society's J. N. Hospital and Medical Research Center, Belgaum, India and (ii) to quantitatively estimate the amount of non-infectious and infectious waste generated in different wards/sections. During the study, it was observed that: (i) the personnel working under the occupier (who has control over the institution to take all steps to ensure biomedical waste is handled without any adverse effects to human health and the environment) were trained to take adequate precautionary measures in handling these bio-hazardous waste materials, (ii) the process of segregation, collection, transport, storage and final disposal of infectious waste was done in compliance with the Standard Procedures, (iii) the final disposal was by incineration in accordance to EPA Rules 1998 (iv) the non-infectious waste was collected separately in different containers and treated as general waste, and (v) on an average about 520 kg of non-infectious and 101 kg of infectious waste is generated per day (about 2.31 kg per day per bed, gross weight comprising both infectious and non-infectious waste). This hospital also extends its facility to the neighboring clinics and hospitals by treating their produced waste for incineration
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Trimba, Roman; Laughlin, Richard T; Krishnamurthy, Anil; Ross, Joseph S; Fox, Justin P
2016-03-01
Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience. We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups. Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization. Copyright © 2016 Elsevier Inc. All rights reserved.
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Three-tiered integration of PACS and HIS toward next generation total hospital information system.
Kim, J H; Lee, D H; Choi, J W; Cho, H I; Kang, H S; Yeon, K M; Han, M C
1998-01-01
The Seoul National University Hospital (SNUH) started a project to innovate the hospital information facilities. This project includes installation of high speed hospital network, development of new HIS, OCS (order communication system), RIS and PACS. This project aims at the implementation of the first total hospital information system by seamlessly integrating these systems together. To achieve this goal, we took three-tiered systems integration approach: network level, database level, and workstation level integration. There are 3 loops of networks in SNUH: proprietary star network for host computer based HIS, Ethernet based hospital LAN for OCS and RIS, and ATM based network for PACS. They are linked together at the backbone level to allow high speed communication between these systems. We have developed special communication modules for each system that allow data interchange between different databases and computer platforms. We have also developed an integrated workstation in which both the OCS and PACS application programs run on a single computer in an integrated manner allowing the clinical users to access and display radiological images as well as textual clinical information within a single user environment. A study is in progress toward a total hospital information system in SNUH by seamlessly integrating the main hospital information resources such as HIS, OCS, and PACS. With the three-tiered systems integration approach, we could successfully integrate the systems from the network level to the user application level.
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Robinson, James C; Miller, Kelly
Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and
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Directory of Open Access Journals (Sweden)
Jorge Calvo-Lon
2017-12-01
Full Text Available Purpose: Bloodstream infections (BSIs are an important cause of mortality in patients with solid tumors. We conducted a retrospective study to evaluate the epidemiologic profile and mortality of patients with solid tumors who have BSIs and were admitted to Mexico Hospital. This is the first study in Costa Rica and Central America describing the current epidemiologic situation. Methods: We analyzed the infectious disease database for BSIs in patients with solid tumors admitted to Mexico Hospital from January 2012 to December 2014. Epidemiology and mortality were obtained according to microorganism, antibiotic sensitivity, tumor type, and presence of central venous catheter (CVC. Descriptive statistics were used. Results: A total of 164 BSIs were recorded, the median age was 58 years, 103 patients (63% were males, and 128 cases of infection (78% were the result of gram-negative bacilli (GNB. Klebsiella pneumoniae (21%, Escherichia coli (21%, and Pseudomonas aeruginosa (15% were the most common microorganisms isolated. Gram-positive cocci (GPC were found in 36 patients, with the most frequent microorganisms being Staphylococcus aureus (10% and Staphyloccocus epidermidis (6%. With respect to tumor type, BSIs were more frequent in the GI tract (57% followed by head and neck (9% and genitourinary tract (8%. Regarding antibiotic susceptibility, only 17% (GNB expressed extended-spectrum beta-lactamase and 12% (GPC had methicillin resistance. Patients with CVCs (n = 59 were colonized mainly by GNB (78%. Overall the mortality rate at 30 days was about 30%. Conclusion: GNB are the most frequent cause of BSIs in solid tumors and in patients with CVCs. GI cancers had more BSIs than other sites. Mortality and antibiotic sensitivity remained stable and acceptable during this observational period in this Latin American population.
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Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad
2017-07-01
The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.
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Liotta, Flavia; d'Antonio, Giuseppe; Esposito, Giovanni; Fabbricino, Massimiliano; van Hullebusch, Eric D; Lens, Piet N L; Pirozzi, Francesco; Pontoni, Ludovico
2014-10-01
This work investigates the role of the moisture content on anaerobic digestion of food waste, as representative of rapidly biodegradable substrates, analysing the role of volatile fatty acid production on process kinetics. A range of total solids from 4.5% to 19.2% is considered in order to compare methane yields and kinetics of reactors operated under wet to dry conditions. The experimental results show a reduction of the specific final methane yield of 4.3% and 40.8% in semi-dry and dry conditions compared with wet conditions. A decreasing trend of the specific initial methane production rate is observed when increasing the total solids concentration. Because of lack of water, volatile fatty acids accumulation occurs during the first step of the process at semi-dry and dry conditions, which is considered to be responsible for the reduction of process kinetic rates. The total volatile fatty acids concentration and speciation are proposed as indicators of process development at different total solids content. © The Author(s) 2014.
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Directory of Open Access Journals (Sweden)
Attilio Converti
2006-01-01
Full Text Available Response surface methodology was used to establish a relationship between total solids content, milk base, heat treatment temperature, and sample temperature, and consistency index, flow behaviour index, and apparent viscosity of plain stirred yogurts. Statistical treatments resulted in developments of mathematical models. All samples presented shear thinning fluid behaviour. The increase of the content of total solids (9.3–22.7 % and milk base heat treatment temperature (81.6–98.4 °C resulted in a significant increase in consistency index and a decrease in flow behaviour index. Increase in the sample temperature (1.6–18.4 °C caused a decrease in consistency index and increase in flow behaviour index. Apparent viscosity was directly related to the content of total solids. Rheological properties of yogurt were highly dependent on the content of total solids in milk.
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Gao, Qin; Yao, Sanxi; Widom, Michael
2015-03-01
Density functional theory (DFT) provides an accurate and first-principles description of solid structures and total energies. However, it is highly time-consuming to calculate structures with hundreds of atoms in the unit cell and almost not possible to calculate thousands of atoms. We apply and adapt machine learning algorithms, including compressive sensing, support vector regression and artificial neural networks to fit the DFT total energies of substitutionally disordered boron carbide. The nonparametric kernel method is also included in our models. Our fitted total energy model reproduces the DFT energies with prediction error of around 1 meV/atom. The assumptions of these machine learning models and applications of the fitted total energies will also be discussed. Financial support from McWilliams Fellowship and the ONR-MURI under the Grant No. N00014-11-1-0678 is gratefully acknowledged.
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Usry, J. W.; Whitlock, C. H.
1981-01-01
Management of water resources such as a reservoir requires using analytical models which describe such parameters as the suspended sediment field. To select or develop an appropriate model requires making many measurements to describe the distribution of this parameter in the water column. One potential method for making those measurements expeditiously is to measure light transmission or turbidity and relate that parameter to total suspended solids concentrations. An instrument which may be used for this purpose was calibrated by generating curves of transmission measurements plotted against measured values of total suspended solids concentrations and beam attenuation coefficients. Results of these experiments indicate that field measurements made with this instrument using curves generated in this study should correlate with total suspended solids concentrations and beam attenuation coefficients in the water column within 20 percent.
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Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement
Directory of Open Access Journals (Sweden)
Remedios López-Liria
2015-01-01
Full Text Available Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Results. The groups did not significantly differ in the leg side (right/left or clinical characteristics (P>0.05. After the intervention, both groups showed significant improvements (P<0.001 from the baseline values in the level of pain (visual analogue scale, the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices, balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.
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Yadav, Vijesh; Gupta, Vijay Kumar; Meena, Ganga Sahay
2018-05-01
Studied the effect of culture (2, 2.5 and 3%), ultrafiltered (UF) retentate addition (0, 11, 18%), total milk solids (13, 13.50, 14%) and heat treatments (80 and 85 °C/30 min) on the change in pH and titratable acidity (TA), sensory scores and rheological parameters of yoghurt. With 3% culture levels, the required TA (0.90% LA) was achieved in minimum 6 h incubation. With an increase in UF retentate addition, there was observed a highly significant decrease in overall acceptability, body and texture and colour and appearance scores, but there was highly significant increase in rheological parameters of yoghurt samples. Yoghurt made from even 13.75% total solids containing nil UF retentate was observed to be sufficiently firm by the sensory panel. Most of the sensory attributes of yoghurt made with 13.50% total solids were significantly better than yoghurt prepared with either 13 or 14% total solids. Standardised milk heated to 85 °C/30 min resulted in significantly better overall acceptability in yoghurt. Overall acceptability of optimised yoghurt was significantly better than a branded market sample. UF retentate addition adversely affected yoghurt quality, whereas optimization of culture levels, totals milk solids and others process parameters noticeably improved the quality of plain set yoghurt with a shelf life of 15 days at 4 °C.
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Srebrenkoska, Vineta; Golomeova, Saska; Zhezhova, Silvana
2013-01-01
Waste is unwanted or useless materials from households, industry, agriculture, hospitals. Waste materials in solid state are classified as solid waste. Increasing of the amount of solid waste and the pressure what it has on the environment, impose the need to introduce sustainable solid waste management. Advanced sustainable solid waste management involves several activities at a higher level of final disposal of the waste management hierarchy. Minimal use of material and energy resources ...
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Coal mine water (CMW) is typically treated to remove suspended solids, acidity, and soluble metals, but high concentrations of total dissolved solids (TDS) have been reported to impact the environment at several CMW discharge points. Consequently, various states have establishe...
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Nasrabadi, Touraj; Ruegner, Hermann; Schwientek, Marc; Bennett, Jeremy; Fazel Valipour, Shahin; Grathwohl, Peter
2018-01-01
Suspended particles in rivers can act as carriers of potentially bioavailable metal species and are thus an emerging area of interest in river system monitoring. The delineation of bulk metals concentrations in river water into dissolved and particulate components is also important for risk assessment. Linear relationships between bulk metal concentrations in water (CW,tot) and total suspended solids (TSS) in water can be used to easily evaluate dissolved (CW, intercept) and particle-bound metal fluxes (CSUS, slope) in streams (CW,tot = CW + CSUS TSS). In this study, we apply this principle to catchments in Iran (Haraz) and Germany (Ammer, Goldersbach, and Steinlach) that show differences in geology, geochemistry, land use and hydrological characteristics. For each catchment, particle-bound and dissolved concentrations for a suite of metals in water were calculated based on linear regressions of total suspended solids and total metal concentrations. Results were replicable across sampling campaigns in different years and seasons (between 2013 and 2016) and could be reproduced in a laboratory sedimentation experiment. CSUS values generally showed little variability in different catchments and agree well with soil background values for some metals (e.g. lead and nickel) while other metals (e.g. copper) indicate anthropogenic influences. CW was elevated in the Haraz (Iran) catchment, indicating higher bioavailability and potential human and ecological health concerns (where higher values of CSUS/CW are considered as a risk indicator).
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Lewis, Ryan C; Gaffney, Shannon H; Le, Matthew H; Unice, Ken M; Paustenbach, Dennis J
2012-09-01
Workers handle catalysts extensively at petroleum refineries throughout the world each year; however, little information is available regarding the airborne concentrations and plausible exposures during this type of work. In this paper, we evaluated the airborne concentrations of 15 metals and total dust generated during solid catalyst loading and unloading operations at one of the largest petroleum refineries in the world using historical industrial hygiene samples collected between 1989 and 2006. The total dust and metals, which included aluminum, cadmium, chromium, cobalt, copper, iron, lead, manganese, molybdenum, nickel, platinum, silicon, silver, vanadium, and zinc, were evaluated in relation to the handling of four different types of solid catalysts associated with three major types of catalytic processes. Consideration was given to the known components of the solid catalysts and any metals that were likely deposited onto them during use. A total of 180 analytical results were included in this analysis, representing 13 personal and 54 area samples. Of the long-term personal samples, airborne concentrations of metals ranged from refinery and perhaps other modern refineries during the timeframe examined. Copyright © 2011 Elsevier GmbH. All rights reserved.
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Partial and total electronic stopping cross sections of atoms and solids for protons
International Nuclear Information System (INIS)
Kaneko, Toshiaki.
1990-12-01
Based on a wave packet theory (Phys. Rev. A40, 2188(1989); Phys. Stat. Sol. (B)156,49(1989)), partial and total electronic cross sections of target elements in atomic and solid phases with atomic number Z ranging from 2 (He) to 92 (U) are tabulated shell by shell for protons with velocity v from 0.2V 0 to 2OV 0 (V 0 =2.18 x 10 8 cm/s). (author)
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Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B
2017-01-01
This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes. Copyright © 2016 Elsevier Inc. All rights reserved.
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Directory of Open Access Journals (Sweden)
Ika Ayu Wijayanti
2017-03-01
Full Text Available The purpose of this research was to find out the best concentration of adding sago flour in yoghurt based on viscosity, overrun, melting rate and total solid of yoghurt ice cream. The experiment was designed by Completely Randomized Design (CRD using four treatments were 0 %, 2 %, 4 %, 6 % from volume of fresh milk and four replication. The data were analyzed by using Analysis of Variance (ANOVA and continued by Duncan’s Multiple Range Test (DMRT. Result of this research showed that concentration of adding sago flour in yoghurt gave highly significant difference effect (P<0.01 on viscosity, overrun, melting rate and total solid of yoghurt ice cream. It can be concluded that the adding of sago flour 2% in yoghurt gave the best result with the viscosity was 1750.75 cP, overrun was 25.14%, melting rate was 39.13 minutes/50 g, total solid was 36.20% and gave the best quality of yoghurt ice cream.
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Xian, Ying; Holloway, Robert G; Pan, Wenqin; Peterson, Eric D
2012-06-01
Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate. Using the 2005 to 2006 New York state data, we examined the degree to which hospital stroke mortality rankings varied regarding ischemic versus hemorrhagic versus total stroke. Observed/expected ratio was calculated using the Agency for Healthcare Research and Quality Inpatient Quality Indicator software. The observed/expected ratio and outlier status based on stroke types across hospitals were examined using Pearson correlation coefficients (r) and weighted κ. Overall 30-day stroke mortality rates were 15.2% and varied from 11.3% for ischemic stroke and 37.3% for intracerebral hemorrhage. Hospital risk-adjusted ischemic stroke observed/expected ratio was weakly correlated with its own intracerebral hemorrhage observed/expected ratio (r=0.38). When examining hospital performance group (mortality better, worse, or no different than average), disagreement was observed in 35 of 81 hospitals (κ=0.23). Total stroke mortality observed/expected ratio and rankings were correlated with intracerebral hemorrhage (r=0.61 and κ=0.36) and ischemic stroke (r=0.94 and κ=0.71), but many hospitals still switched classification depending on mortality metrics. However, hospitals treating a higher percent of hemorrhagic stroke did not have a statistically significant higher total stroke mortality rate relative to those treating fewer hemorrhagic strokes. Hospital stroke mortality ratings varied considerably depending on whether ischemic, hemorrhagic, or total stroke mortality rates were used. Public reporting of stroke mortality measures should consider providing risk-adjusted outcome on separate stroke types.
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Hughes, J M
1992-09-01
Winter Park Memorial Hospital (Winter Park, Florida) began implementation of a well-strategized plan for total quality management (TQM) in 1987. Having no guidelines for applying TQM to health care but using the industrial quality management techniques of Philip Crosby Associates, Inc, the hospital made the transition and saved thousands of dollars in the process. This article describes the transition, especially the integral part played by the Medical Staff Quality Council in changing the hospital's culture.
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International Nuclear Information System (INIS)
Sanchez Murillo, Ricardo; Leon, Sandra; Saravia, Ana Yuri; Mena Sanchez, Carlos de
2009-01-01
The total concentration of suspends solids and heavy metals were determined of the Basin of rio Morote. The study spanned six sampling campaigns between April 2003 and May 2005. Sampling points were selected to correspond to places from the high basin to the mouth of the rio Morote in the Golfo de Nicoya. Suspends total solids concentration (TSS) on average exceeds 200 mg/L during the rainy season at the mouth. Enrichment of metals as: Cu, Ni, Cd and Fe was found in riverbed sediments; but not in Pb. The concentration of Zn has been near the limit value (200 mg/kg) in the dry season, value which has been established for the Environmental Protection Agency of United States (EPA). (author) [es
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Distribution of Total Suspended Solids Concentration in a River
Directory of Open Access Journals (Sweden)
Ahmad Hanif Asyhar
2012-08-01
Full Text Available Disposal of either industrial or nonindustrial wastewater into a river has a potential to cause riverpollution. Because each load of wastewater discharged into a river contains physical, chemical, and biological parametersthat determine water quality, so that it can affect the dissolved oxygen concentration in a river. Therefore the conductedresearch was aimed to determine the pattern of pollutant dispersion in Surabaya River within the section that is closed tothe Karang Pilang Monitoring Station - Surabaya. Parameter used in this research was Total Suspended Solids (TSS. Themethod used was the finite volume method with Quadratic Upwind Interpolation Convective Kinematics (QUICK schemeby means of developing models of dispersion water pollutants in a river. The governing equation was controlled by the lawsof mass conservation, momentum conservation, and pollution transport equation. Further, these equations were solvedusing numerical calculation and followed by numerical simulation. From the numerical simulation results, it can beconcluded that the magnitude of pollutant dispersion is determined by the initial discharged TSS concentrations into theriver, however the longitudinal direction is more dominantly influenced than in lateral directions.
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Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K
2006-11-01
Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.
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Real-space formulation of the electrostatic potential and total energy of solids
International Nuclear Information System (INIS)
Pask, J E; Sterne, P A
2004-01-01
We develop expressions for the electrostatic potential and total energy of crystalline solids which are amenable to direct evaluation in real space. Unlike conventional reciprocal space formulations, no Fourier transforms or reciprocal lattice summations are required, and the formulation is well suited for large-scale, parallel computations. The need for reciprocal space expressions is eliminated by replacing long-range potentials by equivalent localized charge distributions and incorporating long-range interactions into boundary conditions on the unit cell. In so doing, a simplification of the conventional reciprocal space formalism is obtained. The equivalence of the real- and reciprocal space formalisms is demonstrated by direct comparison in self-consistent density-functional calculations
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Directory of Open Access Journals (Sweden)
Lucila Akiko Nagashima
2007-07-01
Full Text Available Os resíduos sólidos de serviços de saúde (RSSS representam reduzida parcela do total dos resíduos sólidos urbanos gerados diariamente por uma cidade. Considerando a própria origem, parte desses resíduos apresenta riscos e dificuldades especiais em seu manejo, devido especialmente ao caráter infeccioso de alguns componentes. Estasconstatações associadas à necessidade de conhecer a situação dos RSSS do Hospital Universitário Regional de Maringá motivaram a elaboração do estudo. A pesquisa buscou identificar as diferentes fontes geradoras, caracterizar qualitativa e quantitativamente osresíduos gerados determinando a taxa de geração diária. A caracterização foi efetuada mediante a pesagem dos resíduos, acompanhamento das atividades internas do hospital, quanto aos procedimentos de coleta, armazenamento interno e externo e transporte de seus resíduos sólidos. Constatou-se que do total de resíduos gerados, cerca de 53% são considerados contaminados, percentual creditado como não-satisfatório para uma parcela significante de bibliografia consultada.Solid health-care waste (SHCW represents only a small fraction of the total urban solid waste generated daily in a city. Taking its origin into consideration, part of this waste presents risks and special difficulties in handling, especially due to the infectious aspects of some components. The elaboration of study was motivated by these findings, associated with the need to find out the conditions of the SHCW from the Maringá Regional University Hospital. The research attempted to identify the different generating sources, quantifying and qualifying the generated waste, and determining the daily generated rate. The characterization was done by weighing the waste, observing internal hospital activities regarding collection procedures, internal and external storage and transportation of the waste. It was verified that from the total generated waste, around 53% is considered
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Management of hospitals solid waste in Khartoum State.
Saad, Suhair A Gayoum
2013-10-01
This research had been conducted during year 2012 to review existing data on hospital waste management for some of Khartoum town hospitals and to try to produce appropriate proposals acceptable for waste management and final treatment methods. The overall status of hospital waste management in Khartoum has been assessed through direct visits and designated questionnaires. Eight main hospitals were covered in the study with an overall bed capacity of 2,978. The current waste management practice observed at all studied hospitals was that most of waste, office, general, food, construction debris, and hazardous chemical materials were all mixed together as they are generated, collected, and finally disposed of. Only a small portion of waste in some hospitals (part of potentially infectious, body parts, and sharps) are collected separately and treated in a central incinerator. The estimated value of per bed generation rate in the studied hospitals was found to be 0.87 kg/day, which lies within the range for the low-income countries. In all studied hospitals, it was found that workers were working under very poor unsafe conditions with very low salaries ($35 to $45 per month on average). About 90 % were completely illiterate or had very low education levels. At the national level, no laws considering hospital waste, or even hazardous waste, were found; only some federal general environmental regulations and some procedures from town and city localities for controlling general municipal waste exist. At the hospital level, no policies or rules were found, except in the radiotherapy center, where they manage radioactive wastes under the laws of the Sudanese Atomic Agency. Urgent actions are needed for the remediation and prevention of hazards associated with this type of waste.
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development of improved solid hospital waste management ...
African Journals Online (AJOL)
A pre-intervention situation analysis was conducted to assess Hospital Waste Management (HWM) practices, solutions were proffered for the observed inadequacies and advocacy was made to Hospital administration for which a number of interventional measures were instituted. A post interventional survey was conducted ...
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Energy Technology Data Exchange (ETDEWEB)
Barrett, A; Barrett, A J; Powles, R L [Institute of Cancer Research, Sutton (UK). Surrey Branch; Royal Marsden Hospital, London (UK))
1979-06-01
The experience with total body irradiation at the Royal Marsden Hospital is described for an elective program of transplantation in patients with acute myeloid leukaemia (AML) in first remission. Dose rate appears to be a critical factor in the reduction of radiation-associated damage and careful monitoring of the actual dose distribution and dose received is mandatory.
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Jafari, S M; Jabari, S S; Dehnad, D; Shahidi, S A
2017-03-01
In this research, our main idea was to apply thermal processing by nanofluids instead of conventional pasteurization processes, to shorten duration of thermal procedure and improve nutritional contents of fruit juices. Three different variables of temperature (70, 80 and 90 °C), nanofluid concentration (0, 2 and 4%) and time (30, 60 and 90 s) were selected for thermal processing of tomato juices by a shell and tube heat exchanger. The results demonstrated that 4% nanofluid concentration, at 30 °C for 30 s could result in 66% vitamin C retention of fresh juice while it was about 56% for the minimum nanofluid concentration and maximum temperature and time. Higher nanoparticle concentrations made tomato juices that require lowered thermal durations, because of better heat transfer to the product, and total phenolic compounds dwindle less severely; In fact, after 30 s thermal processing at 70 °C with 0 and 4% nanoparticles, total phenolic compounds were maintained by 71.9 and 73.6%, respectively. The range of total soluble solids for processed tomato juices was 5.4-5.6, meaning that nanofluid thermal processing could preserve the natural condition of tomato juices successfully. Based on the indices considered, a nanofluid thermal processing with 4% nanoparticle concentration at the temperature of 70 °C for 30 s will result in the best nutritional contents of final tomato juices.
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Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T
2017-11-01
The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs. The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA. The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age. Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. Copyright © 2017 Elsevier Inc. All rights reserved.
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Solid Waste Management Available Information Materials. Total Listing 1966-1976.
Larsen, Julie L.
This publication is a compiled and indexed bibliography of solid waste management documents produced in the last ten years. This U.S. Environmental Protection Agency (EPA) publication is compiled from the Office of Solid Waste Management Programs (OSWMP) publications and the National Technical Information Service (NTIS) reports. Included are…
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Loads of nitrate, phosphorus, and total suspended solids from Indiana watersheds
Bunch, Aubrey R.
2016-01-01
Transport of excess nutrients and total suspended solids (TSS) such as sediment by freshwater systems has led to degradation of aquatic ecosystems around the world. Nutrient and TSS loads from Midwestern states to the Mississippi River are a major contributor to the Gulf of Mexico Hypoxic Zone, an area of very low dissolved oxygen concentration in the Gulf of Mexico. To better understand Indiana’s contribution of nutrients and TSS to the Mississippi River, annual loads of nitrate plus nitrite as nitrogen, total phosphorus, and TSS were calculated for nine selected watersheds in Indiana using the load estimation model, S-LOADEST. Discrete water-quality samples collected monthly by the Indiana Department of Environmental Management’s Fixed Stations Monitoring Program from 2000–2010 and concurrent discharge data from the U. S. Geological Survey streamflow gages were used to create load models. Annual nutrient and TSS loads varied across Indiana by watershed and hydrologic condition. Understanding the loads from large river sites in Indiana is important for assessing contributions of nutrients and TSS to the Mississippi River Basin and in determining the effectiveness of best management practices in the state. Additionally, evaluation of loads from smaller upstream watersheds is important to characterize improvements at the local level and to identify priorities for reduction.
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Directory of Open Access Journals (Sweden)
Estela Azeka
2009-02-01
Full Text Available OBJECTIVE: The aim of this study was to report a single center experience of organ and tissue transplantation INTRODUCTION: This is the first report of organ and tissue transplantation at the Hospital das Clínicas of the University of Sao Paulo Medical School. METHODS: We collected data from each type of organ transplantation from 2002 to 2007. The data collected were patient characteristics and actuarial survival Kaplan-Meier curves at 30 days, one year, and five years RESULTS: There were a total of 3,321 transplants at our institution and the 5-year survival curve ranged from 53% to 88%. CONCLUSION: This report shows that solid organ and tissue transplants are feasible within the institution and allow us to expect that the quality of transplantation will improve in the future.
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Hospital Value-Based Purchasing (HVBP) – Total Performance Score
U.S. Department of Health & Human Services — A list of hospitals participating in the Hospital VBP Program and their Clinical Process of Care domain scores, Patient Experience of Care dimension scores, and...
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Courtney, P Maxwell; Darrith, Brian; Bohl, Daniel D; Frisch, Nicholas B; Della Valle, Craig J
2017-11-15
Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA). With use of the U.S. Centers for Medicare & Medicaid Services (CMS) Inpatient Charge Data, we identified 45 physician-owned and 2,657 non-physician-owned hospitals that performed ≥11 primary TKA and THA procedures in 2014. Cost data, patient-satisfaction scores, and risk-adjusted complication and 30-day readmission scores for knee and hip arthroplasty patients were obtained from the multiyear CMS Hospital Compare database. Physician-owned hospitals received lower mean Medicare payments than did non-physician-owned hospitals for THA and TKA procedures ($11,106 compared with $12,699; p = 0.002). While the 30-day readmission score did not differ significantly between the 2 types of hospitals (4.48 compared with 4.62 for physician-owned and non-physician-owned, respectively; p = 0.104), physician-owned hospitals had a lower risk-adjusted complication score (2.83 compared with 3.04; p = 0.015). Physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital (93.9 compared with 87.9; p CMS payment methodology. Our findings suggest that physician-owned hospitals are associated with lower mean Medicare costs, fewer complications, and higher patient satisfaction following THA and TKA than non-physician-owned hospitals. Policymakers should consider these data when debating the current moratorium on physician-owned hospital expansion. Therapeutic Level III. See
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Bottle, Alex; Loeffler, Mark D; Aylin, Paul; Ali, Adam M
2018-02-26
All-cause 30-day hospital readmission is in widespread use for monitoring and incentivizing hospital performance for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, little is known on the extent to which all-cause readmission is influenced by hospital or surgeon performance and whether alternative measures may be more valid. This is an observational study using multilevel modeling on English administrative data to determine the interhospital and intersurgeon variation for 3 readmission metrics: all-cause, surgical, and return-to-theater. Power calculations estimated the likelihood of identifying whether the readmission rate for a surgeon or hospital differed from the national average by a factor of 1.25, 1.5, 2, or 3 times, for both average and high-volume providers. 259,980 THAs and 311,033 TKAs were analyzed. Variations by both surgeons and hospitals were smaller for the all-cause measure than for the surgical or return-to-theater metrics, although statistical power to detect differences was higher. Statistical power to detect surgeon-level rates of 1.25 or 1.5 times the average was consistently low. However, at the hospital level, the surgical readmission measure showed more variation by hospital while maintaining excellent power to detect differences in rates between hospitals performing the average number of THA or TKA cases per year in England. In practice, more outliers than expected from purely random variation were found for all-cause and surgical readmissions, especially at hospital level. The 30-day surgical readmission rate should be considered as an adjunctive measure to 30-day all-cause readmission rate when assessing hospital performance. Copyright © 2018 Elsevier Inc. All rights reserved.
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Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L
2018-04-01
To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.
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Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini
2012-07-01
The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and "other". Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective
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Mandjukov, Petko; Orani, Anna Maria; Han, Eunmi; Vassileva, Emilia
2015-01-01
The most critical step in almost all commonly used analytical procedures for Hg determination is the sample preparation due to its extreme volatility. One of the possible solutions of this problem is the application of methods for direct analysis of solid samples. The possibilities for solid sampling high resolution continuum source atomic absorption spectrometry (HR CS AAS) determination of total mercury in various marine environmental samples e.g. sediments and biota are object of the present study. The instrumental parameters were optimized in order to obtain reproducible and interference free analytical signal. A calibration technique based on the use of solid standard certified reference materials similar to the nature of the analyzed sample was developed and applied to various CRMs and real samples. This technique allows simple and reliable evaluation of the uncertainty of the result and the metrological characteristics of the method. A validation approach in line with the requirements of ISO 17025 standard and Eurachem guidelines was followed. With this in mind, selectivity, working range (0.06 to 25 ng for biota and 0.025 to 4 ng for sediment samples, expressed as total Hg) linearity (confirmed by Student's t-test), bias (1.6-4.3%), repeatability (4-9%), reproducibility (9-11%), and absolute limit of detection (0.025 ng for sediment, 0.096 ng for marine biota) were systematically assessed using solid CRMs. The relative expanded uncertainty was estimated at 15% for sediment sample and 8.5% for marine biota sample (k = 2). Demonstration of traceability of measurement results is also presented. The potential of the proposed analytical procedure, based on solid sampling HR CS AAS technique was demonstrated by direct analysis of sea sediments form the Caribbean region and various CRMs. Overall, the use of solid sampling HR CS AAS permits obtaining significant advantages for the determination of this complex analyte in marine samples, such as straightforward
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A total quality management approach to healthcare waste management in Namazi Hospital, Iran.
Askarian, Mehrdad; Heidarpoor, Peigham; Assadian, Ojan
2010-11-01
Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings. Copyright © 2010 Elsevier Ltd. All rights reserved.
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Carvalho Júnior, Lúcio Honório de; Temponi, Eduardo Frois; Paganini, Vinícius Oliveira; Costa, Lincoln Paiva; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques
2015-01-01
the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.
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Solid-Liquid Extraction Kinetics of Total Phenolic Compounds (TPC from Red Dates
Directory of Open Access Journals (Sweden)
Bee Lin Chua
2018-01-01
Full Text Available Red dates are one of the most famous herbal plants in making traditional Chinese medicine. They contain large amount of bioactive compounds. The objectives of this research were to optimise the crude extract yield and total phenolic compounds (TPC yield from red dates using response surface methodology (RSM and model the extraction kinetics of TPC yield from red dates. Date fruits were dried in an oven under temperatures 50°C, 60°C, 70°C and 80°C until a constant weight was obtained. The optimum drying temperature was 60°C as it gave the highest crude extract yield and TPC yield. Besides that, single factor experiments were used to determine the optimum range of four extraction parameters which were: liquid-solid ratio (10-30 ml/g; ultrasonic power (70-90%; extraction temperature (50-70°C; and extraction time (40-60min. The optimum range of the four parameters were further optimised using the Box-Behken Design (BBD of RSM. The extraction conditions that gave the highest crude extract yield and TPC yield were chosen. The optimum value for liquid-solid ratio, ultrasonic power, extraction temperature and extraction time were 30ml/g, 70%, 60°C and 60 min respectively. The two equations generated from RSM were reliable and can be used to predict the crude extract yield and TPC yield. The higher the extraction temperature, liquid-solid ratio, and extraction time and lower ultrasonic power, the higher the crude extract and TPC yield. Finally, the results of TPC yield versus time based on the optimum extraction parameters from RSM optimisation were fitted into three extraction kinetic models (Peleg’s model, Page’s model and Ponomaryov’s model. It was found that the most suitable kinetic model to represent the extraction process of TPC from red dates was Page’s model due to its coefficient of determination (R2 was the closest to unity, 0.9663 while its root mean square error (RMSE was the closest to zero, 0.001534.
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Type 2 diabetes and in-hospital complications after revision of total hip and knee arthroplasty.
Directory of Open Access Journals (Sweden)
Ana López-de-Andrés
Full Text Available To assess the effect of type 2 diabetes (T2DM on hospital outcomes such as in hospital postoperative complications (IHPC, length of hospital stay (LOHS and in-hospital mortality (IHM after the revision of total hip arthroplasty (RHA and total knee arthroplasty (RKA and to identify factors associated with IHPC among T2DM patients undergoing these procedures.We performed a retrospective study using the Spanish National Hospital Discharge Database, 2005-2014. We included patients who were ≥40 years old that had undergone RHA and RKA. For each T2DM patient, we selected a year-, gender-, age- and Charlson Comorbidity Index-matched non-diabetic patient.We identified 44,055 and 39,938 patients who underwent RHA (12.72% with T2DM and RKA (15.01% with T2DM. We matched 4,700 and 5,394 couples with RHA and RKA, respectively. Any IHPC was more frequent among patients with T2DM than among non-T2DM patients (19% vs. 15.64% in the RHA cohort and 12.94% vs. 11.09% in the RKA cohort, respectively. For patients who underwent RHA, postoperative infection (4.51% vs. 2.94%, p<0.001, acute post-hemorrhagic anemia (9.53% vs. 7.70%, p<0.001, mean LOHS and IHM were significantly higher in patients with T2DM. Among RKA patients, the incidence of acute posthemorrhagic anemia (7.21% vs. 5.62%; p = 0.001 and urinary tract infection (1.13% vs. 0.72%; p = 0.029 was significantly higher in patients with diabetes. Older age, obesity, infection due to internal joint prosthesis, myocardial infarction, congestive heart failure, mild liver disease and renal disease and emergency room admission were significantly associated with a higher risk of IHPC in T2DM patients. IHPC decreased over time only in T2DM patients who underwent RHA (OR 0.94, 95%CI 0.89-0.98.Patients with T2DM who underwent RHA and RKA procedures had more IHPC after controlling for the effects of possible confounders. LOHS and IHM were also higher among RHA patients with diabetes. Older age, comorbidity, obesity
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Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D
2018-04-01
Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.
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International Nuclear Information System (INIS)
1995-01-01
The article drawn up within the framework of 'the assessment of the state of the environment in Lebanon' provides an overview of solid waste management, and assesses future wastes volume and waste disposal issues.In particular it addresses the following concerns: - Long term projections of solid waste arisings (i.e. domestic, industrial, such commercial wastes, vehicle types, construction waste, waste oils, hazardous toxic wastes and finally hospital and clinical wastes) are described. - Appropriate disposal routes, and strategies for reducing volumes for final disposal - Balance between municipal and industrial solid waste generation and disposal/treatment and - environmental impacts (aesthetics, human health, natural environment )of existing dumps, and the potential impact of government plans for construction of solid waste facilities). Possible policies for institutional reform within the waste management sector are proposed. Tables provides estimations of generation rates and distribution of wastes in different regions of Lebanon. Laws related to solid waste management are summarized
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Directory of Open Access Journals (Sweden)
Dörning, Hans
2007-03-01
Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part I of the publication, we present the results of the approach based on administrative data. Methods: We used administrative data from the AOK-Lower Saxony of the years 2000, 2001 and 2002. The study population comprised all beneficiaries, who received total hip replacement in the years 2000 or 2001. Performance indicators used where “critical incident (Mortality or revision” and “number of revisions” within the first year. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries in each of the two years. Multivariate modelling (logistic and poisson regression was used to estimate the performance indicators by case-mix variables (age, sex, co-diagnoses and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or SMR respectively with respect to a pre-selected reference hospital. The resulting rankings were compared with each other, with regard to temporal stability, and the impact of case-mix variables.Results: About 4500 beneficiaries received total hip replacement in each year (n2000: 4482; n2001: 4579. The ranking included 65 hospitals. Comparing the years 2000 and 2001, the temporal stability of the rankings based on a single performance indicator was low (Spearman rang correlation coefficients 0.158 and 0.191. The agreement of rankings based on different performance indicators in the
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Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W
2017-02-01
Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
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Directory of Open Access Journals (Sweden)
Schäfer, Thomas
2007-03-01
Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part II of the publication, we present the results of the approach based on administrative and patient-derived data. Methods: We used administrative data from a large health insurance (AOK-Lower Saxony of the year 2002 and from a patient survey. The study population comprised mainly beneficiaries, who received primary total hip replacement in the year 2002, were mailed a survey 6 month post-operatively and participated in the survey. Performance indicators used where “Revision”, “Complications” and “Change of functional impairment”. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries. Multivariate modelling (logistic regression and generalized linear models was used to estimate the performance indicators by case-mix variables (a.o. age, sex, co-morbidity, medical history and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or Standardized Difference (SDR with respect to a pre-selected reference hospital. The resulting rankings were compared with each other and with regard to the impact of case-mix variables. Results: 4089 beneficiaries received primary total hip replacement in 2002. 3293 patients participated in the survey (80.5%. The ranking included 60 hospitals. The agreement of rankings based on different performance indicators in the same year was low to high (a correlation
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Bacteria contamination of touch surfaces in Polish hospital wards
Directory of Open Access Journals (Sweden)
Anna Różańska
2017-08-01
Full Text Available Background: The objective of the study has been to evaluate the pathogenic bacteria contamination of touch surfaces in hospital wards. Material and Methods: Samples were taken from frequently touched surfaces in the hospital environment in 13 units of various types. Culturing was carried out on solid blood agar and in growth broth (tryptic soy broth – TSB. Species identification was performed using the analytical profile index (API biochemical testing and confirmed with matrix assisted laser desorption ionization time-flight mass spectrometry (MALDI-TOF-MS system. Results: The total of 161 samples were taken for the study. Fifty-two of them, after 24 h of culture on a solid medium, demonstrated bacterial growth and further 60 samples had growth after prior multiplication in TSB. Overall, 69.6% of samples exhibited growth of 19 bacterial species. Pathogenic species – representing indicator organisms of efficiency of hospital cleaning – was demonstrated by 21.4% of samples. Among them Acinetobacter spp., Enterocococci spp. and Staphylococcus aureus were identified. Coagulase-negative staphylococci (CNS were predominant. The proportion of various groups of bacteria significantly varied in respective hospitals, and in various types of wards. Disturbing observation is a large proportion of resistance of isolated CNS strains as a potential reservoir of resistance genes. Conclusions: The results show that touch surfaces in hospital units are contaminated by both potentially pathogenic and pathogenic bacterial species. In connection with the reported, also in Poland, frequent omission or incorrect execution of hand hygiene by hospital staff, and probably patients, touch surfaces still constitute important reservoir of pathogenic bacteria. Improving hand hygiene compliance of health-care workers with recommendations is necessary for increasing biological safety of hospital environment. Med Pr 2017;68(3:459–467
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Directory of Open Access Journals (Sweden)
Lúcio Honório de Carvalho Júnior
2015-02-01
Full Text Available Objective: the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. Materials and methods: the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. Results: between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. Conclusion: according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.
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Energy Technology Data Exchange (ETDEWEB)
Mandjukov, Petko; Orani, Anna Maria; Han, Eunmi; Vassileva, Emilia, E-mail: e.vasileva-veleva@iaea.org
2015-01-01
The most critical step in almost all commonly used analytical procedures for Hg determination is the sample preparation due to its extreme volatility. One of the possible solutions of this problem is the application of methods for direct analysis of solid samples. The possibilities for solid sampling high resolution continuum source atomic absorption spectrometry (HR CS AAS) determination of total mercury in various marine environmental samples e.g. sediments and biota are object of the present study. The instrumental parameters were optimized in order to obtain reproducible and interference free analytical signal. A calibration technique based on the use of solid standard certified reference materials similar to the nature of the analyzed sample was developed and applied to various CRMs and real samples. This technique allows simple and reliable evaluation of the uncertainty of the result and the metrological characteristics of the method. A validation approach in line with the requirements of ISO 17025 standard and Eurachem guidelines was followed. With this in mind, selectivity, working range (0.06 to 25 ng for biota and 0.025 to 4 ng for sediment samples, expressed as total Hg) linearity (confirmed by Student's t-test), bias (1.6–4.3%), repeatability (4–9%), reproducibility (9–11%), and absolute limit of detection (0.025 ng for sediment, 0.096 ng for marine biota) were systematically assessed using solid CRMs. The relative expanded uncertainty was estimated at 15% for sediment sample and 8.5% for marine biota sample (k = 2). Demonstration of traceability of measurement results is also presented. The potential of the proposed analytical procedure, based on solid sampling HR CS AAS technique was demonstrated by direct analysis of sea sediments form the Caribbean region and various CRMs. Overall, the use of solid sampling HR CS AAS permits obtaining significant advantages for the determination of this complex analyte in marine samples, such as
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MBR technology: a promising approach for the (pre-)treatment of hospital wastewater.
Beier, S; Cramer, C; Mauer, C; Köster, S; Schröder, H Fr; Pinnekamp, J
2012-01-01
Membrane bioreactor (MBR) technology is a very reliable and extensively tested solution for biological wastewater treatment. Nowadays, separate treatment of highly polluted wastewater streams especially from hospitals and other health care facilities is currently under investigation worldwide. In this context, the MBR technology will play a decisive role because an effluent widely cleaned up from solids and nutrients is absolutely mandatory for a subsequent further elimination of organic trace pollutants. Taking hospital wastewater as an example, the aim of this study was to investigate to what extent MBR technology is an adequate 'pre-treatment' solution for further elimination of trace pollutants. Therefore, we investigated - within a 2-year period - the performance of a full-scale hospital wastewater treatment plant (WWTP) equipped with a MBR by referring to conventional chemical and microbiological standard parameters. Furthermore, we measured the energy consumption and tested different operating conditions. According to our findings the MBR treatment of the hospital wastewater was highly efficient in terms of the removal of solids and nutrients. Finally, we did not observe any major adverse effects on the operation and performance of the MBR system which potentially could derive from the composition of the hospital wastewater. In total, the present study proved that MBR technology is a very efficient and reliable treatment approach for the treatment of highly polluted wastewater from hospitals and can be recommended as a suitable pre-treatment solution for further trace pollutant removal.
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Cunningham, Aaron J; Lofberg, Katrine M; Krishnaswami, Sanjay; Butler, Marilyn W; Azarow, Kenneth S; Hamilton, Nicholas A; Fialkowski, Elizabeth A; Bilyeu, Pamela; Ohm, Erika; Burns, Erin C; Hendrickson, Margo; Krishnan, Preetha; Gingalewski, Cynthia; Jafri, Mubeen A
2017-12-01
An expedited recovery protocol for management of pediatric blunt solid organ injury (spleen, liver, and kidney) was instituted across two Level 1 Trauma Centers, managed by nine pediatric surgeons within three hospital systems. Data were collected for 18months on consecutive patients after protocol implementation. Patient demographics (including grade of injury), surgeon compliance, National Surgical Quality Improvement Program (NSQIP) complications, direct hospital cost, length of stay, time in the ICU, phlebotomy, and re-admission were compared to an 18-month control period immediately preceding study initiation. A total of 106 patients were treated (control=55, protocol=51). Demographics were similar among groups, and compliance was 78%. Hospital stay (4.6 vs. 3.5days, p=0.04), ICU stay (1.9 vs. 1.0days, p=0.02), and total phlebotomy (7.7 vs. 5.3 draws, p=0.007) were significantly less in the protocol group. A decrease in direct hospital costs was also observed ($11,965 vs. $8795, p=0.09). Complication rates (1.8% vs. 3.9%, p=0.86, no deaths) were similar. An expedited, hemodynamic-driven, pediatric solid organ injury protocol is achievable across hospital systems and surgeons. Through implementation we maintained quality while impacting length of stay, ICU utilization, phlebotomy, and cost. Future protocols should work to further limit resource utilization. Retrospective cohort study. Level II. Copyright © 2017 Elsevier Inc. All rights reserved.
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Medalie, Laura
2016-12-20
The U.S. Geological Survey, in cooperation with the New England Interstate Water Pollution Control Commission and the Vermont Department of Environmental Conservation, estimated daily and 9-month concentrations and fluxes of total and dissolved phosphorus, total nitrogen, chloride, and total suspended solids from 1990 (or first available date) through 2014 for 18 tributaries of Lake Champlain. Estimates of concentration and flux, provided separately in Medalie (2016), were made by using the Weighted Regressions on Time, Discharge, and Season (WRTDS) regression model and update previously published WRTDS model results with recent data. Assessment of progress towards meeting phosphorus-reduction goals outlined in the Lake Champlain management plan relies on annual estimates of phosphorus flux. The percent change in annual concentration and flux is provided for two time periods. The R package EGRETci was used to estimate the uncertainty of the trend estimate. Differences in model specification and function between this study and previous studies that used WRTDS to estimate concentration and flux using data from Lake Champlain tributaries are described. Winter data were too sparse and nonrepresentative to use for estimates of concentration and flux but were sufficient for estimating the percentage of total annual flux over the period of record. Median winter-to-annual fractions ranged between 21 percent for total suspended solids and 27 percent for dissolved phosphorus. The winter contribution was largest for all constituents from the Mettawee River and smallest from the Ausable River. For the full record (1991 through 2014 for total and dissolved phosphorus and chloride and 1993 through 2014 for nitrogen and total suspended solids), 6 tributaries had decreasing trends in concentrations of total phosphorus, and 12 had increasing trends; concentrations of dissolved phosphorus decreased in 6 and increased in 8 tributaries; fluxes of total phosphorus decreased in 5 and
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Total cross sections for slow-electron (1--20 eV) scattering in solid H2O
International Nuclear Information System (INIS)
Michaud, M.; Sanche, L.
1987-01-01
An analytical method is proposed to determine absolute total cross sections per scatterer and related mean free paths for low-energy electron scattering in disordered molecular solid films. The procedure is based on a two-stream multiple-scattering model of the thickness dependence of the film reflectivity for elastic electrons. The expected analytical behavior and accuracy are tested on a model sample whose scattering properties are generated by a Monte Carlo simulation from initially known parameters. The effects of multiple scattering inside the film and at its interfaces are taken into account and discussed. The thickness dependence of the elastic electron reflectivity of H 2 O film condensed at 14 K is reported between 1 and 20 eV incident energy with a spectrometer resolution of 10 MeV. The proposed method is applied to extract from these measurements the energy dependence of the total effective and total inelastic cross sections for electron scattering in amorphous ice
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Capson-Tojo, Gabriel; Trably, Eric; Rouez, Maxime; Crest, Marion; Bernet, Nicolas; Steyer, Jean-Philippe; Delgenès, Jean-Philippe; Escudié, Renaud
2018-01-01
This study evaluated the influence of the co-substrate proportions (0-60% of cardboard in dry basis) and the initial total solid contents (20-40%) on the batch fermentation performance. Maximum hydrogen yields were obtained when mono-fermenting food waste at high solids contents (89mlH 2 ·gVS -1 ). The hydrogen yields were lower when increasing the proportions of cardboard. The lower hydrogen yields at higher proportions of cardboard were translated into higher yields of caproic acid (up to 70.1gCOD·kgCOD bio -1 ), produced by consumption of acetic acid and hydrogen. The highest substrate conversions were achieved at low proportions of cardboard, indicating a stabilization effect due to higher buffering capacities in co-fermentation. Clostridiales were predominant in all operational conditions. This study opens up new possibilities for using the cardboard proportions for controlling the production of high added-value products in dry co-fermentation of food waste. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Wang, Quan; Jiang, Jianguo; Zhang, Yujing; Li, Kaimin
2015-01-01
The effect of initial total solids (TS) concentration on volatile fatty acid (VFAs) production from food waste under mesophilic conditions (35 °C) was determined. VFAs concentration and composition, biogas production, soluble chemical oxygen demand concentration, TS and volatile solids (VS) reduction, and ammonia nitrogen [Formula: see text] release were investigated. The VFAs concentrations were 26.10, 39.68, 59.58, and 62.64 g COD/L at TS contents of 40, 70, 100, and 130 g/L, respectively. While the VFAs' yields ranged from 0.467 to 0.799 g COD/g VSfed, decreased as initial TS increased. The percentage of propionate was not affected by TS concentration, accounting for 30.19-34.86% of the total VFAs, while a higher percentage of butyrate and lower percentage of acetate was achieved at a higher TS concentration. Biogas included mainly hydrogen and carbon dioxide and the maximum hydrogen yield of 148.9 ml/g VSfed was obtained at 130 g TS/L. [Formula: see text] concentration, TS and VS reductions increased as initial TS increased. Considering the above variables, we conclude that initial TS of 100 g/L shall be the most appropriate to VFAs production.
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International Nuclear Information System (INIS)
Voudrias, Evangelos; Goudakou, Lambrini; Kermenidou, Marianthi; Softa, Aikaterini
2012-01-01
solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective unit production rates were: (1) for reagents 1.7 (2.4) g/patient/d and 0.3 (0.4) g/examination/d, (2) for solvents 248 (127) g/patient/d and 192 (101) g/examination/d, (3) for dyes and tracers 4.7 (1.4) g/patient/d and 2.5 (0.9) g/examination/d and (4) for solid waste 54 (28) g/patient/d and 42 (22) g/examination/d.
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Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty....
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Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty rehabilitat......The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...... rehabilitation. Since hospital stay duration has decreased considerably, the need for post-discharge physiotherapy may also have changed. Thus, the indication for and types of rehabilitation programmes need to be studied within the context of fast-track knee arthroplasty. Udgivelsesdato: 2009-Feb-23...
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International Nuclear Information System (INIS)
Nasrabadi, T.; Ruegner, H.; Sirdari, Z.Z.; Schwientek, M.; Grathwohl, P.
2016-01-01
The present study was carried out in Haraz basin (Iran) that is located in south of the Caspian Sea. The goal of this study was to establish correlations amongst total suspended solids concentration (TSS) and turbidity with total pollutant concentrations to evaluate the dissolved and particle-bound concentrations of major toxic metals. It also aimed to validate TSS and/or turbidity measurements as proxies to monitor pollutant fluxes. Eight metals, namely nickel, lead, cadmium, copper, zinc, cobalt, arsenic and strontium were analyzed for dissolved and total concentrations in water at ten locations within the catchment. TSS and turbidity were also measured. Sampling campaigns were designed to cover both the rainy (December) and the dry (May) season within the basin. The robust relationship between TSS (202–1212 mg/l) and turbidity (63–501 NTUs) in both seasons warranted their interchangeable potential as proxies within the observed ranges. Total element concentrations were plotted in separate attempts versus TSS and turbidity for all locations and both events. Very good linear correlations were attained where the slopes represent the metals concentration on suspended solids and the intercept the dissolved concentration in water. The results achieved by these linear regressions were in very good agreement with independently measured values for dissolved concentration and concentrations on river bed sediments taken at the same locations. This demonstrates that turbidity and/or TSS measurements may be used for monitoring of metal loads if once calibrated against total concentration of metals. The results also revealed that in the lower Haraz catchment metal concentrations on suspended and river bed sediment were homogeneously distributed along the investigated river stretch. This is assumed to be due to intensive gravel and sand mining activities in the upper and middle part of the catchment. - Highlights: • Turbidity is evaluated as a feasible proxy to predict
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Energy Technology Data Exchange (ETDEWEB)
Meza Monge, K
1998-07-01
The current handling, treatment and final disposition of the hospital solid waste in Costa Rica are considered inadequate or at least insufficient. This situation represents a serious danger for the population's health and the environment, because they are exposed to infectious agents, toxic substances and even radioactive products that are generated among the residuals of the centers of health. This work, alternatives propose for the treatment and adequate final disposition of the solid waste produced in the hospitals of the country. They take into consideration the characteristics that present these residuals, the advantages and disadvantages of each one of the existent techniques and the technical and economic possibilities of the country. For this purpose, in first instance, a revision about the properties, the quality and the quantity of the solid waste produced by the national hospital centers was carried out. Also, a diagnostic of the current situation of the treatment and final disposition of these residuals in some of the most important hospitals of the country, as well as of the possibilities of physical space with that they count on was carried out. Then, the existent different treatment techniques and final disposition for the solid waste that comes from the centers of health are described, as well as their advantages and disadvantages and a comparative analysis of the same ones is carried out. The objective is completed, since alternatives of treatment and final disposition that are considered appropriate for this type of residuals are planned. Nevertheless, in the future, more detailed investigations and studies of feasibility, with the purpose of developing handling programs and elimination of the solid waste for each one of the hospital centers in Costa Rica should be carried out. (Author) [Spanish] El actual manejo, tratamiento y disposicion final de los desechos solidos hospitalarios en Costa Rica se considera inadecuado o cuando menos
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Stability investigation of total parenteral nutrition admixture prepared in a hospital pharmacy
Directory of Open Access Journals (Sweden)
Mirković Dušica
2008-01-01
Full Text Available Background/Aim. In the cases when nutrition of patients can not be orally nor enterally performed, parenteral nutrition is a method of the therapy that provides more successful and rapid recovery. In that way, hospitalization can be significantly shorter, healing costs reduced and mortality minimized. Total parenteral nutrition (TPN admixtures are the most complex systems which contain amino acids, carbohydrates, lipid emulsion, macroelectrolytes (Na+, K+, Ca2+, Mg2+, Cl-, SO42-, PO43-, oligoelements, hydro- and liposoluble vitamines, heparin, insulin and water. Concerning the mentioned complexity, special attention should be payed to physicochemical and microbiological stability of a mixture, because of interactions among components, that can be very hard to analyze. The aim of this study was to investigate the problem of stability of TPN admixtures prepared in a hospital pharmacy. Methods. Admixture TPN was aseptically prepared in laminar air - flow environment on the basis of the specified order in supplementing components and additives to basic solutions. Solutions were kept in sterile multicompartment ethylene-vinyl-acetate bags. After preparation and slow homogenization, TPN admixtures were submitted to physicochemical and microbiological stability analyses in various period of time. The assessment of physical stability of TPN admixture was done on the basis of visual inspection, determination of pH value and measuring of particle size. The investigation of sterility and pyrogenic test were performed according to Ph. Yug. V regulations. Results. Physico-chemical and microbiological analyses were applied and no significant changes in visual sense, pH value and droplet size stability of the TPN admixture were observed during the period of 60 hours. The lipid droplets were smaller in size than 5 μm, that is the most common pharmacopoeia requirement. Conclusion. The results of our study confirmed that a TPN admixture prepared in a hospital
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Total hip arthroplasty in Jesenice General hospital 1985–2006 – what has been done and look forward
Directory of Open Access Journals (Sweden)
Tomaž Silvester
2007-11-01
Full Text Available Background: Total arthroplasty is one of the most interesting and fast developing fields in orthopaedic surgery. Practically every joint in the human body is involved, total hip arthroplasties (THA being most frequent and with the longest history. Information on long-term results and survival of different types of prosthesis is invaluable for both patients and surgeons.Patients and methods: Between 1985 and 2006 there were 1563 THAs performed in Jesenice General Hospital. Average age at the time of operation was 67 years, almost two thirds of patients were women. The reason for operation was in 72 % idiopathic arthrosis and in 14 % sequaele of dysplasia.Results: There were 1370 primary procedures and 193 revisions (12.6 %. Aseptic loosening of the implant was the most frequent reason for revision (74 % and infection was observed in 1.5 %. In the first ten years of this research hybrid type of prosthesis was most frequently used, but nowadays, non-cemented prosthesis is used in majority of cases.Conclusions: Total hip arthroplasty is well established procedure at the Jesenice General Hospital. It considerably improves quality of life of the patient, for both, short- and long term, results are very good. New minimal invasive surgical techniques make postoperative rehabilitation faster and easier. The Register of prosthesis enables us to regularly analyze the results and provides treatment outcome information concerning the choice of prosthesis and the optimal surgical technique. Jesenice General Hospital is well recognized as one of the centers for arthroplasties in our country.
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Forecasting models for flow and total dissolved solids in Karoun river-Iran
Salmani, Mohammad Hassan; Salmani Jajaei, Efat
2016-04-01
Water quality is one of the most important factors contributing to a healthy life. From the water quality management point of view, TDS (total dissolved solids) is the most important factor and many water developing plans have been implemented in recognition of this factor. However, these plans have not been perfect and very successful in overcoming the poor water quality problem, so there are a good volume of related studies in the literature. We study TDS and the water flow of the Karoun river in southwest Iran. We collected the necessary time series data from the Harmaleh station located in the river. We present two Univariate Seasonal Autoregressive Integrated Movement Average (ARIMA) models to forecast TDS and water flow in this river. Then, we build up a Transfer Function (TF) model to formulate the TDS as a function of water flow volume. A performance comparison between the Seasonal ARIMA and the TF models are presented.
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Chang, Yu-Min; Liu, Chien-Chung; Dai, Wen-Chien; Hu, Allen; Tseng, Chao-Heng; Chou, Chieh-Mei
2013-01-01
This work presents the enforcement performance of recent Haulien County, Taiwan municipal solid waste (MSW) recycling management programs. These programs include: Mandatory Refuse Sorting and Recycling, Diverse Bulk Waste Reuse, Pay-as-you-Discharge, Total Food Waste Recycling, Restricted Use on Plastic Shopping Bags & Plastic Tableware, Recycling Fund Management, and Ash Reuse. These programs provide incentives to reduce the MSW quantity growth rate. It was found that the recycled material fraction of MSW generated in 2001 was from 6.8%, but was 32.4% in 2010 and will increase stably by 2-5% yearly in the near future. Survey data for the last few years show that only 2.68% (based on total MSW generated) of food waste was collected in 2001. However, food waste was up to 9.7% in 2010 after the Total Food Waste Recycling program was implemented. The reutilization rate of bottom ash was 20% in 2005 and up to 65% in 2010 owing to Ash Reuse Program enforcement. A quantified index, the Total Recycle Index, was proposed to evaluate MSW management program performance. The demonstrated county will move toward a zero waste society in 2015 if the Total Recycle Index approaches 1.00. Exact management with available programs can lead to slow-growing waste volume and recovery of all MSW.
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Directory of Open Access Journals (Sweden)
MA Abduli
2015-07-01
Methods: The study was a descriptive cross-sectional one conducted from 2010 to 2014. Relevant officials of the waste recovery in 22 regions of Tehran were approached in order to collect data about municipal solid waste generation through interviewing, filling out questionnaires, conducting field visits from Aradkooh Disposal and Processing Complex and collecting information on disposal and destiny of wastes. Then the data were compiled and analyzed. Results: Total solid waste generation in Tehran from 2010 to 2014 amounted to respectively 3389662, 3399344, 3449338 and 3245157 Metric Tons, categorized into three groups of municipal, companies and townships and hospital wastes. Most of the generated waste produced in Tehran was that of households and commercial (known as municipal waste from 22 Regions of Tehran. Based on the surveys conducted, per capita solid waste generation of 11 regions of Tehran ranged from 550 to 1000 grams and in other 11 ones from 1000 to 1521 grams per capita per day. The lowest and highest waste generation rate belonged respectively to region 13 with 556 grams and region 12 with 1521 grams per capita per day in 2011. Conclusion: Comparing per capita generation of municipal solid waste in different municipal regions in Tehran with maximum acceptable capacity of waste generation indicates the deviation of waste generation of all Tehran regions from the standard acceptable amount. Therefore, not only is it necessary to plan and take strategic measures to reduce Tehran waste generation but also these programs and measures should be specific to each region considering its specifications and solid waste quality and quantity.
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Edge, Katelyn J; Dafforn, Katherine A; Simpson, Stuart L; Ringwood, Amy H; Johnston, Emma L
2015-06-01
Resuspended contaminated sediments represent an important route of contaminant exposure for aquatic organisms. During resuspension events, filter-feeding organisms are exposed to contaminants, in both the dissolved form (at the gills) and the particulate form (in the digestive system). In addition, these organisms must manage the physical stress associated with an increase in total suspended solids (TSS). To date, few studies have experimentally compared the contributions to biological stress of contaminated and clean suspended solids. The authors mixed field-collected sediments (cellular biomarkers (lysosomal membrane stability, lipid peroxidation, and glutathione) were measured to evaluate sublethal toxicity. Lysosomal membrane stability was the most sensitive biomarker for distinguishing effects from resuspended contaminated sediments, as increasing amounts of contaminated TSS increased lysosomal membrane destabilization. The authors' results illustrate the importance of considering contaminant exposures from resuspended sediments when assessing the toxicity of contaminants to aquatic organisms. © 2015 SETAC.
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Development and evaluation of a magnetic solid-phase radioimmunoassay for total human thyroxine (T4)
International Nuclear Information System (INIS)
Abbas, S. H.; Hassan, A. M. E.; Abdalla, O. M.; Zahran, A. B.; Shabbo, N. M.; Ali, N. I.; Gubara, A.
2009-02-01
In this study a simple and rapid magnetic solid-phase radioimmunoassay (RIA) for human thyroxine (T4) was developed using locally raised sheep thyroxine antibody and radioiodinated thyroxine (T4) tracer by chloramine-T method. The assay involves two hours incubation at ambient temperature rang (30 to 35 o C ) associated with the antibody covalently linked by the easily performed carbonyldiimidazole (CDI) method to magnetic particles obtained from SIPAC. 0.1% triton with sodium azide used as a wash buffer. L-Thyroxine Na-salt peta hydrate from sigma was used for the preparation of standards and quality control sera. The coupled magnetic anti-T4 solid phase titrated in order to find out the suitable antibody concentration (titre) to be used in the assay. Optimizations followed by validation procedures were done. When correlated with kits imported from NETRIA and AMERSHAM, results were found to be highly comparable r=0.965 and p<0.05. Shelf life was also studied, so that the local prepared T4 RIA magnetic reagents can be used for the measurement of total human thyroxine with a very low cost compared to imported kits. (Author)
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Surgical waste audit of 5 total knee arthroplasties.
Stall, Nathan M; Kagoma, Yoan M; Bondy, Jennifer N; Naudie, Douglas
2013-04-01
Operating rooms (ORs) are estimated to generate up to one-third of hospital waste. At the London Health Sciences Centre, prosthetics and implants represent 17% of the institution's ecological footprint. To investigate waste production associated with total knee arthroplasties (TKAs), we performed a surgical waste audit to gauge the environmental impact of this procedure and generate strategies to improve waste management. We conducted a waste audit of 5 primary TKAs performed by a single surgeon in February 2010. Waste was categorized into 6 streams: regular solid waste, recyclable plastics, biohazard waste, laundered linens, sharps and blue sterile wrap. Volume and weight of each stream was quantified. We used Canadian Joint Replacement Registry data (2008-2009) to estimate annual weight and volume totals of waste from all TKAs performed in Canada. The average surgical waste (excluding laundered linens) per TKA was 13.3 kg, of which 8.6 kg (64.5%) was normal solid waste, 2.5 kg (19.2%) was biohazard waste, 1.6 kg (12.1%) was blue sterile wrap, 0.3 kg (2.2%) was recyclables and 0.3 kg (2.2%) was sharps. Plastic wrappers, disposable surgical linens and personal protective equipment contributed considerably to total waste. We estimated that landfill waste from all 47 429 TKAs performed in Canada in 2008-2009 was 407 889 kg by weight and 15 272 m3 by volume. Total knee arthroplasties produce substantial amounts of surgical waste. Environmentally friendly surgical products and waste management strategies may allow ORs to reduce the negative impacts of waste production without compromising patient care. Level IV, case series.
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Environmental pollution from solid wastes
International Nuclear Information System (INIS)
Jervis, R.E.; Krishnan, S.S.; Accetone, P.; Arifin, N.; Ko, M.M.C.; Nhan, C.; Nguyen, L.; Vela, L.; Yee, T.
1992-01-01
Research completed under the CRP during the past two years has encompassed several related aspects of environmental problems associated with solid wastes: assessment of major sources of toxic elements in a variety of solid waste forms, their leachability by simulated groundwater or rain/acid rain and the determination of the contribution of hospital incinerator to atmospheric releases. The summary of the findings of these investigations are given in this report. Unexpected high levels of cadmium have been found in many solid wastes. Leaching tests indicate that, in some cases, over 70% of this can be leached out into the nearby waterways. Combustibility tests indicated that 35 to 45% of it is emitted to the atmosphere during burning. This explains the increased levels of cadmium in air particulates sampled downwind from waste incinerators. Plastic items in municipal and hospital wastes were particularly elevated in Cd, Cl, Cr, Ba and Zn. Up to 1300 μg/g of Cd was found in some domestic items. By inference, Pb also is found in some common plastics but the current studies did not permit Pb determination in solid wastes, but only in aerosols. (author). 8 tabs
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Total versus subtotal Laparoscopic Hysterectomy: A comparative study in Arash Hospital
Directory of Open Access Journals (Sweden)
Samiei H
2009-09-01
Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. "n"nMethods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups."n"nResults: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03. Although, the hemoglobin (gr/dl drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05 Blood transfusion were common in SLH (1 case Versus 3 Cases. The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04. The drug requirements to
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Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T
2017-12-01
The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes. We classified the reasons for readmissions as either procedure- or medical-related. Cost-to-charge ratios supplied with the Nationwide Readmissions Database were used to compute the individual per-patient cost of 90-day readmissions as a continuous variable in separate general linear models for THA and TKA. Payer, patient, clinical, and hospital factors were treated as covariates. We estimated the national burden of readmissions by payer and by the reason for readmission. The national rates of 30- and 90-day readmissions after THA were 4% (95% confidence interval [CI], 4.2%-4.5%) and 8% (95% CI, 7.5%-8.1%), respectively. The national rates of 30- and 90-day readmissions after primary TKA were 4% (95% CI, 3.8%-4.0%) and 7% (95% CI, 6.8%-7.2%), respectively. The five most important variables responsible for the cost of 90-day THA readmissions (in rank order, based
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Lepot, Mathieu; Aubin, Jean-Baptiste; Bertrand-Krajewski, Jean-Luc
2013-01-01
Many field investigations have used continuous sensors (turbidimeters and/or ultraviolet (UV)-visible spectrophotometers) to estimate with a short time step pollutant concentrations in sewer systems. Few, if any, publications compare the performance of various sensors for the same set of samples. Different surrogate sensors (turbidity sensors, UV-visible spectrophotometer, pH meter, conductivity meter and microwave sensor) were tested to link concentrations of total suspended solids (TSS), total and dissolved chemical oxygen demand (COD), and sensors' outputs. In the combined sewer at the inlet of a wastewater treatment plant, 94 samples were collected during dry weather, 44 samples were collected during wet weather, and 165 samples were collected under both dry and wet weather conditions. From these samples, triplicate standard laboratory analyses were performed and corresponding sensors outputs were recorded. Two outlier detection methods were developed, based, respectively, on the Mahalanobis and Euclidean distances. Several hundred regression models were tested, and the best ones (according to the root mean square error criterion) are presented in order of decreasing performance. No sensor appears as the best one for all three investigated pollutants.
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Draghi, Patrícia Ferrante; Fernandes, Julio Cesar Bastos
2017-03-01
We developed a label-free potentiometric biosensor using tyrosinase extracted from Musa acuminata and immobilized by covalent bond on a surface of a solid-contact transducer. The transducer was manufactured containing two layers. The first layer contained a blend of poly(vinyl) chloride carboxylated (PVC-COOH), graphite and potassium permanganate. On this layer, we deposited a second layer containing just a mixture of poly(vinyl chloride) carboxylated and graphite. On the last layer of the transducer, we immobilized the tyrosinase enzyme by reaction with N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride. The solid-contact potentiometric biosensor presented at low detection limit of 7.3×10 -7 M and a linear range to catechol concentration between 9.3×10 -7 M and 8.3×10 -2 M. This biosensor was applied to determine the amount of total phenols in different samples of honey and propolis. The results agreed with the Folin-Ciocalteu method. Copyright © 2016 Elsevier B.V. All rights reserved.
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Fernández-Ruiz, Ramón; Friedrich K., E. Josue; Redrejo, M. J.
2018-02-01
The main goal of this work was to investigate, in a systematic way, the influence of the controlled modulation of the particle size distribution of a representative solid sample with respect to the more relevant analytical parameters of the Direct Solid Analysis (DSA) by Total-reflection X-Ray Fluorescence (TXRF) quantitative method. In particular, accuracy, uncertainty, linearity and detection limits were correlated with the main parameters of their size distributions for the following elements; Al, Si, P, S, K, Ca, Ti, V, Cr, Mn, Fe, Ni, Cu, Zn, As, Se, Rb, Sr, Ba and Pb. In all cases strong correlations were finded. The main conclusion of this work can be resumed as follows; the modulation of particles shape to lower average sizes next to a minimization of the width of particle size distributions, produce a strong increment of accuracy, minimization of uncertainties and limit of detections for DSA-TXRF methodology. These achievements allow the future use of the DSA-TXRF analytical methodology for development of ISO norms and standardized protocols for the direct analysis of solids by mean of TXRF.
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Robledo-Narváez, Paula N; Muñoz-Páez, Karla M; Poggi-Varaldo, Hector M; Ríos-Leal, Elvira; Calva-Calva, Graciano; Ortega-Clemente, L Alfredo; Rinderknecht-Seijas, Noemí; Estrada-Vázquez, Carlos; Ponce-Noyola, M Teresa; Salazar-Montoya, J Alfredo
2013-10-15
Hydrogen is a valuable clean energy source, and its production by biological processes is attractive and environmentally sound and friendly. In México 5 million tons/yr of agroindustrial wastes are generated; these residues are rich in fermentable organic matter that can be used for hydrogen production. On the other hand, batch, intermittently vented, solid substrate fermentation of organic waste has attracted interest in the last 10 years. Thus the objective of our work was to determine the effect of initial total solids content and initial pH on H2 production in batch fermentation of a substrate that consisted of a mixture of sugarcane bagasse, pineapple peelings, and waste activated sludge. The experiment was a response surface based on 2(2) factorial with central and axial points with initial TS (15-35%) and initial pH (6.5-7.5) as factors. Fermentation was carried out at 35 °C, with intermittent venting of minireactors and periodic flushing with inert N2 gas. Up to 5 cycles of H2 production were observed; the best treatment in our work showed cumulative H2 productions (ca. 3 mmol H2/gds) with 18% and 6.65 initial TS and pH, respectively. There was a significant effect of TS on production of hydrogen, the latter decreased with initial TS increase from 18% onwards. Cumulative H2 productions achieved in this work were higher than those reported for organic fraction of municipal solid waste (OFMSW) and mixtures of OFMSW and fruit peels waste from fruit juice industry, using the same process. Specific energetic potential due to H2 in our work was attractive and fell in the high side of the range of reported results in the open literature. Batch dark fermentation of agrowastes as practiced in our work could be useful for future biorefineries that generate biohydrogen as a first step and could influence the management of this type of agricultural wastes in México and other countries and regions as well. Copyright © 2013 Elsevier Ltd. All rights reserved.
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International Nuclear Information System (INIS)
Nowar, M.S.; Eldarawany, A.A.; Habeeb, A.A.
1992-01-01
This investigation aimed to study the effects of aflatoxins B 1 +G 1 mixture mainly on total body water (TBW) and on total body solids (TBS) of male albino rats. Some blood components and some reproductive characteristic were also taken into consideration. Two groups, each of 8 male rats were fed the same ration. Rats of one group had been individually ingested daily with a dose of 22 μg B 1 plus 22 μg G 1 for 15 successive weeks. The obtained results showed that aflatoxin administration caused: 1- A decrease in final body weight (FBW), TBW (P<0.01) and TBS (P<0.05). 2- A decrease in serum total proteins (P<0.01), albumin (P<0.05), globulin (P<0.05), glucose (P<0.05) and increase in serum cholesterol, GOT and GPT (P<0.05) activities. 3- A decrease in each of the number of effective matings of males and delivery percentages of females mated with treated males.1 tab
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Turbidity and Total Suspended Solids on the Lower Cache River Watershed, AR.
Rosado-Berrios, Carlos A; Bouldin, Jennifer L
2016-06-01
The Cache River Watershed (CRW) in Arkansas is part of one of the largest remaining bottomland hardwood forests in the US. Although wetlands are known to improve water quality, the Cache River is listed as impaired due to sedimentation and turbidity. This study measured turbidity and total suspended solids (TSS) in seven sites of the lower CRW; six sites were located on the Bayou DeView tributary of the Cache River. Turbidity and TSS levels ranged from 1.21 to 896 NTU, and 0.17 to 386.33 mg/L respectively and had an increasing trend over the 3-year study. However, a decreasing trend from upstream to downstream in the Bayou DeView tributary was noted. Sediment loading calculated from high precipitation events and mean TSS values indicate that contributions from the Cache River main channel was approximately 6.6 times greater than contributions from Bayou DeView. Land use surrounding this river channel affects water quality as wetlands provide a filter for sediments in the Bayou DeView channel.
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Directory of Open Access Journals (Sweden)
Andree H. Koop
2018-01-01
Full Text Available Background/Aims. The aim of this study was to evaluate the association of fluid balance with outcomes in patients hospitalized with acute pancreatitis (AP. Methods. This was a retrospective study of patients hospitalized between May 2008 and June 2016 with AP and a clinical order for strict recording of intake and output. Data collected included various types of fluid intake and output at 24 and 48 hours after admission. The primary outcome was length of stay (LOS. Analysis was performed using single-variable and multivariable negative binomial regression models. Results. Of 1256 patients hospitalized for AP during the study period, only 71 patients (5.6% had a clinical order for strict recording of intake and output. Increased urine output was associated with a decreased LOS at 24 and 48 hours in univariable analysis. An increasingly positive fluid balance (total intake minus urine output at 24 hours was associated with a longer LOS in multivariable analysis. Conclusions. Few patients hospitalized for AP had a documented order for strict monitoring of fluid intake and output, despite the importance of monitoring fluid balance in these patients. Our study suggests an association between urine output and fluid balance with LOS in AP.
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Varacallo, Matthew A; Herzog, Leah; Toossi, Nader; Johanson, Norman A
2017-06-01
Total joint arthroplasty procedures continue to provide consistent, long-term success and high patient satisfaction scores. However, early unplanned readmission to the hospital imparts significant financial risks to individual institutions as we shift away from the traditional fee-for-service payment model. Using a combination of our hospital's administrative database and retrospective chart reviews, we report the 30-day and 90-day readmission rates and all causes of readmission following all unilateral, primary elective total hip and knee arthroplasty procedures at a large, urban, academic hospital from 2004 to 2013. In total, 1165 primary total hip (511) and knee (654) arthroplasty procedures were identified, and the 30-day and 90-day unplanned readmission rates were 4.6% and 7.3%, respectively. A multivariate regression model controlled for a variety of potential clinical and surgical confounders. Increasing body mass index levels, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each independently correlated with risk of both 30-day and 90-day unplanned readmission to our institution. Additionally, use of general anesthesia during the procedure independently correlated with risk of readmission at 30 days only, while congestive heart failure independently correlated with risk of 90-day unplanned readmission. Readmissions related directly to the surgical site accounted for 47% of the cases, and collectively totaled more than any single medical or clinical complication leading to unplanned readmission within the 90-day period. Increasing body mass index values, general anesthesia, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each were independent risk factors for early unplanned readmission. Copyright © 2017 Elsevier Inc. All rights reserved.
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Performance of A Pilot-Scale Vermifilter for the Treatment of A Real Hospital Wastewater
Directory of Open Access Journals (Sweden)
Nahid Ghobadi
2016-12-01
Full Text Available In this study, the performance of a pilot-scale vermifilter (VF for the treatment of hospital wastewater using the earthworm species Eisenia fetida was evaluated. The earthworms’ gut acts as a bioreactor and can ingest the wastewater solid and liquid organic wastes and expel these as vermicompost. A pilot-scale vermifilter was installed and operated for 133 days in one of hospitals in Hamadan city; the designed system was fed with the influent passed through coarse and fine grillage and the sedimentation tank of the hospital’s sanitary collection system. In order to study the efficiency of the system, the variations of pH value, chemical oxygen demand (COD, biochemical oxygen demand (BOD5, and total suspended solids (TSS were measured. In addition, a conventional geofilter (GF without Earthworm was used as the experimental control. The vermifiltration caused a significant decrease in the levels of COD (75%, BOD5 (93%, and TSS (89% as well as neutralized pH in the wastewater. Also, these contents in the geofilter were observed to be 65%, 71%, and 71%, respectively. The vermifiltration technology can, therefore, be applied as an environmentally friendly method for hospital wastewater treatment.
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PAEDIATRIC POSTERIOR FOSSA TUMORS: A CLIN ICO - PATHOLOGICAL STUDY I N A TERTIARY CARE HOSPITAL
Directory of Open Access Journals (Sweden)
Raja Sekhar Kennedy
2015-09-01
Full Text Available INTRODUCTION: Tumors of the Central Nervous S ystem , are the second commonest childhood tumors and are the most common solid paediatric tumors comprising 40% - 50% of all tumors . 1 2 Posterior fossa brain tumors are one of the most devastating forms of human illnesses wh ich are more common in children. AIMS AND OBJECTIVES : To study the incidence, clinicopathological features and management of paediatric posterior fossa tumors. MATERIALS AND METHOD S : This is a prospective study done in the Department of Neurosurgery, Ranga raya Medical College, Government General Hospital, Kakinada from 2012 to 2015. It is a Tertiary Care Hospital. A total of 25 paediatric patients ranging from infants to 15 years were included in the study. DISCUSSION AND CONCL USION: Posterior fossa tumors are the commonest solid brain tumors of children with a rate of 2.4 per lakh of children at risk per year. The predominant symptoms are headache and vomiting followed by cerebellar symptoms (gait disturbances. Posterior fossa tumors are predominantly seen in children with peak incidence in first decade. Commonest presenting symptoms are due to raised intracranial pressure with headache and vomiting followed by cerebellar symptoms. Meticulous microsurgical techniques are to be followed in removing these tum ors. The incidence of recurrence is very less after gross total excision. Prognosis is good in patients with total excision
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Directory of Open Access Journals (Sweden)
I Gede Hendrawan
2016-06-01
Full Text Available Benoa bay is one of estuary that located in the Southern part of Bali Island, and as a strategic tourism destination. The increased of the human activity has an important role to give an ecological pressure for the seawater ecosystem in the Benoa bay. Total suspended solid (TSS and turbidity is one of the important indicators that could be determining the quality of the seawater. As the estuary, Benoa bay received fresh water from the river discharge that also potentially carries any material to the bay. In addition, port activity is also has an important role in contributing a various material to the Benoa bay. From this research, we found that the TSS concentration and the turbidity are higher in the surface water and also in the bottom layer. TSS concentration and the turbidity also varied from the bay mouth trough the line of vessel onto the inner of bay. TSS concentration and turbidity in the bay mouth has a smaller concentration rather than in the inner part of bay. TSS concentration and turbidity in the inner of bay could be caused by the port activity. In addition, seawater circulation is also has an importan factor to contributing the TSS concentration and the turbidity. Sea current would be erroted the seabottom and with the different shape of the topography could be increased the TSS and turbidity.
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JUICE EXTRACTION FOR TOTAL SOLUBLE SOLIDS CONTENT DETERMINATION IN MELON
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Paulo Sérgio Lima e Silva
2006-01-01
Full Text Available The total soluble solids content (TSSC shows high positive correlation with sugars content, and therefore is generally accepted as an important quality trait of fruits. In melon, this evaluation is usually done by grinding a slice of the fruit's pulp in a household food processor, straining the ground material and then proceeding the TSSC determination in the resulting juice. This evaluation is labor-intensive and takes a long time to complete. An alternative process was delineated for obtaining the juice: the pulp of the fruit slice would be transversally cut one or more times, and longitudinally pressed by hand to obtain the juice. The objective of this work was to compare processes for obtaining juice to evaluate TSSC in melons. Fifty, 15, and 15 fruits of the Galia, Yellow, and Cantaloupe type melons were evaluated, respectively. Each fruit was considered as a block, and was longitudinally split into six fractions with similar sizes, which corresponded to the plots. The following treatments were evaluated: fraction without cuts, fractions with one, three, five, or seven transversal cuts, and the fraction treated by the conventional process. It was concluded that the procedure by which the melon slices of Galia, Yellow and Cantaloupe types are pressed for obtaining the juice to evaluate TSSC can overestimate this content. This would probably be due to the fact that the most internal section of the mesocarp presents greater TSSC than the portions closer to the epicarp.
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Stochastic modeling of total suspended solids (TSS) in urban areas during rain events.
Rossi, Luca; Krejci, Vladimir; Rauch, Wolfgang; Kreikenbaum, Simon; Fankhauser, Rolf; Gujer, Willi
2005-10-01
The load of total suspended solids (TSS) is one of the most important parameters for evaluating wet-weather pollution in urban sanitation systems. In fact, pollutants such as heavy metals, polycyclic aromatic hydrocarbons (PAHs), phosphorous and organic compounds are adsorbed onto these particles so that a high TSS load indicates the potential impact on the receiving waters. In this paper, a stochastic model is proposed to estimate the TSS load and its dynamics during rain events. Information on the various simulated processes was extracted from different studies of TSS in urban areas. The model thus predicts the probability of TSS loads arising from combined sewer overflows (CSOs) in combined sewer systems as well as from stormwater in separate sewer systems in addition to the amount of TSS retained in treatment devices in both sewer systems. The results of this TSS model illustrate the potential of the stochastic modeling approach for assessing environmental problems.
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STUDY ON WASTEWATER TREATMENT SYSTEMS IN HOSPITALS OF IRAN
Directory of Open Access Journals (Sweden)
M. Majlesi Nasr, A. R. Yazdanbakhsh
2008-07-01
Full Text Available Nowadays, water resources shortage is one of the most important issues for environmental engineers and managers as well as its conservation due to population growth and ever-increasing water demands. Besides, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components. In this paper, physical and chemical specifications of produced wastewater in hospitals of Iran were investigated experiments. Results were compared with the effluent parameters of wastewater standards of Iranian Department of the Environment. 70 governmental hospitals from different provinces of Iran were selected by purposive (non-random sampling method. For data analysis, SPSS and EXCEL softwares were applied. The findings of the study showed that 52% of the surveyed hospitals were not equipped and 48% were equipped with wastewater treatment systems. The mean of Biochemical Oxygen Demand, Chemical Oxygen Demand and Total Suspended Solids of the effluent of wastewater treatment systems were reported as 113, 188 and 99 mg/L respectively. Comparison of the indicators between effluents of wastewater treatment systems and the standards of Departments of the Environment, showed the inefficiency in these systems and it was concluded that despite the recent improvements in hospital wastewater treatment systems, they should be upgraded based on the remarks in this paper.
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Directory of Open Access Journals (Sweden)
Reynolds Matthew W
2011-05-01
Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1
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On the disposal of solid radioactive wastes at hospitals
International Nuclear Information System (INIS)
Rogge, B.; Lewe, P.
1987-01-01
The disposal of radioactive materials in hospitals represents a considerable problem from the point of view of economics and organisation as well as from the point of view of radiological safety. On the one-hand, groups of people (nursing personal and clean-up crews) are involved in the handling of contaminated materials who can be instructed in special handling procedures only to a limited degree with the result that simple and clear procedures must be developed; on the other hand, such simply structured routes of disposal result in enormous volumes of radioactive waste, which represent a considerable cost factor. At the Offenbach City Hospital a concept has been created which takes these problems into account. It consists of nuclide-specific collection in groups, reduction of volume by breaking up of materials, interim storage, and government approved disposal as special hospital waste materials. (orig.) [de
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1991-01-01
More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity. The panel presentations and Keynote speeches revolving around the theme of total quality leadership provided a solid base of understanding of the importance, benefits, and principles of total quality management (TQM). The presentations from the conference are summarized.
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Directory of Open Access Journals (Sweden)
Seyed Ali Sajjadi
2018-01-01
Full Text Available Aims: Health-care waste is one of the most crucial issues in solid waste management due to its adverse effects on human health and the environment. The aim of this study was to investigate the present situation of health-care waste management in Sajadieh Hospital in Torbat-e Jam to find the major challenges and offer the best practice regarding this issue. Materials and Methods: This cross-sectional study was conducted in Sajadieh hospital in Torbat-e Jam in 2017. The total amount of waste produced in hospital was measured for 3 months. Waste management pattern was carried out based on a checklist obtained from the Ministry of Health (MOH of Iran. Excel software was employed for data analysis. Results: In total, the mean amount of wastes generated in studied hospital was 658.9 kg/day, including domestic waste (397.6 kg/day and hazardous waste (261.4 kg/day. The highest amount of hazardous wastes was generated in operating room with 32.9 kg/day. Quantity analysis of total waste showed that food wastes (25% comprise the highest fraction. Based on MOH checklist, the status of the waste management practices was determined as fair. Conclusions: The results of this study showed that despite the segregation of hospital wastes, the amount of hazardous wastes were higher than recommended guidelines. Therefore, more attention of the authorities and the correction of hospital waste management are required.
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Hospitals look to hospitality service firms to meet TQM goals.
Hard, R
1992-05-20
Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.
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Directory of Open Access Journals (Sweden)
Robert Robinson
2015-08-01
Full Text Available Introduction. Hospital readmission within 30 days of discharge is a target for health care cost savings through the medicare Value Based Purchasing initiative. Because of this focus, hospitals and health systems are investing considerable resources into the identification of patients at risk of hospital readmission and designing interventions to reduce the rate of hospital readmission. Malnutrition is a known risk factor for hospital readmission.Materials and Methods. All medical patients 65 years of age or older discharged from Memorial Medical Center from January 1, 2012 to March 31, 2012 who had a determination of serum albumin level and total lymphocyte count on hospital admission were studied retrospectively. Admission serum albumin levels and total lymphocyte counts were used to classify the nutritional status of all patients in the study. Patients with a serum albumin less than 3.5 grams/dL and/or a TLC less than 1,500 cells per mm3 were classified as having protein energy malnutrition. The primary outcome investigated in this study was hospital readmission for any reason within 30 days of discharge.Results. The study population included 1,683 hospital discharges with an average age of 79 years. The majority of the patients were female (55.9% and had a DRG weight of 1.22 (0.68. 219 patients (13% were readmitted within 30 days of hospital discharge. Protein energy malnutrition was common in this population. Low albumin was found in 973 (58% patients and a low TLC was found in 1,152 (68% patients. Low albumin and low TLC was found in 709 (42% of patients. Kaplan–Meier analysis shows any laboratory evidence of PEM is a significant (p < 0.001 predictor of hospital readmission. Low serum albumin (p < 0.001 and TLC (p = 0.018 show similar trends. Cox proportional-hazards regression analysis showed low serum albumin (Hazard Ratio 3.27, 95% CI [2.30–4.63] and higher DRG weight (Hazard Ratio 1.19, 95% CI [1.03–1.38] to be significant
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Directory of Open Access Journals (Sweden)
Christian W. Huck
2016-05-01
Full Text Available A review with more than 100 references on the principles and recent developments in the solid-phase extraction (SPE prior and for in situ near and attenuated total reflection (ATR infrared spectroscopic analysis is presented. New materials, chromatographic modalities, experimental setups and configurations are described. Their advantages for fast sample preparation for distinct classes of compounds containing different functional groups in order to enhance selectivity and sensitivity are discussed and compared. This is the first review highlighting both the fundamentals of SPE, near and ATR spectroscopy with a view to real sample applicability and routine analysis. Most of real sample analyses examples are found in environmental research, followed by food- and bioanalysis. In this contribution a comprehensive overview of the most potent SPE-NIR and SPE-ATR approaches is summarized and provided.
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STUDY OF PAEDIATRIC SOLID TUMOURS FOR A PERIOD OF 5 YEARS
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Basumitra Das
2017-12-01
Full Text Available BACKGROUND Paediatric Solid Neoplasms (PSN are a global problem. There is significant variation of incidence of paediatric solid neoplasms in various regions of the world. Benign tumours are more common than cancer. In an effort to better understand the prevalence of paediatric solid tumours in our region, a retrospective review of the tumours diagnosed histopathologically was carried out. MATERIALS AND METHODS This is a retrospective study undertaken in a tertiary care hospital for a period of five years. All the benign and malignant paediatric solid tumours of children below 14 years from January 2012 to December 2016 were retrieved and analysed according to age, sex and histopathological diagnosis. Leukaemias were excluded from our study. All tumours were diagnosed on conventional haematoxylin and eosin-stained sections. RESULTS A total of 109 cases of solid paediatric tumours were received during this period. Of these, maximum of 30 tumours were of soft tissue tumours followed by Central Nervous System (CNS and bone tumours with 24 and 23 cases, respectively. 7 cases of blastomas were also observed. CONCLUSION This study showed benign and malignant tumours to be of near-equal prevalence. Soft tissue tumours were the most common. Ratio of benign tumours to malignant were almost equal below 4 years. Malignant tumours were higher in 5-9 years group.
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Removal of total suspended solid by natural coagulant derived from cassava peel waste
Mohd-Asharuddin, S.; Othman, N.; Mohd-Zin, N. S.; Tajarudin, H. A.
2018-04-01
The present study was aimed to investigate the performance of starch derived from cassava peel waste as primary coagulant and coagulant aid. Comparable study was also conducted using commercially used aluminium sulfate (alum) as primary coagulant. A series of Jar tests were performed using raw water from Sembrong Barat water treatment plant. It was observed that coagulation test using cassava peel starch (CPS) alone had unappreciable removing ability. However, it was found that combination of alum-CPS successfully achieve up to 90.48% of total suspended solid (TSS) removal under optimized working conditions (pH 9, 7.5mg/L : 100 mg/L of alum : CPS dosage, rapid mixing of 200 rpm for 1 minute; 100 rpm for 2 minutes, slow mixing of 25 rpm for 30 minutes and 30 minutes settling time). This remarks the reduction in alum dosage up to 50% compared to coagulation test using alum alone. Therefore this finding suggesting that CPS can be considered as potential source of sustainable and effective coagulant aid for water treatment especially in developing countries.
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Kim, Hae-Cheol; Son, Seunghyun; Kim, Yong Hoon; Khim, Jong Seong; Nam, Jungho; Chang, Won Keun; Lee, Jung-Ho; Lee, Chang-Hee; Ryu, Jongseong
2017-08-15
The Yellow Sea is a shallow marginal sea with a large tidal range. In this study, ten areas located along the western coast of the Korean Peninsula are investigated with respect to remotely sensed water quality indicators derived from NASA MODIS aboard of the satellite Aqua. We found that there was a strong seasonal trend with spatial heterogeneity. In specific, a strong six-month phase-lag was found between chlorophyll-a and total suspended solid owing to their inversed seasonality, which could be explained by different dynamics and environmental settings. Chlorophyll-a concentration seemed to be dominantly influenced by temperature, while total suspended solid was largely governed by local tidal forcing and bottom topography. This study demonstrated the potential and applicability of satellite products in coastal management, and highlighted find that remote-sensing would be a promising tool in resolving orthogonality of large spatio-temporal scale variabilities when combining with proper time series analyses. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Characteristic of total suspended particulate (TSP) containing Pb and Zn at solid waste landfill
Budihardjo, M. A.; Noveandra, K.; Samadikun, B. P.
2018-05-01
Activities conducted at municipal solid waste landfills (MSWLs) potentially cause air pollution. Heavy vehicles in MSWLs release various pollutants that can have negative impacts for humans. One noticeable pollutant at MSWLs is airborne total suspended particulate (TSP) which may contain heavy metals such as Pb and Zn and can cause disease when inhaled by humans. In this study, TSP from a landfill in Semarang, Indonesia was collected and characterized to quantify the concentration of Pb and Zn. Meteorological factors (i.e. temperature, humidity and wind velocity) and landfill activities were considered as factors affecting pollutant concentrations. TSP was sampled using dust samplers while the concentrations of heavy metals in TSP were analyzed using an Atomic Absorption Spectrophotometer (AAS). Pb concentration ranged from 0.84 to 1.78 µg/m3 while Zn concentration was from 7.87 to 8.76 µg/m3. The levels of Pb were below the threshold specified by the Indonesian Government. Meanwhile, the threshold for Zn has not yet been determined.
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Directory of Open Access Journals (Sweden)
Rita Khatir
2015-09-01
Full Text Available Sweet corn has short shelf life at room temperature storage in the tropical countries (28-33°C. The quality deterioration of sweet corn can be determined by the decrease of its sugar content. The study aimed to estimate the shelf life of sweet corn based on the reduction of its total soluble solid (TSS by using Arrhenius model. The samples were prepared from fresh harvested corn stored for 10 days at 3 different temperatures of 5, 15 and 28 °C. Total soluble solid (TSS were analyzed every day by using abbe refractrometer. Organoleptic analysis was used by using hedonic scales from 1 to 7. The analysis was conducted until respondents had graded the samples at score 5 (dislike slightly, 6 (dislike and approaches can be used to calculate the shelf life of sweet corn. The acceleration factor for the TSS degradation at null approach, it was estimated that if the sweet corn were stored at temperature of 30, 25, 20, 15, 10 and 5°C, the shelf temperatures, the shelf life of sweet corn would be 3.7, 4.5, 5.6, 6.8, 8.4, and 10.3 days. In conclusion, the shelf life predictions of sweet corn were valid well with the experimental results. Keywords: Sweet corn, shelf life, total soluble solid ABSTRAK Umur simpan jagung manis relatif singkat apalagi kalau disimpan pada suhu ruang di negara-negara tropis (28-32°C. Kerusakan jagung manis dapat diindikasikan dengan penurunan kandungan gulanya. Penelitian ini bertujuan untuk menduga umur simpan jagung manis berdasarkan reaksi penurunan kandungan total padatan terlarutnya (TPT dengan pendekatan model Arrhenius. Jagung manis segar yang baru siap panen segera disimpan selama 10 hari pada 3 kombinasi suhu yaitu 5, 15 dan 28°C. Setiap hari dilakukan analisis kandungan TPT dengan . Uji organoleptik dilakukan dengan skala hedonik 1-7. Proses pengamatan dihentikan apabila responden telah memberikan nilai 5 (agak tidak suka, 6 (tidak suka dan 7 (sangat tidak suka. Pendekatan model Arrhenius dilakukan dengan dua
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Ghimire, Anish; Trably, Eric; Frunzo, Luigi; Pirozzi, Francesco; Lens, Piet N L; Esposito, Giovanni; Cazier, Elisabeth A; Escudié, Renaud
2018-01-01
Production of biohydrogen and related metabolic by-products was investigated in Solid State Dark Fermentation (SSDF) of food waste (FW) and wheat straw (WS). The effect of the total solids (TS) content and H 2 partial pressure (pp H2 ), two of the main operating factors of SSDF, were investigated. Batch tests with FW at 10, 15, 20, 25 and 30% TS showed considerable effects of the TS on metabolites distribution. H 2 production was strongly inhibited for TS contents higher than 15% with a concomitant accumulation of lactic acid and a decrease in substrate conversion. Varying the pp H2 had no significant effect on the conversion products and overall degradation of FW and WS, suggesting that pp H2 was not the main limiting factor in SSDF. This study showed that the conversion of complex substrates by SSDF depends on the substrate type and is limited by the TS content. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Pandia, S.; Tanata, S.; Rachel, M.; Octiva, C.; Sialagan, N.
2018-02-01
The waste from tapioca industry is as an organic waste that contains many important compounds such as carbohydrate, protein, and glucose. This research as aimed to know the effect of fermentation time from solid waste combined with waste-water from the tapioca industry to percentage reduction of TSS. The study was started by mixing the solid and liquid wastes from tapioca industry at a ratio of 70:30, 60:40, 50:50, 40:60, and 30:70 (w/w) with a starter from solid waste of cattle in a batch anaerobic digester. The percentage reduction of TSS was 72.2289 at a ratio by weight of the composition of solid and liquid wastes from tapioca industry was 70:30 after 30 days of fermentation time.
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Genoptraening efter total knaealloplastik
DEFF Research Database (Denmark)
Holm, Bente; Kehlet, Henrik
2009-01-01
The short- and long-term benefits of post-discharge physiotherapy regimens after total knee arthroplasty are debatable. A national survey including hospitals in Denmark that perform total knee arthroplasty showed a large variability in indication and regimen for post-knee arthroplasty...
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Directory of Open Access Journals (Sweden)
Ana Lúcia Lei Munhoz Lima
2001-03-01
Full Text Available Foram estudados 46 pacientes submetidos a artroplastia total do quadril em um Instituto de Ortopedia de São Paulo, Brasil, no período de 1993 a 1995, com o objetivo de obter a real frequência das infecções hospitalares da ferida operatória superficial e profunda que ocorrem nessa cirurgia. O estudo baseou-se no acompanhamento pré-operatório, trans-operatório e pós-operatório com seguimento mínimo de três meses de todos os pacientes, no sentido de caracterizar os agentes etiológicos das infecções e os fatores de risco que contribuem para o seu desenvolvimento. Foi observada uma freqüência total de 15.1% de infecções hospitalares, sendo 6.5% de infecção superficial da ferida operatória, 6.5% de infecção profunda e 2.1% de infecção do trato urinário. Os agentes etiológicos encontrados foram Pseudomonas aeruginosa (2 casos, Staphylococcus coagulase negativo (2 casos, Morganella morgani (1 caso e associação de Acinetobacter calcoaceticus (2 casos. O fator de risco com significância estatística observado nesta casuística foi o tempo cirúrgico aumentado. Concluiu-se que a frequência de infecção da ferida cirúrgica superficial e profunda nas artroplastias totais de quadril foi maior, nesta casuística, do que a relatada na literatura internacional, com elevada participação de bacilos Gram-negativos como agentes etiológicos e tendo como principal fator de risco o tempo cirúrgico aumentado.We studied 46 patients submitted to total hip replacement at an Orthopaedics Institute in the city of São Paulo, Brazil, from 1993 to 1995, in order to determine the real frequency of hospital infections of the superficial and deep surgical wounds occurring in this operation. The study consisted of preoperative, transoperative and postoperative monitoring and a minimum follow-up period of three months for all patients in order to characterise the etiologic agents of the infections and risk factors contributing to the
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AbioCor totally implantable artificial heart. How will it impact hospitals?
2002-09-01
Although heart transplantation remains the most effective treatment for severe heart failure, there are far fewer donor hearts available than there are patients who could benefit from them. One approach to addressing this shortfall is the total artificial heart, or TAH. To date, however, no TAH design has been able to achieve one of the ultimate goals of heart replacement: to allow a patient to live a reasonably normal life without being connected to external machinery. A new design, the AbioCor TAH developed by Abiomed Inc., may make this goal achievable. Thanks to a power system that transfers energy through the skin without the aid of wires, the AbioCor--currently undergoing clinical trials in the United States--allows the patient to be completely mobile. The lack of transcutaneous wires also eliminates the primary source of the infections that have plagued TAH patients in the past. Though it is not without drawbacks, the AbioCor could represent a crucial advance in TAH technology. In this Technology Overview, we describe the operation of the AbioCor and discuss its likely impact on hospitals if it is approved for marketing in the United States. We also discuss a related cardiac-support technology: ventricular assist devices (VADs), which may also be used for permanent cardiac support someday.
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Can hospitals compete on quality? Hospital competition.
Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W
2015-09-01
In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.
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Directory of Open Access Journals (Sweden)
Ramkrishna Bhalchandra
2014-01-01
Full Text Available Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.
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2016-05-20
regular insulin has significantly increased in recent years. These patients are severely insulin resistant requiring high doses of insulin to achieve...on U-500 Insulin Admitted to the Hospital presented at SURF Conference, San Antonio, TX 20 May 201 6 with MDWI 41-108, and has been assigned local...59th CSPG/SGVU) C.201 4 . I 52d PROTOCOL TITLE Evaluation of Total Dai ly Dose and Glycemic Control for Patients on U-500 Insulin Admitted to the
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All-Round Marketing Increases Hospital Popularity.
Ziqi, Tao
2015-06-01
Xuzhou Center Hospital is in a competing medical market in Xuzhou city. This hospital has been dedicating to improve the medical skills and provide professional and individualized service to the patients in order to improve the patient's experience and increase the patient's satisfaction. On the other side, this hospital has provided an all-round marketing campaign to build up the social influence and public reputation through public-praise marketing, web marketing, media marketing, and scholar marketing. Besides, this hospital has been cooperating with foreign medical institutions and inviting foreign medical specialists to academic communication. With the combined effects of improving medical service and all-round marketing, the hospital's economic performance has been enhanced significantly and laid a solid foundation for its ambition to become the first-class hospital in Huaihai Economic Zone.
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Difficulty in the usage of nuclides in hospitals
International Nuclear Information System (INIS)
Ueda, Hideo
1980-01-01
In Japan, the uses of radioisotopes in hospitals are increasing year after year. Therefore, the problems of the treatment and disposal of radioactive wastes are important. The liquid and gaseous wastes with radioactivity concentrations below the maximum permissible levels are allowed to be disposed of on the sites by the law. However, high-level liquid wastes and solid wastes cannot be disposed of on the sites. These wastes stored in steel drums are collected by Japan Radioisotope Association, and finally treated and disposed of on the site of Japan Atomic Energy Research Institute. The nuclides used in hospitals are principally Tc-99m, and also 131 I, 198 Au, 125 I and 3 H. The following matters are described: the present situation, radioactive wastes from medical treatments, and the management of radioactive solid, liquid and gaseous wastes from hospitals. (J.P.N.)
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Correlation between conductivity and total dissolved solid in various type of water: A review
Rusydi, Anna F.
2018-02-01
Conductivity (EC) and total dissolved solids (TDS) are water quality parameters, which are used to describe salinity level. These two parameters are correlated and usually expressed by a simple equation: TDS = k EC (in 25 °C). The process of obtaining TDS from water sample is more complex than that of EC. Meanwhile, TDS analysis is very important because it can illustrate groundwater quality, particularly in understanding the effect of seawater intrusion better than EC analysis. These conditions make research in revealing TDS/EC ratios interesting to do. By finding the ratio value, TDS concentration can be measured easily from EC value. However, the ratio cannot be defined easily. Previous research results have found that the correlation between TDS and EC are not always linear. The ratio is not only strongly influenced by salinity contents, but also by materials contents. Furthermore, the analysis of TDS concentration from EC value can be used to give an overview of water quality. For more precision, TDS concentrations need to be analyzed using the gravimetric method in the laboratory.
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Chong, Y; Unklesbay, N; Dowdy, R
2000-09-01
To investigate the perceived total quality management (TQM) performance of their department by clinical nutrition managers and dietitians, and foodservice managers and supervisors, in hospital food and nutrition service departments. Using a 2-part questionnaire containing items about 3 constructs of TQM performance and demographic characteristics, participants rated their perceptions of TQM performance. Employees in 7 Council of Teaching Hospitals. Of the 128 possible respondents, 73 (57%) completed the study. Correlation analysis to identify relationships between demographic characteristics and TQM performance. Analysis of variance to investigate statistical differences among hospitals and between subject groups and types of employment positions. Three TQM constructs--organization, information, and quality management--were evaluated. The clinical nutrition manager and dietitian group had mean ratings between 3.1 and 4.7 (5-point Likert scale); the foodservice manager and supervisor group had mean ratings from 2.7 to 4.0. Education level was significantly correlated (r = 0.44) to performance of employee training in the clinical nutrition group. The number of employees directly supervised was negatively correlated (r = -0.21) to the performance of employee training in the foodservice group. As the dynamic roles of dietitians change, many dietitians will occupy management positions in organizations such as restaurants, health food stores, food processing/distribution companies, and schools. This study demonstrates how a TQM survey instrument could be applied to clinical nutrition and foodservice settings. Dietitians will need to assess TQM in their workplace facilities, especially because of the direct links of TQM to productivity and client satisfaction.
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Characterization of Hospital Residuals
International Nuclear Information System (INIS)
Blanco Meza, A.; Bonilla Jimenez, S.
1997-01-01
The main objective of this investigation is the characterization of the solid residuals. A description of the handling of the liquid and gassy waste generated in hospitals is also given, identifying the source where they originate. To achieve the proposed objective the work was divided in three stages: The first one was the planning and the coordination with each hospital center, in this way, to determine the schedule of gathering of the waste can be possible. In the second stage a fieldwork was made; it consisted in gathering the quantitative and qualitative information of the general state of the handling of residuals. In the third and last stage, the information previously obtained was organized to express the results as the production rate per day by bed, generation of solid residuals for sampled services, type of solid residuals and density of the same ones. With the obtained results, approaches are settled down to either determine design parameters for final disposition whether for incineration, trituration, sanitary filler or recycling of some materials, and storage politics of the solid residuals that allow to determine the gathering frequency. The study concludes that it is necessary to improve the conditions of the residuals handling in some aspects, to provide the cleaning personnel of the equipment for gathering disposition and of security, minimum to carry out this work efficiently, and to maintain a control of all the dangerous waste, like sharp or polluted materials. In this way, an appreciable reduction is guaranteed in the impact on the atmosphere. (Author) [es
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Salinity: Electrical conductivity and total dissolved solids
The measurement of soil salinity is a quantification of the total salts present in the liquid portion of the soil. Soil salinity is important in agriculture because salinity reduces crop yields by reducing the osmotic potential making it more difficult for the plant to extract water, by causing spe...
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Shen, Jiacheng; Zhu, Jun
2016-01-01
Poultry litter (PL) can be good feedstock for biogas production using anaerobic digestion. In this study, methane production from batch co-digestion of PL and wheat straw (WS) was investigated for two factors, i.e., total solid (2%, 5%, and 10%) and volatile solid (0, 25, and 50% of WS), constituting a 3 × 3 experimental design. The results showed that the maximum specific methane volume [197 mL (g VS)(‑1)] was achieved at 50% VS from WS at 5% TS level. It was estimated that the inhibitory threshold of free ammonia was about 289 mg L(--1), beyond which reduction of methanogenic activity by at least 54% was observed. The specific methane volume and COD removal can be expressed using two response surface models (R(2) = 0.9570 and 0.9704, respectively). Analysis of variance of the experimental results indicated that the C/N ratio was the most significant factor influencing the specific methane volume and COD removal in the co-digestion of these two materials.
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[Improvement approaches in the hospital setting: From total quality management to Lean].
Curatolo, N; Lamouri, S; Huet, J-C; Rieutord, A
2015-07-01
Hospitals have to deal strong with economic constraints and increasing requirements in terms of quality and safety of care. To address these constraints, one solution could be the adoption of approaches from the industry sector. Following the decree of April 6, 2011 on the quality management of the medication use process, some of these approaches, such as risk management, are now part of the everyday work of healthcare professionals. However, other approaches, such as business process improvement, are still poorly developed in the hospital setting. In this general review, we discuss the main approaches of business process improvements that have been used in hospitals by focusing specifically on one of the newest and most currently used: Lean. Copyright © 2014. Published by Elsevier Masson SAS.
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Directory of Open Access Journals (Sweden)
M ArabBanadaki
2016-03-01
Full Text Available Introduction: In Total Quality Management, Quality is not only an admirable phenomenon but also is a customer inalienable right and will be created through the involvement and participation of all employees, managers and customers of an organization. This study was designed to evaluate staff attitudes in teaching hospitals of Yazd in the field of Total Quality Management by using fuzzy logic. Methods: This was a descriptive, analytical, cross – sectional study. Research population, were all staff in teaching hospitals of Yazd that among them 235 people were randomly Stratified, selected and studied. Data for this study were collected through a questionnaire. Since the theory of fuzzy is more suitable approach for measuring linguistic variables, so this paper determines the attitude of staff in the field of Quality Management by the use of fuzzy logic. Results: Results showed that the dimensions of the “Identification and training of staff," "empowerment and teamwork of Employees" and "support and leadership of the top management organization" respectively ranked first, second and third importance In terms of staff. Conclusion: Criteria of identification and training of staff and teamwork and support and leadership of the top management organization are Important in motivating Total Quality Management. So in total quality management improve programs, these aspects should be prioritized according to the degree of importance and effort to improve the quality of service.
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Wang, Xiao; Duan, Xu; Chen, Jianguang; Fang, Kuo; Feng, Leiyu; Yan, Yuanyuan; Zhou, Qi
2016-01-01
In this study the effect of volatile to total solids (VS/TS) on anaerobic digestion of waste activated sludge (WAS) pretreated by alkaline, thermal and thermal-alkaline strategies was studied. Experimental results showed that the production of methane from sludge was increased with VS/TS. When anaerobic digesters were fed with sludge pretreated by the thermal-alkaline method, the average methane yield was improved from 2.8 L/d at VS/TS 0.35 to 4.7 L/d at VS/TS 0.56. Also, the efficiency of VS reduction during sludge anaerobic digestion varied between 18.9% and 45.6%, and increased gradually with VS/TS. Mechanism investigation of VS/TS on WAS anaerobic digestion suggested that the general activities of anaerobic microorganisms, activities of key enzymes related to sludge hydrolysis, acidification and methanogenesis, and the ratio of Archaea to Bacteria were all increased with VS/TS, showing good agreement with methane production.
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Use of the total motile sperm count to predict total fertilization failure in in vitro fertilization
Repping, Sjoerd; van Weert, Janne-Meije; Mol, Ben W. J.; de Vries, Jan W. A.; van der Veen, Fulco
2002-01-01
Objective: To evaluate the capacity of baseline characteristics and total motile sperm count (TMC) to predict total fertilization failure (TIFF) in patients undergoing IVF. Design: Retrospective cohort study. Setting: University hospital. Patient(s): Eight hundred ninety-two couples with a total of
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Bakan, Ismail; Buyukbese, Tuba; Ersahan, Burcu
2014-01-01
This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals. Copyright © 2013 John Wiley & Sons, Ltd.
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Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital
Directory of Open Access Journals (Sweden)
Mishra Vinod
2012-08-01
Full Text Available Abstract Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD. Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™ from 2005-2009 (period 1 were analyzed together with costs from nine patients using another LVAD (HeartWare™ from 2009-June 2011 (period 2. For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299, and the corresponding DRG- reimbursement (2009 was $ 143, 192 . The mean LOS was 54 days (range 12- 127. For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664 and the corresponding DRG- reimbursement (2010 was $ 136, 963. The mean LOS was 49 days (range 31- 93. The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14
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Environmental management in public hospitals: Environmental management in Colombia
Juan Pablo Rodríguez-Miranda; César Augusto García-Ubaque; María Camila García-Vaca
2016-01-01
Introduction: Activities in hospitals have environmental impacts which may pose risks to human and environmental health if they are not managed correctly. For this reason, it is necessary to implement an environmental management plan in hospitals that not only focuses on solid waste management but includes all aspects associated with health within institutions. Objective: To review environmental management aspects related to public hospitals in order to identify environmental management a...
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2014-01-01
To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS (“Circulatory Support System”), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom. PMID:24577369
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Energy Technology Data Exchange (ETDEWEB)
NONE
1999-05-27
Presently ordinance regulation norms settle down on the hospital solid residuals. A definition of solid residuals, contaminated, common, the transport, treatment,installation and integral handling of the same ones is presented in normative happiness. For finish a classification of a residuals in: infectious, piercing or sharp and special as well as duties and sanctions. [Spanish] En el presente decreto se establecen normas reglamentarias sobre los residuos solidos hospitalarios.Una definicion de los residuos solidos hospitalarios,contaminados,comunes, el transporte,tratamiento,instalacion de tratamiento,disposicion final y manejo integral de los mismos es presentada en dicha normativa.Por ultimo se establece una clasificacion de residuos solidos : infecciosos, punzantes o cortantes y especiales asi como tambien obligaciones y sanciones por incumplimiento.
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Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Shafir, Shira; Wang, May; Sorvillo, Frank
2016-01-01
Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients. The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes. A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000-2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity. In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: $9,777 (2000) to $29,690 (2011). Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms
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Directory of Open Access Journals (Sweden)
Wittbrodt ET
2018-05-01
Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee
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Hospital infections waste and its proper disposal
International Nuclear Information System (INIS)
Bhatti, A.Q.; Memon, A.A.; Mahar, R.B.
2002-01-01
Hazardous hospital waste is a unique in several ways. There are a large variety of wastes but volume is a small relative to industrial wastes. Hospital infections solid waste is getting to be serious problem day by day. This waste contribute to the overall pollution in the city; much of it is also hazardous, thus putting at risk the health of those who come into contact with it. This paper addresses the various aspects of incineration, recycling and landfill process with detailed illustration. Hospital waste management in rural hospitals of Pakistan with particular reference to Gambat Hospital is discussed in this paper, including study of existing waste management system, estimation of waste production per day from different sources of Hospital and suitable waste management system is recommended. (author)
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Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B
2015-06-01
To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.
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Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S
2017-03-01
Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift
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Dantas, A. R. V.; Gauthier, M. K.; Coss, J. R.
1985-01-01
The total integrated dose response of three CMOS devices manufactured by Solid State Scientific has been measured using CO-60 gamma rays. Key parameter measurements were made and compared for each device type. The data show that the CD4011, CD4013, and CD4060 produced by this manufacturers should not be used in any environments where radiation levels might exceed 1,000 rad(Si).
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Directory of Open Access Journals (Sweden)
Anna-Lisa Stefani
2010-01-01
Full Text Available Fifty Polish Friesian veal calves were administrated high amounts of two different solid feeds (maize grain and a mix diet containing 10% of straw and 8% of soy in addition to the traditional milk replacer diet. Compared to the mix diet, maize grain had a lower content of iron, copper and zinc and a minor fibre level. Effects of the two diets on calves’ blood haemoglobin, iron, iron metabolism parameters, copper and zinc concentrations were studied. Haemoglobin concentration resulted higher at the end of the fattening for calves fed the mix diet, as expected. Values remained, however, within ranges that allowed acceptable carcass paleness. Haematic iron, unsaturated iron binding capacity (UIBC and total iron binding capacity (TIBC levels were not significantly different between the two solid feeds. Lower copper and zinc blood concentrations resulted for calves fed the mix diet were likely due to the feed fibre interfering with the bioavailability of the two minerals, according to what happens for iron.
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Sekaran, G; Karthikeyan, S; Boopathy, R; Maharaja, P; Gupta, V K; Anandan, C
2014-01-01
The rice-husk-based mesoporous activated carbon (MAC) used in this study was precarbonized and activated using phosphoric acid. N2 adsorption/desorption isotherm, X-ray powder diffraction, electron spin resonance, X-ray photoelectron spectroscopy and scanning electron microscopy, transmission electron microscopy, (29)Si-NMR spectroscopy, and diffuse reflectance spectroscopy were used to characterize the MAC. The tannery wastewater carrying high total dissolved solids (TDS) discharged from leather industry lacks biodegradability despite the presence of dissolved protein. This paper demonstrates the application of free electron-rich MAC as heterogeneous catalyst along with Fenton reagent for the oxidation of persistence organic compounds in high TDS wastewater. The heterogeneous Fenton oxidation of the pretreated wastewater at optimum pH (3.5), H2O2 (4 mmol/L), FeSO4[Symbol: see text]7H2O (0.2 mmol/L), and time (4 h) removed chemical oxygen demand, biochemical oxygen demand, total organic carbon and dissolved protein by 86, 91, 83, and 90%, respectively.
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Musau, Steve; Vian, Taryn
2008-01-01
Hospitals are vulnerable to corruption. In the U.S., health care fraud has been stimated to cost $60 billion per year, or 3% of total health care expenditures - much of it in the hospital sector. Hospitals account for 50% or more of health care pending in many countries. Fraud and corruption in hospitals negatively affect access and quality, as public servants make off with resources which could have been used to reduce out-of-pocket expenditures for patients, or improve needed services. This...
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[Long-term psychiatric hospitalizations].
Plancke, L; Amariei, A
2017-02-01
Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had
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Institutional total energy case studies
Energy Technology Data Exchange (ETDEWEB)
Wulfinghoff, D.
1979-07-01
Profiles of three total energy systems in institutional settings are provided in this report. The plants are those of Franciscan Hospital, a 384-bed facility in Rock Island, Illinois; Franklin Foundation Hospital, a 100-bed hospital in Franklin, Louisiana; and the North American Air Defense Command Cheyenne Mountain Complex, a military installation near Colorado Springs, Colorado. The case studies include descriptions of plant components and configurations, operation and maintenance procedures, reliability, relationships to public utilities, staffing, economic efficiency, and factors contributing to success.
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TOTAL HIP REPLACEMENTS AT KIKUYU HOSPITAL, KENYA
African Journals Online (AJOL)
equipments, few trained personnel and the high cost of implants. It is mainly in the ..... function more affected than the sensory a day after. There was a foot drop. .... 60: Issue 2, 217-. 220. 13. NIH Consensus Development Panel on Total Hip.
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Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick
2017-11-01
Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.
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Zeeshan, Farrukh; Tabbassum, Misbah; Jorgensen, Lene; Medlicott, Natalie J
2018-02-01
Protein drugs may encounter conformational perturbations during the formulation processing of lipid-based solid dosage forms. In aqueous protein solutions, attenuated total reflection Fourier transform infrared (ATR FT-IR) spectroscopy can investigate these conformational changes following the subtraction of spectral interference of solvent with protein amide I bands. However, in solid dosage forms, the possible spectral contribution of lipid carriers to protein amide I band may be an obstacle to determine conformational alterations. The objective of this study was to develop an ATR FT-IR spectroscopic method for the analysis of protein secondary structure embedded in solid lipid matrices. Bovine serum albumin (BSA) was chosen as a model protein, while Precirol AT05 (glycerol palmitostearate, melting point 58 ℃) was employed as the model lipid matrix. Bovine serum albumin was incorporated into lipid using physical mixing, melting and mixing, or wet granulation mixing methods. Attenuated total reflection FT-IR spectroscopy and size exclusion chromatography (SEC) were performed for the analysis of BSA secondary structure and its dissolution in aqueous media, respectively. The results showed significant interference of Precirol ATO5 with BSA amide I band which was subtracted up to 90% w/w lipid content to analyze BSA secondary structure. In addition, ATR FT-IR spectroscopy also detected thermally denatured BSA solid alone and in the presence of lipid matrix indicating its suitability for the detection of denatured protein solids in lipid matrices. Despite being in the solid state, conformational changes occurred to BSA upon incorporation into solid lipid matrices. However, the extent of these conformational alterations was found to be dependent on the mixing method employed as indicated by area overlap calculations. For instance, the melting and mixing method imparted negligible effect on BSA secondary structure, whereas the wet granulation mixing method promoted
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Lu, Qin; Yi, Jing; Yang, Dianhai
2016-01-01
High-solid anaerobic digestion of sewage sludge achieves highly efficient volatile solid reduction, and production of volatile fatty acid (VFA) and methane compared with conventional low-solid anaerobic digestion. In this study, the potential mechanisms of the better performance in high-solid anaerobic digestion of sewage sludge were investigated by using 454 high-throughput pyrosequencing and real-time PCR to analyze the microbial characteristics in sewage sludge fermentation reactors. The results obtained by 454 high-throughput pyrosequencing revealed that the phyla Chloroflexi, Bacteroidetes, and Firmicutes were the dominant functional microorganisms in high-solid and low-solid anaerobic systems. Meanwhile, the real-time PCR assays showed that high-solid anaerobic digestion significantly increased the number of total bacteria, which enhanced the hydrolysis and acidification of sewage sludge. Further study indicated that the number of total archaea (dominated by Methanosarcina) in a high-solid anaerobic fermentation reactor was also higher than that in a low-solid reactor, resulting in higher VFA consumption and methane production. Hence, the increased key bacteria and methanogenic archaea involved in sewage sludge hydrolysis, acidification, and methanogenesis resulted in the better performance of high-solid anaerobic sewage sludge fermentation.
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Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz
2018-03-01
The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.
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Evaluation of dry solid waste recycling from municipal solid waste: case of Mashhad city, Iran.
Farzadkia, Mahdi; Jorfi, Sahand; Akbari, Hamideh; Ghasemi, Mehdi
2012-01-01
The recycling for recovery and reuse of material and energy resources undoubtedly provides a substantial alternative supply of raw materials and reduces the dependence on virgin feedstock. The main objective of this study was to assess the potential of dry municipal solid waste recycling in Mashhad city, Iran. Several questionnaires were prepared and distributed among various branches of the municipality, related organizations and people. The total amount of solid waste generated in Mashhad in 2008 was 594, 800 tons with per capita solid waste generation rate of 0.609 kg person(-1) day(-1). Environmental educational programmes via mass media and direct education of civilians were implemented to publicize the advantages and necessity of recycling. The amount of recycled dry solid waste was increased from 2.42% of total dry solid waste (2588.36 ton year(-1)) in 1999 to 7.22% (10, 165 ton year(-1)) in 2008. The most important fractions of recycled dry solid waste in Mashhad included paper and board (51.33%), stale bread (14.59%), glass (9.73%), ferrous metals (9.73%), plastic (9.73%), polyethylene terephthalate (2.62%) and non-ferrous metals (0.97%). It can be concluded that unfortunately the potential of dry solid waste recycling in Mashhad has not been considered properly and there is a great effort to be made in order to achieve the desired conditions of recycling.
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Holom, Geir Hiller; Hagen, Terje P
2017-08-18
To compare the quality of care-using unplanned acute hospital readmissions as a quality measure-among patients treated at private for-profit hospitals (PFPs), private non-profit hospitals (PNPs) and public hospitals (PUBs) in Norway. A retrospective comparative study using the Norwegian Patient Register. Readmissions were evaluated by logistic regressions both using adjustment for various patient-level and other covariates, and a two-stage model using distance as an instrumental variable. The Norwegian healthcare system. All publicly financed patients having primary total hip (37 897 patients) or primary total knee arthroplasty (25 802 patients) at one of the three hospital types from 2009 to 2014. 30-day unplanned acute hospital readmission rate. We found highest readmission rates among PUBs and lowest among PFPs, for both procedures. However, the patients were on average more than 2 years younger at PFPs. PFPs also treated the least severe patients, while PUBs treated the most severe. Using adjustment for various patient-level and other covariates, compared to PUBs, both PFPs and PNPs had lower odds of readmission following both procedures. However, using the instrumental variable method, the only significant difference found was a lower odds of readmission at PNPs among hip patients when compared with PUBs. No patients in our data set were readmitted to PFPs, those originally treated at PFPs were readmitted to either PNPs or PUBs, and PUBs received most of the readmitted patients across hospital types. Quality differences between hospital types were small; however, PNPs had significantly lower readmission rates compared with PUBs among patients having total hip arthroplasty. PUBs received the larger part of the readmitted patients across hospital types and thus play an essential role in the care of more complex patients and for readmissions, regardless of any quality differences. © Article author(s) (or their employer(s) unless otherwise stated in the
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Hospital waste management in nonteaching hospitals of Lucknow City, India
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Manish Kumar Manar
2014-01-01
Full Text Available Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices.
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Directory of Open Access Journals (Sweden)
Hussein Abdul-Ridha Mohammed
2018-01-01
Full Text Available he pollution of drinking water is a dangerous problem for the whole world, it can threaten the health of people and as people in developed society attaches more importance to environmental protection, it is of great research significance to intelligently and remotely monitoring the environment. Therefore in this paper, a remote water monitoring system for Baghdad drinking water system is suggested. The proposed system consists of data sensing and monitoring nodes at different locations in Baghdad to sensing and analyzes the data. These nodes are periodically measured Total Dissolved Solids (TDS. In case of measured value above TDS threshold which is 500 ppm, then an automated warning message will be sent to authorize persons in the maintenance center via Global Position System to take the correct action. This suggested structure has several advantages over traditional monitoring systems in terms of price, portability, reliability, applicability and takes a sample from a water tap in easy and real-time approach.
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Hospital waste management in El-Beheira Governorate, Egypt.
Abd El-Salam, Magda Magdy
2010-01-01
This study investigated the hospital waste management practices used by eight randomly selected hospitals located in Damanhour City of El-Beheira Governorate and determined the total daily generation rate of their wastes. Physico-chemical characteristics of hospital wastes were determined according to standard methods. A survey was conducted using a questionnaire to collect information about the practices related to waste segregation, collection procedures, the type of temporary storage containers, on-site transport and central storage area, treatment of wastes, off-site transport, and final disposal options. This study indicated that the quantity of medical waste generated by these hospitals was 1.249tons/day. Almost two-thirds was waste similar to domestic waste. The remainder (38.9%) was considered to be hazardous waste. The survey results showed that segregation of all wastes was not conducted according to consistent rules and standards where some quantity of medical waste was disposed of with domestic wastes. The most frequently used treatment method for solid medical waste was incineration which is not accepted at the current time due to the risks associated with it. Only one of the hospitals was equipped with an incinerator which is devoid of any air pollution control system. Autoclaving was also used in only one of the selected hospitals. As for the liquid medical waste, the survey results indicated that nearly all of the surveyed hospitals were discharging it in the municipal sewerage system without any treatment. It was concluded that the inadequacies in the current hospital waste management practices in Damanhour City were mainly related to ineffective segregation at the source, inappropriate collection methods, unsafe storage of waste, insufficient financial and human resources for proper management, and poor control of waste disposal. The other issues that need to be considered are a lack of appropriate protective equipment and lack of training and
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Characterization of domestic graywater and graywater solids.
Sievers, Jan Christian; Londong, Jörg
2018-03-01
The knowledge of loads and concentrations is fundamental for the design of graywater treatment units, but the data on the characteristics of graywater and in particular graywater solids are weak. As general design values regarding graywater treatment facilities are not available for Germany, the objective of this article is to elaborate the characteristics of graywater and graywater solids. This paper describes the results of six sampling campaigns carried out on graywater systems in the German cities Berlin, Lübeck and Kiel. All graywater samples were collected proportional to the flow and the graywater solids were gathered separately. The collected data include graywater volumes and characteristics regarding the organic pollution (chemical oxygen demand (COD), 5-day biochemical oxygen demand (BOD 5 )) and nutrients (total nitrogen (TN), total phosphorus (TP)). The graywater volume fluctuated depending on the location. The specific average flow was 68 litre per inhabitant per day (L/inh.d). Inhabitant-specific loads of 49.3 gCOD t /inh·d, 28 gBOD 5 /inh.d, 1 gTN t /inh.d and 0.38 gTP t /inh.d (subscript 't' = total) were found. Information about the composition of graywater solids in terms of quantity and quality is seriously lacking. Therefore, graywater solids were examined with respect to organic matter (COD) and nutrients (TN, TP). The contribution of graywater solids with particle sizes over 200 microns in relation to the total inhabitant-specific load was approximately 3-8% depending on the parameter. The qualitative and quantitative characteristics of the investigated graywater fractions may serve as a base for the estimation of design values.
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Applying a Network-Lens to Hospitality Business Research: A New Research Agenda
AUBKE, Florian
2014-01-01
Hospitality businesses are first and foremost places of social interaction. This paper argues for an inclusion of network methodology into the tool kit of hospitality researchers. This methodology focuses on the interaction of people rather than applying an actor-focused view, which currently seems dominant in hospitality research. Outside the field, a solid research basis has been formed, upon which hospitality researchers can build. The paper introduces the foundations ...
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Propuesta de tratamiento integral de los residuos hospitalarios en el hospital ii tarapoto
Condori, Luisa
2010-01-01
This research aimed to make a diagnosis on solid waste generation in the Hospital II Tarapoto, in order to make a comprehensive proposal for their treatment and their management. In order to do that monthly samples were taken in the different services offered by the Zonal Hospital II Tarapoto in 2007. The sampling consisted of collecting information about the class, volume and weight of solid waste generated in those facilities, according to the methodology proposed by PAHO. It was found that...
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Technical efficiency of selected hospitals in Eastern Ethiopia.
Ali, Murad; Debela, Megersa; Bamud, Tewfik
2017-12-01
This study examines the relative technical efficiency of 12 hospitals in Eastern Ethiopia. Using six-year-round panel data for the period between 2007/08 and 2012/13, this study examines the technical efficiency, total factor productivity, and determinants of the technical inefficiency of hospitals. Data envelopment analysis (DEA) and DEA- based Malmquist productivity index used to estimate relative technical efficiency, scale efficiency, and total factor productivity index of hospitals. Tobit model used to examine the determinants of the technical inefficiency of hospitals. The DEA Variable Returns to Scale (VRS) estimate indicated that 6 (50%), 5 (42%), 3 (25%), 3 (25%), 4 (33%), and 3 (25%) of the hospitals were technically inefficient while 9 (75%), 9 (75%), 7 (58%), 7 (58%), 7 (58%) and 8 (67%) of hospitals were scale inefficient between 2007/08 and 2012/13, respectively. On average, Malmquist Total Factor Productivity (MTFP) of the hospitals decreased by 3.6% over the panel period. The Tobit model shows that teaching hospital is less efficiency than other hospitals. The Tobit regression model further shows that medical doctor to total staff ratio, the proportion of outpatient visit to inpatient days, and the proportion of inpatients treated per medical doctor were negatively related with technical inefficiency of hospitals. Hence, policy interventions that help utilize excess capacity of hospitals, increase doctor to other staff ratio, and standardize number of inpatients treated per doctor would contribute to the improvement of the technical efficiency of hospitals.
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MODIFIED TECHNIQUE OF TOTAL LARYNGECTOMY
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Predrag Spirić
2010-12-01
Full Text Available Surgical technique of total laryngectomy is well presented in many surgical textbooks. Essentially, it has remained the same since Gluck an Soerensen in 1922 described all its details. Generally, it stresses the U shape skin incision with releasing laryngeal structures and removing larynx from up to down. Further, pharyngeal reconstruction is performed with different kinds of sutures in two or more layers and is finished with skin suture and suction drainage. One of worst complications following this surgery is pharyngocutaneous fistula (PF. Modifications proposed in this this article suggests vertical skin incision with larynx removal from below upwards. In pharyngeal reconstruction we used the running locked suture in submucosal plan with „tobacco sac“ at the end on the tongue base instead of traditional T shaped suture. Suction drains were not used.The aim of study was to present the modified surgical technique of total laryingectomy and its impact on hospital stay duration and pharyngocutanous fistula formation. In this randomized study we analyzed 49 patients operated with modified surgical technique compared to 49 patient operated with traditional surgical technique of total laryngectomy. The modified technique of total laryngectomy was presented. Using modified technique we managed to decrease the PF percentage from previous 20,41% to acceptable 8,16% (p=0,0334. Also, the average hospital stay was shortened from 14,96 to 10,63 days (t =-2.9850; p=0.0358.The modified technique of total laryngectomy is safe, short and efficient surgical intervention which decreases the number of pharyngocutaneos fistulas and shortens the hospital stay.
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SWINE MANURE SOLIDS SEPARATION AND THERMOCHEMICAL CONVERSION TO HEAVY OIL
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Shuangning Xiu
2009-05-01
Full Text Available Separation of solids from liquid swine manure and subsequent thermo-chemical conversion (TCC of the solids fraction into oil is one way of reducing the waste strength and odor emission. Such processing also provides a potential means of producing renewable energy from animal wastes. Gravity settling and mechanical separation techniques, by means of a centrifuge and belt press, were used to remove the solids from liquid swine manure. The solid fractions from the above separation processes were used as the feedstock for the TCC process for oil production. Experiments were conducted in a batch reactor with a steady temperature 305 oC, and the corresponding pressure was 10.34 Mpa. Gravity settling was demonstrated to be capable of increasing the total solids content of manure from 1% to 9%. Both of the mechanical separation systems were able to produce solids with dry matter around 18% for manure, with 1% to 2% initial total solids. A significant amount of volatile solid (75.7% was also obtained from the liquid fraction using the belt press process. The oil yields of shallow pit manure solids and deep pit manure solids with belt press separation were 28.72% and 29.8% of the total volatile solids, respectively. There was no visible oil product obtained from the deep pit manure solids with centrifuge separation. It is believed that it is the volatile solid content and the other components in the manure chemical composition which mainly deter-mine the oil production.
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Solid State Sensor for Simultaneous Measurement of Total Alkalinity and pH of Seawater.
Briggs, Ellen M; Sandoval, Sergio; Erten, Ahmet; Takeshita, Yuichiro; Kummel, Andrew C; Martz, Todd R
2017-09-22
A novel design is demonstrated for a solid state, reagent-less sensor capable of rapid and simultaneous measurement of pH and Total Alkalinity (A T ) using ion sensitive field effect transistor (ISFET) technology to provide a simplified means of characterization of the aqueous carbon dioxide system through measurement of two "master variables": pH and A T . ISFET-based pH sensors that achieve 0.001 precision are widely used in various oceanographic applications. A modified ISFET is demonstrated to perform a nanoliter-scale acid-base titration of A T in under 40 s. This method of measuring A T , a Coulometric Diffusion Titration, involves electrolytic generation of titrant, H + , through the electrolysis of water on the surface of the chip via a microfabricated electrode eliminating the requirement of external reagents. Characterization has been performed in seawater as well as titrating individual components (i.e., OH - , HCO 3 - , CO 3 2- , B(OH) 4 - , PO 4 3- ) of seawater A T . The seawater measurements are consistent with the design in reaching the benchmark goal of 0.5% precision in A T over the range of seawater A T of ∼2200-2500 μmol kg -1 which demonstrates great potential for autonomous sensing.
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Hospitals Productivity Measurement Using Data Envelopment Analysis Technique.
Torabipour, Amin; Najarzadeh, Maryam; Arab, Mohammad; Farzianpour, Freshteh; Ghasemzadeh, Roya
2014-11-01
This study aimed to measure the hospital productivity using data envelopment analysis (DEA) technique and Malmquist indices. This is a cross sectional study in which the panel data were used in a 4 year period from 2007 to 2010. The research was implemented in 12 teaching and non-teaching hospitals of Ahvaz County. Data envelopment analysis technique and the Malmquist indices with an input-orientation approach, was used to analyze the data and estimation of productivity. Data were analyzed using the SPSS.18 and DEAP.2 software. Six hospitals (50%) had a value lower than 1, which represents an increase in total productivity and other hospitals were non-productive. the average of total productivity factor (TPF) was 1.024 for all hospitals, which represents a decrease in efficiency by 2.4% from 2007 to 2010. The average technical, technologic, scale and managerial efficiency change was 0.989, 1.008, 1.028, and 0.996 respectively. There was not a significant difference in mean productivity changes among teaching and non-teaching hospitals (P>0.05) (except in 2009 years). Productivity rate of hospitals had an increasing trend generally. However, the total average of productivity was decreased in hospitals. Besides, between the several components of total productivity, variation of technological efficiency had the highest impact on reduce of total average of productivity.
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van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A
2016-10-01
Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
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Managing the health care solid waste in selected districts of Punjab, Pakistan
International Nuclear Information System (INIS)
Ullah, J.H.; Ahmad, K.
2010-01-01
Hospital and other health care facilities (HCFs) are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities (HCFs) in Punjab, the largest province of Pakistan, a sample of fifteen (HCFs) was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities. (author)
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Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...
African Journals Online (AJOL)
Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, ...
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Directory of Open Access Journals (Sweden)
Agata Kujawa-Szewieczek
2016-05-01
Full Text Available Background: Few studies have evaluated the incidence and risk factors of Clostridium difficile infection (CDI in the adult Polish population, in particular in solid organ recipients hospitalized at the nephrological ward.Aim: The aim of this study was to analyze Clostridium difficile infections (CDI among patients hospitalized in the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice.Material/Methods: Thirty-seven patients with Clostridium difficile infection diagnosed between October 2011 and November 2013 (26 months, identified among a total of 3728 patients hospitalized in this department during this period, were included in this retrospective, single-center study. The CDI definition was based on the current recommendations of the European Society of Clinical Microbiology and Infectious Diseases.Results: The observation period was divided into two 13-month intervals. Increased incidence (of borderline significance of CDI in the second period compared to the first period was observed (1.33% vs 0.65% respectively; p=0.057. Patients after kidney (n=11, kidney and pancreas (n=2 and liver (n=5 transplantation represented 48% of the analyzed CDI patients, and in half of these patients (50% CDI symptoms occurred within the first 3 months after transplantation. Clostridium difficile infection leads to irreversible deterioration of graft function in 38% of kidney recipients. Most incidents of CDI (70% were identified as nosocomial infection.Conclusions: 1. Clostridium difficile infection is particularly common among patients in the early period after solid organ transplantation. 2. Clostridium difficile infection may lead to irreversible deterioration of transplanted kidney function.
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Evaluation of Productivity of Zymotis Solid-State Bioreactor Based on Total Reactor Volume
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Oscar F. von Meien
2002-01-01
Full Text Available In this work a method of analyzing the performance of solid-state fermentation bioreactors is described. The method is used to investigate the optimal value for the spacing between the cooling plates of the Zymotis bioreactor, using simulated fermentation data supplied by a mathematical model. The Zymotis bioreactor has good potential for those solid-state fermentation processes in which the substrate bed must remain static. The current work addresses two design parameters introduced by the presence of the internal heat transfer plates: the width of the heat transfer plate, which is governed by the amount of heat to be removed and the pressure drop of the cooling water, and the spacing between these heat transfer plates. In order to analyze the performance of the bioreactor a productivity term is introduced that takes into account the volume occupied within the bioreactor by the heat transfer plates. As part of this analysis, it is shown that, for logistic growth kinetics, the time at which the biomass reaches 90 % of its maximum possible value is a good estimate of the optimum harvesting time for maximizing productivity. Application of the productivity analysis to the simulated fermentation results suggests that, with typical fast growing fungi ( = 0.324 h–1, the optimal spacing between heat transfer plates is of the order of 6 cm. The general applicability of this approach to evaluate the productivity of solid-state bioreactors is demonstrated.
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2013-08-19
... Connective Tissue) a. Reverse Shoulder Procedures b. Total Ankle Replacement Procedures 6. MDC 15 (Newborns... specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric... Issues. James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee...
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Directory of Open Access Journals (Sweden)
M Kafaei
2013-03-01
Full Text Available Introduction: Sleep is an effective factor in the recovery processes. Many variables affect on the sleep quality of hospitalized elderly people. This study was conducted to determine the factors disturbing sleep quality among hospitalized older adult patients in Kashan hospitals. Methods: A cross-sectional study was carried out on a sample of 390 elderly hospitalized patients in Kashan hospitals. The study data was gathered via Pittsburgh Sleep Quality Index (PSQI Questionnaire. A global total score of 5 or greater indicated a “poor" quality of sleep. The data were analyzed using Chi square, t- test and binary logistic regression at multivariate model. Results: The total quality of sleep was poor in hospitalized elderly patients (7/2±4/8. Sex, marital status, level of education, type of ward, previous hospitalization experience, use of hypnotics at home and hospital, and previous sleep disorders were statistically associated with quality of sleep; however, there was not significant relationship between quality of sleep and age, length of hospitalization, and daytime napping. In the final regression model, marital status (OR=4.6, level of education (OR=1.9, length of hospitalization (OR=1.1, Previous hospitalization experience (OR=0.4, use of hypnotics in hospital (OR=0.27 and previous sleep disorder (OR=0.01 were the most important determinants of sleep quality. Conclusion: Quality of sleep was poor in hospitalized elderly due to a wide range of sleep disturbing factors. The most important factors involved marital status, level of education, previous hospitalization experience, previous sleep disorder and use of hypnotics in hospital.
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The cost of hospitalization in Crohn's disease.
Cohen, R D; Larson, L R; Roth, J M; Becker, R V; Mummert, L L
2000-02-01
The aim of this study was to evaluate the demographics, resource use, and costs associated with hospitalization of Crohn's disease patients. All patients hospitalized at our institution from 7/1/96 to 6/30/97 with a primary diagnosis of "Crohn's Disease" were analyzed using a computerized database. Data are presented "per hospitalization." A total of 175 hospitalizations (147 patients) were identified. Mean patient age was 36.5 yr; 61% were female; 82% Caucasian. Payer mix was most commonly contracted (57%), commercial (21%), or Medicare (13%). 57% of hospitalizations had a primary surgical procedure; the remainder were medical. Average length of stay was 8.7 days (surgical, 9.6 days; medical, 7.5 days). The average cost of hospitalization, excluding physician fees, was $12,528 (surgical, $14,409; medical, $10,020), whereas average charges were $35,378 (surgical, $46,354; medical, $20,744), including physician fees, which averaged $7,249 (surgical, $11,217; medical, $1,959). Mean reimbursements were $21,968 (surgical, $28,946; medical, $12,666) with average weighted reimbursement rates of 60.17% of hospital charges, 69.57% of physician fees. The distribution of costs across subcategories was: Surgery (39.6%), Pharmacy (18.6%), Laboratory (3.8%), Radiology (2.1%), Pathology (0.8%), Endoscopy (0.3%), and Other Hospital Costs (34.9%). Of the hospitalizations, 87% included treatment with steroids, 23% with immunomodulators, and 14% with aminosalicylates; 27% included the administration of total parenteral nutrition, which accounted for 63% of the total pharmacy costs. Surgery accounts for the majority of hospitalizations, nearly 40% of their total costs, and 75% of overall charges and reimbursements. Therapy that decreases the number of surgical hospitalizations should substantially reduce inpatient Crohn's disease costs, as well as overall costs.
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Mayers, William; Schwartz, Brian; Schwartz, Aaron; Moretti, Vincent; Goldstein, Wayne; Shah, Ritesh
2016-09-01
While a majority of total hip arthroplasty (THA) is performed for osteoarthritis (OA), a significant portion is performed in the setting of avascular necrosis (AVN). The purpose of this study is to evaluate recent trends, patient demographics, and in hospital outcomes for primary THA in the setting of AVN in the United States. The National Hospital Discharge Survey database was searched for patients admitted to US hospitals after a primary THA for the years 2001-2010. Patients were then separated into two groups by ICD-9 diagnosis codes for OA and AVN. The rates of THA for AVN (r = 0.65) and THA for OA (r = 0.82) both demonstrated a positive correlation with time. The mean patient age of the AVN group was significantly lower (56.9 vs 65.9 years, p < 0.01). Men accounted for 51.9 % of the AVN group and 43.0 % of the OA group (p < 0.01). The AVN group had a significantly higher percentage of African Americans (11.2 % vs 5.4 %, p < 0.01) when compared to the OA group. The AVN group had a higher rate of myocardial infarction (0.3 % vs 0.07 %, p = 0.0163) and a higher average number of medical co-morbidities (5.16 vs 4.77, p < 0.01). Patients undergoing THA for AVN were more likely to be younger, male, African American, have more medical co-morbidities, and more likely to have a myocardial infarction than those with OA. While the number of primary THAs performed for AVN in the United States has increased over the past ten years, the rate of primary THA for OA increased at a much more rapid rate.
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The Impact of Hospital Size on CMS Hospital Profiling.
Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J
2016-04-01
The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.
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Directory of Open Access Journals (Sweden)
Yan-Ru Zhao
2015-01-01
Full Text Available Chemometrics methods coupled with hyperspectral imaging technology in visible and near infrared (Vis/NIR region (380–1030 nm were introduced to assess total soluble solids (TSS in mulberries. Hyperspectral images of 310 mulberries were acquired by hyperspectral reflectance imaging system (512 bands and their corresponding TSS contents were measured by a Brix meter. Random frog (RF method was used to select important wavelengths from the full wavelengths. TSS values in mulberry fruits were predicted by partial least squares regression (PLSR and least-square support vector machine (LS-SVM models based on full wavelengths and the selected important wavelengths. The optimal PLSR model with 23 important wavelengths was employed to visualise the spatial distribution of TSS in tested samples, and TSS concentrations in mulberries were revealed through the TSS spatial distribution. The results declared that hyperspectral imaging is promising for determining the spatial distribution of TSS content in mulberry fruits, which provides a reference for detecting the internal quality of fruits.
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Directory of Open Access Journals (Sweden)
Amin Talebpour
2016-06-01
Full Text Available Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma
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McFarland, Daniel C; Ornstein, Katherine A; Holcombe, Randall F
2015-08-01
Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. A total of 3907 HVBP-participating hospitals. There were 934,800 patient surveys by the most conservative estimate. A total of 3144 county demographics (US Census) and HCAHPS surveys. Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. © 2015 Society of Hospital Medicine.
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Study on the collection and disposal of hospital solid wastes in Karaj City (Iran)
International Nuclear Information System (INIS)
Farzadkia, M.; Sabily, M.; Ghanbary, S.
2009-01-01
Hospitals and other health care institutions generate waste day in and day out which may be a potential health hazard to the health care workers, the general public and, the flora and fauna of that area. Safe and effective management of hospital waste is not only a legal necessity but also a social responsibility. Many of hospitals in Iran neither have a satisfactory waste disposal system nor a waste management and disposal policy. (Author)
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Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.
Directory of Open Access Journals (Sweden)
Jeevan Acharya
Full Text Available Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs.A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study.The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%, clothes (9.8% and transport (7.3%. For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007, employed house head (p = 0.011, monthly family income more than 25,000 NRs (Nepalese Rupees (p = 0.014, private hospital as a place of delivery (p = 0.0001, C-section as a mode of delivery (p = 0.0001, longer duration (>5days of stay in hospital (p = 0.0001, longer distance (>15km from house to hospital (p = 0.0001 and longer travel time (>240 minutes from house to hospital (p = 0.007 showed a significant association with the higher hidden costs (>25000 NRs.Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time were associated with hidden costs. Hidden costs can be a
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Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.
Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan; Adhikari, Bipin
2016-01-01
Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a
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Development of total medical material distribution management system.
Uto, Y; Kumamoto, I
1994-07-01
Since September 1992, attempts have been made at Kagoshima University Hospital to develop the Medical Material Distribution Management System which helps to realize optimal hospital management as a subsystem of the Total Hospital Information System of Kagoshima University (THINK). As this system has been established, it has become possible for us to have an accurate grasp of the flow and stock of medical materials at our hospital. Furthermore, since September 1993, the Medical Material Distribution Management System has been improved and the Total Medical Material Distribution Management System has been smoothly introduced into the site of clinical practice. This system enables automatic demands for fees for treatment with specific instruments and materials covered by health insurance. It was difficult to predict the effect of this system, because no similar system had been developed in Japan. However, more satisfactory results than expected have been obtained since its introduction.
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Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy.
Yun, Sung Il; Lee, Yoon Hyung; Kim, Jae Soo; Cho, Sung Ryong; Kim, Bum Soo; Kwon, Joon Beom
2012-11-01
Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.
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Applying a Network-Lens to Hospitality Business Research: A New Research Agenda
Directory of Open Access Journals (Sweden)
Florian AUBKE
2014-06-01
Full Text Available Hospitality businesses are first and foremost places of social interaction. This paper argues for an inclusion of network methodology into the tool kit of hospitality researchers. This methodology focuses on the interaction of people rather than applying an actor-focused view, which currently seems dominant in hospitality research. Outside the field, a solid research basis has been formed, upon which hospitality researchers can build. The paper introduces the foundations of network theory and its applicability to the study of organizations. A brief methodological introduction is provided and potential applications and research topics relevant to the hospitality field are suggested.
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Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M
2018-02-08
To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.
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Appropriateness of pediatric hospitalization in a general hospital in Kuwait.
Shafik, Magdy H; Seoudi, Tarek M M; Raway, Tarek S; Al Harbash, Nowair Z; Ahmad, Meshal M A; Al Mutairi, Hanan F
2012-01-01
To determine the rate of inappropriate pediatric admissions using the Pediatric Appropriateness Evaluation Protocol (PAEP) and to examine variables associated with inappropriateness of admissions. A prospective study was conducted in the Department of Pediatrics, Farwania General Hospital, Kuwait, to examine successive admissions for appropriateness of admission as well as several sociodemographic characteristics over a 5-month period (August 2010 to December 2010). A total of 1,022 admissions were included. Of the 1,022 admissions, 416 (40.7%) were considered inappropriate. Factors associated with a higher rate of inappropriate admission included older age of patients and self-referral. The rate of inappropriate hospitalization of children was high in Farwania Hospital, Kuwait, probably due to the relatively free health care services, parental preference for hospital care, easy access to hospital services, and insufficient education about the child's condition. Copyright © 2012 S. Karger AG, Basel.
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Directory of Open Access Journals (Sweden)
DIOFANOR ACEVEDO
2012-12-01
Full Text Available El objetivo de este estudio fue determinar los efectos del incremento de los sólidos totales con lactosuero parcialmente desmineralizado en las determinaciones de flujo del Suero costeño. Los resultados muestran que el flujo fue de naturaleza no-newtoniana, las curvas se ajustaron mejor al modelo de Herschel-Bulkley, previamente evaluado por la ecuación de Casson. El aumento de los sólidos totales disminuye el índice de flujo (n, aumenta el umbral de fluencia (?0 y el coeficiente de consistencia (K, presentando un adelgazamiento por corte o cizalladuraO objetivo deste estudo foi determinar os efeitos do aumento de sólidos totais com soro parcialmente desmineralizado na determinação do fluxo de soro costenho. Os resultados mostram que o fluxo era de curvas não-newtoniano montado um modelo de Herschel-Bulkley, previamente avaliada pela equação de Casson. O aumento do teor de sólidos diminui a taxa de fluxo (n aumenta a tensão de escoamento (?0 e o coeficiente de consistência (K, indicando uma tesoura de desbaste ou de corte.The main objective in this study was to determine the effects of increment in total solids concentration with partially dematerialized whey for the flow determinations in Suero Costeño. The results shown that the increase in total solids concentration affects the rheological properties, like consistency coefficient (K and an increment of the values of yield stress (?0, while the flow index (n values slightly decreased, showing a leverage in shear-thinning behavior
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Simultaneous and staged bilateral total hip arthroplasty
DEFF Research Database (Denmark)
Lindberg-Larsen, Martin; Joergensen, Christoffer Calov; Husted, Henrik
2013-01-01
Bilateral total hip arthroplasty (BTHA) and bilateral simultaneous total hip arthroplasty (BSTHA) are done increasingly. Previous studies evaluating outcomes after bilateral procedures have found different results. The aim of this study was to investigate length of hospital stay (LOS), 30 days...
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Modules for estimating solid waste from fossil-fuel technologies
International Nuclear Information System (INIS)
Crowther, M.A.; Thode, H.C. Jr.; Morris, S.C.
1980-10-01
Solid waste has become a subject of increasing concern to energy industries for several reasons. Increasingly stringent air and water pollution regulations result in a larger fraction of residuals in the form of solid wastes. Control technologies, particularly flue gas desulfurization, can multiply the amount of waste. With the renewed emphasis on coal utilization and the likelihood of oil shale development, increased amounts of solid waste will be produced. In the past, solid waste residuals used for environmental assessment have tended only to include total quantities generated. To look at environmental impacts, however, data on the composition of the solid wastes are required. Computer modules for calculating the quantities and composition of solid waste from major fossil fuel technologies were therefore developed and are described in this report. Six modules have been produced covering physical coal cleaning, conventional coal combustion with flue gas desulfurization, atmospheric fluidized-bed combustion, coal gasification using the Lurgi process, coal liquefaction using the SRC-II process, and oil shale retorting. Total quantities of each solid waste stream are computed together with the major components and a number of trace elements and radionuclides
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Directory of Open Access Journals (Sweden)
Tom Schaal
Full Text Available The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction.A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model.The bivariate analysis showed a strong association between satisfaction and sex (male or female, the patients' health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met.The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.
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Schaal, Tom; Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim
2017-01-01
The increase in the number of patients presenting with osteoarthritis in the past decade has led to a 32% increase in knee replacement surgeries designed to reduce restrictions on patient movement and improve their quality of life. Patient satisfaction is becoming an increasingly important indicator of quality of care. This study was designed to identify predictors of various service components in the treatment process and hospital key performance indicators significantly associated with patient satisfaction. A multicenter cross-sectional study was conducted with 856 patients having their primary total knee replacements at 41 hospitals. Patient satisfaction was queried via a validated, multidimensional questionnaire mainly using a six-point scale. In addition to bivariate calculations, patient satisfaction was the dependent variable in a binary logistic regression model. The bivariate analysis showed a strong association between satisfaction and sex (male or female), the patients' health before admission, and the length of stay. The number of cases treated at each hospital did not reveal any impact on satisfaction. The multivariate analysis identified three predictors associated with overall satisfaction. The strongest factor was the treatment outcome and the weakest was the quality of food. It became apparent that the statutory procedure minimums were not being met. The relevant factors influencing patient satisfaction were partially the same as previous study results and allowed more detailed conclusions. The results provide suggestions across hospitals that could help health care providers better meet needs of patients after knee arthroplasties.
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Directory of Open Access Journals (Sweden)
Alessandro Leite Cavalcanti
2013-01-01
Full Text Available Background: The use of liquid pharmaceutical preparations is a daily occurrence for some children. Evidences show a significant relation between the intake of oral sucrose based medicines and an increase incidence in dental caries. Aim: This in vitro experimental study evaluated the Total Soluble Solids Content (TSSC by means of Brix scale refractometry and the endogenous pH of antimicrobials of pediatric use presented as oral suspensions. Materials and Methods: Nine medications (6 chemotherapics and 3 antibiotics were evaluated by random experiment with 3 repetitions for each sample. The analysis of TSSC readings were performed by Brix refractometry using the Abbé refractometer, and the pH values were determined by potentiometry. Results: The mean TSS contents ranged from 11.73 (Keflaxina to 63.83 (Azitromed. The minimum and maximum mean pH values were 4.12 (Keflaxina and 10.97 (Zitroneo, respectively. Conclusions: The chemotherapic antimicrobials evaluated in this study presented the highest TSSC means, while the antibiotics showed pHs below the values considered as critical, which may contribute to the development of caries lesions in case of inadequate administration of these medications to children.
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A Multifactorial Analysis of Reconstruction Methods Applied After Total Gastrectomy
Directory of Open Access Journals (Sweden)
Oktay Büyükaşık
2010-12-01
Full Text Available Aim: The aim of this study was to evaluate the reconstruction methods applied after total gastrectomy in terms of postoperative symptomology and nutrition. Methods: This retrospective study was conducted on 31 patients who underwent total gastrectomy due to gastric cancer in 2. Clinic of General Surgery, SSK Ankara Training Hospital. 6 different reconstruction methods were used and analyzed in terms of age, sex and postoperative complications. One from esophagus and two biopsy specimens from jejunum were taken through upper gastrointestinal endoscopy from all cases, and late period morphological and microbiological changes were examined. Postoperative weight change, dumping symptoms, reflux esophagitis, solid/liquid dysphagia, early satiety, postprandial pain, diarrhea and anorexia were assessed. Results: Of 31 patients,18 were males and 13 females; the youngest one was 33 years old, while the oldest- 69 years old. It was found that reconstruction without pouch was performed in 22 cases and with pouch in 9 cases. Early satiety, postprandial pain, dumping symptoms, diarrhea and anemia were found most commonly in cases with reconstruction without pouch. The rate of bacterial colonization of the jejunal mucosa was identical in both groups. Reflux esophagitis was most commonly seen in omega esophagojejunostomy (EJ, while the least-in Roux-en-Y, Tooley and Tanner 19 EJ. Conclusion: Reconstruction with pouch performed after total gastrectomy is still a preferable method. (The Medical Bulletin of Haseki 2010; 48:126-31
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Direct cost comparison of totally endoscopic versus open ear surgery.
Patel, N; Mohammadi, A; Jufas, N
2018-02-01
Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.
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Management of hospital radioactive wastes
International Nuclear Information System (INIS)
Mantrana, D.
1986-01-01
The general structure of a regulatory scheme for the management of hospital radioactive wastes is presented. The responsabilities of an institution in the radioactive waste management, and storage conditions are defined. The radioactive wastes are classified in physical terms, and the criteria for evaluating the activity of solid wastes are described. The container characteristics and, the types of treatments given to the wastes are specified. (M.C.K.) [pt
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Is hospital 'community benefit' charity care?
Bakken, Erik; Kindig, David A
2012-10-01
The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.
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Adina Morosanu, Gabriela; Zaharia, Liliana; Ioana-Toroimac, Gabriela; Belleudy, Philippe
2017-04-01
The total dissolved solids (TDS) is a river water quality parameter reflecting its concentration in solute ions. It is sensitive to many physical and anthropogenic features of the watershed. In this context, the objective of this work is to analyze the spatial variation of the TDS and to identify the role of the main controlling factors (e.g. geology, soils, land use) in Jiu River and some of its main tributaries, by using a methodology based on GIS and multivariate analysis. The Jiu watershed (10,000 kmp) is located in south-western Romania and it has a high diversity of physical and anthropogenic features influencing the water flow and its quality. The study is based on TDS measurements performed in August, 2016, during low flow conditions in the Jiu River and its tributaries. To measure in situ the TDS (ppm), an EC/TDS/Temperature Hand-held Tester was used in the 12 measuring points on Jiu River and in another 7 points on some of its tributaries. Across the hydrographic basin, the recorded TDS values ranged from 31 ppm to 607 ppm, while in the case of Jiu River, the TDS varied between 38 ppm at Lonea station (upper Jiu River) and 314 ppm at Išalniča (in the lower course). For each catchment corresponding to the sampling points, the influence of some contiguous features was defined on the basis of the lithology (marls, limestones, erodible bedrocks) and soils (clay textures), as well as the land cover/use influencing the solubility and solid content. This assessment was carried out in GIS through a set of spatial statistics analysis by calculating the percentages of the catchment coverage area for each determinant. In order to identify the contributions of different catchment features on the TDS variability, principal components analysis (PCA) was then applied. The results revealed the major role of the marls and clayey soils in the increase of TDS (on the Amaradia and Gilort rivers and some sections in the middle course of the Jiu River). In contrast
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????????????, ?. ?.; ????????, ?. ?.; ?????, ?. ?.
2012-01-01
? ?????? ???????? ??????? ??????? ???????? ?? ???????????? ??????????? ????????? SolidWorks/SolidWorks Flow Simulation (COSMOSFloWorks)/SolidWorks Simulation ??? ?????????? ???????? ?? ????????????? ???. ??? ???????? ????????? ???????? ?????????? ?? ?????? ???????? ??????? ? ????????????? ?????? ? ????????????? ????????????? ?????????? ???????????? SolidWorks Flow Simulation (COSMOSFloWorks). ??? ???????????? ??????????? ????????????? ?????? ?? ????????? ??????????? ??????? ?? ??????????? ...
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Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S
2016-03-01
The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.
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Craver, Christopher; Belk, Kathy W; Myers, Gerard J
2018-01-01
Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (tHb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of tHb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery. A retrospective study was conducted on patients who underwent coronary artery bypass graft (CABG) and/or valve replacement (VR) procedures from January 2014 to June 2016, using MedAssets discharge data. The patient population was sub-divided by the measurement modality (tHb and Hct), using detailed billing records and Current Procedural Terminology coding. Cost was calculated using hospital-specific cost-to-charge ratios. Multivariable logistic regression was performed to identify significant drivers of RBC transfusion and resource utilization. The study population included 18,169 cardiovascular surgery patients. Hct-monitored patients accounted for 66% of the population and were more likely to have dual CABG and VR procedures (10.4% vs 8.9%, p=0.0069). After controlling for patient and hospital characteristics, as well as patient comorbidities, Hct-monitored patients had significantly higher RBC transfusion risk (OR=1.26, CI 1.15-1.38, pcosts (IRR=1.15, pcost (IRR=1.22, pcost compared to Hct monitoring.
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Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries
Demetriades, Demetrios; Hadjizacharia, Pantelis; Constantinou, Costas; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali
2006-01-01
Objective: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. Background: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. Patients and Methods: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. Results: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a “blush” on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27
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International Nuclear Information System (INIS)
Masunaga, Shin-ichiro; Ono, Koji; Sakurai, Yoshinori; Takagaki, Masao; Kobayashi, Tooru; Kinashi, Yuko; Suzuki, Minoru
2001-01-01
Purpose: Response of quiescent (Q) and total tumor cells in solid tumors to reactor neutron beam irradiation with two different cadmium (Cd) ratios was examined in terms of micronucleus (MN) frequency and apoptosis frequency, using four different tumor cell lines. Methods and Materials: C57BL mice bearing EL4 tumors, C3H/He mice bearing SCC VII or FM3A tumors, and Balb/c mice bearing EMT6/KU tumors received 5-bromo-2'-deoxyuridine (BrdU) continuously for 5 days via implanted mini-osmotic pumps to label all proliferating (P) cells. Thirty min after i.p. injection of sodium borocaptate- 10 B (BSH), or 3 h after oral administration of p-boronophenylalanine- 10 B (BPA), the tumors were irradiated with neutron beams. The tumors without 10 B-compound administration were irradiated with neutron beams or γ-rays. This neutron beam irradiation was performed using neutrons with two different Cd ratios. The tumors were then excised, minced, and trypsinized. The tumor cell suspensions thus obtained were incubated with cytochalasin-B (a cytokinesis blocker), and the MN frequency in cells without BrdU labeling (=Q cells) was determined using immunofluorescence staining for BrdU. Meanwhile, for apoptosis assay, 6 h after irradiation, tumor cell suspensions obtained in the same manner were fixed, and the apoptosis frequency in Q cells was also determined with immunofluorescence staining for BrdU. The MN and apoptosis frequencies in total (P+Q) tumor cells were determined from the tumors that were not pretreated with BrdU. Results: Without 10 B-compounds, the sensitivity difference between total and Q cells was reduced by neutron beam irradiation. Under our particular neutron beam irradiation condition, relative biological effectiveness (RBE) of neutrons was larger in Q cells than in total cells, and the RBE values were larger for low Cd-ratio than high Cd-ratio neutrons. With 10 B-compounds, both frequencies were increased for each cell population, especially for total cells. BPA
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Directory of Open Access Journals (Sweden)
M. H. Dehghani, K. Azam, F. Changani, E. Dehghani Fard
2008-04-01
Full Text Available The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past, medical waste was often mixed with municipal solid waste and disposed in residential waste landfills or improper treatment facilities in Iran. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better managing the wastes from healthcare facilities. This study was carried in 12 educational hospitals of Tehran University of Medical Sciences. The goals of this study were to characterize solid wastes generated in healthcare hospitals, to report the current status of medical waste management and to provide a framework for the safe management of these wastes at the considered hospitals. The methodology was descriptive, cross-sectional and consisted of the use of surveys and interviews with the authorities of the healthcare facilities and with personnel involved in the management of the wastes. The results showed that medical wastes generated in hospitals were extremely heterogeneous in composition. 42% of wastes were collected in containers and plastic bags. In 75% of hospitals, the stay-time in storage sites was about 12-24h. 92% of medical wastes of hospitals were collected by covered-trucks. In 46% of hospitals, transferring of medical wastes to temporary stations was done manually. The average of waste generation rates in the hospitals was estimated to be 4.42kg/bed/day.
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Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma
2017-04-01
Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.
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Directory of Open Access Journals (Sweden)
Solomon Daniel H
2010-07-01
Full Text Available Abstract Background Studies on critical pathway use have demonstrated decreased length of stay and cost without compromise in quality of care. However, pathway effectiveness is difficult to determine given methodological flaws, such as small or single center cohorts. We studied the effect of critical pathways on total knee replacement outcomes in a large population-based study. Methods We identified hospitals in four US states that performed total knee replacements. We sent a questionnaire to surgical administrators in these hospitals including items about critical pathway use and hospital characteristics potentially related to outcomes. Patient data were obtained from Medicare claims, including demographics, comorbidities, 90-day postoperative complications and length of hospital stay. The principal outcome measure was the risk of having one or more postoperative complications. Results Two hundred ninety five hospitals (73% responded to the questionnaire, with 201 reporting the use of critical pathways. 9,157 Medicare beneficiaries underwent TKR in these hospitals with a mean age of 74 years (± 5.8. After adjusting for both patient and hospital related variables, patients in hospitals with pathways were 32% less likely to have a postoperative complication compared to patients in hospitals without pathways (OR 0.68, 95% CI 0.50-0.92. Patients managed on a critical pathway had an average length of stay 0.5 days (95% CI 0.3-0.6 shorter than patients not managed on a pathway. Conclusion Medicare patients undergoing total knee replacement surgery in hospitals that used critical pathways had fewer postoperative complications than patients in hospitals without pathways, even after adjusting for patient and hospital related factors. This study has helped to establish that critical pathway use is associated with lower rates of postoperative mortality and complications following total knee replacement after adjusting for measured variables.
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Disposable products in the hospital waste stream.
Gilden, D. J.; Scissors, K. N.; Reuler, J. B.
1992-01-01
Use of disposable products in hospitals continues to increase despite limited landfill space and dwindling natural resources. We analyzed the use and disposal patterns of disposable hospital products to identify means of reducing noninfectious, nonhazardous hospital waste. In a 385-bed private teaching hospital, the 20 disposable products of which the greatest amounts (by weight) were purchased, were identified, and total hospital waste was tabulated. Samples of trash from three areas were so...
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Bio solids Effects in Chihuahuan Desert Rangelands: A Ten-Year Study
International Nuclear Information System (INIS)
Wester, D.B; Sosebee, R.E; Fish, E.B; Villalobos, J.C; Zartman, R.E; Gonzalez, R.M; Jurado, P.; Moffet, C.A
2011-01-01
Arid and semiarid rangelands are suitable for responsible bio solids application. Topical application is critical to avoid soil and vegetation disturbance. Surface-applied bio solids have long-lasting effects in these ecosystems. We conducted a 10-year research program investigating effects of bio solids applied at rates from 0 to 90 dry Mg ha -1 on soil water infiltration; runoff and leachate water quality; soil erosion; forage production and quality; seedling establishment; plant physiological responses; nitrogen dynamics; bio solids decomposition; and grazing animal behavior and management. Bio solids increased soil water infiltration and reduced erosion. Effects on soil water quality were observed only at the highest application rates. Bio solids increased soil nitrate-nitrogen. Bio solids increased forage production and improved forage quality. Bio solids increased leaf area of grasses; photosynthetic rates were not necessarily increased by bio solids. Bio solids effects on plant establishment are expected only under moderately favorable conditions. Over an 82-mo exposure period, total organic carbon, nitrogen, and total and available phosphorus decreased and inorganic matter increased. Grazing animals spent more time grazing, ruminating, and resting in bio solids-treated areas; positive effects on average daily gain were observed during periods of higher rainfall. Our results suggest that annual bio solids application rates of up to 18 Mg ha -1 are appropriate for desert rangelands.
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International Nuclear Information System (INIS)
Filik, Hayati; Yanaz, Zeynep
2009-01-01
A selective colorimetric-solid-phase extraction (C-SPE) method for the determination of total vanadium in water samples was developed. This method introduced a new variation of C-SPE. The colour reaction is based on the reaction of vanadium(V) ternary complex formed with 1-(2-Pyridylazo)-2-naphtol (PAN) in the presence hydrogen peroxide (H 2 O 2 ). In this technique, the target analytes in samples are extracted onto solid matrix loaded with a colorimetric reagent and then quantified directly on the adsorbent surface by using a miniature fiber optic reflectance spectrometer. The measurements were carried out at a wavelength of 589.4 nm since it yielded the largest divergence different in reflectance spectra before and after reaction with the vanadium. The overall time required for the C-SPE procedure was ∼20 min. The amount of concentrated V is then determined in a few seconds by using miniature reflectance spectrometer. At the optimal conditions, a calibration curve was constructed, revealing a linear range of 0.05-0.52 mg L -1 and a detection limit as low as 0.01 mg L -1 while the RSD lower than 2.8%. In order to verify the accuracy of the method, a certified reference water samples (TMDA) were analysed and the results obtained were in good agreement with the certified values. The proposed method was applied to the determination of vanadium in tap water, seawater samples with a recovery for the spiked samples in the range of 98-102%.
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Zeng, Honglian; Liu, Zhenli; Zhao, Siyu; Shu, Yisong; Song, Zhiqian; Wang, Chun; Dong, Yunzhuo; Ning, Zhangchi; He, Dan; Wang, Menglei; Lu, Cheng; Liu, Yuanyan; Lu, Aiping
2016-10-01
Citrus fruit is an important health-promoting food that is rich in dietary phenolic metabolites. Traditional Chinese medicines, such as Zhishi and Zhiqiao, come from young and immature fruits of Citrus cultivars. The preparation of diversified bioactive phenolic products and establishment of the corresponding quality control methodology are challenging and necessary. In the current study, four types of solid-phase extraction sorbents for the enrichment and clean-up of the phenolic matrix were evaluated. A solid-phase extraction column coated with Strata-X was finally used in the procedure. Twenty phenolic compounds were selected to evaluate the extraction performances of the sorbents using high-performance liquid chromatography analysis. Under the optimized conditions, good linearities were obtained with R 2 more than 0.9996 for all analytes with LODs of 0.04-1.012 μg/g. Intra- and interday relative standard deviation values were less than 3%, and the recovery was equal to or higher than 90.02%. Compared to non-solid-phase extraction process, the content of total phenolic products was elevated 35.55-68.48% with solid-phase extraction. Finally, the developed and validated method was successfully applied to the discrimination of Zhishi samples from different species as well as Zhishi and Zhiqiao samples in different development stages. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
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Huang, Ze-Ning; Huang, Chang-Ming; Zheng, Chao-Hui; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lin, Jian-Xian; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Tu, Ru-Hong; Lin, Ju-Li
2017-10-21
To evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG). A total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL. Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups ( P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A ( P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL ("Have you felt pain" and "Have you had difficulty eating solid food") ( P < 0.05). The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.
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Sputtering of solid deuterium by He-ions
DEFF Research Database (Denmark)
Schou, Jørgen; Stenum, B.; Pedrys, R.
2001-01-01
Sputtering of solid deuterium by bombardment of 3He+ and 4He+ ions was studied. Some features are similar to hydrogen ion bombardment of solid deuterium, but for the He-ions a significant contribution of elastic processes to the total yield can be identified. The thin-film enhancement is more pro...... pronounced than that for hydrogen projectiles in the same energy range....
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Value-based purchasing and hospital acquired conditions: are we seeing improvement?
Spaulding, Aaron; Zhao, Mei; Haley, D Rob
2014-12-01
To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Fongsatitkul, Prayoon; Elefsiniotis, Panagiotis; Wareham, David G
2010-09-01
This paper describes how the degradation of the organic fraction of municipal solid waste (OFMSW) is affected through codigestion with varying amounts of return activated sludge (RAS). Solid waste that had its inorganic fraction selectively removed was mixed with RAS in ratios of 100% OFMSW, 50% OFMSW/50% RAS, and 25% OFMSW/75% RAS. The total solids (TS) concentration was held at 8% and three anaerobic digester systems treating the mixtures were held (for the first run) at a total hydraulic retention time (HRT) of 28 days. Increasing amounts of RAS did not however improve the mixture's digestability, as indicated by little change and/or a drop in the main performance indices [including percentage volatile solids (VS) removal and specific gas production]. The optimum ratio in this research therefore appeared to be 100% OFMSW with an associated 85.1 ± 0.6% VS removal and 0.72 ± 0.01 L total gas g(- 1) VS. In the second run, the effect of increasing percentage of TS (8, 12% and 15%) at a system HRT of 28 days was observed to yield no improvement in the main performance indices (i.e. percentage VS removal and specific gas production). Finally, during the third run, variations in the total system HRT were investigated at an 8% TS, again using 100% OFMSW. Of the HRTs explored (23, 28 and 33 days), the longest HRT yielded the best performance overall, particularly in terms of specific gas production (0.77 ± 0.01 L total gas g(-1) VS).
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[Total knee and hip prosthesis: variables associated with costs].
Herrera-Espiñeira, Carmen; Escobar, Antonio; Navarro-Espigares, José Luis; Castillo, Juan de Dios Lunadel; García-Pérez, Lidia; Godoy-Montijano, Amparo
2013-01-01
The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.
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Analysis Of Liquid Waste Management At Dr. Mohammad Hoesin Palembang's Hospital
Hartini, Resi; Hasyim, Hamzah; Ainy, Asmaripa
2011-01-01
Background : The hospital is an institution that service activities of preventive, curative, rehabilitative and promotive health. These activities produce solid, liquid, and gas waste. Liquid waste can cause diseases and environment pollution so need special waste management. Dr. Mohammad Hoesin Palembang's Hospital producea lot of liquid waste. Method : This study is a descriptive research with qualitative approach. Sources of information consist four informants. The research are using dept...
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Autologous blood transfusion in total knee replacement surgery.
Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana
2013-03-01
Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.
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Strategies for reducing implant costs in the revision total knee arthroplasty episode of care.
Elbuluk, Ameer M; Old, Andrew B; Bosco, Joseph A; Schwarzkopf, Ran; Iorio, Richard
2017-12-01
Implant price has been identified as a significant contributing factor to high costs associated with revision total knee arthroplasty (rTKA). The goal of this study is to analyze the cost of implants used in rTKAs and to compare this pricing with 2 alternative pricing models. Using our institutional database, we identified 52 patients from January 1, 2014 to December 31, 2014. Average cost of components for each case was calculated and compared to the total hospital cost for that admission. Costs for an all-component revision were then compared to a proposed "direct to hospital" (DTH) standardized pricing model and a fixed price revision option. Potential savings were calculated from these figures. On average, 28% of the total hospital cost was spent on implants for rTKA. The average cost for revision of all components was $13,640 and ranged from $3000 to $28,000. On average, this represented 32.7% of the total hospital cost. Direct to hospital implant pricing could potentially save approximately $7000 per rTKA, and the fixed pricing model could provide a further $1000 reduction per rTKA-potentially saving $8000 per case on implants alone. Alternative implant pricing models could help lower the total cost of rTKA, which would allow hospitals to achieve significant cost containment.
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Productivity of public hospitals in Nepal: a data envelopment analysis.
Silwal, Pushkar Raj; Ashton, Toni
2017-07-20
Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011-2012 to 2013-2014. The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011-2012 to 2013-2014. First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011-2012 to 8613 in 2013-2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011-2012 to 2013-2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Productivity of public hospitals in Nepal: a data envelopment analysis
Ashton, Toni
2017-01-01
Objectives Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011–2012 to 2013–2014. Setting and participants The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011–2012 to 2013–2014. Outcome measures First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Results Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011–2012 to 8613 in 2013–2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011–2012 to 2013–2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. Conclusions In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. PMID:28729314
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Solberg, Eirin
2012-01-01
Master i produktdesign Municipal solid waste refers to waste in a solid form, produced in the daily day life of a society such as packaging, food scrapes, grass clippings, clothing, furniture, paper, electronics and so on. It is called municipal solid waste because it is in the responsibility of the local government and comes from our homes, schools, hospitals and businesses. It is produced 108 tons municipal solid waste in Iringa each day. Iringa district is located approximately 500...
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Development of a master plan for industrial solid waste management
International Nuclear Information System (INIS)
Karamouz, M.; Zahraie, B.; Kerachian, R.; Mahjouri, N.; Moridi, A.
2006-01-01
Rapid industrial growth in the province of Khuzestan in the south west of Iran has resulted in disposal of about 1750 tons of solid waste per day. Most of these industrial solid wastes including hazardous wastes are disposed without considering environmental issues. This has contributed considerably to the pollution of the environment. This paper introduces a framework in which to develop a master plan for industrial solid waste management. There are usually different criteria for evaluating the existing solid waste pollution loads and how effective the management schemes are. A multiple criteria decision making technique, namely Analytical Hierarchy Process, is used for ranking the industrial units based on their share in solid waste related environmental pollution and determining the share of each unit in total solid waste pollution load. In this framework, a comprehensive set of direct, indirect, and supporting projects are proposed for solid waste pollution control. The proposed framework is applied for industrial solid waste management in the province of Khuzestan in Iran and a databank including GIS based maps of the study area is also developed. The results have shown that the industries located near the capital city of the province, Ahwaz, produce more than 32 percent of the total solid waste pollution load of the province. Application of the methodology also has shown that it can be effectively used for development of the master plan and management of industrial solid wastes
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Wright, Jason D; Tergas, Ana I; Hou, June Y; Burke, William M; Chen, Ling; Hu, Jim C; Neugut, Alfred I; Ananth, Cande V; Hershman, Dawn L
2016-07-01
Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. To examine the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. A cohort study of 221 637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The association between hospital competition, hospital financial status, and performance of robotic-assisted surgery was examined. The association between hospital competition was measured with the Herfindahl-Hirschman Index (HHI), hospital financial status was estimated as operating margin, and performance of robotic-assisted surgery was examined using multivariate mixed-effects regression models. We identified 221 637 patients who underwent one of the procedures of interest. The cohort included 30 345 patients who underwent radical prostatectomy; 20 802, total nephrectomy; 8060, partial nephrectomy; 134 985, hysterectomy; and 27 445, oophorectomy. Robotic-assisted operations were performed for 20 500 (67.6%) radical prostatectomies, 1405 (6.8%) total nephrectomies, 2759 (34.2%) partial nephrectomies, 14 047 (10.4%) hysterectomies, and 1782 (6.5%) oophorectomies. Use of robotic-assisted surgery increased for each procedure from January 2010 through December 2011. For all 5 operations, increased market competition (as measured by the HHI) was associated with increased use of robotic-assisted surgery. For prostatectomy, the risk ratios (95% CIs) for undergoing a robotic-assisted procedure were 2.20 (1.50-3.24) at hospitals in moderately competitive markets and 2.64 (1.84-3.78) for highly competitive markets
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Quality of sleep for hospitalized patients in Rasoul-Akram hospital.
Ghanbari Jolfaei, Atefeh; Makvandi, Alena; Pazouki, Abdolreza
2014-01-01
Sleep disturbances have negative effects on medical conditions, mental health and cognitive performance. It was shown that about 60% of inpatients suffer from sleep problems. The aim of this study was to assess the correlation between sleep quality and other factors in the inpatients of Rasoul-e-Akram hospital. In this cross-sectional study, all the hospitalized patients in twelve wards of Rasoul-e-Akram hospital during September 2012, were examined. Sleeping habits of 209 inpatients of different wards were assessed through the Persian version of Pittsburgh Sleep Questionnaire (PSQI). A self-designed 18- question questionnaire was conducted for all patients in order to assess their attitude to interior and atmosphere of wards. Content validity and test retest reliability were evaluated. The pain level was also measured by the visual analog scale (VAS) and scores analyzed by the statistical methods of frequency, percentage, chi-square and logistic regression. The mean of the total scores in PSQI was 8.8±4.8 and 70.8% of the patients were 'poor sleepers' (global PSQI> 5). Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication and attitude toward the overall atmosphere and interior of wards have caused deviation in scores. Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.
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Predictive relationship between polyphenol and nonfat cocoa solids content of chocolate.
Cooper, Karen A; Campos-Giménez, Esther; Jiménez Alvarez, Diego; Rytz, Andreas; Nagy, Kornél; Williamson, Gary
2008-01-09
Chocolate is often labeled with percent cocoa solids content. It is assumed that higher cocoa solids contents are indicative of higher polyphenol concentrations, which have potential health benefits. However, cocoa solids include polyphenol-free cocoa butter and polyphenol-rich nonfat cocoa solids (NFCS). In this study the strength of the relationship between NFCS content (estimated by theobromine as a proxy) and polyphenol content was tested in chocolate samples with labeled cocoa solids contents in the range of 20-100%, grouped as dark (n = 46), milk (n = 8), and those chocolates containing inclusions such as wafers or nuts (n = 15). The relationship was calculated with regard to both total polyphenol content and individual polyphenols. In dark chocolates, NFCS is linearly related to total polyphenols (r2 = 0.73). Total polyphenol content appears to be systematically slightly higher for milk chocolates than estimated by the dark chocolate model, whereas for chocolates containing other ingredients, the estimates fall close to or slightly below the model results. This shows that extra components such as milk, wafers, or nuts might influence the measurements of both theobromine and polyphenol contents. For each of the six main polyphenols (as well as their sum), the relationship with the estimated NFCS was much lower than for total polyphenols (r2 chocolate type, indicating that they might still have some predictive capabilities.
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Assessment of hospital emergency management in the Beijing area.
Yantao, Xin
2011-06-01
In recent years, the number of public health emergencies has increased. Improving hospital emergency management is an important challenge. This is a pilot study intended to assess hospital emergency management in the Beijing area, make recommendations to government health authorities and hospital managers, and offer references for similar studies. This was an observational, cross-sectional survey. Forty-five hospitals in the Beijing area were selected randomly. A self-administered questionnaire was used as a data collection tool. It comprised of three sections: (1) Section A was the introduction; (2) Section B asked for the respondent's personal information; and (3) Section C comprised the major part of the questionnaire and was intended to gather information regarding the hospital's general emergency management situation. The survey response rate was 44%, accounting for 29% of total hospitals that the study targeted. No hospital had an established emergency management department or full-time staff for emergency management. A total of 15-45% of the hospitals had established a hospital emergency management committee, performed a vulnerability analysis, or evaluated emergency management regularly. Twenty-five percent of respondents thought that the local government health authority had established an integrated hospital incident command system. A total of 40%-55% of hospitals contracted with outside institutions for supplements, backup of key functional systems and professional support. After the occurrence of the 2003 severe acute respiratory syndrome (SARS) epidemic, Chinese hospital managers took many measures to improve hospital resilience. However, most of these efforts lacked the guidance of theories, concepts, principles, and methods. An integrated, standardized, operational hospital emergency management model has not been established. Although the survey response rate was relatively low, some clues for further study were discovered, and suggestions to the
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International Nuclear Information System (INIS)
Medina Bermudez, Clara Ines
1999-01-01
The topic of solid residues is specifically of great interest and concern for the authorities, institutions and community that identify in them a true threat against the human health and the atmosphere in the related with the aesthetic deterioration of the urban centers and of the natural landscape; in the proliferation of vectorial transmitters of illnesses and the effect on the biodiversity. Inside the wide spectrum of topics that they keep relationship with the environmental protection, the inadequate handling of solid residues and residues dangerous squatter an important line in the definition of political and practical environmentally sustainable. The industrial development and the population's growth have originated a continuous increase in the production of solid residues; of equal it forms, their composition day after day is more heterogeneous. The base for the good handling includes the appropriate intervention of the different stages of an integral administration of residues, which include the separation in the source, the gathering, the handling, the use, treatment, final disposition and the institutional organization of the administration. The topic of the dangerous residues generates more expectation. These residues understand from those of pathogen type that are generated in the establishments of health that of hospital attention, until those of combustible, inflammable type, explosive, radio-active, volatile, corrosive, reagent or toxic, associated to numerous industrial processes, common in our countries in development
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Solid and liquid radioactive wastes
International Nuclear Information System (INIS)
Cluchet, J.; Desroches, J.
1977-01-01
The problems raised by the solid and liquid radioactive wastes from the CEA nuclear centres are briefly exposed. The processing methods developed at the Saclay centre are described together with the methods for the wastes from nuclear power plants and reprocessing plants. The different storage techniques used at the La Hague centre are presented. The production of radioactive wastes by laboratories, hospitals and private industry is studied for the sealed sources and the various radioactive substances used in these plants. The cost of the radioactive wastes is analysed: processing, transport, long term storage [fr
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Economies of scale and optimal size of hospitals: Empirical results for Danish public hospitals
DEFF Research Database (Denmark)
Kristensen, Troels
number of beds per hospital is estimated to be 275 beds per site. Sensitivity analysis to partial changes in model parameters yields a joint 95% confidence interval in the range 130 - 585 beds per site. Conclusions: The results indicate that it may be appropriate to consolidate the production of small...... the current configuration of Danish hospitals is subject to scale economies that may justify such plans and to estimate an optimal hospital size. Methods: We estimate cost functions using panel data on total costs, DRG-weighted casemix, and number : We estimate cost functions using panel data on total costs......, DRG-weighted casemix, and number of beds for three years from 2004-2006. A short-run cost function is used to derive estimates of long-run scale economies by applying the envelope condition. Results: We identify moderate to significant long-run economies of scale when applying two alternative We...
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Energy Technology Data Exchange (ETDEWEB)
Koo, Ja-Kong; Do, Nam-Young [Korea Advanced Institute of Science & Technology, Taejon (Korea, Republic of)
1996-12-31
The K site near Seoul began landfilling in 1992. The landfilled wastes include municipal solid waste (66.4%), construction residues (20.4%), water and wastewater sludges (trace levels), and hazardous waste (trace levels). The water content of the municipal solid waste is very high (47.3%); as a result, the leachate level (average E.L.) of the landfill, the design value of which is 7.0 m, was measured at 10.3 m in January 1995 and is increasing. The increase of leachate level in the landfill site causes a problem with slope stability. The leachate level at each disposal stage divided by the intermediate cover layer was calculated with the HELP (Hydrologic Evaluation of Landfill Performance) model and calibrated with the data measured from February 1993 to June 1995. Also, the hydraulic conductivities of the waste layer and the intermediate cover layer in each stage were calibrated continuously with HELP model analysis. To verify these results, the total water balance in the landfill site was calculated using the infiltration rate calculated from HELP modeling. The leachate level was E.L. 10.0 m, which was close to the measured leachate level. To estimate the change of the leachate level in the future, the total water balances with different leachate discharge rates of 3,000, 3,500, and 5,000 m{sup 3}/day were analyzed. When the leachate discharge rate was 5,000 ton/day and the initial water content was decreased below 25%, the average leachate level was 10.8 m. This result satisfies the safety factor requirements (=1.3) for landfill slope stability. 4 refs., 8 figs., 1 tab.
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O'Neill, Liam; Dexter, Franklin; Park, Sae-Hwan; Epstein, Richard H
2017-09-01
Most surgical discharges (54%) at the average hospital are for procedures performed no more often than once per month at that hospital. We hypothesized that such uncommon procedures would be associated with an even greater percentage of the total cost of performing all surgical procedures at that hospital. Observational study. State of Texas hospital discharge abstract data: 4th quarter of 2015 and 1st quarter of 2016. Inpatients discharged with a major therapeutic ("operative") procedure. For each of N=343 hospitals, counts of discharges, sums of lengths of stay (LOS), sums of diagnosis related group (DRG) case-mix weights, and sums of charges were obtained for each procedure or combination of procedures, classified by International Classification of Diseases version 10 Procedure Coding System (ICD-10-PCS). Each discharge was classified into 2 categories, uncommon versus not, defined as a procedure performed at most once per month versus those performed more often than once per month. Major procedures performed at most once per month per hospital accounted for an average among hospitals of 68% of the total inpatient costs associated with all major therapeutic procedures. On average, the percentage of total costs associated with uncommon procedures was 26% greater than expected based on their share of total discharges (Pcosts among surgical patients can be attributed to procedures performed at most once per month per hospital. The finding that such uncommon procedures account for a large percentage of costs is important because methods of cost accounting by procedure are generally unsuitable for them. Copyright © 2017 Elsevier Inc. All rights reserved.
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Rasolomanana, Santatriniaina Denise; Lessard, Paul; Vanrolleghem, Peter A
2012-01-01
To obtain greater precision in modelling small agricultural watersheds, a shorter simulation time step is beneficial. A daily time step better represents the dynamics of pollutants in the river and provides more realistic simulation results. However, with a daily evaluation performance, good fits are rarely obtained. With the Shuffled Complex Evolution (SCE) method embedded in the Soil and Water Assessment Tool (SWAT), two calibration approaches are available, single-objective or multi-objective optimization. The goal of the present study is to evaluate which approach can improve the daily performance with SWAT, in modelling flow (Q), total suspended solids (TSS) and total phosphorus (TP). The influence of weights assigned to the different variables included in the objective function has also been tested. The results showed that: (i) the model performance depends not only on the choice of calibration approach, but essentially on the influential parameters; (ii) the multi-objective calibration estimating at once all parameters related to all measured variables is the best approach to model Q, TSS and TP; (iii) changing weights does not improve model performance; and (iv) with a single-objective optimization, an excellent water quality modelling performance may hide a loss of performance of predicting flows and unbalanced internal model components.
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Rochín-Medina, Jesús J; Ramírez, Karina; Rangel-Peraza, Jesús G; Bustos-Terrones, Yaneth A
2018-03-01
Spent coffee grounds are waste material generated during coffee beverage preparation. This by-product disposal causes a negative environmental impact, in addition to the loss of a rich source of nutrients and bioactive compounds. A rotating central composition design was used to determine the optimal conditions for the bioactivity of phenolic compounds obtained after the solid state fermentation of spent coffee grounds by Bacillus clausii . To achieve this, temperature and fermentation time were varied according to the experimental design and the total phenolic and flavonoid content, antioxidant activity and antimicrobial activity were determined. Surface response methodology showed that optimum bioprocessing conditions were a temperature of 37 °C and a fermentation time of 39 h. Under these conditions, total phenolic and flavonoid contents increased by 36 and 13%, respectively, in fermented extracts as compared to non-fermented. In addition, the antioxidant activity was increased by 15% and higher antimicrobial activity was observed against Gram positive and negative bacteria. These data demonstrated that bioprocessing optimization of spent coffee grounds using the surface response methodology was an important tool to improve phenolic extraction, which could be used as an antioxidant and antimicrobial agents incorporated into different types of food products.
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International Nuclear Information System (INIS)
Narin, Ibrahim; Kars, Ayse; Soylak, Mustafa
2008-01-01
Due to the toxicity of chromium, species depend on their chemical properties and bioavailabilities, speciation of chromium is very important in environmental samples. A speciation procedure for chromium(III), chromium(VI) and total chromium in environmental samples is presented in this work, prior to flame atomic absorption spectrometric determination of chromium. The procedure is based on the adsorption of Cr(III)-diphenylcarbazone complex on Amberlite XAD-1180 resin. After oxidation of Cr(III), the developed solid phase extraction system was applied to determinate the total chromium. Cr(III) was calculated as the difference between the total Cr content and the Cr(VI) content. The analytical conditions for the quantitative recoveries of Cr(VI) on Amberlite XAD-1180 resin were investigated. The effects of some alkaline, earth alkaline, metal ions and also some anions were also examined. Preconcentration factor was found to be 75. The detection limits (LOD) based on three times sigma of the blank (N: 21) for Cr(VI) and total chromium were 7.7 and 8.6 μg/L, respectively. Satisfactory results for the analysis of total chromium in the stream sediment (GBW7310) certified reference material for the validation of the presented method was obtained. The procedure was applied to food, water and pharmaceutical samples successfully
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Anxiety, depression in patients receiving chemotherapy for solid tumors
International Nuclear Information System (INIS)
Mansoor, S.; Jehangir, S.
2015-01-01
To determine the frequency of anxiety and depression in patients undergoing chemotherapy for solid tumors using Hospital Anxiety Depression Scale (HADS). Study Design: Cross sectional descriptive study. Place and Duration of Study: Out-patient department of Armed Forces Institute of Mental Health, Rawalpindi from June 2011 to December 2011. Methodology: Consecutive non probability sampling technique was used to select patients of age (25-70 years), male or female, who had received atleast 03 cycles of chemotherapy for solid tumors. Those with history of prior psychiatric illness, current use of psychotropic medication or psychoactive substance use, and any major bereavement in past one year were excluded from the study. After taking informed consent, relevant socio- demographic data was collected and HADS was administered. HADS-A cut off score of 7 was taken as significant anxiety while a HADS-D cut off score of 7 was taken as significant depression. Results: The total number of participants was 209. The mean age of patients was 42.9 years, with 55.5% males and 44.5% females. Overall 33/209 (15.8%) patients had anxiety while 56/209 (26.8%) were found to have depression. There was a higher frequency of anxiety and depression in younger patients (less than age 40 years), females, patients who were single or divorced, and patients receiving chemotherapy for pancreatic carcinoma. Conclusion: Patients undergoing chemotherapy suffer from considerable levels of anxiety and depression, thus highlighting the need for specialized interventions. (author)
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Geographical differences in the relationship between total dissolved ...
African Journals Online (AJOL)
on the Department of Water Affairs water quality database. ... Keywords: conversion factors, electrical conductivity, field instruments, rivers, total dissolved solids, water quality ... of a number of TDS:EC ratios in samples where both measure-.
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Energy Technology Data Exchange (ETDEWEB)
Ramalhao, Adriano Gorga; Seno, Carlos Eduardo; Ribeiro, Alice [3M do Brasil, Sumare, SP (Brazil)
2008-07-01
There is a wide variation in the amount of particulate material in sea water by a great number of reasons. The most well-known contaminant is the organic material derived from seaweed or fish spawning causing seasonally sensitive variations in the water quality treated and injected for enhance oil recovery. This paper presents the results of one year the water monitoring form water sampled at 30 meters deep in the Roncador field, which is located 125 km from the coast with a depth of 1290 meters. It was observed the water seasonal variation with peaks in summer and winter. The monitoring was done through particle counting and distribution analysis and total solids in suspension. It was noted that even in peak with largest amount of particles and greater quantity of solid in suspension the particles had remained concentrated in the range bellow 25 {mu}m. For that reason the life of final filter elements may vary and pre-filters are many times ineffective and sometimes even bypassed due to frequent clogging and not to do the protecting job of the final filter. (author)
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Risk of malnutrition of hospitalized children in a university public hospital.
Muñoz-Esparza, Nelly Carolina; Vásquez-Garibay, Edgar Manuel; Romero-Velarde, Enrique; Troyo-Sanromán, Rogelio
2017-02-01
The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p malnutrition and require greater monitoring of nutritional status during hospitalization.
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Development of a total reflection X-ray fluorescence spectrometer for ...
Indian Academy of Sciences (India)
Unknown
design and use of a peltier cooled solid state detector for energy dispersive detection. Alignment and ... X-ray beam at a glancing angle less than the critical angle at which total ... materials is < 1 so that external total reflection takes place at an ...
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Can there be mutual support between hospital marketing and continuous quality improvement?
Weiland, D E
1992-01-01
Marketing the results of continuous quality improvement in hospitals builds a growing bank of loyal customers in an increasingly competitive and quality-oriented environment: If healthcare institutions want to survive and flourish, they must develop a lasting relationship with their customers. The long-term goal of CQI is to provide quality products and services. If marketing managers can sell these improved services, hospitals will build a solid client foundation.
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The potential of household solid waste reduction in Sukomanunggal District, Surabaya
Warmadewanthi, I. D. A. A.; Kurniawati, S.
2018-01-01
The rapid population growth affects the amount of waste generated. Sukomanunggal Subdistrict is the densest area in West Surabaya which has a population of 100,602 inhabitants with a total area of 11.2 km2. The population growth significantly affects the problem of limited land for landfill facilities (final processing sites). According to the prevailing regulations, solid waste management solutions include the solid waste reduction and management. This study aims to determine the potential reduction of household solid waste at the sources. Household solid waste samplings were performed for eight consecutive days. The samples were then analyzed to obtain the generation rate, density, and composition so that the household solid waste reduction potential for the next 20 years could be devised. Results of the analysis showed that the value of waste is 0.27 kg/person/day, while the total household solid waste generation amounted to 27,162.58 kg/day or 187.70 m3/day. Concerning the technical aspects, the current solid waste reduction in Sukomanunggal Subdistrict has reached 2.1% through the application of waste bank, composting, and scavenging activities at the dumping sites by the garbage collectors. In the year of 2036, the potential reduction of household solid waste in Sukomanunggal Subdistrict has been estimated to reach 28.0%.
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Financial Analysis of National University Hospitals in Korea.
Lee, Munjae
2015-10-01
This paper provides information for decision making of the managers and the staff of national university hospitals. In order to conduct a financial analysis of national university hospitals, this study uses reports on the final accounts of 10 university hospitals from 2008 to 2011. The results of comparing 2008 and 2011 showed that there was a general decrease in total assets, an increase in liabilities, and a decrease in total medical revenues, with a continuous deficit in many hospitals. Moreover, as national university hospitals have low debt dependence, their management conditions generally seem satisfactory. However, some individual hospitals suffer severe financial difficulties and thus depend on short-term debts, which generally aggravate the profit and loss structure. Various indicators show that the financial state and business performance of national university hospitals have been deteriorating. These research findings will be used as important basic data for managers who make direct decisions in this uncertain business environment or by researchers who analyze the medical industry to enable informed decision-making and optimized execution. Furthermore, this study is expected to contribute to raising government awareness of the need to foster and support the national university hospital industry.
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International Nuclear Information System (INIS)
Sajeena Beevi, B.; Madhu, G.; Sahoo, Deepak Kumar
2015-01-01
Highlights: • Performance of the reactor was evaluated by the degradation of volatile solids. • Biogas yield at the end of the digestion was 52.9 L/kg VS. • Value of reaction rate constant, k, obtained was 0.0249 day −1 . • During the digestion 66.7% of the volatile solid degradation was obtained. - Abstract: Anaerobic digestion (AD) of the organic fraction of municipal solid waste (OFMSW) is promoted as an energy source and waste disposal. In this study semi dry anaerobic digestion of organic solid wastes was conducted for 45 days in a lab-scale batch experiment for total solid concentration of 100 g/L for investigating the start-up performances under thermophilic condition (50 °C). The performance of the reactor was evaluated by measuring the daily biogas production and calculating the degradation of total solids and the total volatile solids. The biogas yield at the end of the digestion was 52.9 L/kg VS (volatile solid) for the total solid (TS) concentration of 100 g/L. About 66.7% of the volatile solid degradation was obtained during the digestion. A first order model based on the availability of substrate as the limiting factor was used to perform the kinetic studies of batch anaerobic digestion system. The value of reaction rate constant, k, obtained was 0.0249 day −1
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Energy Technology Data Exchange (ETDEWEB)
Sajeena Beevi, B., E-mail: sajeenanazer@gmail.com [Department of Chemical Engineering, Govt. Engineering College, Thrissur, Kerala 680 009 (India); Madhu, G., E-mail: profmadhugopal@gmail.com [Division of Safety & Fire Engineering, School of Engineering, Cochin University of Science and Technology, Cochin, Kerala 682 022 (India); Sahoo, Deepak Kumar, E-mail: dksahoo@gmail.com [Division of Safety & Fire Engineering, School of Engineering, Cochin University of Science and Technology, Cochin, Kerala 682 022 (India)
2015-02-15
Highlights: • Performance of the reactor was evaluated by the degradation of volatile solids. • Biogas yield at the end of the digestion was 52.9 L/kg VS. • Value of reaction rate constant, k, obtained was 0.0249 day{sup −1}. • During the digestion 66.7% of the volatile solid degradation was obtained. - Abstract: Anaerobic digestion (AD) of the organic fraction of municipal solid waste (OFMSW) is promoted as an energy source and waste disposal. In this study semi dry anaerobic digestion of organic solid wastes was conducted for 45 days in a lab-scale batch experiment for total solid concentration of 100 g/L for investigating the start-up performances under thermophilic condition (50 °C). The performance of the reactor was evaluated by measuring the daily biogas production and calculating the degradation of total solids and the total volatile solids. The biogas yield at the end of the digestion was 52.9 L/kg VS (volatile solid) for the total solid (TS) concentration of 100 g/L. About 66.7% of the volatile solid degradation was obtained during the digestion. A first order model based on the availability of substrate as the limiting factor was used to perform the kinetic studies of batch anaerobic digestion system. The value of reaction rate constant, k, obtained was 0.0249 day{sup −1}.
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Arndt, H.-D.; Rizzo, S.; Nöcker, Chr.; Wackchaure, V.N.; Milroy, L.G.; Bieker, V.; Calderon, A.; Tran, T.T.N.; Brand, S.; Dehmelt, L.; Waldmann, H.
2015-01-01
Macrocyclic natural products (NPs) and analogues thereof often show high affinity, selectivity, and metabolic stability, and methods for the synthesis of NP-like macrocycle collections are of major current interest. We report an efficient solid-phase/cyclorelease method for the synthesis of a
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Yap, S D; Astals, S; Jensen, P D; Batstone, D J; Tait, S
2017-06-01
Batch solid-phase anaerobic digestion is a technology for sustainable on-farm treatment of solid residues, but is an emerging technology that is yet to be optimised with respect to start-up and inoculation. In the present study, spent bedding from two piggeries (site A and B) were batch digested at total solids (TS) concentration of 5, 10 and 20% at mesophilic (37°C) and thermophilic (55°C) temperatures, without adding an external inoculum. The results showed that the indigenous microbial community present in spent bedding was able to recover the full methane potential of the bedding (140±5 and 227±6L CH 4 kgVS fed -1 for site A and B, respectively), but longer treatment times were required than for digestion with an added external inoculum. Nonetheless, at high solid loadings (i.e. TS level>10%), the digestion performance was affected by chemical inhibition due to ammonia and/or humic acid. Thermophilic temperatures did not influence digestion performance but did increase start-up failure risk. Further, inoculation of residues from the batch digestion to subsequent batch enhanced start-up and achieved full methane potential recovery of the bedding. Inoculation with liquid residue (leachate) was preferred over a solid residue, to preserve treatment capacity for fresh substrate. Overall, the study highlighted that indigenous microbial community in the solid manure residue was capable of recovering full methane potential and that solid-phase digestion was ultimately limited by chemical inhibition rather than lack of suitable microbial community. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Total filmless digital radiology service
International Nuclear Information System (INIS)
Mun, S.K.; Goeringer, F.; Benson, H.; Horii, S.C.
1989-01-01
The completion of a comprehensive picture archiving and communication system (PACS) at Georgetown University Hospital has allowed us to identify a number of technical, administrative, personnel, and operational issues that will affect a total digital radiology service. With a hospital-wide digital imaging network system, computer simulation of communications and storage options, and economic modeling, we have developed a feasibility study and implementation strategy for the smooth transition to a nearly filmless radiology service over the next several years. This paper describes the technical and operational requirements for various database operations, workstations (used in diagnosis, review, and education), and communications. Site and installation planning, personnel training, and transition operations are discussed
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International Nuclear Information System (INIS)
Salazar Monge, F. J.
1999-01-01
The handling that is given at the moment to the hospital solid waste in Costa Rica is considered inadequate, due to the lack of the personnel's of cleaning training, segregation, vehicles of transport and recipients, signaling, team of personal protection, schedule and gathering route and recycle. This situation represents a serious danger for the population's health and the since environment is exposed infectious agents toxic substances and even radioactive products that are generated in the residuals of the centers of health. In this work they intend improvements to the system of handling of solid waste of the hospital Calderon Guardia, and you evaluates each one of the points mentioned previously. A revision was made about the properties, the quality and the quantity of the produced solid waste and an I diagnose of the current situation in this center of health. The proposed improvements are based on the regional program of hospital solid waste, agreement ALA91/33 (this it was elaborated in 1997 by a cooperation initiative between the European Union and the Governments from Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama) and the Norms for the Handling of dangerous Solid Waste in Establishments of Health (elaborated by the Costa Rican Box of the Public Health) their advantages and disadvantages are also exposed and he/she is carried out a comparative analysis among the handling plan proposed in these documents and the one that is used at the moment in the Calderon Guardia hospital. Some of the detected problems are: it lacks of team of personal protection, the appropriate recipients are not used, storage of waste inside the hospital, the vehicles used in the internal transport are not appropriate, bad organization of the storing center, among others [es
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Total body water and total body potassium in anorexia nervosa
Energy Technology Data Exchange (ETDEWEB)
Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.
1984-08-01
In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.
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Total body water and total body potassium in anorexia nervosa
International Nuclear Information System (INIS)
Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.
1984-01-01
In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation
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Candiduria in hospitalized patients in teaching hospitals of Ahvaz.
Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B
2012-12-01
Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.
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Early enteral nutrition after total gastrectomy for gastric cancer.
Chen, Wei; Zhang, Zheng; Xiong, Maoming; Meng, Xiangling; Dai, Fen; Fang, Jun; Wan, Hong; Wang, Miaofeng
2014-01-01
To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition (TPN group) after total gastrectomy for gastric cancer. The nutrition index, liver function, patient generated subjective global assessment (PG-SGA) score, the post-operation complications, the hospital stay and hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of Surgery from May 2011 to May 2013 were analyzed retrospectively. A total of 72 patients including 37 cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN group was significantly lower than the EEN group at 21 days (pnutrition indicators. The incidence of complications in the EEN group and TPN group were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the EEN and in the TPN group were up to 12.2 ± 2.5 d vs 14.9 ± 2.9 d (pgastric cancer.
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Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.
Derrick, Jennifer Willahan; Bellini, Sarah Gunnell; Spelman, Julie
2015-11-01
Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments. In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase. Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; Penvironment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.
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Sallis, James F.; Swartz, Michael D.; Hoelscher, Deanna M.; Peskin, Melissa F.
2013-01-01
Introduction Hospitals are the primary worksite of over 5 million adults in the United States, and millions of meals are procured and consumed in this setting. Because many worksite nutrition initiatives use an ecological framework to improve the dietary habits of employees, the nutrition values of foods served in hospitals is receiving attention. Methods This study used the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops to quantitatively describe the consumer nutrition environments of 39 hospitals in Southern California. Data were collected by visiting each facility once from February 2012 through May 2012. Results On average, hospitals achieved only 29%, 33%, and less than 1% of the total possible points for their cafeteria, vending machines, and gift shops sections, respectively; overall, hospitals scored 25% of the total possible points. Large facility size and contracted food service operations were associated with some healthy practices in hospital cafeterias, but we found no association between these variables and the sectional or overall nutrition composite scores. Conclusion The average consumer nutrition environment of hospitals in this sample was minimally conducive to healthful eating. Nutrition-related interventions are warranted in hospital settings. PMID:23823699
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Winston, Courtney P; Sallis, James F; Swartz, Michael D; Hoelscher, Deanna M; Peskin, Melissa F
2013-07-03
Hospitals are the primary worksite of over 5 million adults in the United States, and millions of meals are procured and consumed in this setting. Because many worksite nutrition initiatives use an ecological framework to improve the dietary habits of employees, the nutrition values of foods served in hospitals is receiving attention. This study used the Hospital Nutrition Environment Scan for Cafeterias, Vending Machines, and Gift Shops to quantitatively describe the consumer nutrition environments of 39 hospitals in Southern California. Data were collected by visiting each facility once from February 2012 through May 2012. On average, hospitals achieved only 29%, 33%, and less than 1% of the total possible points for their cafeteria, vending machines, and gift shops sections, respectively; overall, hospitals scored 25% of the total possible points. Large facility size and contracted food service operations were associated with some healthy practices in hospital cafeterias, but we found no association between these variables and the sectional or overall nutrition composite scores. The average consumer nutrition environment of hospitals in this sample was minimally conducive to healthful eating. Nutrition-related interventions are warranted in hospital settings.
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Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand
2009-06-01
Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.
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Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.
Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A
2016-09-01
Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.
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A Decomposition of Hospital Profitability
Directory of Open Access Journals (Sweden)
Jason Turner
2015-06-01
Full Text Available Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover, and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552. The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of
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A Decomposition of Hospital Profitability
Broom, Kevin; Elliott, Michael; Lee, Jen-Fu
2015-01-01
Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO
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Potential of solid state fermentation for production of ergot alkaloids
Trejo Hernandez, M.R.; Raimbault, Maurice; Roussos, Sevastianos; Lonsane, B.K.
1992-01-01
Production of total ergot alkaloids by #Claviceps fusiformis$ in solid state fermentation was 3.9 times higher compared to that in submerged fermentation. Production was equal in the case of #Claviceps purpurea$ but the spectra of alkaloids were advantageous with the use of solid state fermentation. The data establish potential of solid state fermentation which was not explored earlier for production of ergot alkaloids. (Résumé d'auteur)
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Giraldes, Maria Do Rosário
2007-01-01
The main aim of this article is to evaluate the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system using process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc), and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the case-mix index, in 2004, and have been weighted according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered: process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of caesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care The composite indicator of efficiency, weighted by the inverse of the case-mix index presents the lower values in Tondela, Seia, and Fafe, while the Hospital of the Litoral Alentejano is, in this group, the most inefficient. The Agueda Hospital presents the better Composite Efficiency Indicator, in Group II, followed by the Barcelos and S. João da Madeira Hospitals, while the Figueira da Foz Hospital presents the worst situation. In hospitals from Group III the Hospitals of Vale de Sousa, EPE, and the Vila Franca de Xira Hospital present the better Composite Efficiency Indicator followed by the Barreiro Hospital, EPE. In Group IV it is the Hospital of S. Sebastião, EPE, that presents the lowest Composite Efficiency Indicator, followed by the Cascais Hospital, SPA
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Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin
2016-09-01
Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.
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Kranz, William; Carroll, Clinton; Dixon, Darren; Picard, Christine; Goodpaster, John
2017-11-01
A new method has been developed for the determination of fatty acids, sterols, and other lipids which naturally occur within pupae of the blow fly Phormia regina. The method relies upon liquid extraction in non-polar solvent, followed by derivatization using N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) w/ 1% trimethylchlorsilane (TMCS) carried out inside the sample vial. The analysis is facilitated by total vaporization solid-phase microextraction (TV-SPME), with gas chromatography-mass spectrometry (GC-MS) serving as the instrumentation for analysis. The TV-SPME delivery technique is approximately a factor of five more sensitive than traditional liquid injection, which may alleviate the need for rotary evaporation, reconstitution, collection of high performance liquid chromatography fractions, and many of the other pre-concentration steps that are commonplace in the current literature. Furthermore, the ability to derivatize the liquid extract in a single easy step while increasing sensitivity represents an improvement over current derivatization methods. The most common lipids identified in fly pupae were various saturated and unsaturated fatty acids ranging from lauric acid (12:0) to arachinoic acid (20:4), as well as cholesterol. The concentrations of myristic acid (14:0), palmitelaidic acid (16:2), and palmitoleic acid (16:1) were the most reliable indicators of the age of the pupae. Graphical abstract Blow fly pupae were extracted prior to emerging as adults. The extracts were analyzed via total vaporization solid-phase microextraction (TV-SPME), revealing a complex mixture of lipids that could be associated with the age of the insect. This information may assist in determining a post-mortum interval (PMI) in a death investigation.
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The cost of the district hospital: a case study in Malawi.
Mills, A J; Kapalamula, J; Chisimbi, S
1993-01-01
Described in an analysis of the cost to the Ministry of Health of providing district health services in Malawi, with particular emphasis on the district hospital. District resource allocation patterns were assessed by carefully disaggregating district costs by level of care and hospital department. A strikingly low proportion of district recurrent costs was absorbed by salaries and wages (27-39%, depending on the district) and a surprisingly high proportion by medical supplies (24-37%). The most expensive cost centre in the hospital was the pharmacy. A total of 27-39% of total recurrent costs were spent outside the hospital and 61-73% on hospital services. The secondary care services absorbed 40-58% of district recurrent costs. Unit costs by hospital department varied considerably by district, with one hospital being consistently the most expensive and another the cheapest. A total of 3-10 new outpatients could be treated for the average cost of 1 inpatient-day, while 34-55 could be treated for the average cost of 1 inpatient. The efficiency of hospital operations, the scope for redistributing resources districtwide, and the costing methodology are discussed.
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Directory of Open Access Journals (Sweden)
M. Casas
2007-05-01
Full Text Available Objetivo: comparar la eficacia de la instauración precoz de nutrición enteral total (NET frente a nutrición parenteral total (NPT en pacientes con pancreatitis aguda grave (PAG. Métodos: estudio prospectivo aleatorio. Se incluyeron consecutivamente 22 pacientes con PAG aplicando los criterios APACHE II, valores de PCR y graduación de Balthazar en la TC. El grupo I (n = 11 recibió NPT y el grupo II (n = 12 NET. Se valoró la respuesta inflamatoria (PCR, TNF-alfa, IL-6, las proteínas viscerales (pre-albúmina, albúmina, la tasa de complicaciones (síndrome de respuesta inflamatoria sistémica, fallo multiorgánico, infecciones, las intervenciones quirúrgicas, la estancia hospitalaria y la mortalidad. Resultados: no hubo diferencias significativas en los primeros 10 días entre los dos grupos en la evolución de los criterios APACHE II, en las concentraciones de PCR, TNF-alfa e IL-6 ni tampoco en los valores de pre-albúmina y albúmina. Siete pacientes del grupo I presentaron complicaciones graves frente a 4 del grupo II. Requirieron intervención quirúrgica 3 pacientes del grupo I. La estancia hospitalaria fue similar en los dos grupos. Dos pacientes del grupo I fallecieron. Conclusiones: se ha observado una tendencia a una mejor evolución de los pacientes con PAG que utilizaron NET frente a los que utilizaron NPT.Objective: to compare the efficacy of early total enteral nutrition (TEN vs. total parenteral nutrition (TPN in patients with severe acute pancreatitis (SAP. Methods: a total of 22 consecutive patients with SAP were randomized to receive TPN (group I or TEN (group II. SAP was defined applying APACHE II score, C-reactive protein (CRP measurements and/or Balthazar CT scan score. Acute inflammatory response (CRP, TNF-alpha, IL-6, visceral proteins (pre-albumin, albumin, complications (systemic inflammatory response syndrome, multiorgan failure, infections, surgical interventions, length of hospital stay and mortality were
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Directory of Open Access Journals (Sweden)
Andrzej Kotela
2015-01-01
Full Text Available Total knee arthroplasty (TKA is a frequently performed procedure in orthopaedic surgery. Recently, patient-specific instrumentation was introduced to facilitate correct positioning of implants. The aim of this study was to compare the early clinical results of TKA performed with patient-specific CT-based instrumentation and conventional technique. A prospective, randomized controlled trial on 112 patients was performed between January 2011 and December 2011. A group of 112 patients who met the inclusion and exclusion criteria were enrolled in this study and randomly assigned to an experimental or control group. The experimental group comprised 52 patients who received the Signature CT-based implant positioning system, and the control group consisted of 60 patients with conventional instrumentation. Clinical outcomes were evaluated with the KSS scale, WOMAC scale, and VAS scales to assess knee pain severity and patient satisfaction with the surgery. Specified in-hospital data were recorded. Patients were followed up for 12 months. At one year after surgery, there were no statistically significant differences between groups with respect to clinical outcomes and in-hospital data, including operative time, blood loss, hospital length of stay, intraoperative observations, and postoperative complications. Further high-quality investigations of various patient-specific systems and longer follow-up may be helpful in assessing their utility for TKA.
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Potential application of biodrying to treat solid waste
Zaman, Badrus; Oktiawan, Wiharyanto; Hadiwidodo, Mochtar; Sutrisno, Endro; Purwono; Wardana, Irawan Wisnu
2018-02-01
The generation of solid waste around the world creates problems if not properly managed. The method of processing solid waste by burning or landfill is currently not optimal. The availability of land where the final processing (TPA) is critical, looking for a new TPA alternative will be difficult and expensive, especially in big cities. The processing of solid waste using bio drying technology has the potential to produce renewable energy and prevention of climate change. Solid waste processing products can serve as Refuse Derived Fuel (RDF), reduce water content of solid waste, meningkatkan kualitas lindi and increase the amount of recycled solid waste that is not completely separated from home. Biodrying technology is capable of enhancing the partial disintegration and hydrolysis of macromolecule organic compounds (such as C-Organic, cellulose, hemicellulose, lignin, total nitrogen). The application of biodrying has the potential to reduce greenhouse gas emissions such as carbon dioxide (CO2), methane (CH4), and dinitrooksida (N2O). These gases cause global warming.
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CMS penalizes 758 hospitals for safety incidents
Directory of Open Access Journals (Sweden)
Robbins RA
2015-12-01
Full Text Available No abstract available. Article truncated after 150 words. The Centers for Medicare and Medicaid Services (CMS is penalizing 758 hospitals with higher rates of patient safety incidents, and more than half of those were also fined last year, as reported by Kaiser Health News (1. Among the hospitals being financially punished are some well-known institutions, including Yale New Haven Hospital, Medstar Washington Hospital Center in DC, Grady Memorial Hospital, Northwestern Memorial Hospital in Chicago, Indiana University Health, Brigham and Womens Hospital, Tufts Medical Center, University of North Carolina Hospital, the Cleveland Clinic, Hospital of the University of Pennsylvania, Parkland Health and Hospital, and the University of Virginia Medical Center (Complete List of Hospitals Penalized 2016. In the Southwest the list includes Banner University Medical Center in Tucson, Ronald Reagan UCLA Medical Center, Stanford Health Care, Denver Health Medical Center and the University of New Mexico Medical Center (for list of Southwest hospitals see Appendix 1. In total, CMS ...
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Bio-Medical Waste Managment in a Tertiary Care Hospital: An Overview.
Pandey, Anita; Ahuja, Sanjiv; Madan, Molly; Asthana, Ajay Kumar
2016-11-01
Bio-Medical Waste (BMW) management is of utmost importance as its improper management poses serious threat to health care workers, waste handlers, patients, care givers, community and finally the environment. Simultaneously, the health care providers should know the quantity of waste generated in their facility and try to reduce the waste generation in day-to-day work because lesser amount of BMW means a lesser burden on waste disposal work and cost saving. To have an overview of management of BMW in a tertiary care teaching hospital so that effective interventions and implementations can be carried out for better outcome. The observational study was carried out over a period of five months from January 2016 to May 2016 in Chhatrapati Shivaji Subharti Hospital, Meerut by the Infection Control Team (ICT). Assessment of knowledge was carried out by asking set of questions individually and practice regarding awareness of BMW Management among the Health Care Personnel (HCP) was carried out by direct observation in the workplace. Further, the total BMW generated from the present setup in kilogram per bed per day was calculated by dividing the mean waste generated per day by the number of occupied beds. Segregation of BMW was being done at the site of generation in almost all the areas of the hospital in color coded polythene bags as per the hospital protocol. The different types of waste being collected were infectious solid waste in red bag, soiled infectious waste in yellow bag and sharp waste in puncture proof container and blue bag. Though awareness (knowledge) about segregation of BMW was seen in 90% of the HCP, 30%-35% did not practice. Out of the total waste generated (57912 kg.), 8686.8 kg. (15%) was infectious waste. Average infectious waste generated was 0.341 Kg per bed per day. The transport, treatment and disposal of each collected waste were outsourced and carried out by 'Synergy' waste management Pvt. Ltd. The practice of BMW Management was lacking in 30
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Alzahrani, Sami H; Alamri, Sultan H
2017-07-03
Malnutrition is a nutritional disorder that adversely affects the body from a functional or clinical perspective. It is very often observed in the elderly population. This study aimed to estimate the prevalence of malnutrition among hospitalized elderly patients and its associated factors and outcomes in terms of length of stay and mortality in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. In a cross-sectional study, we evaluated the nutritional status of hospitalized elderly patients using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF). A total of 248 hospitalized patients were included (70.0 ± 7.7 years; 60% female). According to the MNA-SF, a total of 76.6% patients were either malnourished or at risk of malnutrition. Malnourished patients had significantly lower levels of serum albumin (28.2 ± 7.7), hemoglobin (10.5 ± 1.8), and lymphocyte (1.7 ± 0.91). They had increased tendency to stay in the hospital for longer durations (IQR, 5-11 days; median = 7 days) and had a mortality rate of 6.9%. Malnutrition was highly prevalent among hospitalized elderly and was associated with increased length of stay and mortality.
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Tehrani, David M; Phelan, Michael J; Cao, Chenghua; Billimek, John; Datta, Rupak; Nguyen, Hoanglong; Kwark, Homin; Huang, Susan S
2014-10-01
States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.
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Variation in the cost of care for primary total knee arthroplasties.
Haas, Derek A; Kaplan, Robert S
2017-03-01
The study examined the cost variation across 29 high-volume US hospitals and their affiliated orthopaedic surgeons for delivering a primary total knee arthroplasty without major complicating conditions. The hospitals had similar patient demographics, and more than 80% of them had statistically-similar Medicare risk-adjusted readmission and complication rates. Hospital and physician personnel costs were calculated using time-driven activity-based costing. Consumable supply costs, such as the prosthetic implant, were calculated using purchase prices, and postacute care costs were measured using either internal costs or external claims as reported by each hospital. Despite having similar patient demographics and readmission and complication rates, the average cost of care for total knee arthroplasty across the hospitals varied by a factor of about 2 to 1. Even after adjusting for differences in internal labor cost rates, the hospital at the 90th percentile of cost spent about twice as much as the one at the 10th percentile of cost. The large variation in costs among sites suggests major and multiple opportunities to transfer knowledge about process and productivity improvements that lower costs while simultaneously maintaining or improving outcomes.
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International Nuclear Information System (INIS)
Novack, D.H.; Kiley, J.P.
1987-01-01
The multitude of papers and conferences in recent years on the use of very large megavoltage radiation fields indicates an increased interest in total body, hemibody, and total nodal radiotherapy for various clinical situations. These include high dose total body irradiation (TBI) to destroy the bone marrow and leukemic cells and provide immunosuppression prior to a bone marrow transplant, high dose total lymphoid irradiation (TLI) prior to bone marrow transplantation in severe aplastic anemia, low dose TBI in the treatment of lymphocytic leukemias or lymphomas, and hemibody irradiation (HBI) in the treatment of advanced multiple myeloma. Although accurate provision of a specific dose and the desired degree of dose homogeneity are two of the physicist's major considerations for all radiotherapy techniques, these tasks are even more demanding for large field radiotherapy. Because most large field radiotherapy is done at an extended distance for complex patient geometries, basic dosimetry data measured at the standard distance (isocenter) must be verified or supplemented. This paper discusses some of the special dosimetric problems of large field radiotherapy, with specific examples given of the dosimetry of the TBI program for bone marrow transplant at the authors' hospital
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Laparoscopic total pancreatectomy
Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing
2017-01-01
Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344
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Telerehabilitation Feasibility in Total Joint Replacement
Directory of Open Access Journals (Sweden)
Mark J. Nelson
2017-11-01
Full Text Available Despite documented benefits, many Total Joint Replacement (TJR patients find it difficult to access rehabilitation following discharge from hospital. One solution to improve access for TJR patients is telerehabilitation. This study aimed to assess the feasibility of introducing a telerehabilitation program for TJR patients. TJR patients at QEII Jubilee Hospital were invited to complete a questionnaire regarding their access, feelings towards and preferences in using technology. Seventy-five patients were recruited. Most patients had computer access (72% and internet (69% at home. Sixty-five percent of participants were willing to participate in telerehabilitation. A significant difference was found between older and younger patients. Watching videos on an electronic device was the preferred method for a technology-based home exercise program and phone call the preferred method of communication. Results indicate telerehabilitation in the TJR population is feasible from the perspective of access to, feelings toward, and preferences for technology. Keywords: Hip replacement, Knee replacement, Telerehabilitation, Telemedicine, Total joint replacement
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Chen, Chien-Min; Ke, Yen-Liang
2016-02-01
One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.
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Solid waste management in Khartoum industrial area
International Nuclear Information System (INIS)
Elsidig, N. O. A.
2004-05-01
This study was conducted in Khartoum industrial area (KIA). The study discusses solid waste generation issues in KIA as well as solid waste collection, storage, transport and final disposal methods. A focus on environmental impact resulting from the accumulation of solid waste was presented by reviewing solid waste management in developed as well as developing countries starting from generation to final disposal. Environmental health legislation in Sudan was investigated. The study covers all the (eight) industrial sub-sectors presented in KIA. The main objective of the study is to assess the situation of solid waste in KIA. To fulfill the objectives of the study the researcher deemed it necessary to explore problems related to solid waste generation and solid waste arrangement with special emphasis on final disposal methods. Practically, 31 (thirty-one) factories representing the different industrial sub-sectors in KIA were studied. This represents 25% of the total number of factories located in KIA. Data were obtained by, questionnaires, interviews and observations mainly directed to concerned officials, solid waste workers, pickers and brokers. Obtained data were stored, coded, tabulated and analyzed using the computer systems (excel and SPSS programmes). The obtained results should clear deficiency in the management of solid waste which led to great environmental deterioration in KIA and neighboring residential areas. The environment in studied area is continuously polluted due to high pollution loads and unproved solid waste management. In order to maintain health environment operating factories have to pretreated their solid waste according to the recognized standards and waste minimization techniques such as recycling and re use should be widely applied, moreover, running crash programme for environmental sanitation in Khartoum state should be expanded and improved to include special characteristics of solid waste from industries. Finally, increase awareness
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Quantification classification and management of hospital waste in Lahore city
International Nuclear Information System (INIS)
Khan, M.R.; Riaz, M
2010-01-01
Systematic disposal of hospital waste is a major problem encountered by different countries including Pakistan. Efforts are on the way to achieve this objective techno-economically. To quantify infectious and total waste produced by the hospitals of Lahore, classify it to know the nature of their components and to collect information about its management. The background information and secondary data were collected by consultation of literature in the libraries and visiting different websites on Internet. The primary data were collected by gathering the responses of the Chief Executives, Medical Superintendents and Medical and Environmental Staff of all hospitals scheduled as reference models through interview. The total quantity of infectious waste produced by the hospitals and other health care units is approximately 785 million tons per annum while the total waste including municipal component is approximately 3,925 million tons per annum. The current status of awareness about proper health care waste disposal is improving but at a slow pace. It may be concluded that the management of hospital waste in five hospitals of Lahore city is systematic. However, the staff handling the waste was not fully trained for proper segregation of the hospital wastes. Incinerators being used for waste disposal are a major source of secondary air pollution therefore, this method should be discouraged. Instead, the feasibility of thermoelectric power generation may be looked into. Proper disposal of hospital wastes should be in placed in every hospital and trained staff should be employed for the job. (author)
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Fecundity as a biomarker of health? - Semen quality and subsequent hospitalization
DEFF Research Database (Denmark)
Lindahl-Jacobsen, Rune; Latif, Tabassam; Skakkebæk, Niels Erik
. Men with a low total sperm count had a 50% higher risk of first hospitalization from all causes of disease (95%CI: 1.4-1.6). The higher risk of hospitalization was robust across disease categories and not confined to specific diseases. A man with low sperm concentration (0-10 mill/ml) had an average...... Hospital Discharge Registry for hospitalizations and the Central Person Registry to obtain information on vital status and childhood status. A clear dose - response relationship between semen quality (total sperm count, sperm concentration or sperm motility) and survival was observed in both cohorts...... data from two unique Danish cohorts; The Copenhagen Sperm Analysis Laboratory and the Fertility Clinic - Frederiksberg Hospital. In total, semen samples from 51,543 and 4,712 men from the two cohorts respectively for the period 1963-2010 was used for the analysis. The data was linked to the Danish...
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Hip fracture in hospitalized medical patients
Directory of Open Access Journals (Sweden)
Zapatero Antonio
2013-01-01
Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.
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The Synergy between Meteorological Parameters and the Total ...
African Journals Online (AJOL)
because of its origin from mostly non-urban areas that ... particles in the air are readily removed by falling rain drop ..... Their physics and Physical ... Mass. Concentrations and Metals Speciation of PM2.5. PM10 and total suspended solids in ...
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Efficiency of hospital cholera treatment in Ecuador
Directory of Open Access Journals (Sweden)
Creamer Germán
1999-01-01
Full Text Available This study analyzed the efficiency of cholera treatment in three hospitals representative of the Ecuadorian public health system in order to provide hospital directors and administrators and health service policy-makers with information to plan responses to future epidemics and to reduce the costs of cholera treatment in general. For the study, total and excess cholera treatment costs were calculated using hospital files and statistics and an in-hospital surveillance system of the cholera cases. The type and quantity of each input used for each treatment were analyzed, as well as the number of days hospitalized, according to the severity of the illness. With this process, excess costs were determined in relation to a "treatment norm" that would have been appropriate for each patient. The researchers found that 45% of the cholera treatment costs were excessive. The most important contributor was excess recurrent costs (90%, including extended hospital stays, disproportionate use of intravenous rehydration solutions, and unnecessary laboratory tests. Excess capital costs, from land, buildings, and hospital equipment, represented 10% of the total excess treatment costs. No significant relationship was found between treatment costs and the severity of the illness, nor between costs and a patient's age. A patient's sex appeared to be an important variable, with the cost of treating women being notably higher than for men. An inverse relationship was found between treatment costs and the complexity of the hospital. The researchers concluded there was an inefficient use of resources in the treatment of cholera in the three hospitals where the research was performed.
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Robinson, James C
2011-06-01
To examine the association between hospital market concentration and pricing. Hospitals have been merging into systems that potentially wield bargaining power over private health insurers. Concern is growing among policy makers that these systems may respond to provisions of the 2010 health reform legislation by further increasing consolidation and prices. Multivariate statistical methods were used to evaluate the association between hospital market concentration, prices, and profits (contribution margins) for commercially insured patients admitted for any of 6 major cardiac and orthopedic surgery procedures, adjusting for characteristics of the patient (diagnoses, comorbidities,complications) and of the hospital (size, patient volume, teaching status). Data were obtained on 11,330 patients treated in 61 hospitals in 27 markets across 8 states in 2008. Hospital prices for patients in concentrated markets were higher than hospital prices for otherwise-comparable patients in competitive markets by 25.1% for coronary angioplasty, 13.0%for cardiac rhythm management (CRM) device insertion, 19.2% for total knee replacement, 24.1%for total hip replacement, 19.3% for lumbar spine fusion, and 22.7% for cervical spine fusion (P markets by $5259 for angioplasty, $3417 for CRM device insertion, $4123 for total knee replacement, $5889 for total hip replacement, $7931 for lumbar spine fusion, and $4663 for cervical spine fusion (P markets charge significantly higher prices and earn significantly higher margins from private insurers than do hospitals in competitive markets.
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Gauthier-Kwan, Olivier Y; Dobransky, Johanna S; Dervin, Geoffrey F
2018-02-05
Outpatient total knee arthroplasty (TKA) has been made possible with advances in perioperative care and standardized clinical inpatient pathways. While many studies report on benefits of outpatient programs, none explore patient-reported outcome measures. As such, our goals were to compare the short-term quality of recovery; highlight postdischarge hospital resources utilization; and report on 2-year functional outcomes scores. This was a prospective comparative cohort study of 43 inpatients (43 TKAs) and 43 outpatients (43 TKAs) operated on by a single surgeon between September 28, 2010 and May 5, 2015. All patients were given a diary to complete at 1, 3, 7, 14, and 28 days postoperatively; we collected 90-day complications, readmissions, and emergency department visits; Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index scores were completed preoperatively and 2 years postoperatively. SPSS (IBM, version 22.0) was used for all statistical analyses. Quality of recovery (QoR-9) was similar in the outpatient TKA group compared with the inpatient group. No statistically significant differences were observed for Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index subscores (P > .05). There was 1 readmission in both outpatient and inpatient groups. Six inpatients and 8 outpatients returned to the emergency department for any reason within 90 days, with no statistical significance observed between the 2 groups (P = .771). Outpatient TKA in selected patients produced similar short-term and 2-year patient-reported outcome measures and a comparable 90-day postdischarge hospital resource utilization when compared to an inpatient cohort, supporting further investigation into outpatient TKA. Copyright © 2018 Elsevier Inc. All rights reserved.
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Reliability of hospital cost profiles in inpatient surgery.
Grenda, Tyler R; Krell, Robert W; Dimick, Justin B
2016-02-01
With increased policy emphasis on shifting risk from payers to providers through mechanisms such as bundled payments and accountable care organizations, hospitals are increasingly in need of metrics to understand their costs relative to peers. However, it is unclear whether Medicare payments for surgery can reliably compare hospital costs. We used national Medicare data to assess patients undergoing colectomy, pancreatectomy, and open incisional hernia repair from 2009 to 2010 (n = 339,882 patients). We first calculated risk-adjusted hospital total episode payments for each procedure. We then used hierarchical modeling techniques to estimate the reliability of total episode payments for each procedure and explored the impact of hospital caseload on payment reliability. Finally, we quantified the number of hospitals meeting published reliability benchmarks. Mean risk-adjusted total episode payments ranged from $13,262 (standard deviation [SD] $14,523) for incisional hernia repair to $25,055 (SD $22,549) for pancreatectomy. The reliability of hospital episode payments varied widely across procedures and depended on sample size. For example, mean episode payment reliability for colectomy (mean caseload, 157) was 0.80 (SD 0.18), whereas for pancreatectomy (mean caseload, 13) the mean reliability was 0.45 (SD 0.27). Many hospitals met published reliability benchmarks for each procedure. For example, 90% of hospitals met reliability benchmarks for colectomy, 40% for pancreatectomy, and 66% for incisional hernia repair. Episode payments for inpatient surgery are a reliable measure of hospital costs for commonly performed procedures, but are less reliable for lower volume operations. These findings suggest that hospital cost profiles based on Medicare claims data may be used to benchmark efficiency, especially for more common procedures. Copyright © 2016 Elsevier Inc. All rights reserved.
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Antimicrobial consumption at Auckland City Hospital: 2006-2009.
Ticehurst, Rob; Thomast, Mark
2011-04-15
We aimed to determine the level of antimicrobial consumption by adult inpatients at Auckland City Hospital (Auckland, New Zealand) and to compare our findings with those in other developed nations. We used the computerised records of the central Auckland District Health Board (ADHB) pharmacy to measure the amount of antimicrobials dispensed to inpatients (excluding psychiatric units, day stay units and outpatient clinics) during 2006 to 2009. The total weight of each antimicrobial dispensed was used to determine the number of defined daily doses (DDDs) dispensed. The Information Management and Technical Services department of ADHB provided data on the number of admissions and inpatient days, and these data, together with information from the 2006 census, were used to calculate antimicrobial consumption for adult inpatients measured in DDDs/100 admissions, DDDs/100 inpatient days and DDDs/1000 population. Total antimicrobial consumption by adult inpatients increased from 74 DDDs/100 inpatient days in 2006 to 80.3 DDDs/100 inpatient days in 2009. The level of consumption did not vary greatly with the season. The total level of consumption was very similar to that seen in adult inpatients in hospitals in Australia and Scandinavian countries. The level of consumption of fluoroquinolones, third or fourth generation cephalosporins, carbapenems and vancomycin (antimicrobial classes that are not available for unrestricted use in Auckland City Hospital) was comparable to or less than that seen in adult inpatients in hospitals in Australia or Scandinavian countries. Beta-lactamase susceptible penicillins (such as benzyl penicillin and phenoxymethylpenicillin) comprised a relatively small proportion of total penicillin use and beta-lactamase inhibitor combinations (predominantly amoxicillin/clavulanate) a relatively large proportion of total penicillin use, when compared with Scandinavian hospitals. The antimicrobial stewardship programme at Auckland City Hospital has
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Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.
Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John
2015-02-01
Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Identifying the key personnel in a nurse-initiated hospital waste reduction program.
McDermott-Levy, Ruth; Fazzini, Carol
2010-01-01
Hospitals in the United States generate more than 6600 tons of trash a day and approximately 85% of the waste is nonhazardous solid waste such as food, cardboard, and plastic. Treatment and management of hospital waste can lead to environmental problems for the communities that receive the waste. One health system's shared governance model provided the foundation to develop a nurse-led hospital waste reduction program that focused on point-of-care waste management. Waste reduction program development required working with a variety of departments within and external to the health system. The interdisciplinary approach informed the development of the waste reduction program. This article identifies the key departments that were necessary to include when developing a hospital waste reduction program.
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Maternity and parental leave policies at COTH hospitals: an update. Council of Teaching Hospitals.
Philibert, I; Bickel, J
1995-11-01
Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.
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Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo
2018-02-23
To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.
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Coccidioidomycosis-associated hospitalizations, California, USA, 2000-2011.
Sondermeyer, Gail; Lee, Lauren; Gilliss, Debra; Tabnak, Farzaneh; Vugia, Duc
2013-10-01
In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000-2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.
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Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study.
Giri, Samita; Risnes, Kari; Uleberg, Oddvar; Rogne, Tormod; Shrestha, Sanu Krishna; Nygaard, Øystein Petter; Koju, Rajendra; Solligård, Erik
2018-01-01
Natural disasters pose a great challenge to the health systems and individual health facilities. In low-resource settings, disaster preparedness systems are often limited and not been well described. Two devastating earthquakes hit Nepal within a 17-days period in 2015. This study aims to describe the burden and distribution of emergency cases to a local hospital. This is a prospective observational study of patients presenting to a local hospital for a period of 21 days following the earthquake on April 25, 2015. Demographic and clinical information was prospectively registered for all patients in the systematic emergency registry. Systematic telephone interviews were conducted in a random sample of the patients 90 days after admission to the hospital. A total of 2,003 emergency patients were registered during the period. The average daily number of emergency patients during the first five days was almost five times higher (n = 150) than the pre-incident daily average (n = 35). The majority of injuries were fractures (58%), 348 (56%) in the lower extremities. A total of 345 surgical procedures were performed and the hospital treated 111 patients with severe injuries related to the earthquake (compartment syndrome, crush injury, and internal injury). Among those with follow-up interviews, over 90% reported that they had been severely affected by the earthquakes; complete house damage, living in temporary shelter, or loss of close family member. The hospital experienced a very high caseload during the first days, and the majority of patients needed orthopaedic services. The proportion of severely injured and in-hospital deaths were relatively low, probably indicating that the most severely injured did not reach the hospital in time. The experiences underline the need for robust and easily available local health services that can respond to disasters.
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Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients
Bruce, Lisa; Li, Nien-Chen; Mooney, Ann; Maddux, Franklin W.
2014-01-01
Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions (“down in the dumps” and “downhearted and blue”). A high depressive affect score corresponded with an average response of “some of the time” or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively. Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models. Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future
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Cataract incidence after total-body irradiation
International Nuclear Information System (INIS)
Zierhut, D.; Lohr, F.; Schraube, P.; Huber, P.; Haas, R.; Hunstein, W.; Wannenmacher, M.
1997-01-01
Purpose: Aim of this retrospective study was to evaluate cataract incidence in a homogeneous group of patients after total-body irradiation followed by autologous bone marrow transplantation or peripheral blood stem cell transplantation. Method and Materials: Between 11/1982 and 6/1994 in total 260 patients received in our hospital total-body irradiation for treatment of haematological malignancy. In 1996-96 patients out of these 260 patients were still alive. 85 from these still living patients (52 men, 33 women) answered evaluable on a questionnaire and could be examined ophthalmologically. Median age of these patients was 38,5 years (15 - 59 years) at time of total-body irradiation. Radiotherapy was applied as hyperfractionated total-body irradiation with a median dose of 14,4 Gy in 12 fractions over 4 days. Minimum time between fractions was 4 hours, photons with a energy of 23 MeV were used, and the dose rate was 7 - 18 cGy/min. Results: Median follow-up is now 5,8 years (1,7 - 13 years). Cataract occurred in (28(85)) patients after a median time of 47 months (1 - 104 months). In 6 out of these 28 patients who developed a cataract, surgery of the cataract was performed. Whole-brain irradiation prior to total-body irradiation was more often in the group of patients developing a cataract (14,3%) vs. 10,7% in the group of patients without cataract. Conclusion: Cataract is a common side effect of total-body irradiation. Cataract incidence found in our patients is comparable to results of other centres using a fractionated regimen for total-body irradiation. The hyperfractionated regimen used in our hospital does obviously not result in a even lower cataract incidence. In contrast to acute and late toxicity in other organ/organsystems, hyperfractionation of total-body irradiation does not further reduce toxicity for the eye-lens. Dose rate may have more influence on cataract incidence
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Older age impacts on survival outcome in patients receiving curative surgery for solid cancer
Directory of Open Access Journals (Sweden)
Chang-Hsien Lu
2018-07-01
Full Text Available Summary: Background: Given the global increase in aging populations and cancer incidence, understanding the influence of age on postoperative outcome after cancer surgery is imperative. This study aimed to evaluate the impact of age on survival outcome in solid cancer patients receiving curative surgery. Methods: A total of 37,288 patients receiving curative surgeries for solid cancers between 2007 and 2012 at four affiliated Chang Gung Memorial Hospital were included in the study. All patients were categorized into age groups by decades for survival analysis. Results: The percentages of patient populations aged <40 years, 40–49 years, 50–59 years, 60–69 years, 70–79 years, and ≥80 years were 9.7%, 17.7%, 27.8%, 22.1%, 16.9%, and 5.7%, respectively. The median follow-up period was 38.9 months (range, 22.8–60.4 months and the overall, cancer-specific, and noncancer-specific mortality rates were 26.0%, 17.6%, and 8.5%, respectively. The overall mortality rate of patients in different age groups were 18.5%, 21.1%, 22.0%, 25.3%, 35.3%, and 49.0%, respectively. Compared to patients aged <40 years, more significant decrease in long-term survival were observed in aging patients. Multivariate analysis showed higher postoperative short-term mortality rates in patients older than 70 years, and the adjusted odds ratio of mortality risk ranged from 1.47 to 1.74 and 2.26 to 3.03 in patients aged 70–79 years and ≥80 years, respectively, compared to those aged <40 years. Conclusion: Aging was a negative prognostic factor of survival outcome in solid cancer patients receiving curative surgery. After adjustment of other clinicopathologic factors, the influence of age on survival outcome was less apparent in the elderly. Keywords: Age, Solid cancer, Surgical resection, Prognosis
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Hospital waste management status in Lebanon
International Nuclear Information System (INIS)
Karam, R.; Oueida, F.; Tissot-Guerraz, F.; Trepo, D.; Collombel, C.
2000-01-01
author.The existing management of hospital waste in Lebanon currently poses both an environmental hazard as well as a public health risk. This is due mainly to lack of legislation, information and modern treatment and disposal facilities designed for this purpose. A nation-wide questionnaire survey was conducted to asses the status of hospital waste management. The study started from October 1997 till August 1998. We found that 75% of the surveyed hospitals completely ignore their total waste quantity: 73% of hospitals surveyed practice segregation at source of infectious, pathological, sharps and pharmaceuticals; more than 40% dispose of their hospital risk wastes through the municipality waste disposal, 24% by burning in open fires, 14% by on-site hospital incinerators, 11% in on-site dumping, 8% handled by a private contractor and 1% in uncontrolled landfill. We conclude that with some exceptions, the hospital waste management situation in Lebanon is very far from being satisfactory and therefore needs to be reconsidered. 1 Fig., 6 tabs., 18 refs
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Results of a hospital waste survey in private hospitals in Fars province, Iran
International Nuclear Information System (INIS)
Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein
2004-01-01
Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field
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Annetta, M G; Pittiruti, M; De Rosa, S; Franchi, P; Pintaudi, G; Caricato, A; Antonelli, M
2015-11-01
A proper strategy for fighting hospital malnutrition should include nutritional screening of all hospitalized patients, adequate utilization of the Hospital facilities - such as Clinical Nutrition Services or Nutrition Teams - and an adequate algorithm for the adoption of proper nutrition support (oral, enteral or parenteral) with proper timing. The main aim of the present study was to investigate the current policies of different non-intensive wards of our institution (a 1100 beds University Hospital) in terms of prevention of hospital malnutrition. We conducted a one-day survey to verify the current policies of nutritional screening and the indication to nutritional support in adult patients, interviewing nurses and physicians of our non-intensive hospital wards. A total of 29 wards were considered, which sum up to 755 hospitalized patients. We found that nutritional screening at admission is routinely assessed only in 41% of wards and that oral nutrient intake is controlled regularly only in 72%. Indication to clinical nutrition support and specifically to artificial nutrition is not consistent with the current international guidelines. Only 14% of patients were receiving artificial nutrition at the moment of the survey and the majority of them were given parenteral nutrition rather than enteral feeding. Our survey confirmed that in large hospitals the main barriers to the fight against hospital malnutrition are the lack of knowledge and/or commitment by nurses and physicians as well as the lack of well-defined hospital policies on early nutritional screening, surveillance of nutritional status and indication to nutrition support.
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Biochemical changes in low-salt solid-state fermented soy sauce ...
African Journals Online (AJOL)
Results showed that after a 15-day aging period, the contents of total nitrogen, formol titration nitrogen, free amino acids, reducing sugar, total sugar and the brown color were increased. However, pH was decreased during the fermentation period. Furthermore, contents of total free amino acids in low-salt solid-state ...
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Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana.
Abebe, Worknehe Agegnehu; Rukewe, Ambrose; Bekele, Negussie Alula; Stoffel, Moeng; Dichabeng, Mompelegi Nicoh; Shifa, Jemal Zeberga
2016-01-01
Adults and children are required to fast before anaesthesia to reduce the risk of regurgitation and aspiration of gastric contents. However, prolonged periods of fasting are unnecessary and may cause complications. This study was conducted to evaluate preoperative fasting period in our centre and compare it with the ASA recommendations and factors that influence fasting periods. This is a cross-sectional study of preoperative fasting times among elective surgical patients. A total numbers of 260 patients were interviewed as they arrived at the reception area of operating theatre using questionnaire. Majority of patients (98.1%) were instructed to fast from midnight. Fifteen patients (5.8%) reported that they were told the importance of preoperative fasting. The mean fasting period were 15.9±2.5 h (range 12.0-25.3 h) for solids and 15.3±2.3 h (range 12.0-22.0 h) for liquids. The mean duration of fasting was significantly longer for patients operated after midday compared to those operated before midday, pfasting periods were 7.65 times longer for clear liquid and 2.5 times for solids than the ASA guidelines. It is imperative that the Hospital should establish Preoperative fasting policies and teach the staff who should ensure compliance with guidelines.
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Preoperative fasting times in elective surgical patients at a referral Hospital in Botswana
Abebe, Worknehe Agegnehu; Rukewe, Ambrose; Bekele, Negussie Alula; Stoffel, Moeng; Dichabeng, Mompelegi Nicoh; Shifa, Jemal Zeberga
2016-01-01
Introduction Adults and children are required to fast before anaesthesia to reduce the risk of regurgitation and aspiration of gastric contents. However, prolonged periods of fasting are unnecessary and may cause complications. This study was conducted to evaluate preoperative fasting period in our centre and compare it with the ASA recommendations and factors that influence fasting periods. Methods This is a cross-sectional study of preoperative fasting times among elective surgical patients. A total numbers of 260 patients were interviewed as they arrived at the reception area of operating theatre using questionnaire. Results Majority of patients (98.1%) were instructed to fast from midnight. Fifteen patients (5.8%) reported that they were told the importance of preoperative fasting. The mean fasting period were 15.9±2.5 h (range 12.0-25.3 h) for solids and 15.3±2.3 h (range 12.0-22.0 h) for liquids. The mean duration of fasting was significantly longer for patients operated after midday compared to those operated before midday, pfasting periods were 7.65 times longer for clear liquid and 2.5 times for solids than the ASA guidelines. It is imperative that the Hospital should establish Preoperative fasting policies and teach the staff who should ensure compliance with guidelines. PMID:27222691
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Carbon-based strong solid acid for cornstarch hydrolysis
Energy Technology Data Exchange (ETDEWEB)
Nata, Iryanti Fatyasari, E-mail: yanti_tkunlam@yahoo.com [Chemical Engineering Study Program, Faculty of Engineering, Lambung Mangkurat University, Jl. A. Yani Km. 36 Banjarbaru, South Kalimantan 70714 (Indonesia); Irawan, Chairul; Mardina, Primata [Chemical Engineering Study Program, Faculty of Engineering, Lambung Mangkurat University, Jl. A. Yani Km. 36 Banjarbaru, South Kalimantan 70714 (Indonesia); Lee, Cheng-Kang, E-mail: cklee@mail.ntust.edu.tw [Department of Chemical Engineering, National Taiwan University of Science and Technology, 43 Keelung Rd. Sec.4, Taipei 106, Taiwan (China)
2015-10-15
Highly sulfonated carbonaceous spheres with diameter of 100–500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO{sub 3}H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO{sub 3}H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst. - Highlights: • Carbon solid acid was successfully prepared by one-step hydrothermal carbonization. • The acrylic acid as monomer was effectively reduce the diameter size of particle. • The solid acid catalyst show good catalytic performance of starch hydrolysis. • The solid acid catalyst is not significantly deteriorated after repeated use.
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Carbon-based strong solid acid for cornstarch hydrolysis
International Nuclear Information System (INIS)
Nata, Iryanti Fatyasari; Irawan, Chairul; Mardina, Primata; Lee, Cheng-Kang
2015-01-01
Highly sulfonated carbonaceous spheres with diameter of 100–500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO 3 H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO 3 H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst. - Highlights: • Carbon solid acid was successfully prepared by one-step hydrothermal carbonization. • The acrylic acid as monomer was effectively reduce the diameter size of particle. • The solid acid catalyst show good catalytic performance of starch hydrolysis. • The solid acid catalyst is not significantly deteriorated after repeated use
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Estimating Nitrogen Availability of Heat-Dried Bio solids
International Nuclear Information System (INIS)
Cogger, C.G.; Bary, A.I.; Myhre, E.A.
2011-01-01
As heat-dried bio solids become more widely produced and marketed, it is important to improve estimates of N availability from these materials. Objectives were to compare plant-available N among three different heat-dried bio solids and determine if current guidelines were adequate for estimating application rates. Heat-dried bio solids were surface applied to tall fescue (Festuca arundinacea Schreb.) in Washington State, USA, and forage yield and N uptake measured for two growing seasons following application. Three rates of urea and a zero-N control were used to calculate N fertilizer efficiency regressions. Application year plant-available N (estimated as urea N equivalent) for two bio solids exceeded 60% of total N applied, while urea N equivalent for the third bio solids was 45%. Residual (second-year) urea N equivalent ranged from 5 to 10%. Guidelines for the Pacific Northwest USA recommend mineralization estimates of 35 to 40% for heat-dried bio solids, but this research shows that some heat-dried materials fall well above that range.
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Management of hospital radioactive wastes
International Nuclear Information System (INIS)
Houy, J.C.; Rimbert, J.C.; Bouvet, C.; Laugle, S.
1997-01-01
The hospital radioactive wastes are of three types: solid, liquid and gaseous. Prior to final evacuation all these wastes are checked by a detector the threshold of which is lower than the standard. This system allows detecting activities very low under the daily recommended threshold of 37 kBq (1μ Ci), for the group II. In metabolic radiotherapy the unsealed sources of iodine 131 will form mainly the wastes arising from the rooms contaminated by the patient himself. In this service anything touching the patient's room most by systematically checked. All the rooms are provided with toilette with two compartments, one connected traditionally to the sewerage system for faeces and the other coupled to tanks for urine storing. The filled reservoirs waits around 10 month span prior to being emptied, after checking, into the sewerage system. The volume activity most be lower than 7 Bq per liter (standard). For the hot labs, injection room and in-vitro lab, the liquid waste retrieved from dedicated stainless sinks are stored in storage tanks and will waits for 2 years before evacuation. The undies coming from the metabolic radiotherapy service are possible contaminated by the patient sheets, pillow cases, etc. These undies freshly contaminated may be contaminating if the contamination is non fixated. All the undies coming from this service are checked like all the wastes by means of the fixed detector. For the solid wastes two evacuation channels are possible: the urban garbage repository for household wastes and the Brest waste repository for hospital wastes. For the liquid waste arising for urines, used washing water, etc, the evacuation will be done towards city sewerage system after storing or dilution. Concerning the liquid wastes presenting chemical risks, they will be evacuated in cans by NETRA. Concerning the gaseous wastes, trapped on active carbon filters, they will be handled like solid wastes and will be directed to the waste repository of Brest. The other
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Variation in Use of Blood Transfusion in Primary Total Hip and Knee Arthroplasties.
Menendez, Mariano E; Lu, Na; Huybrechts, Krista F; Ring, David; Barnes, C Lowry; Ladha, Karim; Bateman, Brian T
2016-12-01
There is growing clinical and policy emphasis on minimizing transfusion use in elective joint arthroplasty, but little is known about the degree to which transfusion rates vary across US hospitals. This study aimed to assess hospital-level variation in use of allogeneic blood transfusion in patients undergoing elective joint arthroplasty and to characterize the extent to which variability is attributable to differences in patient and hospital characteristics. The study population included 228,316 patients undergoing total knee arthroplasty (TKA) at 922 hospitals and 88,081 patients undergoing total hip arthroplasty (THA) at 606 hospitals from January 1, 2009 to December 31, 2011 in the Nationwide Inpatient Sample database, a 20% stratified sample of US community hospitals. The median hospital transfusion rates were 11.0% (interquartile range, 3.5%-18.5%) in TKA and 15.9% (interquartile range, 5.4%-26.2%) in THA. After fully adjusting for patient- and hospital-related factors using mixed-effects logistic regression models, the average predicted probability of blood transfusion use in TKA was 6.3%, with 95% of the hospitals having a predicted probability between 0.37% and 55%. For THA, the average predicted probability of blood transfusion use was 9.5%, with 95% of the hospitals having a predicted probability between 0.57% and 66%. Hospital transfusion rates were inversely associated with hospital procedure volume and directly associated with length of stay. The use of blood transfusion in elective joint arthroplasty varied widely across US hospitals, largely independent of patient case-mix and hospital characteristics. Copyright © 2016 Elsevier Inc. All rights reserved.
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International Nuclear Information System (INIS)
Dimian Mayorga, Omar David; Sandoval Daza, Alejandro; Vargas Turriago, Marcela; Perez Torres, Javier
2005-01-01
14 patients with acetabular dysplasia were treated at Hospital Universitario Clinica San Rafael with total hip arthroplasty with uncemented cup internization. According to Crowe classification, one was type 1, eight were type 2 and five were type 3. The average follow up was twenty-four months. The Harris hip score was used for the clinical evaluation with a pre operative average of 35 points and 37 points post operative. The average cup internization was four millimeters, with an average cup protrutio of 47% and an average of cup coverage of 81%. The average internization of the femoral head's center was 26mm. screws for cup fixation were used in 3 patients. We did not have complications nor implant revision at the time of follow up
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Potential for radioactive patient excreta in hospital trash and medical waste
International Nuclear Information System (INIS)
Evdokimoff, V.; Cash, C.; Buckley, K.
1994-01-01
Radioactive excreta from nuclear medicine patients can enter solid waste as common trash and medical biohazardous waste. Many landfills and transfer stations now survey these waste streams with scintillation detectors which may result in rejection of a hospital's waste. Our survey indicated that on the average either or both of Boston University Medical Center Hospital's waste streams can contain detectable radioactive excreta on a weekly basis. To avoid potential problems, radiation detectors were installed in areas where housekeepers carting trash and medical waste must pass through to ensure no radioactivity leaves the institution. 3 refs
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Epidemiology of paediatric poisoning reporting to a tertiary hospital ...
African Journals Online (AJOL)
Methods. We conducted a retrospective study from January 2007 to January 2012 at the Komfo Anokye Teaching Hospital, a tertiary hospital in Ghana. Results. Poisoning is a significant health problem in the study area. A total of 253 children reported to the hospital with poisoning over the 61month period, with an average ...
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Energy Technology Data Exchange (ETDEWEB)
Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Asan Medical Center, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kim, Young Tae [Seoul National University College of Medicine, Department of Thoracic and Cardiovascular Surgery, Seoul (Korea, Republic of); Park, Young Sik [Seoul National University Hospital, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul (Korea, Republic of); Seoul National University College of Medicine, Department of Internal Medicine, Seoul (Korea, Republic of)
2017-12-15
To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)
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International Nuclear Information System (INIS)
Lee, Sang Min; Park, Chang Min; Song, Yong Sub; Kim, Hyungjin; Goo, Jin Mo; Kim, Young Tae; Park, Young Sik
2017-01-01
To retrospectively evaluate the feasibility of CT assessment-based direct surgical resection of part-solid nodules (PSNs) with solid components > 5 mm without preoperative percutaneous transthoracic needle biopsies (PTNBs). From January 2009-December 2014, 85 PSNs with solid components > 5 mm on CT were included. Preoperative PTNBs were performed for 41 PSNs (biopsy group) and CT assessment-based direct resections were performed for 44 PSNs (direct surgery group). Diagnostic accuracy and complication rates of the groups were compared. Pathological results of 83 PSNs excluding two indeterminate nodules included 76 adenocarcinomas (91.6%), two adenocarcinomas in situ (2.4%) and five benign lesions (6.0%). In the biopsy group, the overall sensitivity, specificity and accuracy for the diagnosis of adenocarcinoma were 78.9% (30/38), 100% (1/1) and 79.5% (31/39), respectively. Pneumothorax and haemoptysis occurred in 11 procedures (26.8%). In the direct surgery group, the respective values for the diagnosis of adenocarcinoma were 100% (38/38), 0% (0/6) and 86.4% (38/44), respectively. Seven pneumothoraces (15.9%); no haemoptysis occurred during localization procedures. There were no significant differences in diagnostic accuracy (P = 0.559) between the two groups. CT assessment-based direct resection can be reasonable for PSNs with solid part > 5 mm. (orig.)
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Fine particulate air pollution and hospital visits for asthma in Beijing, China
International Nuclear Information System (INIS)
Tian, Yaohua; Xiang, Xiao; Juan, Juan; Sun, Kexin; Song, Jing; Cao, Yaying; Hu, Yonghua
2017-01-01
Data on fine particulate matter (PM 2.5 ) in China were first announced in 2013. The primary objective of this study was to evaluate the acute effects of PM 2.5 on asthma morbidity in Beijing, China. A total of 978,658 asthma hospital visits consisting of 928,607 outpatient visits, 40,063 emergency room visits and 9988 hospital admissions from January 1, 2010, to June 30, 2012, were identified from the Beijing Medical Claim Data for Employees. A generalized additive Poisson model was applied to explore the association between PM 2.5 and health service use. The mean daily PM 2.5 concentration was 99.5 μg/m 3 with a range from 7.2 μg/m 3 to 492.8 μg/m 3 . Ambient PM 2.5 concentration was significantly associated with increased use of asthma-related health services. Every 10 μg/m 3 increase in PM 2.5 concentration on the same day was significantly associated with a 0.67% (95% CI, 0.53%–0.81%), 0.65% (95% CI, 0.51%–0.80%), and 0.49% (95% CI, 0.35%–0.64%) increase in total hospital visits, outpatient visits and emergency room visits, respectively. The exposure–response association between PM 2.5 concentration and hospital visits for asthma exacerbations was approximately linear. In conclusion, this study found that short-term elevations in PM 2.5 concentration may increase the risk of asthma exacerbations. Our findings contribute to the limited scientific literature concerning the acute effects of PM 2.5 on asthma morbidity outcomes in developing countries. - Graphical abstract: The exposure-response curve of 3-day (lag0–2) moving average fine particulate matter (PM 2.5 ) concentrations and hospital visits for asthma between January 1, 2010, and June 30, 2012, in Beijing, China. Note: The X-axis is the 3-day (lag0–2) moving average PM 2.5 concentrations (μg/m 3 ). Y-axis is the predicted log (relative risk (RR)), after adjusting for temperature, relative humidity, day of week, public holiday, and calendar time, is shown by the solid line, and the dotted
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Management of a Pregnancy with a Solid Pseudopapillary Neoplasm of the Pancreas
Directory of Open Access Journals (Sweden)
Atakan Tanacan
2018-01-01
Full Text Available A 26-year-old primigravid patient, at 35 weeks and 2 days of gestation, was referred to Hacettepe University Hospital for pancreatic mass, giant cervical myoma, maternal systemic lupus erythematosus, thrombocytopenia, and onset of preterm labor. At 36 weeks and 1 day of gestation (6 days after admission to the hospital, regular uterine contractions started and cervical dilatation with effacement was observed. Because of breech presentation and giant cervical myoma, a cesarean section was performed on the primigravid patient under general anesthesia. Four months after the birth, subtotal pancreatectomy, partial gastrectomy, duodenectomy, cholecystectomy, and omentectomy (Whipple procedure were performed. The pathologic diagnosis was of a solid pseudopapillary neoplasm of the pancreas; the patient was discharged from hospital after ten days.
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Directory of Open Access Journals (Sweden)
Marcia Alves CHAVES
2018-03-01
Full Text Available Abstract A factorial categorical design totalling six treatments was applied to investigate the influence of the substitution of corn starch with whole and partially defatted chia flour under the technical characteristics (centesimal composition, instrumental analyses, and sensory evaluation and nutritional disorders (composition of fatty acids and index of the nutritional quality of the lipid fraction of ‘dulce de leche’ concentrated to 72 and 78 °B. The treatments with chia flour concentrated to 72 °B showed higher moisture content and lower compression force, and when the concentration range increased to 78 °B, the levels of total lipids amounted up to 1.40 times when compared to treatment with corn starch. The polyunsaturated fatty acids, particularly omega-3 and omega-6 levels, were higher in treatments with chia flour on both tracks of concentration, allowing a reduction in the atherogenic index and thrombogenic index effects and the n-6/n-3 ratio. The treatments of ‘dulce de leche’ with a lower concentration of soluble solids obtained greater acceptance and consumer purchase intention. The application of whole chia flour in small proportions and in the concentration of 72 °B was the most appropriate under the studied conditions, showing improvement in the nutritional quality and with good technical aspects of candy made with goat milk.
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Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I
2013-01-01
Serum albumin levels have been used to evaluate the severity of the burns and the nutrition protein status in burn people, specifically in the response of the burn patient to the nutrition. Although it hasn't been proven if all these associations are fully funded. The aim of this retrospective study was to determine the relationship of serum albumin levels at 3-7 days after the burn injury, with the total body surface area burned (TBSA), the length of hospital stay (LHS) and the initiation of the oral/enteral nutrition (IOEN). It was carried out with the health records of patients that accomplished the inclusion criteria and were admitted to the burn units at the University Hospital of Reina Sofia (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA) over a 10 years period, between January 2000 and December 2009. We studied the statistical association of serum albumin levels with the TBSA, LHS and IOEN by ANOVA one way test. The confidence interval chosen for statistical differences was 95%. Duncan's test was used to determine the number of statistically significantly groups. Were expressed as mean±standard deviation. We found serum albumin levels association with TBSA and LHS, with greater to lesser serum albumin levels found associated to lesser to greater TBSA and LHS. We didn't find statistical association with IOEN. We conclude that serum albumin levels aren't a nutritional marker in burn people although they could be used as a simple clinical tool to identify the severity of the burn wounds represented by the total body surface area burned and the lenght of hospital stay.
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Tchamdja, T; Balaka, A; Tchandana, M; Agbétra, A
2015-01-01
To determine the cost of hospitalization per day in the neonatal department of Principal Hospital of Dakar. This prospective study took place during the month of July 2011 in the newborn unit. The activity-based costing method was used to analyze costs. During the study period, 52 newborns were hospitalized for a total of 590 days. The cost of the human resources during that month was 9,907,832 FCFA (US $ 19,815.66), the cost of depreciation of fixed assets was estimated at 571,952 FCFA (US $ 1143.90), and supplies at 112,084 FCFA (US $ 224.17). External services cost 386,753 FCFA (US $ 773.51) and support services 6,917,380.65 FCFA (US $ 13,834.7613). The monthly expenses incurred for the hospitalization of newborns totaled 17,896,002 FCFA (US $ 35,792), for a cost per patient per day of 30,332.20 FCFA (US $ 60.66) and an average cost of hospitalization 334,153.88 FCFA (US $ 668,31). This study is the first of its kind in Senegal and neighboring countries. By applying the ABC approach, we can obtain a more detailed and precise estimate of the cost of activities and services. Process improvements and corrective actions should make it possible to identify cost drivers, such as time.
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Managing ash from the combustion of solid waste
International Nuclear Information System (INIS)
Hauser, R.
1992-01-01
This paper reports that with millions of tons of refuse being combusted each year, increasing concern over the environment impact of the residue produced has caused both regulators and the resource recovery industry to address the technical and regulatory issues relating to the safe handling and disposal of ash. The basic issue concerning solid waste combustion ash management in this country is how, based on past, recent, and ongoing scientific research, solid waste combustion ash should be handled. Typically, refuse contains approximately 20 to 25 percent residue, which is collected either on grates at the bottom of the combustion chamber or filtered from the exhaust gases by the air pollution control equipment. The fly ash component of the total residue stream is between 10 and 30 percent of the total residue while the bottom ash content ranges from 70 to 90 percent of the total weight, depending upon the air pollution control equipment utilized, especially acid gas scrubbing equipment
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[Hospital admissions due to varicella in a tertiary hospital].
Guzmán Laura, K P; Periañez Vasco, A; Falcón Neyra, M D; Croche Santander, B
2014-06-01
Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
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Directory of Open Access Journals (Sweden)
Jasenka Gajdoš Kljusurić
2015-01-01
Full Text Available Barley is a grain whose consumption has a significant nutritional benefit for human health as a very good source of dietary fibre, minerals, vitamins, and phenolic and phytic acids. Nowadays, it is more and more often used in the production of plant milk, which is used to replace cow milk in the diet by an increasing number of consumers. The aim of the study was to classify barley milk and determine the optimal processing conditions in barley milk production based on NIR spectra, particle size, and total dissolved solids analysis. Standard recipe for barley milk was used without added additives. Barley grain was ground and mixed in a blender for 15, 30, 45, and 60 seconds. The samples were filtered and particle size of the grains was determined by laser diffraction particle sizing. The plant milk was also analysed using near infrared spectroscopy (NIRS, in the range from 904 to 1699 nm. Furthermore, conductivity of each sample was determined and microphotographs were taken in order to identify the structure of fat globules and particles in the barley milk. NIR spectra, particle size distribution, and conductivity results all point to 45 seconds as the optimal blending time, since further blending results in the saturation of the samples.
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Directory of Open Access Journals (Sweden)
Renata Santos Silva
2015-03-01
Full Text Available This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$ 99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.
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An audit of pregnancy outcomes in solid organ transplant recipients at a metropolitan hospital.
Fang, Yunjing E; Nayyar, Roshini; Diplock, Hayley
2018-04-22
Pregnancies in patients with solid organ transplants have higher rates of complications and caesarean sections (CS). To perform an audit of the pregnancy outcomes in transplant recipients, to determine the rate of CS in our cohort, the appropriate skin incision for CS in these patients and to formulate recommendations for preoperative planning. This is a retrospective cohort study. All patients who had a solid organ transplant were identified from the obstetrics database. The operation records of the transplant recipients who delivered by CS were reviewed and the de-identified data were evaluated for pregnancy outcomes. This cohort consisted of 22 women: six had simultaneous pancreas and kidney (SPK) transplants and 16 had kidney transplants. Over a ten-year period, four women had two pregnancies and one had a twin pregnancy, thus 27 babies were born. The rate of CS was 58% (n = 15) and the surgical approach in 13 of these patients was by Pfannenstiel incision. One patient had an elective midline incision at the first CS, which was repeated in the next pregnancy. Two CS were complicated by bladder injury, both occurring in SPK recipients. Patients with solid organ transplants have a higher rate of CS and SPK patients may be at a higher risk of bladder injuries during CS. Our data suggest that Pfannenstiel skin incision is still suitable for these patients. We recommend reviewing the operative details of the transplant operation and a pelvic magnetic resonance imaging for pre-operative planning. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
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Methane potential of sterilized solid slaughterhouse wastes.
Pitk, Peep; Kaparaju, Prasad; Vilu, Raivo
2012-07-01
The aim of the current study was to determine chemical composition and methane potential of Category 2 and 3 solid slaughterhouse wastes rendering products (SSHWRP) viz. melt, decanter sludge, meat and bone meal (MBM), technical fat and flotation sludge from wastewater treatment. Chemical analyses showed that SSHWRP were high in protein and lipids with total solids (TS) content of 96-99%. Methane yields of the SSHWRP were between 390 and 978 m(3) CH(4)/t volatile solids (VS)(added). Based on batch experiments, anaerobic digestion of SSHWRP from the dry rendering process could recover 4.6 times more primary energy than the energy required for the rendering process. Estonia has technological capacity to sterilize all the produced Category 2 and 3 solid slaughterhouse wastes (SSHW) and if separated from Category 1 animal by-products (ABP), it could be further utilized as energy rich input material for anaerobic digestion. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Nurses' views of patient handoffs in Japanese hospitals
DEFF Research Database (Denmark)
Gu, Xiuzhu; Andersen, Henning Boje; Madsen, Marlene Dyrløv
2012-01-01
Staff perceptions of risks associated with patient handoffs were investigated in a survey of nurses in 6 Japanese hospitals. A total of 1462 valid responses were collected from nurses with an overall response rate of 74%. Respondents are moderately satisfied with the transfer of information and r...... and responsibility during handoffs. However, the handoff system was identified as immature. Hospital, work setting, and work experience affected nurses' views of handoff quality. Strategies for improving patient handoffs in Japan are proposed.......Staff perceptions of risks associated with patient handoffs were investigated in a survey of nurses in 6 Japanese hospitals. A total of 1462 valid responses were collected from nurses with an overall response rate of 74%. Respondents are moderately satisfied with the transfer of information...
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de la Rosa, D. A.; Velasco, A.; Rosas, A.; Volke-Sepúlveda, T.
The daily municipal solid waste (MSW) generation in the Mexico City Metropolitan Area (MCMA) is the highest nationwide (˜26000 ton day -1); this amount is discarded in sanitary landfills and controlled dumps. Information about the type and concentration of potential pollutants contained in landfill gas (LFG) from these MSW disposal sites is limited. This study intends to generate information about the composition of LFG from five MSW disposal sites with different operational characteristics and stages, in order to identify their contribution as potential pollutant sources of total gaseous mercury (TGM) and volatile organic compounds (VOCs). Important methane (CH 4) contents (>55%) in LFG were registered at three of the five sites, while two sites were found in semi-aerobic conditions (CH 4clay cover. High values of the TGM air/LFG ratio were also related to external TGM sources of influence, as a landfill in operation stage located at a highly industrialized area.
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Yousuf, Ahasa; Bastidas-Oyanedel, Juan-Rodrigo; Schmidt, Jens Ejbye
2018-04-28
Food waste landfilling causes environmental degradation, and this work assesses a sustainable food valorization technique. In this study, food waste is converted into lactic acid in a batch assembly by dark fermentation without pH control and without the addition of external inoculum at 37 °C. The effect of total solid (TS), enzymatic and aeration pretreatment was investigated on liquid products concentration and product yield. The maximum possible TS content was 34% of enzymatic pretreated waste, and showed the highest lactic acid concentration of 52 g/L, with a lactic acid selectivity of 0.6 g lactic /g totalacids . The results indicated that aeration pretreatment does not significantly improve product concentration or yield. Non-pretreated waste in a 29% TS system showed a lactic acid concentration of 31 g/L. The results showed that enzymatic pretreated waste at TS of 34% results in the highest production of lactic acid. Copyright © 2018 Elsevier Ltd. All rights reserved.
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A managerial accounting analysis of hospital costs.
Frank, W G
1976-01-01
Variance analysis, an accounting technique, is applied to an eight-component model of hospital costs to determine the contribution each component makes to cost increases. The method is illustrated by application to data on total costs from 1950 to 1973 for all U.S. nongovernmental not-for-profit short-term general hospitals. The costs of a single hospital are analyzed and compared to the group costs. The potential uses and limitations of the method as a planning and research tool are discussed.
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The use of adaptive equipment following total knee replacement
McNaught, Jamie; Paul, Lorna
2015-01-01
Introduction: This study evaluates the need for adaptive equipment following total knee replacement. There are no recent studies to guide occupational therapists in the optimum time adaptive equipment is required following total knee replacement.\\ud \\ud Method: A non-experimental, concurrent mixed methods approach was used. The study population was patients attending for total knee replacement at a large general hospital. Outcome measures were the Oxford Knee Score, the United Kingdom Functio...
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Carbon-based strong solid acid for cornstarch hydrolysis
Nata, Iryanti Fatyasari; Irawan, Chairul; Mardina, Primata; Lee, Cheng-Kang
2015-10-01
Highly sulfonated carbonaceous spheres with diameter of 100-500 nm can be generated by hydrothermal carbonization of glucose in the presence of hydroxyethylsulfonic acid and acrylic acid at 180 °C for 4 h. The acidity of the prepared carbonaceous sphere C4-SO3H can reach 2.10 mmol/g. It was used as a solid acid catalyst for the hydrolysis of cornstarch. Total reducing sugar (TRS) concentration of 19.91 mg/mL could be obtained by hydrolyzing 20 mg/mL cornstarch at 150 °C for 6 h using C4-SO3H as solid acid catalyst. The solid acid catalyst demonstrated good stability that only 9% decrease in TRS concentration was observed after five repeat uses. The as-prepared carbon-based solid acid catalyst can be an environmentally benign replacement for homogeneous catalyst.
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Al-Khatib, Issam A; Eleyan, Derar; Garfield, Joy
2016-09-01
Hospitals and health centers provide a variety of healthcare services and normally generate hazardous waste as well as general waste. General waste has a similar nature to that of municipal solid waste and therefore could be disposed of in municipal landfills. However, hazardous waste poses risks to public health, unless it is properly managed. The hospital waste management system encompasses many factors, i.e., number of beds, number of employees, level of service, population, birth rate, fertility rate, and not in my back yard (NIMBY) syndrome. Therefore, this management system requires a comprehensive analysis to determine the role of each factor and its influence on the whole system. In this research, a hospital waste management simulation model is presented based on the system dynamics technique to determine the interaction among these factors in the system using a software package, ithink. This model is used to estimate waste segregation as this is important in the hospital waste management system to minimize risk to public health. Real data has been obtained from a case study of the city of Nablus, Palestine to validate the model. The model exhibits wastes generated from three types of hospitals (private, charitable, and government) by considering the number of both inpatients and outpatients depending on the population of the city under study. The model also offers the facility to compare the total waste generated among these different types of hospitals and anticipate and predict the future generated waste both infectious and non-infectious and the treatment cost incurred.
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Economic burden associated with hospital postadmission dehydration.
Pash, Elizabeth; Parikh, Niraj; Hashemi, Lobat
2014-11-01
Development of dehydration after hospital admission can be a measure of quality care, but evidence describing the incidence, economic burden, and outcomes of dehydration in hospitalized patients is lacking. The objective of this study was to compare costs and resource utilization of U.S. patients experiencing postadmission dehydration (PAD) with those who do not in a hospital setting. All adult inpatient discharges, excluding those with suspected dehydration present on admission (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes for dehydration: 276.0, 276.1, 276.5), were identified from the Premier database using ICD-9-CM codes. PAD and no-PAD (NPAD) groups were matched on propensity score adjusting for demographics (age, sex, race, medical, elective patients), patient severity (All Patient Refined Diagnosis-Related Groups severity scores), and hospital characteristics (geographic location, bed size, teaching and urban hospital). Costs, length of stay (LOS), and incidence of mortality and catheter-associated urinary tract infection (CAUTI) were compared between groups using the t test for continuous variables and the χ(2) test for categorical variables. In total, 86,398 (2.1%) of all the selected patients experienced PAD. Postmatching mean total costs were significantly higher for the PAD group compared with the NPAD group ($33,945 vs $22,380; P < .0001). Departmental costs were also significantly higher for the PAD group (all P < .0001). Compared with the NPAD group, the PAD group had a higher mean LOS (12.9 vs 8.2 days), a higher incidence of CAUTI (0.6% vs 0.5%), and higher in-hospital mortality (8.6% vs 7.8%) (all P < .05). The results for subgroup analysis also showed significantly higher total cost and longer LOS days for patients with PAD (all P < .05). The economic burden associated with hospital PAD in medical and surgical patients was substantial. © 2014 American Society for Parenteral and Enteral
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Efficiency and productivity of hospitals in Vietnam.
Pham, Thuy Linh
2011-01-01
The purpose of this paper is to examine the relative efficiency and productivity of hospitals during the health reform process. Data envelopment analyses method (DEA) with the input-oriented variable-returns-to-scale model was used to calculate efficiency scores. Malmquist total factor productivity index approach was then employed to calculate productivity of hospitals. Data of 101 hospitals was extracted from databases of the Ministry of Health, Vietnam from the years 1998 to 2006. There was evidence of improvement in overall technical efficiency from 65 per cent in 1998 to 76 per cent in 2006. Hospitals' productivity progressed around 1.4 per cent per year, which was mainly due to the technical efficiency improvement. Furthermore, provincial hospitals were more technically efficient than their central counterparts and hospitals located in different regions performed differently. The paper provides an insight in the performance of Vietnamese public hospitals that has been rarely examined before and contributes to the existing literature of hospital performance in developing countries
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SOLIDS PRECIPITATION EVENT IN MCU CAUSAL ANALYSIS AND RECOMMENDATIONS FROM SOLIDS RECOVERY TEAM
Energy Technology Data Exchange (ETDEWEB)
Garrison, A.; Aponte, C.
2014-08-15
A process upset occurred in the Modular Caustic-Side Solvent Extraction Unit (MCU) facility on April 6th, 2014. During recovery efforts, a significant amount of solids were found in the Salt Solution Feed Tank (SSFT), Salt Solution Receipt Tanks (SSRTs), two extraction contactors, and scrub contactors. The solids were identified by Savannah River National Laboratory (SRNL) as primarily sodium oxalate and sodium alumina silicate (NAS) with the presence of some aluminum hydroxide. NAS solids have been present in the SSFT since simulant runs during cold chemical startup of MCU in 2007, and have not hindered operations since that time. During the process upset in April 2014, the oxalate solids partially blocked the aqueous outlet of the extraction contactors, causing salt solution to exit through the contactor organic outlet to the scrub contactors with the organic phase. This salt solution overwhelmed the scrub contactors and passed with the organic phase to the strip section of MCU. The partially reversed flow of salt solution resulted in a Strip Effluent (SE) stream that was high in Isopar™ L, pH and sodium. The primary cause of the excessive solids accumulation in the SSRTs and SSFT at MCU is attributed to an increase in the frequency of oxalic acid cleaning of the 512-S primary filter. Agitation in the SSRTs at MCU in response to cold weather likely provided the primary mechanism to transfer the solids to the contactors. Sources of the sodium oxalate solids are attributed to the oxalic acid cleaning solution used to clean the primary filter at the Actinide Removal Process (ARP) filtration at 512-S, as well as precipitation from the salt batch feed, which is at or near oxalate saturation. The Solids Recovery Team was formed to determine the cause of the solids formation and develop recommendations to prevent or mitigate this event in the future. A total of 53 recommendations were generated. These recommendations were organized into 4 focus areas: • Improve
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de Castro, S. M. M.; Singhal, D.; Aronson, D. C.; Busch, O. R. C.; van Gulik, T. M.; Obertop, H.; Gouma, D. J.
2007-01-01
BACKGROUND: Solid-pseudopapillary neoplasms (SPNs) of the pancreas are increasingly diagnosed, but the exact surgical management in terms of extent of the resection is not well defined. MATERIALS AND METHODS: Patients operated on in our hospital between January 1993 and March 2005 formed the study
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Assessments of lake profiling on temperature, Total Suspended ...
African Journals Online (AJOL)
Interpolation were performed on temperature, total suspended solid (TSS) and turbidity (TUR) based on in-situ and ex-situ analyses according to the correlation matrix and linear regression at 14 different depths for the Chomor River and Mahadir Island. The result showed outlet significantly decreased over depth caused the ...
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Geographical differences in the relationship between total dissolved ...
African Journals Online (AJOL)
The practical application of these findings is that users of EC meters should not simply apply a blanket conversion factor, but need to select an applicable factor for the river system in which they are measuring. Keywords: conversion factors, electrical conductivity, field instruments, rivers, total dissolved solids, water quality ...
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EARNINGS MANAGEMENT IN U.S. HOSPITALS.
Dong, Gang Nathan
2016-01-01
This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.
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DEFF Research Database (Denmark)
Solborg Bjerrum, Søren; Mikkelsen, Kim Lyngby; la Cour, Morten
2015-01-01
PURPOSE: To study the epidemiology and mortality in patients who had cataract surgery in public hospitals and private hospitals/clinics in Denmark between 2004 and 2012 and to assess the validity of the Danish cataract registries. METHODS: Register- and chart-based study. RESULTS: A total of 411...... 140 cataract operations were performed in 243 856 patients. Patients who had cataract surgery in public hospitals had an overall statistically significantly 62% higher mortality compared to patients who had cataract surgery in private hospitals/clinics. The decrease in mean age at first eye cataract...... surgery in private hospitals/clinics was statistically significantly greater compared to the decrease in mean age at first eye cataract surgery in public hospitals (p
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Effect of early release of tourniquet in total knee arthroplasty
International Nuclear Information System (INIS)
Abbas, K.; Raza, H.; Umer, M.; Hafiz, K.
2013-01-01
To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Study Design: Comparative study. Place and Duration of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. Methodology: One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss (determined by Gross method) and other study variables were noted as per objective and computed. Results: There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 L and 1.108 L in group-A and B respectively (p = 0.27). Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Conclusion: Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay. (author)
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Health information technology vendor selection strategies and total factor productivity.
Ford, Eric W; Huerta, Timothy R; Menachemi, Nir; Thompson, Mark A; Yu, Feliciano
2013-01-01
The aim of this study was to compare health information technology (HIT) adoption strategies' relative performance on hospital-level productivity measures. The American Hospital Association's Annual Survey and Healthcare Information and Management Systems Society Analytics for fiscal years 2002 through 2007 were used for this study. A two-stage approach is employed. First, a Malmquist model is specified to calculate hospital-level productivity measures. A logistic regression model is then estimated to compare the three HIT adoption strategies' relative performance on the newly constructed productivity measures. The HIT vendor selection strategy impacts the amount of technological change required of an organization but does not appear to have either a positive or adverse impact on technical efficiency or total factor productivity. The higher levels in technological change experienced by hospitals using the best of breed and best of suite HIT vendor selection strategies may have a more direct impact on the organization early on in the process. However, these gains did not appear to translate into either increased technical efficiency or total factor productivity during the period studied. Over a longer period, one HIT vendor selection strategy may yet prove to be more effective at improving efficiency and productivity.
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Doran, James P; Zabinski, Stephen J
2015-03-01
In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.
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Nasrullah, Muhammad; Vainikka, Pasi; Hannula, Janne; Hurme, Markku; Kärki, Janne
2015-02-01
This is the third and final part of the three-part article written to describe the mass, energy and material balances of the solid recovered fuel production process produced from various types of waste streams through mechanical treatment. This article focused the production of solid recovered fuel from municipal solid waste. The stream of municipal solid waste used here as an input waste material to produce solid recovered fuel is energy waste collected from households of municipality. This article presents the mass, energy and material balances of the solid recovered fuel production process. These balances are based on the proximate as well as the ultimate analysis and the composition determination of various streams of material produced in a solid recovered fuel production plant. All the process streams are sampled and treated according to CEN standard methods for solid recovered fuel. The results of the mass balance of the solid recovered fuel production process showed that 72% of the input waste material was recovered in the form of solid recovered fuel; 2.6% as ferrous metal, 0.4% as non-ferrous metal, 11% was sorted as rejects material, 12% as fine faction and 2% as heavy fraction. The energy balance of the solid recovered fuel production process showed that 86% of the total input energy content of input waste material was recovered in the form of solid recovered fuel. The remaining percentage (14%) of the input energy was split into the streams of reject material, fine fraction and heavy fraction. The material balances of this process showed that mass fraction of paper and cardboard, plastic (soft) and wood recovered in the solid recovered fuel stream was 88%, 85% and 90%, respectively, of their input mass. A high mass fraction of rubber material, plastic (PVC-plastic) and inert (stone/rock and glass particles) was found in the reject material stream. © The Author(s) 2014.
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DECREASE OF SOLIDS IN GRAY WATER BY AERATION PROCESS
Directory of Open Access Journals (Sweden)
Gerardo Alonso Torres-Avalos
2017-07-01
Full Text Available The activated sludge process is a biological treatment consisting basically of agitation and aeration of a waste water mixture and a selected microorganisms sludge. The oxidation of organic matter was determined with several tests such as BOD5 (Biochemical Oxygen Demand, TSS (Total Sedimented Solids, SS (Sediment Solids, TDS (Total Dissolved Solids, FVS (fixed and volatile solids and finally a measurement of treated water turbidity. The results obtained for the reduction of the organic load during the first two days of treatment (samples 1, 2 and 3 are visible in each of the organic loading tests; during the last two days according to the samples 4 and 5 the solids showed an increase in organic load. The related organoleptic properties such as color showed a notable decrease. As for the tests performed at pH show a change, samples 1, 2 and 3 approaching a range where they are neutral and the last two samples (4 and 5 the pH has an elevation until it becomes alkaline. The efficiency of the method used for the treatment of residual water during the first days reduced the organic load with a variation of TS and TSS of 760, 569 ppm respectively. This is a viable alternative since this is a low cost method with short term results because organoleptic properties such as odor and color were lost during the first day of treatment.
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ASSESSMENT OF TANNERY BASED SOLID WASTES MANAGEMENT IN ASILI, NAIROBI KENYA
Directory of Open Access Journals (Sweden)
Richard O. Oruko
2014-06-01
Full Text Available Solid wastes generated in Nairobi and its environs are posing a serious environmental challenge to the authorities and public, especially the hazardous and non-biodegradable solid wastes from leather industries. There were environmental concerns and complaints from workers and residents living adjacent to Asili tanneries limited about degradation of natural and inbuilt environment. This pointed to the effect of environmental pollution by the tannery. The broad objective of study was to assess the effectiveness of tannery based solid wastes management, by identifying and analyzing the concentration levels of sodium chlorides,sulphide, chromium ions and total phenols as selected pollutants along the tanning stages, in Nairobi river, borehole water, and soils around the dump site inside the tannery. Experimental (laboratory analysis design was used.Descriptive statistics was used in analyzing data resulting in means and tables. The means concentration of total Chrome was 2633.38mg/L,Sodium chloride 609.93mg/L, Sulphide 129.77mg/L, total Phenols 10.91mg/L in the soil sampled around the composite dump site.. In Nairobi river water the means of Sodium chloride was 317.48mg/L, Sulphide 24.00mg/L, total Phenol 3.97mg/L and total Chrome Nil, While means concentration in borehole water, had Sodium chloride detected at 354.73mg/L, Sulphide 6.67mg/L, total Phenol 0.03mg/L and total Chrome as Nil, indicating heavily contaminated ecosystems above the discharge set limits of National Environmental Management Authority and Nairobi city water and sewerage company.
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Adsorption of heavy metals by road deposited solids.
Gunawardana, Chandima; Goonetilleke, Ashantha; Egodawatta, Prasanna
2013-01-01
The research study discussed in the paper investigated the adsorption/desorption behaviour of heavy metals commonly deposited on urban road surfaces, namely, Zn, Cu, Cr and Pb, for different particle size ranges of solids. The study outcomes, based on field studies and batch experiments, confirmed that road deposited solids particles contain a significantly high amount of vacant charge sites with the potential to adsorb additional heavy metals. Kinetic studies and adsorption experiments indicated that Cr is the most preferred metal element to associate with solids due to the relatively high electronegativity and high charge density of trivalent cation (Cr(3+)). However, the relatively low availability of Cr in the urban road environment could influence this behaviour. Comparing total adsorbed metals present in solids particles, it was found that Zn has the highest capacity for adsorption to solids. Desorption experiments confirmed that a low concentration of Cu, Cr and Pb in solids was present in water-soluble and exchangeable form, whilst a significant fraction of adsorbed Zn has a high likelihood of being released back into solution. Among heavy metals, Zn is considered to be the most commonly available metal among road surface pollutants.
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Relationship between serum total magnesium and serum potassium ...
African Journals Online (AJOL)
Relationship between serum total magnesium and serum potassium in emergency surgical patients in a tertiary hospital in Ghana. Robert Djagbletey, Brenda Phillips, Frank Boni, Christian Owoo, Ebenezer Owusu-Darkwa, Papa Kobina Gyakye deGraft-Johnson, Alfred E. Yawson ...
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Liu, Qiuliang; Geng, Peishuo; Shi, Longyan; Wang, Qi; Wang, Pengliang
2018-06-01
To compare the efficacy and safety of tranexamic acid and aminocaproic acid for reducing blood loss and transfusion requirements after total knee and total hip arthroplasty. We conduct electronic searches of Medline (1966-2017.11), PubMed (1966-2017.11), Embase (1980-2017.11), ScienceDirect (1985-2017.11) and the Cochrane Library (1900-2017.11). The primary outcomes, including total blood loss, hemoglobin decline and transfusion requirements. Secondary outcomes include length of hospital stay and postoperative complications such as the incidence of deep vein thrombosis and pulmonary embolism. Each outcome is combined and calculated using the statistical software STATA 12.0. Fixed/random effect model is adopted based on the heterogeneity tested by I 2 statistic. A total of 1714 patients are analyzed across three randomized controlled trials (RCTs) and one non-RCT. The present meta-analysis reveals that TXA is associated with a significantly reduction of total blood loss and postoperative hemoglobin drop compared with EACA. No significant differences are identified in terms of transfusion rates, length of hospital stay, and the incidence of postoperative complications. Although total blood loss and postoperative hemoglobin drop are significant greater in EACA groups, there is no significant difference between TXA and EACA groups in terms of transfusion rates. Based on the current evidence available, higher quality RCTs are still required for further research. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
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rich extract on total polyphenols and antioxidant activity obtained
African Journals Online (AJOL)
Z. Ghouila
USTHB, Organic Functional Analysis Laboratory, 16111 Bab Ezzouar, Algiers, ... Keywords: Ahmeur Bouamer, extraction, grape seeds, total polyphenols, ... These compounds are known as good natural antioxidant agents arising from natural ... surface between solid and liquid phases; this is mainly due to the dispersion of ...
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Nasrullah, Muhammad; Vainikka, Pasi; Hannula, Janne; Hurme, Markku; Oinas, Pekka
2016-01-01
In the production of solid recovered fuel (SRF), certain waste components have excessive influence on the quality of product. The proportion of rubber, plastic (hard) and certain textiles was found to be critical as to the elemental quality of SRF. The mass flow of rubber, plastic (hard) and textiles (to certain extent, especially synthetic textile) components from input waste stream into the output streams of SRF production was found to play the decisive role in defining the elemental quality of SRF. This paper presents the mass flow of polluting and potentially toxic elements (PTEs) in SRF production. The SRF was produced from municipal solid waste (MSW) through mechanical treatment (MT). The results showed that of the total input chlorine content to process, 55% was found in the SRF and 30% in reject material. Of the total input arsenic content, 30% was found in the SRF and 45% in fine fraction. In case of cadmium, lead and mercury, of their total input content to the process, 62%, 38% and 30%, respectively, was found in the SRF. Among the components of MSW, rubber material was identified as potential source of chlorine, containing 8.0 wt.% of chlorine. Plastic (hard) and textile components contained 1.6 and 1.1. wt.% of chlorine, respectively. Plastic (hard) contained higher lead and cadmium content compared with other waste components, i.e. 500 mg kg(-1) and 9.0 mg kg(-1), respectively. © The Author(s) 2015.
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Current status of diagnostic imaging in dental university hospitals in Japan
International Nuclear Information System (INIS)
Sasaki, Takehito; Fujita, Minoru; Katoh, Tsuguhisa; Kobayashi, Kaoru; Okano, Tomohiro; Sato, Kenji; Wada, Shinichi
2004-01-01
The diagnostic imaging examinations in all 29 dental university hospitals in Japan were analyzed during a 1-year period from April 1999 to March 2000. The total number of patients examined was 790859, which corresponded to 27271 patients per hospital on average, with a range from 7872 to 62904. Relative to the total number of patients, intraoral radiography was found to have been most frequently performed, 59% on average, with a range from 40% to 80%, depending on the hospital. Extraoral radiography, mostly panoramic radiography, was 36% on average with the range from 18% to 56%. A significant inverse correlation was observed between the percentages of intraoral and extraoral radiography, relative to the total number of all types of imaging examinations. Computed tomography (CT) examinations were performed with their own apparatuses in 27 hospitals with a frequency of 2.9% of patients in all imaging examinations on average and 9.1% at maximum. The scanning parameter of milliampere seconds (mAs) for individual types of routinely performed CT examinations varied widely, and thus the patient dose can be expected to be considerably reduced, without reducing the amount of diagnostic information to be obtained. Other imaging examinations performed were magnetic resonance imaging in 11 hospitals, X-ray fluoroscopy in 8 hospitals, ultrasonography in 20, nuclear medicine in 5, and bone densitometry in 1 hospital. (author)
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Schramm, Harry F.; Sullivan, Kenneth W.
1991-01-01
An evaluation of the NASA's Marshall Space Flight Center (MSFC) strategy to implement Total Quality Management (TQM) in the Advanced Solid Rocket Motor (ASRM) Project is presented. The evaluation of the implementation strategy reflected the Civil Service personnel perspective at the project level. The external and internal environments at MSFC were analyzed for their effects on the ASRM TQM strategy. Organizational forms, cultures, management systems, problem solving techniques, and training were assessed for their influence on the implementation strategy. The influence of ASRM's effort was assessed relative to its impact on mature projects as well as future projects at MSFC.
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Musijowski, Jacek; Trojanowicz, Marek; Szostek, Bogdan; da Costa Lima, José Luis Fontes; Lapa, Rui; Yamashita, Hiroki; Takayanagi, Toshio; Motomizu, Shoji
2007-09-26
Considering recent reports on widespread occurrence and concerns about perfluoroalkyl substances (PFAS) in environmental and biological systems, analysis of these compounds have gained much attention in recent years. Majority of analyte-specific methods are based on a LC/MS/MS or a GC/MS detection, however many environmental or biological studies would benefit from a total organic fluorine (TOF) determination. Presented work was aimed at developing a method for TOF determination. TOF is determined as an amount of inorganic fluoride obtained after defluorination reaction conducted off-line using sodium biphenyl reagent directly on the sorbent without elution of retained analytes. Recovered fluoride was analyzed using flow-injection system with either fluorimetric or potentiometric detection. The TOF method was tested using perfluorocarboxylic acids (PFCA), including perfluorooctanoic acid (PFOA), as model compounds. Considering low concentrations of PFAS in natural samples, solid-phase extraction as a preconcentration procedure was evaluated. Several carbon-based sorbents were tested, namely multi-wall carbon nanotubes, carbon nanofibres and activated carbon. Good sorption of all analytes was achieved and defluorination reaction was possible to carry out directly on a sorbent bed. Recoveries obtained for PFCAs, adsorbed on an activated carbon sorbent, and measured as TOF, were 99.5+/-1.7, 110+/-9.4, 95+/-26, 120+/-32, 110+/-12 for C4, C6, C8, C10 and C12-PFCA, respectively. Two flow systems that would enable the defluorination reaction and fluoride determination in a single system were designed and tested.
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Sorenson, Jason R.
2013-01-01
Material accumulating and washing off urban street surfaces and ultimately into stormwater drainage systems represents a substantial nonpoint source of solids, phosphorus, and other constituent loading to waterways in urban areas. Cost and lack of usable space limit the type and number of structural stormwater source controls available to municipalities and other public managers. Non-structural source controls such as street cleaning are commonly used by cities and towns for construction, maintenance and aesthetics, and may reduce contaminant loading to waterways. Effectiveness of street cleaning is highly variable and potential improvements to water quality are not fully understood. In 2009, the U.S. Geological Survey, in cooperation with the Massachusetts Department of Environmental Protection, the U.S. Environmental Protection Agency, and the city of Cambridge, Massachusetts, and initiated a study to better understand the physical and chemical nature of the organic and inorganic solid material on street surfaces, evaluate the performance of a street cleaner at removing street solids, and make use of the Source Loading and Management Model (SLAMM) to estimate potential reductions in solid and phosphorus loading to the lower Charles River from various street-cleaning technologies and frequencies. Average yield of material on streets collected between May and December 2010, was determined to be about 740 pounds per curb-mile on streets in multifamily land use and about 522 pounds per curb-mile on commercial land-use streets. At the end-of-winter in March 2011, about 2,609 and 4,788 pounds per curb-mile on average were collected from streets in multifamily and commercial land-use types, respectively. About 86 percent of the total street-solid yield from multifamily and commercial land-use streets was greater than or equal to 0.125 millimeters in diameter (or very fine sand). Observations of street-solid distribution across the entire street width indicated that as
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Welfare standards in hospital mergers.
Katona, Katalin; Canoy, Marcel
2013-08-01
There is a broad literature on the consequences of applying different welfare standards in merger control. Total welfare is usually defined as the sum of consumer and provider surplus, i.e., potential external effects are not considered. The general result is then that consumer welfare is a more restrictive standard than total welfare, which is advantageous in certain situations. This relationship between the two standards is not necessarily true when the merger has significant external effects. We model mergers on hospital markets and allow for not-profit-maximizing behavior of providers and mandatory health insurance. Mandatory health insurance detaches the financial and consumption side of health care markets, and the concept consumer in merger control becomes non-evident. Patients not visiting the merging hospitals still are affected by price changes through their insurance premiums. External financial effects emerge on not directly affected consumers. We show that applying a restricted interpretation of consumer (neglecting externality) in health care merger control can reverse the relation between the two standards; consumer welfare standard can be weaker than total welfare. Consequently, applying the wrong standard can lead to both clearing socially undesirable and to blocking socially desirable mergers. The possible negative consequences of applying a simple consumer welfare standard in merger control can be even stronger when hospitals maximize quality and put less weight on financial considerations. We also investigate the implications of these results for the practice of merger control.
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Percutaneous Dilational Tracheotomy in Solid-Organ Transplant Recipients.
Ozdemirkan, Aycan; Ersoy, Zeynep; Zeyneloglu, Pinar; Gedik, Ender; Pirat, Arash; Haberal, Mehmet
2015-11-01
Solid-organ transplant recipients may require percutaneous dilational tracheotomy because of prolonged mechanical ventilation or airway issues, but data regarding its safety and effectiveness in solid-organ transplant recipients are scarce. Here, we evaluated the safety, effectiveness, and benefits in terms of lung mechanics, complications, and patient comfort of percutaneous dilational tracheotomy in solid-organ transplant recipients. Medical records from 31 solid-organ transplant recipients (median age of 41.0 years [interquartile range, 18.0-53.0 y]) who underwent percutaneous dilational tracheotomy at our hospital between January 2010 and March 2015 were analyzed, including primary diagnosis, comorbidities, duration of orotracheal intubation and mechanical ventilation, length of intensive care unit and hospital stays, the time interval between transplant to percutaneous dilational tracheotomy, Acute Physiology and Chronic Health Evaluation II score, tracheotomy-related complications, and pulmonary compliance and ratio of partial pressure of arterial oxygen to fraction of inspired oxygen. The median Acute Physiology and Chronic Health Evaluation II score on admission was 24.0 (interquartile range, 18.0-29.0). The median interval from transplant to percutaneous dilational tracheotomy was 105.5 days (interquartile range, 13.0-2165.0 d). The only major complication noted was left-sided pneumothorax in 1 patient. There were no significant differences in ratio of partial pressure of arterial oxygen to fraction of inspired oxygen before and after procedure (170.0 [interquartile range, 102.2-302.0] vs 210.0 [interquartile range, 178.5-345.5]; P = .052). However, pulmonary compliance results preprocedure and postprocedure were significantly different (0.020 L/cm H2O [interquartile range, 0.015-0.030 L/cm H2O] vs 0.030 L/cm H2O [interquartile range, 0.020-0.041 L/cm H2O); P = .001]). Need for sedation significantly decreased after tracheotomy (from 17 patients [54.8%] to
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Solid waste management in Macao: Practices and challenges
International Nuclear Information System (INIS)
Jin Jianjun; Wang Zhishi; Ran Shenghong
2006-01-01
The rapid economic development and population growth in Macao have resulted in a large increase in refuse generated over the past decade. In 2003, the quantity of solid waste generated reached 249,255 tons, corresponding to 1.52 kg/day per capita. This figure has been gradually increasing. Domestic solid waste is the primary source of solid waste generation. The data showed that a considerable amount of the solid waste generated can be recycled and reutilized. Due to Macao's small geographic area and high cost of land, landfilling has the lowest priority for waste disposal. Solid waste incineration has been given a top priority over other waste disposal methods although it is much more expensive. In the last decade, more than 80% of the total waste in Macao was incinerated. However, the incineration capacity of the Macao Incineration Plant is going to reach its saturation earlier than expected. Waste minimization, the establishment of an effective waste collection and disposal fee system, and alternate ways dealing with the limited capacity of waste treatment facilities are regarded to be major challenges in the future
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Medicine utilization review at a university teaching hospital in New Delhi
Directory of Open Access Journals (Sweden)
M Aqil
2012-01-01
Full Text Available Objective: A prospective medicine usage evaluation based on prescription monitoring was conducted in the medicine OPD of our university teaching hospital to know prescribing trends of different categories of medicines. Materials and Methods: A total of 600 patients were included in the study comprising of 339 (56.5% males and 261 (43.5% females. The data were recorded within the OPD by a registered pharmacist on a medicine usage evaluation form, approved by The University Institutional Review Board (IRB. Results: A total of 2365 medicines were prescribed to 600 patients during the 3 months study period. The mean number of medicines per prescription were found to be 3.94. Medicines were most frequently prescribed as solid dosage forms (85.62%, especially tablets (70.82%, and liquid formulations (14.12%. Oral route (96.17% was the most preferred mode of administration, followed by topical (2.11% and parenteral (1.60% routes. Combination therapy (94.33% was more prevalent than monotherapy (5.66%. An overwhelming tendency for prescribing medicines by brand names (99% was observed by the physicians. The most frequently prescribed class of medicines were antimicrobials > analgesics > cardiovascular > gastrointestinal agents. The most prescribed individual medicines among various therapeutic classes included isoniazid (antimicrobial, amlodipine (cardiovascular, metformin (hypoglycemic, cetirizine (antiallergic, rabeprazole (GI medicine, atorvastatin (hypolipidemic, dextromethorphan (respiratory medicine, alprazolam (sedative-hypnotic, paracetamol (analgesic. Conclusions: There is a considerable scope of improvement in the existing prescribing practice, especially prescribing by generic names, needs to be encouraged and a hospital formulary has to be developed for the purpose. The number of medicines to be included per prescription should be judged rationally and polypharmacy ought to be curbed. Use of antimicrobial also needs to be rationalized as over
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Directory of Open Access Journals (Sweden)
Fatma Yıldırım
2015-12-01
Full Text Available Objective: Chronic obstructive pulmonary disease (COPD, although a preventable and treatable disease continues to be a major health problem. Acute exacerbations of COPD is a major cause of hospitalization of patients and it constitutes a significant portion of COPD-related health care costs. In this study, we aimed to determine the cost of patients hospitalized with acute exacerbations of COPD in a university hospital. Methods: Data of the patients that were hospitalized due to COPD exacerbation between 1 September 2013-1 September 2014 in Hospital of Gazi University Medical Faculty were retrospectively analyzed. Cost data were gathered from data processing department. Costs were identified for drugs, laboratory tests, bed costs and other materials. Results: A total of 790 patients were hospitalized during twelve months. Among these patients 181 (23.0% patients had COPD and 99 (12.5% were hospitalized due to acute exacerbation of COPD. Of these 99 patients 77 (77.8% were male and 22 (22.2% were female. Forty-nine (49.5% patients were hospitalized from the emergency department, 50 (50.5% patients were from the outpatient clinic. The median age was 70 (64-77 years old and median length of hospital stay was 8 (6-13 days. Ninety-one (91.9% of them were discharged from the service. Eight (8.1% patients were transfered to the intensive care unit (ICU due to respiratory failure, and 7 of these patients (7.4% hospitalized back to the service after treatment at ICU, 2 (2.1% patients died. The median cost per patient was 1.064 (726-1.866 Turkish Lira (TL. Drug costs accounted the largest portion (36.0% of the median cost, followed by bed cost (26.0%. Two (2.1% of patients died in hospital. Although the number of patients without antibiotic usage is less (17.2% vs 82.8%; the median cost per patient in the antibiotic using group was higher than that were without antibiotic using (median 643 vs 1.162 TL p=0.001. Presence of a comorbidity, hypoxemia
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Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition.
Morales, Eva; Cots, Francesc; Sala, Maria; Comas, Mercè; Belvis, Francesc; Riu, Marta; Salvadó, Margarita; Grau, Santiago; Horcajada, Juan P; Montero, Maria Milagro; Castells, Xavier
2012-05-23
We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain). All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros). In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively). P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.
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Biogasification of solid wastes by two-phase anaerobic fermentation
International Nuclear Information System (INIS)
Ghosh, S.; Vieitez, E.R.; Liu, T.; Kato, Y.
1997-01-01
Municipal, industrial and agricultural solid wastes, and biomass deposits, cause large-scale pollution of land and water. Gaseous products of waste decomposition pollute the air and contribute to global warming. This paper describes the development of a two-phase fermentation system that alleviates methanogenic inhibition encountered with high-solids feed, accelerates methane fermentation of the solid bed, and captures methane (renewable energy) for captive use to reduce global warming. The innovative system consisted of a solid bed reactor packed with simulated solid waste at a density of 160 kg/m 3 and operated with recirculation of the percolated culture (bioleachate) through the bed. A rapid onset of solids hydrolysis, acidification, denitrification and hydrogen gas formation was observed under these operating conditions. However, these fermentative reactions stopped at a total fatty acids concentration of 13,000 mg/l (as acetic) at pH 5, with a reactor head-gas composition of 75 percent carbon dioxide, 20 percent nitrogen, 2 percent hydrogen and 3 percent methane. Fermentation inhibition was alleviated by moving the bioleachate to a separate methane-phase fermenter, and recycling methanogenic effluents at pH 7 to the solid bed. Coupled operation of the two reactors promoted methanogenic conversion of the high-solids feed. (author)
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Derivation of a formula for adjusting the total serum calcium in ...
African Journals Online (AJOL)
GRACE
2006-06-16
Jun 16, 2006 ... The total calcium concentration, total protein, albumin and globulin were estimated for 302 patients that reported for serum calcium estimation at the clinical biochemistry laboratory of the Olabisi Onabanjo. University Teaching Hospital, Sagamu, Nigeria. Based on regression analysis, three formulae were.
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DEFF Research Database (Denmark)
Harsten, A; Kehlet, H; Toksvig-Larsen, S
2013-01-01
BACKGROUND: /st>This study was undertaken to compare the effects of general anaesthesia (GA) and spinal anaesthesia (SA) on the need for postoperative hospitalization and early postoperative comfort in patients undergoing fast-track total knee arthroplasty (TKA). METHODS: /st>One hundred and twenty....... Secondary outcome parameters included actual time of discharge, postoperative pain, intraoperative blood loss, length of stay in the Post Anaesthesia Care Unit, dizziness, postoperative nausea and vomiting, need for urinary catheterization and subject satisfaction. RESULTS: /st>GA resulted in shorter LOS...
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Dy, Christopher J; Marx, Robert G; Ghomrawi, Hassan M K; Pan, Ting Jung; Westrich, Geoffrey H; Lyman, Stephen
2015-01-01
Regionalization of total joint arthroplasty (TJA) to high volume hospitals (HVHs) may affect access to care and complication risk. Using administrative data, 2,560,314 patients who underwent primary total hip or knee arthroplasty from 1991 to 2006 were categorized by whether an HVH (>200 annual TJAs) was available locally. Associations among patient characteristics, hospital utilization, and in-hospital complications were estimated using regression modeling. The complication risk was higher (Odds Ratio 1.18 [95% CI: 1.16, 1.20]) if patients went to a local low volume hospital. Black and Medicaid patients were more likely to utilize the local low volume hospital than a local HVH. Utilizing a local HVH is associated with lower complication risks. However, patients from vulnerable groups were less likely to utilize these patterns. Copyright © 2014 Elsevier Inc. All rights reserved.
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Dermatophytes and other pathogenic fungi from hospital staff ...
African Journals Online (AJOL)
hospital staff apparel from protective gown, face- shields and hand gloves were tested for the presence of fungi. Examined samples were collected using the swab culture method. Results: Of a total of 110 swab samples of hospital staff apparel, 56 (51 %) showed fungi contamination including 31 (66 %) of 47 samples from ...
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Directory of Open Access Journals (Sweden)
Tzeng Huey-Ming
2012-03-01
Full Text Available Abstract Background Fall prevention programs for hospitalized patients have had limited success, and the effect of programs on decreasing total falls and fall-related injuries is still inconclusive. This exploratory multi-hospital study examined the unique contribution of call light response time to predicting total fall rates and injurious fall rates in inpatient acute care settings. The conceptual model was based on Donabedian's framework of structure, process, and health-care outcomes. The covariates included the hospital, unit type, total nursing hours per patient-day (HPPDs, percentage of the total nursing HPPDs supplied by registered nurses, percentage of patients aged 65 years or older, average case mix index, percentage of patients with altered mental status, percentage of patients with hearing problems, and call light use rate per patient-day. Methods We analyzed data from 28 units from 4 Michigan hospitals, using archived data and chart reviews from January 2004 to May 2009. The patient care unit-month, defined as data aggregated by month for each patient care unit, was the unit of analysis (N = 1063. Hierarchical multiple regression analyses were used. Results Faster call light response time was associated with lower total fall and injurious fall rates. Units with a higher call light use rate had lower total fall and injurious fall rates. A higher percentage of productive nursing hours provided by registered nurses was associated with lower total fall and injurious fall rates. A higher percentage of patients with altered mental status was associated with a higher total fall rate but not a higher injurious fall rate. Units with a higher percentage of patients aged 65 years or older had lower injurious fall rates. Conclusions Faster call light response time appeared to contribute to lower total fall and injurious fall rates, after controlling for the covariates. For practical relevance, hospital and nursing executives should consider
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Graduate Education for Hospital Administration in the United States: Trends.
Chester, Theodore E.
In 1968, 75% of the 5,466 graduates of hospital administration were in management positions in hospitals and related institutions, and about 1,000 to 1,500 held key government jobs. The US needs approximately 40,000 trained hospital administrators, but the total graduate output is about one-eighth of that amount. Of the 23 existing programs, 8 are…
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Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar
2016-04-01
Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.
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Risk factors for total hip arthroplasty aseptic revision.
Khatod, Monti; Cafri, Guy; Namba, Robert S; Inacio, Maria C S; Paxton, Elizabeth W
2014-07-01
The purpose of this study was to evaluate patient, operative, implant, surgeon, and hospital factors associated with aseptic revision after primary THA in patients registered in a large US Total Joint Replacement Registry. A total of 35,960 THAs registered from 4/2001-12/2010 were evaluated. The 8-year survival rate was 96.7% (95% CI 96.4%-97.0%). Females had a higher risk of aseptic revision than males. Hispanic and Asian patients had a lower risk of revision than white patients. Ceramic-on-ceramic, ceramic-on-conventional polyethylene, and metal-on-conventional polyethylene bearing surfaces had a higher risk of revision than metal-on-highly cross-linked polyethylene. Body mass index, health status, diabetes, diagnosis, fixation, approach, bilateral procedures, head size, surgeon fellowship training, surgeon and hospital volume were not revision risk factors. Copyright © 2014 Elsevier Inc. All rights reserved.
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The generation characteristics of solid radioactive wastes in the KEPCO nuclear power plants
International Nuclear Information System (INIS)
Shon, Soon Hwan; Kang, Duck Won; Kim, Hee Keun
1991-01-01
Solid radwastes generation trend and characteristics were discussed for nuclear power plants in KEPCO. Each plant has a specific tendency of solid radwastes generation due to the plant characteristics. The total volume of solid radwastes generated from nine power plants was accumulated in 23,012 drums by the end of 1989. The average annual volume per unit was about 670 drums. The solid radwaste mostly consisted of solidified concentrates and contaminated trash. The contaminated trash has been the major portion of the solid radwastes since 1982. The volume of the contaminated trash was dependent on the availability factor and period of overhaul. Therefore, the contaminated trash was considered to be a prime target for the solid radwastes minimization plan
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Directory of Open Access Journals (Sweden)
Yallew WW
2016-08-01
Full Text Available Walelegn Worku Yallew,1 Abera Kumie,2 Feleke Moges Yehuala3 1Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, 2School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, 3Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Purpose: Hospital-acquired infection (HAI is a major safety issue affecting the quality of care of hundreds of millions of patients every year, in both developed and developing countries, including Ethiopia. In Ethiopia, there is no comprehensive research that presents the whole picture of HAIs in hospitals. The objective of this study was to examine the nature and extent of HAIs in Ethiopia. Methods: A repeated cross-sectional study was conducted in two teaching hospitals. All eligible inpatients admitted for at least 48 hours on the day of the survey were included. The survey was conducted in dry and wet seasons of Ethiopia, that is, in March to April and July 2015. Physicians and nurses collected the data according to the Centers for Disease Control and Prevention definition of HAIs. Coded and cleaned data were transferred to SPSS 21 and STATA 13 for analysis. Univariate and multivariable logistic regression analyses were used to examine the prevalence of HAIs and relationship between explanatory and outcome variables. Results: A total of 908 patients were included in this survey, the median age of the patients was 27 years (interquartile range: 16–40 years. A total of 650 (71.6% patients received antimicrobials during the survey. There were 135 patients with HAI, with a mean prevalence of 14.9% (95% confidence interval 12.7–17.1. Culture results showed that Klebsiella spp. (22.44% and Staphylococcus aureus (20.4% were the most commonly isolated HAI-causing pathogens in these hospitals. The association of patient age and hospital type with the occurrence of HAI was
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Economic evaluation of municipal solid waste recycling in Yazd:
Eslami H; Mokhtari M; Eslami Dost Z; Barzegar Khanghah MR; Ranjbar Ezzatabadi M
2017-01-01
Background and aims: In every urban waste management plan, recycling and reuse is considered as an economic pattern. This study aimed to economic evaluation of municipal solid waste recycling in Yazd by cost-benefit analysis in 2015. Methods: This research is a descriptive–analytic study which in the data about quality and quantity of municipal solid waste in Yazd city were collected through the sampling and physical analysis and the data about total income and costs from the implementatio...
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Bakar, Coskun; Akgün, H Seval; Al Assaf, A F
2008-01-01
The aim of this paper is to document a study, in which the SERVQUAL scale was used to evaluate hospital services, conducting a preliminary assessment of patient attitudes regarding the important aspects of service dimensions. The SERVQUAL scale was implemented into routine use at the Baskent University Hospitals Network in Baskent, Turkey. The study consisted of 550 randomly chosen patients who presented to any member hospital in that network during January and February 2006 and received treatment as inpatients or outpatients at those healthcare facilities. The SERVQUAL scale was utilised to evaluate hospital services. A questionnaire was completed by a total of 472 (86.0 per cent) patients. The perceived scores of the patients were higher than expected for an ordinary hospital but lower than expected for a high-quality hospital. The highest difference between the perceived service score and the expected service score was found at the Alanya Application and Research Center in Alanya, Turkey. The paper demonstrates the use of the SERVQUAL scale in measuring the functional quality of the hospitals assessed.
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Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders
Institute of Scientific and Technical Information of China (English)
Tahsin COLAK; Tamer AKCA; Ozgur TURKMENOGLU; Hakan CANBAZ; Bora USTUNSOY; Arzu KANIK; Suha AYDI
2008-01-01
Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.
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Leslie, H.A.; Hermens, J.L.; Kraak, M.H.S.
2004-01-01
Body residues of compounds with a narcotic mode of action that exceed critical levels result in baseline toxicity in organisms. Previous studies have shown that internal concentrations in organisms also can be estimated by way of passive sampling. In this experiment, solid-phase microextraction
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Solid waste management. Principles and practice
Energy Technology Data Exchange (ETDEWEB)
Chandrappa, Ramesha [Karnataka State Pollution Control Board, Biomedical Waste, Bangalore (India); Bhusan Das, Diganta [Loughborough Univ. of Technology (United Kingdom). Dept. of Chemical Engineering
2012-11-01
Solid waste was already a problem long before water and air pollution issues attracted public attention. Historically the problem associated with solid waste can be dated back to prehistoric days. Due to the invention of new products, technologies and services the quantity and quality of the waste have changed over the years. Waste characteristics not only depend on income, culture and geography but also on a society's economy and, situations like disasters that affect that economy. There was tremendous industrial activity in Europe during the industrial revolution. The twentieth century is recognized as the American Century and the twenty-first century is recognized as the Asian Century in which everyone wants to earn 'as much as possible'. After Asia the currently developing Africa could next take the center stage. With transitions in their economies many countries have also witnessed an explosion of waste quantities. Solid waste problems and approaches to tackling them vary from country to country. For example, while efforts are made to collect and dispose hospital waste through separate mechanisms in India it is burnt together with municipal solid waste in Sweden. While trans-boundary movement of waste has been addressed in numerous international agreements, it still reaches developing countries in many forms. While thousands of people depend on waste for their lively hood throughout the world, many others face problems due to poor waste management. In this context solid waste has not remained an issue to be tackled by the local urban bodies alone. It has become a subject of importance for engineers as well as doctors, psychologist, economists, and climate scientists and any others. There are huge changes in waste management in different parts of the world at different times in history. To address these issues, an effort has been made by the authors to combine their experience and bring together a new text book on the theory and practice of the
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Ayana, Essayas K; Worqlul, Abeyou W; Steenhuis, Tammo S
2015-08-01
Modeling of suspended sediment emission into freshwater lakes is challenging due to data gaps in developing countries. Existing models simulate sediment concentration at a gauging station upstream and none of these studies had modeled total suspended solids (TSS) emissions by inflowing rivers to freshwater lakes as there are no TSS measurements at the river mouth in the upper Blue Nile basin. In this study a 10year TSS time series data generated from remotely sensed MODIS/Terra images using established empirical relationship is applied to calibrate and validate a hydrology model for Lake Tana in Upper Blue Nile Basin. The result showed that at a monthly time scale TSS at the river mouth can be replicated with Nash-Sutcliffe efficiency (NS) of 0.34 for calibration and 0.21 for validation periods. Percent bias (PBIAS) and ratio of the root-mean-square error to the standard deviation of measured data (RSR) are all within range. Given the inaccessibility and costliness to measure TSS at river mouths to a lake the results found here are considered useful for suspended sediment budget studies in water bodies of the basin. Copyright © 2015 Elsevier B.V. All rights reserved.
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Hospital costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition
Directory of Open Access Journals (Sweden)
Morales Eva
2012-05-01
Full Text Available Abstract Background We aimed to assess the hospital economic costs of nosocomial multi-drug resistant Pseudomonas aeruginosa acquisition. Methods A retrospective study of all hospital admissions between January 1, 2005, and December 31, 2006 was carried out in a 420-bed, urban, tertiary-care teaching hospital in Barcelona (Spain. All patients with a first positive clinical culture for P. aeruginosa more than 48 h after admission were included. Patient and hospitalization characteristics were collected from hospital and microbiology laboratory computerized records. According to antibiotic susceptibility, isolates were classified as non-resistant, resistant and multi-drug resistant. Cost estimation was based on a full-costing cost accounting system and on the criteria of clinical Activity-Based Costing methods. Multivariate analyses were performed using generalized linear models of log-transformed costs. Results Cost estimations were available for 402 nosocomial incident P. aeruginosa positive cultures. Their distribution by antibiotic susceptibility pattern was 37.1% non-resistant, 29.6% resistant and 33.3% multi-drug resistant. The total mean economic cost per admission of patients with multi-drug resistant P. aeruginosa strains was higher than that for non-resistant strains (15,265 vs. 4,933 Euros. In multivariate analysis, resistant and multi-drug resistant strains were independently predictive of an increased hospital total cost in compared with non-resistant strains (the incremental increase in total hospital cost was more than 1.37-fold and 1.77-fold that for non-resistant strains, respectively. Conclusions P. aeruginosa multi-drug resistance independently predicted higher hospital costs with a more than 70% increase per admission compared with non-resistant strains. Prevention of the nosocomial emergence and spread of antimicrobial resistant microorganisms is essential to limit the strong economic impact.
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Service quality of private hospitals: the Iranian patients' perspective.
Zarei, Asghar; Arab, Mohammad; Froushani, Abbas Rahimi; Rashidian, Arash; Ghazi Tabatabaei, S Mahmoud
2012-02-02
Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.
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Preliminary data summary for the hospitals point-source category
International Nuclear Information System (INIS)
Strassler, E.; Hund, F.H.
1989-09-01
The summaries were prepared in order to allow EPA to respond to the mandate of Section 304(m) of the Clean Water Act. Summaries for categories already subject to rulemaking were developed for comparison purposes, and contain only the minimum amount of data needed to provide some perspective on the relative magnitude of the pollution problems created across the categories. The document summarizes the most current information available regarding the discharge of wastewater and solid wastes containing priority and hazardous non-priority pollutants by hospitals. The document provides a technical basis for determining whether additional national regulations should be developed pursuant to the Clean Water Act (CWA), and makes available preliminary information regarding the discharge of priority and hazardous non-priority pollutants by the hospital industry
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Energy Technology Data Exchange (ETDEWEB)
Oliveira, Fernanda F.; Costa, Alessandro M.; Ghilardi Netto, Thomaz, E-mail: ferretti.oliveira@gmail.com [Universidade de Sao Paulo (FFCLRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Ciencias e Letras. Departamento de Fisica; Amaral, Leonardo L. [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Hospital das Clinicas. Servico de Radioterapia
2012-08-15
This paper presents the results of in vivo dosimetry with p-type semiconductors diodes, EDP-15 (Scanditronix Wellhoefer) of two patients who underwent total body irradiation treatments, at Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto University of Sao Paulo (HCFMRP-USP). The diodes were well calibrated and the calibration factors were determined with the aid of a reference ionization chamber (FC065, IBA dosimetry, sensitive volume of 0.65 cm{sup 3}).The calibration was performed in a Total Body Irradiation (TBI) setup, using solid water phantoms. Different lateral thicknesses from one patient were simulated and then the calibration factors were determined by means of maximum depth dose readings (half of the lateral thickness). The response difference between diode readings and the prescribed dose for both treatments was below 4%. This difference is in agreement as recommended by International Commission on Radiation Units (ICRU), which is {+-}5%. (author)
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How a hospital must face a massive emergency: the case of Martini Hospital, Turin
Directory of Open Access Journals (Sweden)
Antonio Morra
2008-09-01
Full Text Available The terms “disaster” or “surge capability”, referred to hospitals, are often used to define a massive casualty admission. This may be a misleading concept, because emergency may as well arise from inside hospitals, and the last years high figures related to fires in the about 2,000 italian hospitals should suggest a different point of view. In this article the authors describe their experience in hospital preparedness at Ospedale Martini in Turin. Hospital operators regularly attend basic (GOM and advanced (HDM© courses about disaster response and organization, and a specific course is dedicated to operators involved in internal safety (fire emergency. In this courses, computer simulations are widely used, associated with conventional didactic. If education is one of the two cornerstones of disaster preparedness at Ospedale Martini, well designed emergency plans and an effective disaster management are the other one. The Internal Emergency Plan (Fire and Evacuation is aimed to give a proper response to fires and other events arising from inside the hospital and potentially requiring its partial or total evacuation. The Massive Casualties Admission Emergency Plan increases the surge capability of the hospital allowing to take care of a great number of injured people, and at the same time avoiding a dramatic fall in the treatment quality. The “Hospital Disaster Management©” system, created by the authors, is an organizational scheme based on team work. Its aim is to “put order in chaos” when hospitals are facing a disaster. Properly trained physicians and nurses, assigned to key positions, act in this system as Hospital Disaster Managers: their tasks are to coordinate the teams, to manage critical resources and to use the emergency plans as powerful instruments.
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Librizzi, Jamie; Flores, Samuel; Morse, Keith; Kelleher, Kelly; Carter, Jodi; Bode, Ryan
2017-06-01
Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision . Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric functional constipation. Copyright © 2017 by the American Academy of Pediatrics.
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Mariano, Caroline; Williams, Grant; Deal, Allison; Alston, Shani; Bryant, Ashley Leak; Jolly, Trevor; Muss, Hyman B
2015-07-01
Geriatric assessment (GA) is an important tool for management of older cancer patients; however, GA research has been performed primarily in the outpatient setting. The primary objective of this study was to determine feasibility of GA during an unplanned hospital stay. Secondary objectives were to describe deficits found with GA, to assess whether clinicians recognized and addressed deficits, and to determine 30-day readmission rates. The study was designed as an extension of an existing registry, "Carolina Senior: Registry for Older Patients." Inclusion criteria were age 70 and older and biopsy-proven solid tumor, myeloma, or lymphoma. Patients had to complete the GA within 7 days of nonelective admission to University of North Carolina Hospital. A total of 142 patients were approached, and 90 (63%) consented to participation. All sections of GA had at least an 83% completion rate. Overall, 53% of patients reported problems with physical function, 63% had deficits in instrumental activities of daily living, 34% reported falls, 12% reported depression, 31% had ≥10% weight loss, and 12% had abnormalities in cognition. Physician documentation of each deficit ranged from 20% to 46%. Rates of referrals to allied health professionals were not significantly different between patients with and without deficits. The 30-day readmission rate was 29%. GA was feasible in this population. Hospitalized older cancer patients have high levels of functional and psychosocial deficits; however, clinician recognition and management of deficits were poor. The use of GA instruments to guide referrals to appropriate services is a way to potentially improve outcomes in this vulnerable population. Geriatric assessment (GA) is an important tool in the management of older cancer patients; however, its primary clinical use has been in the outpatient setting. During an unplanned hospitalization, patients are extremely frail and are most likely to benefit from GA. This study demonstrates
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Solid wastes management in Lebanon
International Nuclear Information System (INIS)
Daniel, Simon E.
1999-01-01
The paper describes the problem of wastes in Lebanon and their management according to international (European and French) descriptions. It presents the situation in Lebanon including the policies taken by the ministry of environment towards the treatment of different types of wastes especially solid wastes. It is estimated that the production of wastes in Lebanon is 5854 tones per day and it is distributed as follows: Domestic wastes 3200 t/d; industrial wastes 1300 t/d; commercial wastes 1000 t/d; slaughter-houses 150 t/d; waste oils 100 t/d; hospital wastes 64 t/d; vehicle wheels 40 t/d. The annual production within regions is also presented in tables. Collection, transportation, recycling, composting and incineration of wastes are included
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Gas production in anaerobic dark-fermentation processes from agriculture solid waste
Sriwuryandari, L.; Priantoro, E. A.; Sintawardani, N.
2017-03-01
Approximately, Bandung produces agricultural solid waste of 1549 ton/day. This wastes consist of wet-organic matter and can be used for bio-gas production. The research aimed to apply the available agricultural solid waste for bio-hydrogen. Biogas production was done by a serial of batches anaerobic fermentation using mix-culture bacteria as the active microorganism. Fermentation was carried out inside a 30 L bioreactor at room temperature. The analyzed parameters were of pH, total gas, temperature, and COD. Result showed that from 3 kg/day of organic wastes, various total gases of O2, CH4, H2, CO2, and CnHn,O2 was produced.
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Gastric emptying of solids and liquids in obesity.
Glasbrenner, B; Pieramico, O; Brecht-Krauss, D; Baur, M; Malfertheiner, P
1993-07-01
The purpose of this study was to determine whether obese patients have different rates of solid and liquid gastric emptying compared to healthy controls. Twenty-four obese patients (7 males, 17 females) were investigated prior to dietary restriction. The patients had a weight excess above ideal weight ranging from 25% to 216% (mean weight 118.1 +/- 6.5 kg). The control group consisted of 8 healthy subjects (4 males, 4 females), within 10% of the ideal weight. The solid phase of the test meal consisted of 40 g bread, 30 g ham, 10 g margarine, and two scrambled eggs labeled with 99mTc. For the liquid phase, 200 ml orange juice was labeled with 201Tl. Three-minute counts of both tracers were taken for 106 min using a large field-of-view gamma camera. In obese patients, a significantly shortened lag phase for the emptying of solids was observed (27.0 +/- 3.3 versus 38.4 +/- 4.1 min; P < 0.05). Half-emptying time (105.9 +/- 6.7 versus 100.7 +/- 5.7 min), emptying rate (0.60 +/- 0.04 versus 0.71 +/- 0.07%/min), and total emptying of solids (49.4 +/- 3.6 versus 50.5 +/- 5.0%) were not different from controls. Obese subjects had a trend to slowed liquid emptying (half-time 82.7 +/- 4.8 versus 69.9 +/- 6.9 min; emptying rate 0.59 +/- 0.03 versus 0.65 +/- 0.03%/min; total emptying 59.8 +/- 2.9 versus 66.0 +/- 3.3%), but this was not statistically significant. There was no correlation between weight or body surface area and rate of solid or liquid gastric emptying.(ABSTRACT TRUNCATED AT 250 WORDS)
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Assessing The Current Status Of Solid Waste Management Of Gondar Town Ethiopia
Directory of Open Access Journals (Sweden)
Mohammed Gedefaw
2015-08-01
Full Text Available Abstract Ethiopia is facing rapid urbanization leading to overcrowding and the development of slums and informal settlements with poor waste management practices. Urban dwellers generally consume more resources than rural dwellers and so generate huge quantities of solid wastes. This study is focused on the overall assessment of the existing MSWM service of Gondar town. The overall objective of this study was assessing the current solid waste management service of Gondar town. Both primary and secondary sources were used to achieve the objectives. The analysis of this study was carried out using both qualitative and quantitative techniques. The findings of this study revealed that the present system of MSWM in Gondar town entirely relied on the municipality which provided the full range of waste collection transportation and disposal service. But the provision of this service is not kept in pace with the town solid waste generation. Based on the findings of this study the town households dominantly produced biodegradable solid wastes with generation rate of 0.21kgpersonday. This made the daily total solid waste generation of households to be 8140Kg. Together with other four solid waste sources the total daily solid waste generation of the town is about 11660 kg. So that MSWM of the town is found in very low status and spatial coverage. This poor status of MSWM is also intensified by three critical factors i.e poor institutional structure and capacity of Sanitation and beautification limited participation and contribution of stakeholders and poor households solid waste management practices. This study concluded that there should be sustainable solid waste management systems reuse recycle composting and incineration through awareness creation and training improvement of SB institutional structure and capacity and implementation of integrated MSWM approach which recognizes and comprises all stakeholders in the town.
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Segregation of solid waste from a fish-processing industry: a sustainable action
Directory of Open Access Journals (Sweden)
Yeda dos Santos Silva
2018-05-01
Full Text Available Segregation techniques represent a sustainable alternative to minimize wastes of raw material in processing industries. This study considered the premise; its purpose was to use segregation techniques to determine the theoretical removal rate of solid compounds present in processing effluents, in order to support the sustainable development of the fish industry. The removal rates obtained for different treatments were evaluated for the parameters: total solids, organic matter and oils and greases, and the efficiency of the segregation of the effluent streams in the different stages of fish processing was evaluated through descriptive statistical analysis. The segregation recovered from 31% to 70% of total solids; from 15% to 97.50% of organic matter, and from 10% to 63% of oils and greases. These results indicates that the raw material can be used in new products, leading to reduced final-effluent concentration.
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Hospital profitability and capital structure: a comparative analysis.
Valvona, J; Sloan, F A
1988-08-01
This article compares the financial performance of hospitals by ownership type and of five publicly traded hospital companies with other industries, using such indicators as profit margins, return on equity (ROE) and total capitalization, and debt-to-equity ratios. We also examine stock returns to investors for the five hospital companies versus other industries, as well as the relative roles of debt and equity in new financing. Investor-owned hospitals had substantially greater margins and ROE than did other hospital types. In 1982, investor-owned chain hospitals had a ROE of 26 percent, 18 points above the average for all hospitals. Stock returns on the five selected hospital companies were more than twice as large as returns on other industries between 1972 and 1983. However, after 1983, returns for these companies fell dramatically in absolute terms and relative to other industries. We also found investor-owned hospitals to be much more highly levered than their government and voluntary counterparts, and more highly levered than other industries as well.
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Total selenium in irrigation drain inflows to the Salton Sea, California, April 2009
May, Thomas W.; Walther, Michael J.; Saiki, Michael K.; Brumbaugh, William G.
2009-01-01
This report presents the results for the final sampling period (April 2009) of a 4-year monitoring program to characterize selenium concentrations in selected irrigation drains flowing into the Salton Sea, California. Total selenium and total suspended solids were determined in water samples. Total selenium, percent total organic carbon, and particle size were determined in sediments. Mean total selenium concentrations in water ranged from 0.98 to 22.9 micrograms per liter. Total selenium concentrations in sediment ranged from 0.078 to 5.0 micrograms per gram dry weight.
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Total picture archiving communication system for medical use at medium-sized hospitals
International Nuclear Information System (INIS)
Kabata, Shun; Goto, Kazuhiko; Yamada, Kazumi; Okaniwa, Hiroshi.
1991-01-01
An increasingly widespread use of diagnostic imaging systems has seen a concomitant rise in the number of medical images. Picture archiving and communication system (PACS) allows filmless storage by digitizing images to record and store into the optical disk, and allows the rapid data retrieval and transmission. It is anticipated that PACS may be a promising approach to the medical routine practice. In January 1991, Hitachi PACS was introduced in Tokyo Hitachi Hospital. In this paper, the experience with PACS in the clinical setting is presented. The process of improvement in PACS is given in terms of the following: the flow of images, image deletion in the image workstation, and the number of sequential images to be observed. (N.K.)
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Wu, Eric Q; Xie, Jipan; Wu, Chun; Du, Ella Xiaoyan; Li, Nanxin; Tan, Ruoding; Liu, Yuanli
2014-03-01
The prevalence of venous thromboembolism (VTE) has been increasing in China. However, the treatment pattern and economic burden of these patients have not been well-understood. The objective of this study was to examine the patient characteristics, treatment pattern, anticoagulant monitoring, and economic burden of VTE among hospitalized patients in China. Hospitalizations with a diagnosis of VTE [including deep vein thrombosis (DVT) or pulmonary embolism (PE)] between 1 January 2010 and 30 June 2013 were included. Descriptive analysis was conducted for patients' characteristics, anticoagulant treatment, international normalized ratio (INR) monitoring, and hospitalization cost [in 2013 Chinese yuan (Y) and US dollars (US$)]. Multivariate regressions were performed to assess factors associated with oral anticoagulant use and total costs of inpatient care. A total of 1,047 VTE-related hospitalizations were selected. The sample had a mean age of 62.4 years, with 45.9 % female. About 46.3 % of hospitalizations used heparin only, 35.0 % used warfarin, 0.8 % used rivaroxaban, and 18.0 % did not use anticoagulants. Among hospitalizations where warfarin was used, 90.8 % received at least one INR test and only 30 % had the last INR within the target therapeutic range (2-3) before discharge. The mean (standard deviation) total cost per hospitalization was Y29,114 (43,772) [US$4,757 (7,152)]. PE, VTE as primary diagnosis, female, insurance coverage, anticoagulant treatment, co-morbidities, admission condition, and surgical procedure were significantly associated with inpatient costs. Conventional anticoagulants were most commonly used in the study sample. Under-monitoring and suboptimal care may be an issue for patients treated with warfarin. The average total inpatient cost of VTE-related hospitalizations is high.
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Solid waste management in local hospitals of the north of Valle del Cauca, Colombia
Directory of Open Access Journals (Sweden)
Patricia Torres L
2010-04-01
Full Text Available Health-care institutions must offer adequate conditions for both employers and users in order to maintain, improve or recover their health status; inadequate health-care solid waste (h s w management is an obstacle to achieve this goal. Objective:to estimate the quantity and composition of h s w in ten healthcare public institutions located in ten municipalities in northern Valle del Cauca region (Colombia. Methodology: quantity and composition of h s w was estimated through two 24 hours sampling rounds. Results: the proportion of hazardous healthcare solid waste (h h s w was usually equal to or higher than 25% and it also surpassed the mean average values reported by organizations like World Health Organization; bio-sanitary waste was the category with major proportion in the h h s w fraction. Discussion: the values obtained in order to determine indicators as kg/bed-day and kg/patient-day were in a lower or equal range of those values reported by different institutional or scientific sources. Considering the health-care services offered in the evaluated institutions, the kg/patient-day indicator is considered more representative than the kg/bed-day.
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Totally tubeless percutaneous nephrolithotomy: is it safe and effective in preschool children?
Ozturk, Ahmet; Guven, Selcuk; Kilinc, Mehmet; Topbaş, Emrah; Piskin, Mesut; Arslan, Mehmet
2010-12-01
After the introduction of tubeless percutaneous nephrolithotomy (PNL), many studies conducted in adult patients have confirmed its efficacy and safety. There are limited studies reporting that tubeless PNL can be safely applied in children, however. Furthermore, there are no reports that evaluate the use of totally tubeless PNL in children. The present study evaluates the results of totally tubeless PNL in preschool children. The data of children seen in our clinic who were considered suitable for totally tubeless PNL were analyzed. Of 16 children, 8 patients underwent totally tubeless PNL (group 1) and 8 standard PNL (group 2). The two groups of patients were compared with regard to length of hospitalization, analgesic requirements, transfusion rates, hemoglobin (Hb) decrease, and immediate, early, and late complications. The mean ages of the patients were 56.6 months (9-84 mos) and 56.0 months (5-84 mos), and the mean follow-up was 21.5 months (3-44 mos) and 43.4 months (36-54 mos) in groups 1 and 2, respectively. Both groups were similar with regard to age, stone size, Hb change, and complications. Although operation duration, hospitalization period, and analgesic requirement were less in the totally tubeless PNL group, these differences were not statistically significant. The latest application of PNL, totally tubeless PNL, is also a safe and effective procedure in very small children if they are selected properly and if the surgeon has sufficient experience with the procedure. More studies with a higher number of participants are needed, however, to confirm that totally tubeless PNL increases the comfort of pediatric patients, decreases their hospitalization period, and is more economical.
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Outpatient admissions and hospital costs of Syrian refugees in a Turkish university hospital.
Tahirbegolli, Bernard; Çavdar, Sabanur; Çetinkaya Sümer, Esin; Akdeniz, Sıdıka I; Vehid, Suphi
2016-07-01
To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey. Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system. Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p less than 0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p less than 0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar. On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency.
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[Comprehensive quality management in hospitals--experience and recommendations].
Schubert, H J
1999-03-01
Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.
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Experimental investigation of solid rocket motors for small sounding rockets
Suksila, Thada
2018-01-01
Experimentation and research of solid rocket motors are important subjects for aerospace engineering students. However, many institutes in Thailand rarely include experiments on solid rocket motors in research projects of aerospace engineering students, mainly because of the complexity of mixing the explosive propellants. This paper focuses on the design and construction of a solid rocket motor for total impulse in the class I-J that can be utilised as a small sounding rocket by researchers in the near future. Initially, the test stands intended for measuring the pressure in the combustion chamber and the thrust of the solid rocket motor were designed and constructed. The basic design of the propellant configuration was evaluated. Several formulas and ratios of solid propellants were compared for achieving the maximum thrust. The convenience of manufacturing and casting of the fabricated solid rocket motors were a critical consideration. The motor structural analysis such as the combustion chamber wall thickness was also discussed. Several types of nozzles were compared and evaluated for ensuring the maximum thrust of the solid rocket motors during the experiments. The theory of heat transfer analysis in the combustion chamber was discussed and compared with the experimental data.
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Radiation resistance of plastic solid
International Nuclear Information System (INIS)
Moriyama, Noboru; Dojiri, Shigeru; Wadachi, Yoshiki
1985-01-01
The radiation from nucleides contained in solidified wates have some effects on the degradation of the solidification materials. This report deals with effects of such radiation on the mechanical strength of waste-plastics composites and on the generation of gasses. It is shown that the mechanical strength of polyethylene and polyester solids will not decrease at a total absorbed dose of 10 6 rad, a dose which a low-level waste composite is expected to receive during an infinite period of time. Rather, it increases in the case of polyethylene. The amount of gas generated from degraded polyethylene is about three times as large as that from polyester, namely, about 6 l per 200 l drum can at 10 6 rad. Hydrogen accounts for about 80 % of the total gas generated from polyethylene. On the other hand, the gas from polyester solid mainly contains hydrogen, carbon dioxide, carbon monoxide and methane, with a composition greatly dependent on the type of the waste contained. It is concluded from these results that plastic materials can serve satisfactorily as for as the effects of radiation on their mechanical strength and gas generation are concerned. A more important problem still remaining to be solved is the effects of radiation on the leaching of radioactive nuclides. (Nogami, K.)
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The productivity and its barriers in public hospitals: case study of Iran
Nabilou, Bahram; Yusefzadeh, Hassan; Rezapour, Aziz; Ebadi Fard Azar, Farbod; Salem Safi, Parviz; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal
2016-01-01
Background: Due to the increasing health care costs, the issue of productivity in hospitals must be taken into great consideration in order to provide, preserve and promote public health services. Thus, increasing the level of productivity must become the main aim of any hospital. Objective of this study is to determine the total factor productivity and its components over the period under the study. Methods: In this cross sectional study, total factor productivity changes of hospitals affiliated to Tehran University of Medical Sciences were measured according to Malmquist index over the period 2009-2014. To estimate total productivity changes using Data Envelopment Analysis method, inputoriented and variable return to scale assumptions were applied and Deap2.1 software was used. Results: The mean value of total productivity changes was 1.013. It means that during the study period the productivity experienced a 1.3% decrease. Technological efficiency changes have the greatest influence on productivity decrease than the other factors. Scale efficiency, managerial efficiency and technical efficiency changes were ranked. Conclusion: Lack of knowledge of hospital personnel on proper application of technology in patient treatment is the main factor leading to productivity decrease resulting from technological changes in the studied hospitals. Therefore, holding courses for personnel in order to teach them the proper use of technology in diagnosis and patient care can be helpful. PMID:27390686
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[Impact of HIV infection in hospital environment].
Martínez Avilés, P; López Benito, I; Berbegal Serra, J
1998-12-01
Retrospective study to review the admissions at the Hospital Marina Alta due to infection for HIV or its complications and look for risk factors. Clinical charts of patients admitted at the hospital from 1989 to 1996 were analyzed. From 11,932 admissions, 199 (1.7%) were due to patients with infection from HIV, resulting in the 2.4% of the total stay. The medium stays were higher (8.6 +/- 7.4 vs 6 +/- 4.5) more re-admissions (42.7% vs 25.5%) and higher mortality (11% vs 7.8%). The parasitic infestations of the nervous central system and cardiovascular were the most numerous number of admissions and also the longer stays. Throughout the years we saw a increase in the patients at the outpatient clinic with HIV infection and a paradogic decrease in the inpatient admissions, and also a decrease in the media stay and total stays. There is a decrease in the admissions at the inpatient level in contrast with a increment of the prevalence in the outpatients with HIV infection. The improved treatments, the experience of the physicians, the use of the Day Hospital and the use of the service of Home Care Hospitalization allows to keep more patients with less admissions and more outpatient visits.
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Rocky mountain spotted fever hospitalizations among American Indians.
Demma, Linda J; Holman, Robert C; Mikosz, Christina A; Curns, Aaron T; Swerdlow, David L; Paisano, Edna L; Cheek, James E
2006-09-01
To describe the epidemiology of Rocky Mountain spotted fever (RMSF) among American Indians/Alaska Natives (AI/ANs), we conducted a retrospective analysis of hospitalization records with an RMSF diagnosis using Indian Health Service (IHS) hospital discharge data for calendar years 1980-2003. A total of 261 RMSF hospitalizations were reported among AIs, for an average annual hospitalization rate of 1.21 per 100,000 persons; two deaths were reported (0.8%). Most hospitalizations (88.5%) occurred in the Southern Plains region, where the rate was 4.23 per 100,000 persons. Children 1-4 years of age had the highest age-specific hospitalization rate of 2.50 per 100,000 persons. The overall annual RMSF hospitalization rate declined during the study period. Understanding the epidemiology of RMSF among AI/ANs and educating IHS/tribal physicians on the diagnosis of tick-borne diseases remain important for the prompt treatment of RMSF and the reduction of the disease occurrence among AI/ANs, particularly in high-risk areas.
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Pressure sores following elective total hip arthroplasty: pitfalls of misinterpretation.
Keong, Nicole; Ricketts, David; Alakeson, Nuki; Rust, Philippa
2004-01-01
OBJECTIVE: To assess the reliability of reporting protocols regarding pressure sores. METHODS: Retrospective data were collected regarding pressure sore rates following total hip arthroplasty operations carried out during 2001 at two orthopaedic units in an NHS hospital (Princess Royal Hospital) and in a local private hospital. RESULTS: Preliminary results presented in audit and interim reports indicated an alarmingly high pressure sore rate across the two sites (17/172 [9.9%] NHS, 23/71 [32.4%] private hospital). On analysis, the data collection system was revealed to be flawed. Grade 1 areas (erythema with no ulceration) were included, leading to a dramatic discrepancy between reported and confirmed pressure sores. Re-analysis showed the confirmed pressure sore rates to be much lower (2.3% NHS, 1.0% private hospital). CONCLUSIONS: This audit suggests that both poor data collection and education lead to inaccurate audit. This may lead to subsequent inappropriate management and inappropriate NHS star ratings. PMID:15140301
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Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A
2013-11-01
Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.
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Hospitalization of abused and neglected children.
Marshall, W N
1997-03-01
To describe the use of inpatient hospitalization for abused and neglected children living in a metropolitan area. Retrospective record review of abused and neglected children admitted in 1992 and 1993 to hospitals with 87% of metropolitan area pediatric admissions; comparison of these data with population, crisis nursery, and child protective services data. Thirty-four abused and neglected children were admitted to hospital, representing 0.3% (34/11,066; 95% confidence interval, 0%-1.2%) of pediatric admissions and 0.2% (34/19,950; 95% confidence interval, 0%-0.6%) of child protective services reports. This represents a rate of hospitalization for child abuse of 10 children (95% confidence interval, 0-46) per 100,000 child population per year. Seven hundred fifteen children were admitted to the crisis nursery by child protective services. Of those admitted to the hospital, 12 needed intensive care, 5 of whom died. Only 3 of 34 hospital-admitted children had private health insurance; 19 of 34 were younger than 1 year. Inpatient hospitalization for abuse represented a small fraction of total pediatric admissions and of child protective services reports. Comprehensive medical care for most abused children and medical education about child abuse must occur in outpatient settings.
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Association Between the 2014 Medicaid Expansion and US Hospital Finances.
Blavin, Fredric
2016-10-11
The Affordable Care Act expanded Medicaid eligibility for millions of low-income adults. The choice for states to expand Medicaid could affect the financial health of hospitals by decreasing the proportion of patient volume and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. To estimate the association between the Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and in those states that did not expand Medicaid. Observational study with analysis of data for nonfederal general medical or surgical hospitals in fiscal years 2011 through 2014, using data from the American Hospital Association Annual Survey and the Health Care Cost Report Information System from the US Centers for Medicare & Medicaid Services. Multivariable difference-in-difference regression analyses were used to compare states with Medicaid expansion with states without Medicaid expansion. Hospitals in states that expanded Medicaid eligibility before January 2014 were excluded. Medicaid expansion in 2014, accounting for variation in fiscal year start dates. Hospital-reported information on uncompensated care, uncompensated care as a percentage of total hospital expenses, Medicaid revenue, Medicaid as a percentage of total revenue, operating margins, and excess margins. The sample included between 1200 and 1400 hospitals per fiscal year in 19 states with Medicaid expansion and between 2200 and 2400 hospitals per fiscal year in 25 states without Medicaid expansion (with sample size varying depending on the outcome measured). Expansion of Medicaid was associated with a decline of $2.8 million (95% CI, -$4.1 to -$1.6 million; P policy change on hospitals' overall finances.
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Morikawa, Takako; Maeda, Kiyoshi; Osaki, Tohmi; Kajita, Hiroyuki; Yotsumoto, Kayano; Kawamata, Toshio
2017-11-01
People exhibiting serious behavioural and psychological symptoms of dementia are usually voluntarily or involuntarily committed to psychiatric hospitals for treatment. In Japan, the average hospital stay for individuals with dementia is about 2 years. Ideally, individuals should be discharged once their symptoms have subsided. However, we see cases in Japan where individuals remain institutionalized long after behavioural and psychological symptoms of dementia are no longer apparent. This study will attempt to identify factors contributing to shorter stays in psychiatric hospitals for dementia patients. Questionnaires consisting of 17 items were mailed to 121 psychiatric hospitals with dementia treatment wards in western Japan. Out of 121 hospitals that received the questionnaires, 45 hospitals returned them. The total number of new patient admissions at all 45 hospitals during the month of August 2014 was 1428, including 384 dementia patients (26.9%). The average length of stay in the dementia wards in August 2014 was 482.7 days. Our findings revealed that the rate of discharge after 2 months was 35.4% for the dementia wards. In addition, we found that the average stay in hospitals charging or planning to charge the rehabilitation fee to dementia patients was significantly shorter than in hospitals not charging the rehabilitation fee. In Japan, dementia patients account for over 25% of new admissions to psychiatric hospitals with dementia wards. The average length of stay in a psychiatric hospital dementia ward is more than 1 year. A discharge after fewer than 2 months is exceedingly rare for those in a dementia ward compared with dementia patients in other wards. If institutions focus on rehabilitation, it may be possible to shorten the stay of dementia patients in psychiatric hospitals. © 2017 Japanese Psychogeriatric Society.
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Lyamuya, Faraja; Michael, Fausta; Jani, Bhavin; Fungo, Yohana; Chambo, Alfred; Chami, Inviolatha; Bulali, Regina; Mpamba, Amina; Cholobi, Happy; Kallovya, Dotto; Kamugisha, Christopher; Mwenda, Jason M; Cortese, Margaret M
2018-04-11
The Tanzania Ministry of Health introduced monovalent human rotavirus vaccine in January 2013, to be administered at ages 6 and 10 weeks. Data suggest there was high vaccine uptake. We used hospital ward registers from 3 hospitals to examine trends in diarrhea hospitalizations among infants before and after vaccine introduction. Ward registers from Dodoma Regional Referral Hospital (Central Tanzania), and two hospitals in Mbeya (Southwest area), Mbeya Zonal Referral Hospital and Mbalizi Hospital, were used to tally admissions for diarrhea among children by age group, month and year. Rotavirus surveillance had started at these hospitals in early 2013; the proportion of infants enrolled and rotavirus-EIA positive were examined by month to determine peak periods of rotavirus disease post-vaccine introduction. Registers were available for 2-4 prevaccine years and 2-3 post introduction years. At Dodoma Regional Referral Hospital, compared with the mean of 2011 and 2012, diarrhea hospitalizations among infants were 26% lower in 2015 and 58% lower in 2016. The diarrhea peak shifted later in the year first by 1 and then by 2-3 months from prevaccine. At the Mbeya hospitals, the number of diarrhea admissions in prevaccine period varied substantially by year. At Mbeya Referral Hospital, diarrhea hospitalizations among infants were lower by 25-37% in 2014 and 11-26% in 2015, while at Mbalizi Hospital, these hospitalizations were 4% lower in 2014 and 14% higher in 2015. Rotavirus testing data demonstrated a lowering of the prevaccine peak, a shift in timing of the peak months and indicated that other diarrheal peaks in post-introduction years were not due to rotavirus. In this ecological evaluation, total diarrhea hospitalizations among infants were lower (≥25% lower in ≥1 year) following introduction in 2 of 3 hospitals. There are challenges in using ward registers to ascertain possible impact of rotavirus vaccine introduction on trends in hospitalizations for
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Assaf, Ramiz; Saleh, Yahya
2017-09-01
Municipalities are responsible for solid waste collectiont for environmental, social and economic purposes. Practices of municipalities should be effective and efficient, with the objectives of reducing the total incurred costs in the solid waste collection network concurrently achieving the highest service level. This study aims at finding the best routes of solid waste collection network in Nablus city-Palestine. More specifically, the study seeks the optimal route that minimizes the total travelled distance by the trucks and hence the resulted costs. The current situation is evaluated and the problem is modelled as a Vehicle Routing Problem (VRP). The VRP is then optimized via a genetic algorithm. Specifically, compared to the current situation, the trucks total travelled distance was reduced by 66%, whereas the collection time was reduced from 7 hours per truck-trip to 2.3 hours. The findings of this study is useful for all municipality policy makers that are responsible for solid waste collection.
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Solid waste management - Pakistan's perspective
International Nuclear Information System (INIS)
Hussain, M.
2003-01-01
The discipline of 'Solid Waste Management' is as old as human civilization itself. The problem had been felt when the human beings commenced living together in the form of communities. The situation got worsened with ever-increasing population and growing industrialization. The developed nations have endeavored to tackle the issue of the industrial and municipal wastes according to the principles of engineering and environment. Most of the developing countries have not dealt with the 'Third Pollution' in the eco-friendly manner. Ironically Pakistan is facing this serious menace because of ever-expanding population (2.2% per annum) and ill management of the wastes and effluents being generated from multifarious activities. These pollutants are degrading the land, air and water resources at alarming rates. In Pakistan about 7,250 tonnes of solid waste is generated per day. Of this quantity only 60-70% is collected and the remaining quantity is allowed to burn indiscriminately or decay in situ. Unfortunately the industrial waste, animal dung and hospital waste are allowed to mix with the municipal waste, which adds to inefficiency of the existing 'Solid Waste Management System'. Scores of faecal, fly, rodent and mosquito born diseases are caused due to open dumping of the waste besides aesthetic impairment of the surroundings. None of the scientifically recognized methods of disposal is practiced. It is not based on administrative, financial, environmental and technical consideration. There is dire necessity of educating the masses to adopt clean habits and resort to generation of minimum waste. Further, nothing is waste as the so-called 'waste material' is the raw material after reuse and recycling for another process. (author)
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Solid waste containing method and solid waste container
International Nuclear Information System (INIS)
Sawai, Takeshi.
1997-01-01
Solid wastes are filled in a sealed vessel, and support spacers are inserted to the gap between the inner wall of a vessel main body and the solid wastes. The solid wastes comprise shorn pieces (crushed pieces) of spent fuel rod cladding tubes, radioactively contaminated metal pieces and miscellaneous solids pressed into a disk-like shape. The sealed vessel comprises, for example, a stainless steel. The solid wastes are filled while being stacked in a plurality of stages. A solidifying filler is filled into the gap between the inner wall and the solid wastes in the vessel main body by way of an upper opening, and the upper opening is closed by a closing lid to provide an entirely sealed state. Alumina particles having high heat conductivity and excellent heat durability are used for the solid filler. It is preferable to fill an inert gas such as a dried nitrogen gas in the sealed vessel. (I.N.)
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The relationship between bed size and profitability in South Carolina hospitals.
Kim, Yang K; Glover, Saundra H; Stoskopf, Carleen H; Boyd, Suzan D
2002-01-01
The purpose of the study is to identify factors affecting hospital profitability and to find the optimal hospital bed size that assures maximum profit. This is a cross-sectional study using survey data obtained from acute care hospitals in South Carolina in 1997. The relationship of hospital profitability and hospital bed size revealed that when bed size increases, hospital profitability increases, decreases, and then increases again. For the patient profit proportion, the turning points in bed size are 238.22 and 560.08. For the total profit proportion, the turning points in bed size are 223.31 and 503.86. The results on the relationship between bed size and hospital profitability indicate that medium-size hospitals have less profitability.
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Hip fracture in hospitalized medical patients
Zapatero Antonio; Barba Raquel; Canora Jesús; Losa Juan E; Plaza Susana; San Roman Jesús; Marco Javier
2013-01-01
Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057%) admittances were coded with an in-hosp...
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Study, analysis and design of plasma torch for the elimination of hospital wastes in Chile
International Nuclear Information System (INIS)
Diaz Ramirez, Ximena Jesus
2014-01-01
Within the field of new technologies in industry, the use of plasma is notable for its high speed of expansion and development. Currently one of its uses is the elimination of waste as it allows to avoid problems such as the formation of airborne byproducts and hazardous solids that represent a serious problem for the environment and human health. Plasma, when it is at extreme temperatures above 3,000 Celsius, causes inorganic waste to disintegrate and to vitrify on a solid residue while organic waste is converted into gases. Unlike any other thermal treatment of waste (incineration, gasification, pyrolysis, etc.) and because it is not a combustion process, but atomization of matter, no pollutant emissions into the atmosphere (dioxins and similar) or ash, there are only simple gases and an inert solid completely vitrified that can be used in the construction, for the obtaining of urban furniture, as decorative element, for example. The project proposes to develop an experimental device, laboratory plasma torch, to investigate its application in the reduction of hospital waste. It is expected to model, design and construct an experimental device that produces a plasma jet, whose temperature is adequate to perform hospital waste treatments at the laboratory level. The main objective of the project is to contribute to the generation of knowledge in the field of hospital waste reduction through the use of technological applications of plasmas, generating the necessary research for the study of art and technological development at the experimental level in the indicated field
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Directory of Open Access Journals (Sweden)
Chung-Shih Huang
2011-06-01
Conclusions: This study revealed that the volume of THAs performed by individual surgeons was a more important determinant of hospital utilization than hospital volume. Perioperative adverse events were associated with patients' age and comorbidity.
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Directory of Open Access Journals (Sweden)
Alejandro Sandoval-Daza
2010-03-01
Full Text Available Introduction: Total hip and knee replacements are surgical procedures commonly used in cases of degenerative articular problems, intrarticular fractures and less common in tumor conditions. Despite its great success complications can arise. Objective: Describe complications in total knee and hip replacements. Methods: A descriptive study, cases serie was done in Hospital Universitario San José in Popayán Colombia, analyzing the period between January 2004 and January 2009, Seventy six patients were included: 53 total hips replacements, 12 cases of partial hip replacements and 11 total knee replacements. Patient's age was in the range between 27 and 97. Results: The main complications founded were: respiratory insufficiency, inability to place the prosthesis, prosthesis dislocation, anemic syndrome, acetabular protrusion, infection, iatrogenic Gushing's syndrome, discrepancy of length limb, residual pain, inability to walk, nosocomial pneumonia, renal failure and periprosthetic fracture. An average of 4, 6% mortality index, 10, 8% hip prosthesis dislocation, 9, 2% infections, all these indices over the different literature reports.
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The Sandia total-dose estimator: SANDOSE description and user guide
International Nuclear Information System (INIS)
Turner, C.D.
1995-02-01
The SANdia total-DOSe Estimator (SANDOSE) is used to estimate total radiation dose to a (BRL-CAT) solid model, SANDOSE uses the mass-sectoring technique to sample the model using ray-tracing techniques. The code is integrated directly into the BRL-CAD solid model editor and is operated using a simple graphical user interface. Several diagnostic tools are available to allow the user to analyze the results. Based on limited validation using several benchmark problems, results can be expected to fall between a 10% underestimate and a factor of 2 overestimate of the actual dose predicted by rigorous radiation transport techniques. However, other situations may be encountered where the results might fall outside of this range. The code is written in C and uses X-windows graphics. It presently runs on SUN SPARCstations, but in theory could be ported to any workstation with a C compiler and X-windows. SANDOSE is available via license by contacting either the Sandia National Laboratories Technology Transfer Center or the author
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Abdulredha, Muhammad; Al Khaddar, Rafid; Jordan, David; Kot, Patryk; Abdulridha, Ali; Hashim, Khalid
2018-04-26
Major-religious festivals hosted in the city of Kerbala, Iraq, annually generate large quantities of Municipal Solid Waste (MSW) which negatively impacts the environment and human health when poorly managed. The hospitality sector, specifically hotels, is one of the major sources of MSW generated during these festivals. Because it is essential to establish a proper waste management system for such festivals, accurate information regarding MSW generation is required. This study therefore investigated the rate of production of MSW from hotels in Kerbala during major festivals. A field questionnaire survey was conducted with 150 hotels during the Arba'een festival, one of the largest festivals in the world, attended by about 18 million participants, to identify how much MSW is produced and what features of hotels impact on this. Hotel managers responded to questions regarding features of the hotel such as size (Hs), expenditure (Hex), area (Ha) and number of staff (Hst). An on-site audit was also carried out with all participating hotels to estimate the mass of MSW generated from these hotels. The results indicate that MSW produced by hotels varies widely. In general, it was found that each hotel guest produces an estimated 0.89 kg of MSW per day. However, this figure varies according to the hotels' rating. Average rates of MSW production from one and four star hotels were 0.83 and 1.22 kg per guest per day, respectively. Statistically, it was found that the relationship between MSW production and hotel features can be modelled with an R 2 of 0.799, where the influence of hotel feature on MSW production followed the order Hs > Hex > Hst. Copyright © 2018 Elsevier Ltd. All rights reserved.
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38 CFR 3.342 - Permanent and total disability ratings for pension purposes.
2010-07-01
... applied with other types of disabilities requiring hospitalization for indefinite periods. The need for... permanency of total disability contained in § 3.340, the following special considerations apply in pension... permanence of total disability will be established as of the earliest date consistent with the evidence in...
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Dulf, Francisc Vasile; Vodnar, Dan Cristian; Socaciu, Carmen
2016-10-15
Evolutions of phenolic contents and antioxidant activities during solid-state fermentation (SSF) of plum pomaces (from the juice industry) and brandy distillery wastes with Aspergillus niger and Rhizopus oligosporus were investigated. The effect of fermentation time on the oil content and major lipid classes in the plum kernels was also studied. Results showed that total phenolic (TP) amounts increased by over 30% for SSF with Rhizopus oligosporus and by >21% for SSF with A. niger. The total flavonoid contents presented similar tendencies to those of the TPs. The free radical scavenging activities of methanolic extracts were also significantly enhanced. The HPLC-MS analysis showed that quercetin-3-glucoside was the major phenolic compound in both fermented plum by-products. The results also demonstrated that SSF not only helped to achieve higher lipid recovery from plum kernels, but also resulted in oils with better quality attributes (high sterol ester and n-3 PUFA-rich polar lipid contents). Copyright © 2016 Elsevier Ltd. All rights reserved.
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Comparing public and private hospitals in China: evidence from Guangdong.
Eggleston, Karen; Lu, Mingshan; Li, Congdong; Wang, Jian; Yang, Zhe; Zhang, Jing; Quan, Hude
2010-03-23
The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care. We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes. Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix. In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of
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Comparing public and private hospitals in China: Evidence from Guangdong
Directory of Open Access Journals (Sweden)
Yang Zhe
2010-03-01
Full Text Available Abstract Background The literature comparing private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from high-income and established market economies. Studies from developing and transitional economies remain scarce, especially regarding patient case-mix and quality of care in public and private hospitals, even though countries such as China have expanded a mixed-ownership approach to service delivery. The purpose of this study is to compare the operations and performance of public and private hospitals in Guangdong Province, China, focusing on differences in patient case-mix and quality of care. Methods We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes. Results Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation. Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix. Conclusions In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital
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[Anesthesia practice in Catalan hospitals and other health care facilities].
Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María
2006-05-24
The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident
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Pyrolysis oil from carbonaceous solid wastes in Malaysia
International Nuclear Information System (INIS)
Islam, M.N.; Jamil, M.K.; Ani, F.N.; Zailani, R.
2000-01-01
The agro-industrial sector of Malaysia produces a huge amount of oil palm and paddy rice. These generate a significant amount of renewable biomass solid wastes in the forms of oil palm shell and rice husk. Apart from this a huge quantity of scrap tyre is generated from the country's faster increasing usage of transportation vehicles like motorcycle, car, bus and lorries. These wastes are producing pollution and disposal problems affecting the environment. Besides energy is not recovered efficiently from these waste resources. From the elemental composition and thermogravimetric analysis (TGA) studies of the wastes, it appeared that the wastes could be used for pyrolysis liquid oil production. Pyrolysis at present is deemed to be a potential method for the conversion of carbonaceous solid wastes into upgraded liquid products which can either be tried for liquid fuel or value-added chemical. A fluidized bed bench scale fast pyrolysis system was employed for this thermochemical conversion process of solid wastes. Silica sand was used as fluidized bed material and nitrogen gas as the fluidising medium. The products obtained were liquid oil, solid char and gas. The liquid oil and solid char were collected separately while the gas was flared. The maximum liquid product yield was found to vary with feedstock material fluidized bed temperature. The maximum liquid product yield was found to be 58, 53 and 40 wt. % of biomass fed at fluidized bed temperature at 500, 525 and 450 0 C respectively for oil palm shell, scrap tyre and rice husk. The solid char yield was 25, 36 and 53 wt. % of biomass fed at the condition of maximum liquid product yield for oil palm shell, scrap tyre and rice husk respectively. The oil products were subjected to FTIR, GC and GC/MS analysis for their group composition and detailed chemical compositions. The pyrolysis oil from scrap tyre was found to contain highest percentage of pure hydrocarbons (25 wt. % of total feed) with esters and oxygenated
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Subtotal versus total abdominal hysterectomy
DEFF Research Database (Denmark)
Andersen, Lea Laird; Ottesen, Bent; Alling Møller, Lars Mikael
2015-01-01
OBJECTIVE: The objective of the study was to compare long-term results of subtotal vs total abdominal hysterectomy for benign uterine diseases 14 years after hysterectomy, with urinary incontinence as the primary outcome measure. STUDY DESIGN: This was a long-term follow-up of a multicenter......, randomized clinical trial without blinding. Eleven gynecological departments in Denmark contributed participants to the trial. Women referred for benign uterine diseases who did not have contraindications to subtotal abdominal hysterectomy were randomized to subtotal (n = 161) vs total (n = 158) abdominal...... from discharge summaries from all public hospitals in Denmark. The results were analyzed as intention to treat and per protocol. Possible bias caused by missing data was handled by multiple imputation. The primary outcome was urinary incontinence; the secondary outcomes were pelvic organ prolapse...
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A New Method for Closure of Total Laryngectomy Wound
Directory of Open Access Journals (Sweden)
M R Fathol Olomi
2008-06-01
Full Text Available Background: Total laryngectomy is the mainstay of treatment for laryngeal cancer. Fistula is one of the most common complications after total laryngectomy. In patients without risk factors such as prior radiotherapy, diabetes mellitus or chronic renal disease, the incidence of pharyngocutaneous fistula is related to wound healing and duration of operation. We have developed a new method that is both simple and without the complication of pharangocutaneous fistula. Herein, we report the efficacy of this innovative method for the closure of total laryngectomy compared to the conventional method for closure.Methods: In this clinical trial, we included 40 patients with grade T3 or T4 squamous cell carcinoma of the larynx. The total laryngectomy of all patients was performed by the standard method. Twenty patients (case group were repaired by the new method for closure and 20 patients (control group were repaired by the standard method. Duration of surgery and hospital stay, bleeding, hematoma, seroma and fistula formation were characterized for every patient and statistically analyzed.Results: The mean age was 59.8 ±7.8 years for the control group and 61.3 ±6.4 years for the case group. Duration of surgery was 150 ±23.2 minutes and 130 ±18.7 minutes for the control and case groups, respectively (p<0.001. Duration of hospital stay was 10.5 ±1.6 and 3.1 ±0.2 days in the control and case groups, respectively (p<0.002. Bleeding, hematoma or seroma were not seen in either group. Pharyngocutaneous fistula occurred in three patients in control group and was not observed in case group.Conclusion: This new method for closure shortens the duration of surgery and hospital stay. Furthermore, the patients in the case group avoided the psychological and traumatic side effects of tube feeding associated with fistula. In addition, no other complications were observed with this method. We recommend the use of this simple and efficient method for wound closure
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Disposal of solid waste in Istanbul and along the Black Sea coast of Turkey
International Nuclear Information System (INIS)
Berkun, Mehmet; Aras, Egemen; Nemlioglu, Semih
2005-01-01
The increasing amount of solid waste arising from municipalities and other sources and its consequent disposal has been one of the major environmental problems in Turkey. Istanbul is a metropolitan city with a current population of around 14 million, and produces about 9000 ton of solid waste every day. The waste composition for Istanbul has changed markedly from 1981 to 1996 with large decreases in waste density, much of which is related to decreased amounts of ash collected in winter. In recent years, the Istanbul region has implemented a new solid waste management system with transfer stations, sanitary landfills, and methane recovery, which has led to major improvements. In the Black Sea region of Turkey, most of the municipal and industrial solid wastes, mixed with hospital and hazardous wastes, are dumped on the nearest lowlands and river valleys or into the sea. The impact of riverside and seashore dumping of solid wastes adds significantly to problems arising from sewage and industry on the Black Sea coast. Appropriate integrated solid waste management systems are needed here as well; however, they have been more difficult to implement than in Istanbul because of more difficult topography, weaker administrative structures, and the lower incomes of the inhabitants
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Solid waste from health services and the environment: perception of the nursing team
Directory of Open Access Journals (Sweden)
Ilisdayne Thallita Soares da Silva
2012-09-01
Full Text Available This study aimed to analyze the perception about the environmental impact of the production process of solid waste from health services of the nursing staff at a hospital in Santa Cruz. Qualitative research conducted in the period March-April 2010. Data were collected through interviews with 17 nurses and analyzed using thematic analysis. The data analysis demonstrated the production of solid wastes, along with the nursing procedures in your workspace. There was also a need for training on the solid waste from health services security-oriented environment, which indicates that knowledge by the nursing staff about this subject is still new, contributing to negative impacts on the environment are generated. Therefore, it is essential to invest in training that involves a process of continuing education, contributing to the consolidation of environmentally responsible values, to promote quality of life associated with sustainability and preservation.
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Directory of Open Access Journals (Sweden)
Pfeiffer Yvonne
2011-07-01
Full Text Available Abstract Background From a management perspective, it is necessary to examine how a hospital's top management assess the patient safety culture in their organisation. This study examines whether the Hospital Survey on Patient Safety Culture for hospital management (HSOPS_M has the same psychometric properties as the HSOPS for hospital employees does. Methods In 2008, a questionnaire survey including the HSOPS_M was conducted with 1,224 medical directors from German hospitals. When assessing the psychometric properties, we performed a confirmatory factor analysis (CFA. Additionally, we proved construct validity and internal consistency. Results A total of 551 medical directors returned the questionnaire. The results of the CFA suggested a satisfactory global data fit. The indices of local fit indicated a good, but not satisfactory convergent validity. Analyses of construct validity indicated that not all safety culture dimensions were readily distinguishable. However, Cronbach's alpha indicated that the dimensions had an acceptable level of reliability. Conclusion The analyses of the psychometric properties of the HSOPS_M resulted in reasonably good levels of property values. Although the set of dimensions within the HSOPS_M needs further scale refinement, the questionnaire covers a broad range of sub-dimensions and supplies important information on safety culture. The HSOPS_M, therefore, is eligible to measure safety culture from the hospital management's points of view and could be used in nationwide hospital surveys to make inter-organisational comparisons.
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A study on radiographic repeat rate data of several hospitals in Jeddah
International Nuclear Information System (INIS)
Al-Malki, M.A.; Abulfaraj, W.H.; Bhuiyan, S.I.; Kinsara, A.A.
2003-01-01
Radiographic repeat rate data in diagnostic radiology in King Fahad Hospital (KFH), King Abdulaziz Hospital (KAH), and Maternity and Children Hospital (MCH) in Jeddah, Saudi Arabia, have been studied. The study provided valuable information to suggest preventive measures to reduce repeats. The variables included in the study are exposure techniques, examination types, total number of films used, number of films repeated, the film sizes, gender, the age groups of the patients, and reason for repetition. The total number of examinations in all three hospitals is 6001 using 8887 films on 5412 patients. The average repeat rate was 7.93%, where the individual hospital repeat rates were 9.57% in the MCH, 7.84% in KAH and 7.44% in KFH. The repeat rate for children and infants was found to be undesirable. The quality assurance (QA) programme can effectively reduce the unnecessary exposure and can identify the cause of the exposure. The overexposure, underexposure and position fault were the foremost contributors for repeats and constitute 32.91%, 28.94% and 22.98% of the total respectively. The QA study identified that human error and equipment malfunction are the major contributors to these causes of repeats. The highest repetition rate was for pelvis, 13.64%, followed by skull, 11.59%, and abdomen, 10.41%. It is estimated that the total area of wasted film in all three hospitals is 74.3 m 2 . As per the average repeat rate, the cost of repeat films in the entire kingdom per year has been projected to be about US$1.82 million (SR 6.83 million) in the government hospitals only. Based on the findings of this study a set of recommendations have been prescribed for the radiology department to reduce the repeat rate and to improve the safety culture. (author)
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A study on radiographic repeat rate data of several hospitals in Jeddah
Energy Technology Data Exchange (ETDEWEB)
Al-Malki, M.A.; Abulfaraj, W.H.; Bhuiyan, S.I.; Kinsara, A.A
2003-07-01
Radiographic repeat rate data in diagnostic radiology in King Fahad Hospital (KFH), King Abdulaziz Hospital (KAH), and Maternity and Children Hospital (MCH) in Jeddah, Saudi Arabia, have been studied. The study provided valuable information to suggest preventive measures to reduce repeats. The variables included in the study are exposure techniques, examination types, total number of films used, number of films repeated, the film sizes, gender, the age groups of the patients, and reason for repetition. The total number of examinations in all three hospitals is 6001 using 8887 films on 5412 patients. The average repeat rate was 7.93%, where the individual hospital repeat rates were 9.57% in the MCH, 7.84% in KAH and 7.44% in KFH. The repeat rate for children and infants was found to be undesirable. The quality assurance (QA) programme can effectively reduce the unnecessary exposure and can identify the cause of the exposure. The overexposure, underexposure and position fault were the foremost contributors for repeats and constitute 32.91%, 28.94% and 22.98% of the total respectively. The QA study identified that human error and equipment malfunction are the major contributors to these causes of repeats. The highest repetition rate was for pelvis, 13.64%, followed by skull, 11.59%, and abdomen, 10.41%. It is estimated that the total area of wasted film in all three hospitals is 74.3 m{sup 2}. As per the average repeat rate, the cost of repeat films in the entire kingdom per year has been projected to be about US$1.82 million (SR 6.83 million) in the government hospitals only. Based on the findings of this study a set of recommendations have been prescribed for the radiology department to reduce the repeat rate and to improve the safety culture. (author)
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Dulf, Francisc Vasile; Vodnar, Dan Cristian; Dulf, Eva-Henrietta; Toşa, Monica Ioana
2015-04-08
The aim of this study was to investigate the effect of solid-state fermentation (SSF) by Aspergillus niger on phenolic contents and antioxidant activity in Sambucus nigra L. and Sambucus ebulus L. berry pomaces. The effect of fermentation time on the total fats and major lipid classes (neutral and polar) was also investigated. During the SSF, the extractable phenolics increased with 18.82% for S. ebulus L. and 11.11% for S. nigra L. The levels of antioxidant activity of methanolic extracts were also significantly enhanced. The HPLC-MS analysis indicated that the cyanidin 3-sambubioside-5-glucoside is the major phenolic compound in both fermented Sambucus fruit residues. In the early stages of fungal growth, the extracted oils (with TAGs as major lipid fraction) increased with 12% for S. nigra L. and 10.50% for S. ebulus L. The GC-MS analysis showed that the SSF resulted in a slight increase of the linoleic and oleic acids level.
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Does electronic health record use improve hospital financial performance? Evidence from panel data.
Collum, Taleah H; Menachemi, Nir; Sen, Bisakha
2016-01-01
The aim of this study was to examine the impact of electronic health record (EHR) adoption on hospital financial performance. We constructed a longitudinal panel using data from the three secondary sources: (a) the 2007-2010 American Hospital Association (AHA) Annual Survey, (b) the 2007-2010 AHA Annual Survey Information Technology Supplement, and (c) the 2007-2011 Medicare Cost Reports from Centers for Medicare and Medicaid Services. Because potential financial benefits attributable to EHR adoption may take some time to accrue, we ran regressions with lags of 1 and 2 years that included hospital and year fixed effects to examine the relationship between the level of EHR adoption and three hospital financial performance measures. A change in the level of EHR adoption was not associated with changes in operating margin or return on assets within hospitals. However, total margin was significantly improved, after 2 years, in hospitals that moved from no EHR to having a comprehensive EHR in all areas of their hospital (β = 0.030, p financial performance measures examined. The improvements in total margin, as opposed to operating margin, are likely due to hospital incentive payments under the Health Information Technology for Economic and Clinical Health Act that are reflected in nonpatient revenues and therefore show up in total margin calculations. Thus, after 2 years of EHR adoption, hospital financial performance is observed to improve based only on meaningful use incentive payments. More research will be needed to determine whether EHR adoption impacts financial performance on a longer time horizon.
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[Prevalence of pressure sores in a university hospital in 2003].
Daideri, G; Berthier, F; Brocker, P; Darmon, M-J; Mignolet, F; Quaranta, J-F; Staccini, P
2006-12-01
To determine the prevalence of pressure sores in a university hospital and to assess the risk of developing a pressure sore. A one-day survey was performed in all hospitalized patients, day hospital excepted. The Garches scale was used to assess the severity of pressure sores and the Braden scale was used to measure the patient's risk for the development of pressure ulcers. One thousand six hundred and eleven patients were included, mean age was 62+/-23 years and 53.3% were over 65 years old. In hospitalized patients, 64% were in acute care, 29% in intermediate medicine and long-term care and 7% in intensive care units. We have found 675 pressure sores in 268 patients, mean age of 76 years; 263 decubitus ulcers were acquired during hospitalization. The most frequent sites were heels (46%) and sacrum (26%). Stage 1 pressure ulcers showed 33% of the total. The total prevalence was 16.6%, 95% CI (14.9-18.6), the hospital acquired pressure sores prevalence was 7.5%, all stages included. A Braden score less than or equal to 15 was found in 29.1% of hospitalized patients. Standard mattresses were used in 37% of patients with pressure sores. Multivariate analysis showed that age and a Braden score less than or equal to 15 were significantly associated with pressure sores. Pressure sores are still an important problem in hospital; occurrence must be considered as an iatrogenic event and management requires a multidisciplinary approach.
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Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F
2010-04-01
To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Scope for energy improvement for hospital imaging services in the USA.
Esmaeili, Amin; Twomey, Janet M; Overcash, Michael R; Soltani, Seyed A; McGuire, Charles; Ali, Kamran
2015-04-01
To aid radiologists by measuring the carbon footprint of CT scans by quantifying in-hospital and out-of-hospital energy use and to assess public health impacts. The study followed a standard life cycle assessment protocol to measure energy from a CT scan then expanding to all hospital electrical energy related to CT usage. In addition, all the fuel energy used to generate electricity and to manufacture the CT consumables was measured. The study was conducted at two hospitals. The entire life cycle energy for a CT scan was 24-34 kWh of natural resource energy per scan. The actual active patient scan energy that produces the images is only about 1.6% of this total life cycle energy. This large multiplier to get total CT energy is a previously undocumented environmental response to the direct radiology order for a patient CT scan. The CT in-hospital energy related to idle periods, where the machine is on but no patients are being scanned and is 14-30-fold higher than the energy used for the CT image. The in-hospital electrical energy of a CT scan makes up only about 25% of the total energy footprint. The rest is generated outside the hospital: 54-62% for generation and transmission of the electricity, while 13-22% is for all the energy to make the consumables. Different CT scanners have some influences on the results and could help guide purchase of CT equipment. The transparent, detailed life cycle approach allows the data from this study to be used by radiologists to examine details of both direct and of unseen energy impacts of CT scans. The public health (outside-the-hospital) impact (including the patients receiving a CT) needs to be measured and included. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
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Alternatives for the treatment of the organic fraction of the urban solid residuals
International Nuclear Information System (INIS)
Benitez Fonseca, Mabelin; Fernandez Mena, Dalia; Abalos Rodriguez, Arelis; Rodriguez Perez, Suyen
2011-01-01
The decomposition of municipal solid waste outdoors, or in some cases burning under the same conditions, is action now and final disposition of these wastes without measuring their consequences. In the student's residence 'Antonio Maceo' Orient University is hosting up to 2250 students belonging to a total of 22 university, generating at full capacity, 3375 kg / day of MSW. This research aims to analyze the solid waste generated in the student's residence, where improperly evaluated the final disposition thereof. It was found that discharges are not separated at the source observed at the landfill, food waste, sweeping waste, paper and cardboard, plastics, glass, metal, textile waste, wood, etc. Samplings were carried out directly in 12 rooms of the residence for a total of 48 people, along with students, as part of the educational activities implemented within this work. The average weight of degradable waste generated was 2.5 kg / day during the sampling, revealing the presence of traces of cooked food (cereals, legumes, carbohydrates), fruit and vegetable remains, remains of shells of different origins ( meats, eggs), remnants of tea, etc. The average content of total solids in the waste sampled was 36.3 ± 5.4% and volatile solids content on dry weight was 81.3 ± 2.5% to an average density of 0.68 g / cm3. This residue is characterized to be treated in an anaerobic batch reactor where it is recirculated leachate and studied the competing microorganisms in the anaerobic degradation of organic fraction of municipal solid waste. (author)
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No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations
Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.
2016-01-01
Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514
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Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach
2011-04-01
HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through
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Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.
Shaikh, Sajid A; Robinson, Richard D; Cheeti, Radhika; Rath, Shyamanand; Cowden, Chad D; Rosinia, Frank; Zenarosa, Nestor R; Wang, Hao
2018-01-30
Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow. Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model. Hospital charges, potential savings of hospital bed hours, and whether detailed discharge instructions provided adequate explanations to patients were also analyzed. A total of 11,527 admissions was entered into final analysis. The median discharge boarding time was approximately 2 h. Adjusted Odds Ratio (AOR) of patients transferring to other hospitals was 7.45 (95% CI 5.35-10.37), to court or law enforcement custody was 2.51 (95% CI 1.84-3.42), and to a skilled nursing facility was 2.48 (95% CI 2.10-2.93). AOR was 0.57 (95% CI 0.47-0.71) if the disposition order was placed during normal office hours (0800-1700). AOR of early case management consultation was 1.52 (95% CI 1.37-1.68) versus 1.73 (95% CI 1.03-2.89) for late consultation. Eighty-eight percent of patients experiencing discharge boarding times within 2 h of disposition expressed positive responses when questioned about the quality of explanations of discharge instructions and follow-up plans based on satisfaction surveys. Similar results (86% positive response) were noted among patients whose discharge boarding times were prolonged (> 2 h, p = 0.44). An average charge of $6/bed/h was noted in all hospital discharges. Maximizing early discharge boarding (≤ 2 h) would have resulted in 16,376 hospital bed hours saved thereby averting $98,256.00 in unnecessary dwell time charges in this study population alone. Type of disposition, case
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Interaction of debris with a solid obstacle: Numerical analysis
International Nuclear Information System (INIS)
Kosinska, Anna
2010-01-01
The subject of this research is the propagation of a cloud of solid particles formed from an explosion-damaged construction. The main objective is the interaction of the cloud (debris) with a solid beam located at some distance from the explosion. The mathematical model involves the flow of the gas using standard conservation equations, and this part of the model is solved numerically. The solid particles are treated as a system of solid points (so-called Lagrangian approach), whose motion is the result of the flowing gas as well as collisions with obstacles. These two issues are described respectively by Newton's second law and the hard-sphere model. The model is used to simulate various cases where the influence of different parameters like the value of the pressure of the explosion, the particle size, the number of particles and the obstacle location are investigated. The results are presented as snapshots of particle location, and also as the particle total momentum during collision with the beam.
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This method describes procedures for preparation and analysis of solid, water and wipe samples for detection and measurement of cyanide amendable to chlorination using acid digestion and spectrophotometry.
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Kim, Jin Gook; Kim, Hong Lim; Kim, Su Jin; Park, Kyo-Sun
2013-01-01
Blueberry fruits from 45 commercial cultivars (39 northern highbush and 6 half highbush blueberry) grown in Suwon, Korea were analyzed for fruit size, soluble solids content, titratable acidity, total anthocyanin content, total phenolic content, and antioxidant activity. Fruit characteristics varied widely among the 45 blueberry cultivars. Fruit weight ranged from 0.9 to 3.6 g, soluble solids content from 8.3 to 14.3 °Brix, and titratable acidity from 0.8% to 3.6%. Antioxidant activity ranged...
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Patidar, Nitish; Weech-Maldonado, Robert; O'Connor, Stephen J; Sen, Bisakha; Trimm, J M Mickey; Camargo, Carlos A
Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011. Data on FSEDs were merged with American Hospital Association Annual Survey, Centers for Medicare and Medicaid Services' Cost Reports, and Area Resource File data. The outcome variable consists of whether or not the hospital operates an FSED. Independent variables include per capita income, percent population over age of 65 years, primary care and specialist physicians per capita, urban location, change in the unemployment rate, change in the population, change in poverty level, market competition, total satellite and autonomous FSEDs in the market, Medicare-managed care penetration rate, hospital beds, total margin, and system membership. We used logistic regression analysis with state and year fixed effects. Standard errors in the regression were clustered by hospital. The number of hospitals operating satellite FSEDs increased from 32 (2.33%) in 2002 to 91 (5.76%) hospitals in 2011 among the 14 states included in the study sample. The results support the hypothesis that hospitals located in munificent environments and more competitive environments (presence of other FSEDs) are more likely to operate an FSED. Organizational level factors such as bed size and system membership are associated with a hospital operating an FSED. The findings may be used by policy makers in developing regulations for hospitals opening FSEDs. Also, study findings of this study may be used by hospitals to make informed decisions when formulating strategies regarding FSEDs.
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Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest
Directory of Open Access Journals (Sweden)
Herlitz Johan
2010-08-01
Full Text Available Abstract Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR, including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.
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Work hours and sleep/wake behavior of Australian hospital doctors.
Ferguson, Sally A; Thomas, Matthew J W; Dorrian, Jillian; Jay, Sarah M; Weissenfeld, Adrian; Dawson, Drew
2010-07-01
The objective of the study was to describe the work and sleep patterns of doctors working in Australian hospitals. Specifically, the aim was to examine the influence of work-related factors, such as hospital type, seniority, and specialty on work hours and their impact on sleep. A total of 635 work periods from 78 doctors were analyzed together with associated sleep history. Work and sleep diary information was validated against an objective measure of sleep/wake activity to provide the first comprehensive database linking work and sleep for individual hospital doctors in Australia. Doctors in large and small facilities had fewer days without work than those doctors working in medium-sized facilities. There were no significant differences in the total hours worked across these three categories of seniority; however, mid-career and senior doctors worked more overnight and weekend on-call periods than junior doctors. With respect to sleep, although higher work hours were related to less sleep, short sleeps (work) were observed at all levels of prior work history (including no work). In this population of Australian hospital doctors, total hours worked do impact sleep, but the pattern of work, together with other nonwork factors are also important mediators.
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[Effects of hospital mergers on health economy].
Ingebrigtsen, Tor
2010-05-06
Norwegian hospitals have been characterised by increasing activity, expansion of services and increasing costs for a long time. Differences in quality and accessibility have been documented between hospitals in various geographic locations. Transferral of hospital ownership to the state (from 2002) aimed at increasing capacities and improving quality of services, but also at restricting the increase of costs. These goals have only been partly met. The structure of hospital trusts and organisation of services are therefore continuously debated. This literature review aims at examining whether hospital mergers can reduce costs and at the same time increase the quality of services offered. Literature was identified through a Medline search using the terms "hospital", "merger" and "cost saving". The results are summarized and discussed. Seven original studies of totally 476 hospital mergers (in the USA, Great Britain and Norway) were identified in the period 1982 - 2000. The literature indicates that hospital mergers have a potential to reduce costs by about 10 % if the process achieves complete fusion of previously independent organisations, with a more optimal dimensioning of services and development of a common organizational culture. Collaboration between top management and the professional bureaucracy are prerequisites for success. Mergers are associated with a significant risk of unexpected problems and temporary reduced quality of the services.
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Economic impact of surgery cancellation in a general hospital, Iran
African Journals Online (AJOL)
unhcc
cause of inefficient use of operating room (OR) time and a drain on finite .... of total hospitalizations. In this hospital (270 beds ... Preoperative instructions not followed or patient not instructed. Change in .... concrete possibilities of reducing the level of surgical cancellations by .... room case-mix problem under uncertainty and.
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Increase in hospital admissions for acute childhood asthma in Cape ...
African Journals Online (AJOL)
To determine whether hospital admissions for acute childhood asthma were rising in Cape Town in line with the experience of other countries, Red Cross War Memorial Children's Hospital's records for the period 1978 - 1990 were analysed. These were compared with total admissions for non-surgical causes and lower ...
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Chronic Hepatitis C-Related Cirrhosis Hospitalization Cost Analysis in Bulgaria
Directory of Open Access Journals (Sweden)
Maria Dimitrova
2017-08-01
Full Text Available ObjectiveHCV infection is a leading cause of chronic liver disease with long-term complications—extensive fibrosis, cirrhosis, and hepatocellular carcinoma. The objective of this study is to perform cost analysis of therapy of patients with chronic HCV-related cirrhosis hospitalized in the University Hospital “Queen Joanna-ISUL” for 3-year period (2012–2014.MethodsIt is a prospective, real life observational study of 297 patients with chronic HCV infection and cirrhosis monitored in the University Hospital “Queen Joanna-ISUL” for 3-year period. Data on demographic, clinical characteristics, and health-care resources utilization (hospitalizations, highly specialized interventions, and pharmacotherapy were collected. Micro-costing approach was applied to evaluate the total direct medical costs. The points of view are that of the National Health Insurance Fund (NHIF, hospital and the patients. Collected cost data are from the NHIF and hospitals tariffs, patients, and from the positive dug list for medicines prices. Descriptive statistics, chi-squared test, Kruskal–Wallis, and Friedman tests were used for statistical processing.Results76% of patients were male. 93% were diagnosed in grade Child-Pugh A and B. 97% reported complications, and almost all developed esophageal varices. During the 3 years observational period, patients did not change the critical clinical values for Child-Pugh status and therefore the group was considered as homogenous. 847 hospitalizations were recorded for 3 years period with average length of stay 17 days. The mortality rate of 6.90% was extremely high. The total direct medical costs for the observed cohort of patients for 3-year period accounted for 1,290,533 BGN (€659,839 with an average cost per patient 4,577 BGN (€2,340. Statistically significant correlation was observed between the total cost per patient from the different payers’ perspective and the Child-Pugh cirrhosis score
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Psychosocial work conditions associated with sickness absence among hospital employees
DEFF Research Database (Denmark)
Suadicani, P; Olesen, K; Bonde, J P
2014-01-01
's salary database. RESULTS: A total of 1809 hospital employees took part with a response rate of 65%. The mean age was 43 (range: 20-69) and 75% were female. Totally, 363 study participants (20%) had at least 14 days sickness absence (defined as high absence) during the preceding year. Associations between...... essential covariates of sickness absence. METHODS: A cross-sectional questionnaire study of hospital employees which sought information on elements of the psychosocial work environment, general health status, life style, age, gender and profession. Data on sickness absence were obtained from the employer...
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Comparison of three cyanogen assays for total cyanogens in cassava (Manihot esculenta Crantz)
DEFF Research Database (Denmark)
Saka, J.D.K.; Mhone, A.R.K.; Brimer, Leon
1997-01-01
The sensitivity and reproducibility of three methods for determining the total cyanogenic potential (CNp) of 7 fresh and processed cassava varieties were determined and compared. The total cyanogen content of fresh cassava roots and three cassava products (kondowole, makaka, and starch) were...... analysed by the acid hydrolysis, microdiffusion with solid state detection and Cooke's enzymatic assays. The total cyanogen contents of the cassava, obtained by the three methods were not significantly different (p....3+or-0.4 and 20.4+or-1.4 mg HCN eq. kg-1 fresh weight by Cooke's, acid hydrolysis and solid state methods, respectively. However, at very low cyanogen levels, less than 5 mg HCN eq. kg-1 fresh weight, the acid hydrolysis method overestimates by 3-5 times. Otherwise, their coefficients of variations...
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Controlling for quality in the hospital cost function.
Carey, Kathleen; Stefos, Theodore
2011-06-01
This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services.
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Management of Grave's disease is improved by total thyroidectomy.
Annerbo, Maria; Stålberg, Peter; Hellman, Per
2012-08-01
A retrospective analysis was performed on 267 consecutive patients with Graves' disease (GD). The principal aim of this study was to evaluate the risk for recurrence and complications when changing the surgical method from subtotal (ST) to total thyroidectomy (TT). Information from 267 consecutive patients operated on for GD between 2000 and 2006 was collected at Uppsala University Hospital (143) and Falun County Hospital (128). There were 229 women and 38 men. Four patients were operated on twice. A total of 40 STs and 229 TTs were performed. Results were compared to those of a previous cohort from the same hospital, with a majority of STs (157/176) performed from 1980 to 1992. The risk for relapse of GD was reduced from 20 to 3.3 % after the shift from ST to TT. In terms of surgical complications, 2.2 % demonstrated permanent vocal cord paralysis and 4.5 % had persistent hypocalcemia, not significant when compared to the previous cohort. In spite of TT, there were four recurrences, all due to remnant thyroid tissue high up at the hyoid bone. Changing the surgical method did not affect postoperative progression of dysthyroid ophthalmopathy (DO, 7.0 vs. 7.5 %). There were no differences in outcome with respect to which hospital the patients had their operation. Change from ST to TT dramatically reduced the risk for recurrence of GD without increasing the rate of complications. TT is not more effective than ST in hampering progression of DO as has been advocated by some. Careful surgical dissection up to the hyoid bone is necessary to avoid recurrence.
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An examination of hospital satisfaction with blood suppliers.
Carden, Robert; DelliFraine, Jami L
2004-11-01
The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.
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Directory of Open Access Journals (Sweden)
Vaňková Ivana
2014-09-01
Full Text Available This paper aims to provide an efficiency evaluation of selected hospital bed care providers during years 2010 -2012 with respect to selected factors: The size of the hospital establishment according to number of beds, number of hospitalized patients, the average length of stay per a patient in care, total staff cost calculated per bed, total revenues calculated per bed, and total costs calculated per bed. For this purpose, hospitals providing primarily acute bed care were chosen. From the legal point of view, they are allowance organizations of a particular region. The evaluation concerns both allocative efficiency and technical efficiency. The allocative efficiency is treated from the proper algorithm point of view and it compares total costs calculated per bed with total revenues calculated per bed. A method denominated Data Envelopment Analysis was applied for the calculation of the technical efficiency of units. To be more specific, it was input-oriented model with constant returns to scale (CCR. The input parameters involve the number of beds, the average length of stay and costs per day of stay. Output parameters were as follows: Bed occupancy in days and the number of hospitalized patients. The data published by the Institute of Health Information and Statistic of the Czech Republic and by ÚFIS system (the Data Base of Ministry of Finance of the Czech Republic were used as the source of data. The evaluation implies that only three hospitals were economically-effective: Silesian Hospital in Opava, Hospital Jihlava, and TGM Hospital Hodonín. The most significant factor influencing the efficiency was determined - the average length of stay.
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Torrefaction Processing for Human Solid Waste Management
Serio, Michael A.; Cosgrove, Joseph E.; Wójtowicz, Marek A.; Stapleton, Thomas J.; Nalette, Tim A.; Ewert, Michael K.; Lee, Jeffrey; Fisher, John
2016-01-01
This study involved a torrefaction (mild pyrolysis) processing approach that could be used to sterilize feces and produce a stable, odor-free solid product that can be stored or recycled, and also to simultaneously recover moisture. It was demonstrated that mild heating (200-250 C) in nitrogen or air was adequate for torrefaction of a fecal simulant and an analog of human solid waste (canine feces). The net result was a nearly undetectable odor (for the canine feces), complete recovery of moisture, some additional water production, a modest reduction of the dry solid mass, and the production of small amounts of gas and liquid. The liquid product is mainly water, with a small Total Organic Carbon content. The amount of solid vs gas plus liquid products can be controlled by adjusting the torrefaction conditions (final temperature, holding time), and the current work has shown that the benefits of torrefaction could be achieved in a low temperature range (< 250 C). These temperatures are compatible with the PTFE bag materials historically used by NASA for fecal waste containment and will reduce the energy consumption of the process. The solid product was a dry material that did not support bacterial growth and was hydrophobic relative to the starting material. In the case of canine feces, the solid product was a mechanically friable material that could be easily compacted to a significantly smaller volume (approx. 50%). The proposed Torrefaction Processing Unit (TPU) would be designed to be compatible with the Universal Waste Management System (UWMS), now under development by NASA. A stand-alone TPU could be used to treat the canister from the UWMS, along with other types of wet solid wastes, with either conventional or microwave heating. Over time, a more complete integration of the TPU and the UWMS could be achieved, but will require design changes in both units.
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Accreditation in a public hospital: perceptions of a multidisciplinary team.
Camillo, Nadia Raquel Suzini; Oliveira, João Lucas Campos de; Bellucci Junior, José Aparecido; Cervilheri, Andressa Hirata; Haddad, Maria do Carmo Fernandez Lourenço; Matsuda, Laura Misue
2016-06-01
to analyze the perceptions of the multidisciplinary team on Accreditation in a public hospital. descriptive, exploratory, qualitative research, performed in May 2014, using recorded individual interviews. In total, 28 employees of a public hospital, Accredited with Excellence, answered the guiding question: "Tell me about the Accreditation system used in this hospital". The interviews were transcribed and subjected to content analysis. of the speeches, three categories emerged: Advantages offered by the Accreditation; Accredited public hospital resembling a private hospital; Pride/satisfaction for acting in an accredited public hospital. participants perceived Accreditation as a favorable system for a quality management in the public service because it promotes the development of professional skills and improves cost management, organizational structure, management of assistance and perception of job pride/satisfaction.
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Influence of leachate recirculation on aerobic and anaerobic decomposition of solid wastes
International Nuclear Information System (INIS)
Bilgili, M. Sinan; Demir, Ahmet; Ozkaya, Bestamin
2007-01-01
In this study, the effect of leachate recirculation on aerobic and anaerobic degradation of municipal solid wastes is determined by four laboratory-scale landfill reactors. The options studied and compared with the traditional anaerobic landfill are: leachate recirculation, landfill aeration, and aeration with leachate recirculation. Leachate quality is regularly monitored by the means of pH, alkalinity, total dissolved solids, conductivity, oxidation-reduction potential, chloride, chemical oxygen demand, ammonia, and total Kjeldahl nitrogen, in addition to generated leachate quantity. Aerobic leachate recirculated landfill appears to be the most effective option in the removal of organic matter and ammonia. The main difference between aerobic recirculated and non-recirculated landfill options is determined at leachate quantity. Recirculation is more effective on anaerobic degradation of solid waste than aerobic degradation. Further studies are going on to determine the optimum operational conditions for aeration and leachate recirculation rates, also with the operational costs of aeration and recirculation
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International Nuclear Information System (INIS)
Papageorgiou, E.; Tsapaki, V.; Tsalafoutas, I. A.; Maurikou, E.; Kottou, S.; Orfanos, A.; Karidas, G.; Fidanis, T.; Zafiriadou, E.; Neofotistou, V.
2007-01-01
Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm 2 for hospital 'A' and 21 and 49 Gy cm 2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm 2 while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm 2 . The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used. (authors)
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Husfeldt, A W; Endres, M I; Salfer, J A; Janni, K A
2012-04-01
Interest in using recycled manure solids (RMS) as a bedding material for dairy cows has grown in the US Midwest. Cost of common bedding materials has increased in recent years and availability has decreased. Information regarding the composition of RMS and its use as a bedding material for dairy cows in the Midwest is very limited. The objectives of this study were to characterize RMS as a bedding material, observe bedding management practices, document methods of obtaining RMS, and describe housing facilities. We visited 38 Midwest dairy operations bedding freestalls with RMS to collect data. Methods of obtaining RMS for bedding included separation of anaerobic digested manure, separation of raw manure, and separation of raw manure followed by mechanical drum-composting for 18 to 24 h. Average bedding moisture of unused RMS was 72.4% with a pH of 9.16. Unused samples contained (on a dry basis) 1.4% N, 44.9% C, 32.7C:N ratio, 0.44% P, 0.70% K, 76.5% neutral detergent fiber, 9.4% ash, 4.4% nonfiber carbohydrates, and 1.1% fat. Moisture was lowest for drum-composted solids before and after use as freestall bedding. After use in the stalls, digested solids had lower neutral detergent fiber content (70.5%) than drum-composted (75.0%) and separated raw (73.1%) solids. Total N content was greater in digested solids (2.0%) than in separated raw (1.7%) solids. Total bacterial populations in unused bedding were greatest in separated raw manure solids but were similar between digested and drum-composted manure solids. Drum-composted manure solids had no coliform bacteria before use as freestall bedding. After use as bedding, digested manure solids had lower total bacteria counts compared with drum-composted and separated raw manure solids, which had similar counts. Used bedding samples of digested solids contained fewer environmental streptococci than drum-composted and separated raw solids and had reduced Bacillus counts compared with separated raw solids. Coliform counts
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Costs of hospital malnutrition.
Curtis, Lori Jane; Bernier, Paule; Jeejeebhoy, Khursheed; Allard, Johane; Duerksen, Donald; Gramlich, Leah; Laporte, Manon; Keller, Heather H
2017-10-01
Hospital malnutrition has been established as a critical, prevalent, and costly problem in many countries. Many cost studies are limited due to study population or cost data used. The aims of this study were to determine: the relationship between malnutrition and hospital costs; the influence of confounders on, and the drivers (medical or surgical patients or degree of malnutrition) of the relationship; and whether hospital reported cost data provide similar information to administrative data. To our knowledge, the last two goals have not been studied elsewhere. Univariate and multivariate analyses were performed on data from the Canadian Malnutrition Task Force prospective cohort study combined with administrative data from the Canadian Institute for Health Information. Subjective Global Assessment was used to assess the relationship between nutritional status and length of stay and hospital costs, controlling for health and demographic characteristics, for 956 patients admitted to medical and surgical wards in 18 hospitals across Canada. After controlling for patient and hospital characteristics, moderately malnourished patients' (34% of surveyed patients) hospital stays were 18% (p = 0.014) longer on average than well-nourished patients. Medical stays increased by 23% (p = 0.014), and surgical stays by 32% (p = 0.015). Costs were, on average, between 31% and 34% (p-values < 0.05) higher than for well-nourished patients with similar characteristics. Severely malnourished patients (11% of surveyed patients) stayed 34% (p = 0.000) longer and had 38% (p = 0.003) higher total costs than well-nourished patients. They stayed 53% (p = 0.001) longer in medical beds and had 55% (p = 0.003) higher medical costs, on average. Trends were similar no matter the type of costing data used. Over 40% of patients were found to be malnourished (1/3 moderately and 1/10 severely). Malnourished patients had longer hospital stays and as a result cost more than well
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Forecasting municipal solid waste generation using prognostic tools and regression analysis.
Ghinea, Cristina; Drăgoi, Elena Niculina; Comăniţă, Elena-Diana; Gavrilescu, Marius; Câmpean, Teofil; Curteanu, Silvia; Gavrilescu, Maria
2016-11-01
For an adequate planning of waste management systems the accurate forecast of waste generation is an essential step, since various factors can affect waste trends. The application of predictive and prognosis models are useful tools, as reliable support for decision making processes. In this paper some indicators such as: number of residents, population age, urban life expectancy, total municipal solid waste were used as input variables in prognostic models in order to predict the amount of solid waste fractions. We applied Waste Prognostic Tool, regression analysis and time series analysis to forecast municipal solid waste generation and composition by considering the Iasi Romania case study. Regression equations were determined for six solid waste fractions (paper, plastic, metal, glass, biodegradable and other waste). Accuracy Measures were calculated and the results showed that S-curve trend model is the most suitable for municipal solid waste (MSW) prediction. Copyright © 2016 Elsevier Ltd. All rights reserved.