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  1. Hospital librarianship in the United States: at the crossroads.

    Science.gov (United States)

    Wolf, Diane G; Chastain-Warheit, Christine C; Easterby-Gannett, Sharon; Chayes, Marion C; Long, Bradley A

    2002-01-01

    This paper examines recent developments in hospital librarianship in the United States, including the current status of hospital-based clinical library services. Several examples of hospital library services are presented that demonstrate some characteristics of struggling and thriving services. The implications of the informationist concept are considered. The continuation of the hospital librarian's primary role in support of patient care is explored, as core competencies are reexamined for relevancy in the new millennium.

  2. Leptospirosis-associated hospitalizations, United States, 1998-2009.

    Science.gov (United States)

    Traxler, Rita M; Callinan, Laura S; Holman, Robert C; Steiner, Claudia; Guerra, Marta A

    2014-08-01

    A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998-2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease-associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.

  3. Emergency department transfers and transfer relationships in United States hospitals.

    Science.gov (United States)

    Kindermann, Dana R; Mutter, Ryan L; Houchens, Robert L; Barrett, Marguerite L; Pines, Jesse M

    2015-02-01

    The objective was to describe transfers out of hospital-based emergency departments (EDs) in the United States and to identify different characteristics of sending and receiving hospitals, travel distance during transfer, disposition on arrival to the second hospital, and median number of transfer partners among sending hospitals. Emergency department records were linked at transferring hospitals to ED and inpatient records at receiving hospitals in nine U.S. states using the 2010 Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases and State Inpatient Databases, the American Hospital Association Annual Survey, and the Trauma Information Exchange Program. Using the Clinical Classification Software (CCS) to categorize conditions, the 50 disease categories with the highest transfer rates were studied, and these were then placed into nine clinical groups. Records were included where both sending and receiving records were available; these data were tabulated to describe ED transfer patterns, hospital-to-hospital distances, final patient disposition, and number of transfer partners. A total of 97,021 ED transfer encounters were included in the analysis from the 50 highest transfer rate disease categories. Among these, transfer rates ranged from 1% to 13%. Circulatory conditions made up about half of all transfers. Receiving hospitals were more likely to be nonprofit, teaching, trauma, and urban and have more beds with greater specialty coverage and more advanced diagnostic and therapeutic resources. The median transfer distance was 23 miles, with 25% traveling more than 40 to 50 miles. About 8% of transferred encounters were discharged from the second ED, but that varied from 0.6% to 53% across the 50 conditions. Sending hospitals had a median of seven transfer partners across all conditions and between one and four per clinical group. Among high-transfer conditions in U.S. EDs, patients are often transferred great distances, more

  4. Social Determinants of Influenza Hospitalization in the United States.

    Science.gov (United States)

    Chandrasekhar, Rameela; Sloan, Chantel; Mitchel, Edward; Ndi, Danielle; Alden, Nisha; Thomas, Ann; Bennett, Nancy M; Kirley, Pam D; Hill, Mary; Anderson, Evan J; Lynfield, Ruth; Yousey-Hindes, Kimberly; Bargsten, Marisa; Zansky, Shelley M; Lung, Krista; Schroeder, Monica; Monroe, Maya; Eckel, Seth; Markus, Tiffanie M; Cummings, Charisse N; Garg, Shikha; Schaffner, William; Lindegren, Mary Lou

    2017-09-05

    Influenza hospitalizations result in substantial morbidity and mortality each year. Little is known about the association between influenza hospitalization and census tract-based socioeconomic determinants beyond the effect of individual factors. To evaluate if census tract-based determinants such as poverty and household crowding would contribute significantly to the risk of influenza hospitalization above and beyond individual level determinants. We analyzed 33,515 laboratory-confirmed influenza-associated hospitalizations that occurred during the 2009-2010 through 2013-2014 influenza seasons using a population-based surveillance system at 14 sites across the United States. Using a multilevel regression model, we found that individual factors were associated with influenza hospitalization with the highest adjusted odds ratio (AOR) of 9.20 (95% CI 8.72-9.70) for those >=65 versus 5-17 years old. African Americans had an AOR of 1.67 (95% CI 1.60-1.73) compared to Whites, and Hispanics had an AOR of 1.21 (95% CI 1.16-1.26) compared to non-Hispanics. Among census tract-based determinants, those living in a tract with >=20% versus poverty had an AOR of 1.31 (95% CI 1.16-1.47), those living in a tract with >=5% versus =40% versus determinants account for 11% of the variability in influenza hospitalization. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. Hospitalization for esophageal achalasia in the United States

    Institute of Scientific and Technical Information of China (English)

    Daniela; Molena; Benedetto; Mungo; Miloslawa; Stem; Anne; O; Lidor

    2015-01-01

    AIM: To assess the outcome of different treatments in patients admitted for esophageal achalasia in the United States.METHODS: This is a retrospective analysis using the Nationwide Inpatient Sample over an 8-year period(2003-2010). Patients admitted with a primary diagnosis of achalasia were divided into 3 groups based on their treatment:(1) Group 1: patients who underwent Heller myotomy during their hospital stay;(2) Group 2: patients who underwent esophagectomy; and(3) Group 3: patients not undergoing surgical treatment. Primary outcome was in-hospital mortality. Secondary outcomes included length of stay(LOS), discharge destination and total hospital charges.RESULTS: Among 27141 patients admitted with achalasia, nearly half(48.5%) underwent Heller myotomy, 2.5% underwent esophagectomy and 49.0% had endoscopic or other treatment. Patients in group 1 were younger, healthier, and had the lowest mortality when compared with the other two groups. Group 2 had the highest LOS and hospital charges among all groups. Group 3 had the highest mortality(1.2%, P < 0.001) and the lowest home discharge rate(78.8%) when compared to the other groups. The most frequently performed procedures among group 3 were esophageal dilatation(25.9%) and injection(13.3%). Among patients who died in this group the most common associated morbidities included acute respiratory failure, sepsis and aspiration pneumonia. CONCLUSION: Surgery for achalasia carries exceedingly low mortality in the modern era; however, in complicated patients, even less invasive treatments are burdened bysignificant mortality and morbidity.

  6. Computers in hospital management and improvements in patients care--new trends in the United States.

    Science.gov (United States)

    Pierskalla, W P; Woods, D

    1988-12-01

    This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.

  7. Hospital markup and operation outcomes in the United States.

    Science.gov (United States)

    Gani, Faiz; Ejaz, Aslam; Makary, Martin A; Pawlik, Timothy M

    2016-07-01

    Although the price hospitals charge for operations has broad financial implications, hospital pricing is not subject to regulation. We sought to characterize national variation in hospital price markup for major cardiothoracic and gastrointestinal operations and to evaluate perioperative outcomes of hospitals relative to hospital price markup. All hospitals in which a patient underwent a cardiothoracic or gastrointestinal procedure were identified using the Nationwide Inpatient Sample for 2012. Markup ratios (ratio of charges to costs) for the total cost of hospitalization were compared across hospitals. Risk-adjusted morbidity, failure-to-rescue, and mortality were calculated using multivariable, hierarchical logistic regression. Among the 3,498 hospitals identified, markup ratios ranged from 0.5-12.2, with a median markup ratio of 2.8 (interquartile range 2.7-3.9). For the 888 hospitals with extreme markup (greatest markup ratio quartile: markup ratio >3.9), the median markup ratio was 4.9 (interquartile range 4.3-6.0), with 10% of these hospitals billing more than 7 times the Medicare-allowable costs (markup ratio ≥7.25). Extreme markup hospitals were more often large (46.3% vs 33.8%, P markup ratio compared with 19.3% (n = 452) and 6.8% (n = 35) of nonprofit and government hospitals, respectively. Perioperative morbidity (32.7% vs 26.4%, P markup hospitals. There is wide variation in hospital markup for cardiothoracic and gastrointestinal procedures, with approximately a quarter of hospital charges being 4 times greater than the actual cost of hospitalization. Hospitals with an extreme markup had greater perioperative morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Trends in hospitalization for takotsubo cardiomyopathy in the United States.

    Science.gov (United States)

    Khera, Rohan; Light-McGroary, KellyAnn; Zahr, Firas; Horwitz, Phillip A; Girotra, Saket

    2016-02-01

    Takotsubo (or stress induced) cardiomyopathy is characterized by transient left ventricular systolic dysfunction. Recent trends in patient volume, characteristics, and outcomes in the United States are unknown. Using 2007-2012 National Inpatient Sample data, we identified 22,005 adults (≥18 years) with a primary and 31,942 adults with a secondary discharge diagnosis of takotsubo cardiomyopathy (International Classification of Diseases, Ninth Revision, code 429.83) who underwent diagnostic coronary angiography. During 2007 to 2012, the incidence of takotsubo cardiomyopathy increased over 3-fold: 52/million discharges in 2007 to 178/million in 2012 (P takotsubo cardiomyopathy in the United States in recent years, suggesting higher incidence than prior reports. Although outcomes have remained favorable, there is an increasing burden of cardiovascular and psychiatric disorders in this population with growing cost of care. Risk of mortality is higher in men and in patients with underlying critical illness. The excess mortality in these groups appears to be mediated by greater severity of disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Tuberculosis management continues to utilize a large amount of hospital resources in the United States.

    Science.gov (United States)

    Allareddy, Veerasathpurush; Rampa, Sankeerth; Allareddy, Veerajalandhar; Nalliah, Romesh P

    2017-01-01

    The objective of this study is to examine longitudinal trends in hospital admissions attributed to tuberculosis and resulting hospitalization outcomes in the United States for the years 2000-2010. We used the Nationwide Inpatient Sample, which is the largest all-payer and nationally representative in-hospital dataset in the United States. All hospitalizations that had a primary diagnosis for tuberculosis were selected for analysis. Patient characteristics and outcomes including discharge status following hospitalization, length of stay in hospital and hospitalization charges were examined. During the study period, a total of 96 431 hospitalizations occurred due to tuberculosis. The mean age of hospitalizations was 48.6 years. Males comprised 64.2% of all hospitalizations; 24.8% were Whites, 25.5% Blacks, 26.5% Hispanics, 14.3% Asians/Pacific Islanders, 1% Native Americans, and 7.9% other/mixed races. Following hospitalization, 72.1% were discharged routinely, 3.4% were transferred to another acute-care hospital, 10.7% to long-term care facilities including skilled nursing facilities, 7.6% to home health care, and 2.1% were discharged against medical advice. There were 3815 patients who died (4% of hospitalizations). The total hospitalization charge for this cohort of patients admitted due to tuberculosis across the United States was $6.96 billion and the total hospitalization days over study period was 1 419 605 days. High-risk cohorts who are likely to be hospitalized due to tuberculosis included Blacks and Hispanics. Majority of hospitalization comprised of males. Even though the annual number of hospitalizations reduced over the study period, substantial amounts of resources are used in hospital settings to manage tuberculosis. © 2015 John Wiley & Sons Ltd.

  10. Hospital use in France and the United States.

    Science.gov (United States)

    Kozak, L J; McCarthy, E; Mizrahi, A; Mizrahi, A; Sandier, S

    1989-01-01

    This report presents national statistics on hospital use from the U.S. National Hospital Discharge Survey conducted by the National Center for Health Statistics and the national survey of hospitalization conducted by CREDES, Centre de Recherche d'Etude et de Documentation en Economie de la Santé, previously the Medical Economics Division of CREDOC. The use statistics compared between the two countries include rates and percent distributions of discharges and days of care and average lengths of stay. These statistics are shown by sex, age, diagnostic category, and other hospital and patient characteristics. The similarities and differences between the two countries in population characteristics, causes of death, health care systems, and hospital systems are also described.

  11. Hospital-Level Changes in Adult ICU Bed Supply in the United States.

    Science.gov (United States)

    Wallace, David J; Seymour, Christopher W; Kahn, Jeremy M

    2017-01-01

    Although the number of intensive care beds in the United States is increasing, little is known about the hospitals responsible for this growth. We sought to better characterize national growth in intensive care beds by identifying hospital-level factors associated with increasing numbers of intensive care beds over time. We performed a repeated-measures time series analysis of hospital-level intensive care bed supply using data from Centers for Medicare and Medicaid Services. All United States acute care hospitals with adult intensive care beds over the years 1996-2011. None. None. We described the number of beds, teaching status, ownership, intensive care occupancy, and urbanicity for each hospital in each year of the study. We then examined the relationship between increasing intensive care beds and these characteristics, controlling for other factors. The study included 4,457 hospitals and 55,865 hospital-years. Overall, the majority of intensive care bed growth occurred in teaching hospitals (net, +13,471 beds; 72.1% of total growth), hospitals with 250 or more beds (net, +18,327 beds; 91.8% of total growth), and hospitals in the highest quartile of occupancy (net, +10,157 beds; 54.0% of total growth). In a longitudinal multivariable model, larger hospital size, teaching status, and high intensive care occupancy were associated with subsequent-year growth. Furthermore, the effects of hospital size and teaching status were modified by occupancy: the greatest odds of increasing ICU beds were in hospitals with 500 or more beds in the highest quartile of occupancy (adjusted odds ratio, 18.9; 95% CI, 14.0-25.5; p hospitals in the highest quartile of occupancy (adjusted odds ratio, 7.3; 95% CI, 5.3-9.9; p bed expansion in the United States is occurring in larger hospitals and teaching centers, particularly following a year with high ICU occupancy.

  12. Hospitalization frequency and charges for neurocysticercosis, United States, 2003-2012.

    Science.gov (United States)

    O'Neal, Seth E; Flecker, Robert H

    2015-06-01

    Neurocysticercosis, brain infection with Taenia solium larval cysts, causes substantial neurologic illness around the world. To assess the effect of neurocysticercosis in the United States, we reviewed hospitalization discharge data in the Nationwide Inpatient Sample for 2003-2012 and found an estimated 18,584 hospitalizations for neurocysticercosis and associated hospital charges totaling >US $908 million. The risk for hospitalization was highest among Hispanics (2.5/100,000 population), a rate 35 times higher than that for the non-Hispanic white population. Nearly three-quarters of all hospitalized patients with neurocysticercosis were Hispanic. Male sex and age 20-44 years also incurred increased risk. In addition, hospitalizations and associated charges related to cysticercosis far exceeded those for malaria and were greater than for those for all other neglected tropical diseases combined. Neurocysticercosis is an increasing public health concern in the United States, especially among Hispanics, and costs the US health care system a substantial amount of money.

  13. Nurse staffing patterns and hospital efficiency in the United States.

    Science.gov (United States)

    Bloom, J R; Alexander, J A; Nuchols, B A

    1997-01-01

    The objective of this exploratory study was to assess the effects of four nurse staffing patterns on the efficiency of patient care delivery in the hospital: registered nurses (RNs) from temporary agencies; part-time career RNs; RN rich skill mix; and organizationally experienced RNs. Using Transaction Cost Analysis, four regression models were specified to consider the effect of these staffing plans on personnel and benefit costs and on non-personnel operating costs. A number of additional variables were also included in the models to control for the effect of other organization and environmental determinants of hospital costs. Use of career part-time RNs and experienced staff reduced both personnel and benefit costs, as well as total non-personnel operating costs, while the use of temporary agencies for RNs increased non-personnel operating costs. An RN rich skill mix was not related to either measure of hospital costs. These findings provide partial support of the theory. Implications of our findings for future research on hospital management are discussed.

  14. Trends in Out-of-Hospital Births in the United States, 1990-2012

    Science.gov (United States)

    ... influenced by differences in state laws pertaining to midwifery practice or out-of-hospital births ( 10–11 ), ... in the United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009. Health ...

  15. Malaria-Related Hospitalizations in the United States, 2000-2014.

    Science.gov (United States)

    Khuu, Diana; Eberhard, Mark L; Bristow, Benjamin N; Javanbakht, Marjan; Ash, Lawrence R; Shafir, Shira C; Sorvillo, Frank J

    2017-07-01

    Few data are available on the burden of malaria hospitalization in the United States. Study of malaria using hospital-based data can better define the impact of malaria and help inform prevention efforts. U.S. malaria cases identified from hospitalization discharge records in the 2000-2014 Nationwide Inpatient Sample were examined. Frequencies and population rates were reported by demographics, infecting species, clinical, financial, institutional, geographic, and seasonal characteristics, and disparities were identified. Time trends in malaria cases were assessed using negative binomial regression. From 2000 to 2014, there were an estimated 22,029 malaria-related hospitalizations (4.88 per 1 million population) in the United States, including 182 in-hospital deaths and 4,823 severe malaria cases. The rate of malaria-related hospitalizations did not change significantly over the study period. The largest number of malaria-related hospitalizations occurred in August. Malaria-related hospitalizations occurred disproportionately among patients who were male, black, or 25-44 years of age. Plasmodium falciparum accounted for the majority of malaria-related hospitalizations. On average, malaria patients were hospitalized for 4.36 days with charges of $25,789. Patients with a malaria diagnosis were more often hospitalized in the Middle Atlantic and South Atlantic census divisions, urban teaching, private not-for-profit, and large-bed-size hospitals. Malaria imposes a substantial disease burden in the United States. Enhanced primary and secondary prevention measures, including strategies to increase the use of pretravel consultations and prompt diagnosis and treatment are needed.

  16. Can National Healthcare-Associated Infections (HAIs) Data Differentiate Hospitals in the United States?

    Science.gov (United States)

    Masnick, Max; Morgan, Daniel J; Sorkin, John D; Macek, Mark D; Brown, Jessica P; Rheingans, Penny; Harris, Anthony D

    2017-10-01

    OBJECTIVE To determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website (http://medicare.gov/hospitalcompare) can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. DESIGN Secondary analysis of publicly available HAI data for calendar year 2013. METHODS We assessed the availability of HAI data for geographically proximate hospitals (ie, hospitals within the same referral region) and then analyzed these data to determine whether they are useful to differentiate hospitals. We assessed data for the 6 HAIs reported by hospitals to the Centers for Disease Control and Prevention (CDC). RESULTS Data were analyzed for 4,561 hospitals representing 88% of registered community and federal government hospitals in the United States. Healthcare-associated infection data are only useful for comparing hospitals if they are available for multiple hospitals within a geographic region. We found that data availability differed by HAI. Clostridium difficile infections (CDI) data were most available, with 82% of geographic regions (ie, hospital referral regions) having >50% of hospitals reporting them. In contrast, 4% of geographic regions had >50% of member hospitals reporting surgical site infections (SSI) for hysterectomies, which had the lowest availability. The ability of HAI data to differentiate hospitals differed by HAI: 72% of hospital referral regions had at least 1 pair of hospitals with statistically different risk-adjusted CDI rates (SIRs), compared to 9% for SSI (hysterectomy). CONCLUSIONS HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI. CDI and catheter-associated urinary tract infection (CAUTI) are more likely to differentiate hospitals than the other publicly reported HAIs. Infect Control Hosp Epidemiol 2017;38:1167-1171.

  17. An overview of distribution of births in United States hospitals in 2008 with implications for small volume perinatal units in rural hospitals.

    Science.gov (United States)

    Simpson, Kathleen Rice

    2011-01-01

    To evaluate the distribution of births among United States (U.S.) hospitals in 2008 as part of the background for the Association of Women's Health, Obstetric and Neonatal Nurses' Guidelines for Professional Registered Nurse Staffing for Perinatal Units. Descriptive analysis of birth volumes in U.S. hospitals using American Hospital Association Annual Survey: 2008. U.S. hospitals providing obstetric (OB) services were identified based on information in any of three fields: OB services, OB beds, or number of births. Data were verified via telephone and/or website for the top 100 hospitals based on volume, hospitals with "Healthcare System" as part of their names, hospitals reporting births but no OB service, and hospitals reporting births. Hospitals with births were queried regarding nurse staffing. Descriptive statistics were used to analyze data. Approximately 3,265 U.S. hospitals offered OB services in 2008. The top 500 hospitals based on volume (15.3%) accounted for almost one half (47.4%) of births, the top 1,000 for 69.2%, and the remaining 2,265 for 30.8%. Fourteen percent of hospitals with births in 2008 reported discontinuing OB services in 2010, in part due to lack of physician coverage and costs. Most hospitals (n=159, 72.3%) with births routinely maintained two OB-skilled nurses in-house in 2010. U.S. births are unevenly distributed among hospitals; 15% have a disproportionate share of nearly one half of all births. Most hospitals (69.4%) are operating medium- to small-volume OB units. Most hospitals (72.3%) with births annually reported currently meeting minimum staffing guidelines. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  18. Increase in fall-related hospitalizations in the United States, 2001-2008

    NARCIS (Netherlands)

    K.A. Hartholt (Klaas); J.A. Stevens (Judy); S. Polinder (Suzanne); T.J.M. van der Cammen (Tischa); P. Patka (Peter)

    2011-01-01

    textabstractBACKGROUND: The objective was to determine secular trends in unintentional fall-related hospitalizations in people aged 65 years and older in the United States. MATERIALS: Data were obtained from a nationally representative sample of emergency department visits from January 1, 2001, to D

  19. Nontuberculous Mycobacteria–associated Lung Disease in Hospitalized Persons, United States, 1998–2005

    Science.gov (United States)

    Billinger, Megan E.; Olivier, Kenneth N.; Viboud, Cecile; Montes de Oca, Ruben; Steiner, Claudia; Holland, Steven M.

    2009-01-01

    The prevalence and trends of pulmonary nontuberculous mycobacteria (NTM)–associated hospitalizations in the United States were estimated using national hospital discharge data. Records were extracted for all persons with a pulmonary NTM International Classification of Diseases code (031.0) hospitalized in the 11 states with continuous data available from 1998 through 2005. Prevalence was calculated using US census data. Pulmonary NTM hospitalizations (031.0) increased significantly with age among both sexes: relative prevalence for persons 70–79 years of age compared with those 40–49 years of age was 15/100,000 for women (9.4 vs. 0.6) and 9/100,000 for men (7.6 vs. 0.83). Annual prevalence increased significantly among men and women in Florida (3.2%/year and 6.5%/year, respectively) and among women in New York (4.6%/year) with no significant changes in California. The prevalence of pulmonary NTM–associated hospitalizations is increasing in selected geographic areas of the United States. PMID:19861046

  20. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006.

    Science.gov (United States)

    Seitz, Amy E; Olivier, Kenneth N; Steiner, Claudia A; Montes de Oca, Ruben; Holland, Steven M; Prevots, D Rebecca

    2010-10-01

    Current data on bronchiectasis prevalence, trends, and risk factors are lacking; such data are needed to estimate the burden of disease and for improved medical care and public health resource allocation. The objective of the present study was to estimate the trends and burden of bronchiectasis-associated hospitalizations in the United States. We extracted hospital discharge records containing International Classification of Diseases, 9th Revision, Clinical Modification codes for bronchiectasis (494, 494.0, and 494.1) as any discharge diagnosis from the State Inpatient Databases from the Agency for Healthcare Research and Quality. Discharge records were extracted for 12 states with complete and continuous reporting from 1993 to 2006. The average annual age-adjusted hospitalization rate from 1993 to 2006 was 16.5 hospitalizations per 100,000 population. From 1993 to 2006, the age-adjusted rate increased significantly, with an average annual percentage increase of 2.4% among men and 3.0% among women. Women and persons aged > 60 years had the highest rate of bronchiectasis-associated hospitalizations. The median cost for inpatient care was 7,827 US dollars (USD) (range, 13-543,914 USD). The average annual age-adjusted rate of bronchiectasis-associated hospitalizations increased from 1993 to 2006. This study furthers the understanding of the impact of bronchiectasis and demonstrates the need for further research to identify risk factors and reasons for the increasing burden.

  1. Inpatient hospital care of children with trisomy 13 and trisomy 18 in the United States.

    Science.gov (United States)

    Nelson, Katherine E; Hexem, Kari R; Feudtner, Chris

    2012-05-01

    Trisomy 13 and trisomy 18 are generally considered fatal anomalies, with a majority of infants dying in the first year after birth. The inpatient hospital care that these patients receive has not been adequately described. This study characterized inpatient hospitalizations of children with trisomy 13 and trisomy 18 in the United States, including number and types of procedures performed. Retrospective repeated cross-sectional assessment of hospitalization data from the nationally representative US Kids' Inpatient Database, for the years 1997, 2000, 2003, 2006, and 2009. Included hospitalizations were of patients aged 0 to 20 years with a diagnosis of trisomy 13 or trisomy 18. The number of hospitalizations for each trisomy type ranged from 846 to 907 per year for trisomy 13 (P = .77 for temporal trend) and 1036 to 1616 per year for trisomy 18 (P < .001 for temporal trend). Over one-third (36%) of the hospitalizations were of patients older than 1 year of age. Patients underwent a total of 2765 major therapeutic procedures, including creation of esophageal sphincter (6% of hospitalizations; mean age 23 months), repair of atrial and ventricular septal defects (4%; mean age 9 months), and procedures on tendons (4%; mean age 8 years). Children with trisomy 13 and trisomy 18 receive significant inpatient hospital care. Despite the conventional understanding of these syndromes as lethal, a substantial number of children are living longer than 1 year and undergoing medical and surgical procedures as part of their treatment.

  2. Does hospital ownership influence hospital referral region health rankings in the United States.

    Science.gov (United States)

    Hamadi, Hanadi; Apatu, Emma; Spaulding, Aaron

    2017-07-21

    Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value-Based Purchasing dataset are utilized to conduct a cross-sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures-access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives-and performance as measured by value-based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not-for-profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for-profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure. Copyright © 2017 John Wiley & Sons, Ltd.

  3. Hospital Utilization and Cost Trends in Canada and the United States

    Science.gov (United States)

    Andersen, Ronald; Hull, John T.

    1969-01-01

    Differences in hospital costs and utilization between the United States and Canada are analyzed and an attempt made to measure the significance of various demographic, economic, and other factors thought to be related to the differences. Increases in utilization are traced to population increases and to actual increased use per person; and cost increases tied to general inflationary trends are separated from those attributable to specific hospital price increases. Differences in the financing and reimbursement mechanisms in the two countries are shown to have had little effect on relative cost increases, which in the period under consideration were parallelled by similar or greater increases in other industrialized nations. PMID:4981616

  4. Health care policy reform: a microanalytic model for comparing hospitals in the United States and Germany.

    Science.gov (United States)

    Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B

    1999-01-01

    Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

  5. Pressure ulcers and prevention among acute care hospitals in the United States.

    Science.gov (United States)

    Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy

    2013-09-01

    Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.

  6. Perceptions of the hospital ethical environment among hospital social workers in the United States.

    Science.gov (United States)

    Pugh, Greg L

    2015-01-01

    Hospital social workers are in a unique context of practice, and one where the ethical environment has a profound influence on the ethical behavior. This study determined the ratings of ethical environment by hospital social workers in large nationwide sample. Correlates suggest by and compared to studies of ethical environment with nurses are explored. Positive ratings of the ethical environment are primarily associated with job satisfaction, as well as working in a centralized social work department and for a non-profit hospital. Religiosity and MSW education were not predictive. Implications and suggestions for managing the hospital ethical environment are provided.

  7. Economic Burden of Hospitalizations for Heat-Related Illnesses in the United States, 2001–2010

    Directory of Open Access Journals (Sweden)

    Michael T. Schmeltz

    2016-09-01

    Full Text Available Understanding how heat waves affect morbidity and mortality, as well as the associated economic costs, is essential for characterizing the human health impacts of extreme heat under a changing climate. Only a handful of studies have examined healthcare costs associated with exposures to high temperatures. This research explores costs associated with hospitalizations for heat-related illness (HRI in the United States using the 2001 to 2010 Nationwide Inpatient Sample (NIS. Descriptive statistics of patient data for HRI hospitalizations were examined and costs of hospitalizations were reported using the all-payer inpatient cost-to-charge ratio. Costs were examined using a log-gamma model with patient and hospital characteristics included as fixed effects. Adjusted mean costs were then compared across racial groups. The mean costs of HRI hospitalizations were higher among racial/ethnic minorities compared to Whites, who accounted for almost 65% of all HRI hospitalizations. Observed differences in costs based on income, insurance, and gender were also significant. These results suggest that these populations are suffering disproportionately from health inequity, thus, they could shoulder greater disease and financial burdens due to climate change. These findings may have important implications in understanding the economic impact public health planning and interventions will have on preventing hospitalizations related to extreme heat.

  8. Burden of hospitalizations for bicycling injuries by motor vehicle involvement: United States, 2002 to 2009.

    Science.gov (United States)

    Hamann, Cara; Peek-Asa, Corinne; Lynch, Charles F; Ramirez, Marizen; Torner, James

    2013-11-01

    Bicycling and bicycling injuries have increased during the past decade in the United States, but research on the extent and outcomes of injuries has lagged behind. This study aimed to estimate the current burden of injury from bicycling injury hospitalizations by motor vehicle crash (MVC) and non-MVC in the United States. We included patients with primary or secondary diagnosis e-codes corresponding to MVC or non-MVC bicycle injury, drawn from the US Nationwide Inpatient Sample (2002-2009). Descriptive statistics, linear regression, and logistic regression were used to examine patient and hospital characteristics (length of stay, total charges, nonroutine discharges, and demographics) associated with hospitalizations for bicycling injuries by motor vehicle involvement. On average, from 2002 to 2009, there were an annually estimated 6,877 MVC and 18,457 non-MVC bicycle injury hospitalizations nationwide. This translates to more than $1 billion of hospital charges overall, $425 million for MVC and $588 million for non-MVC per year. After controlling for covariates, MVC bicycling injury hospitalizations had an average length of stay that was 2 days longer (95% confidence interval [CI], 1.8-2.3) and an average hospitalization charge of $23,424 more (95% CI, $21,360-$25,538) than non-MVC. Those with MVC bicycling injuries were more than two times as likely to have a nonroutine hospital discharge than non-MVC (odds ratio, 2.22; 95% CI, 2.06-2.39). The burden of injury from bicycle crashes is large overall, and MVC-related bicycling injuries result in longer hospital stays, higher costs, and more nonroutine hospital discharges than non-MVC, despite the fact that non-MVC hospitalizations are more frequent and result in higher total charges, overall. To have the greatest impact on reducing the burden of injury from bicycle crashes, educational interventions, policy, and infrastructure changes should include all age groups and prioritize reducing bicycle-motor vehicle

  9. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  10. Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children's Hospitals.

    Science.gov (United States)

    Chan, Katherine H; Bell, Teresa; Cain, Mark; Carroll, Aaron; Benneyworth, Brian D

    2017-03-01

    Guidelines recommend surgical antibiotic prophylaxis for clean-contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children's hospitals. Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean-contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean-contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean-contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean-contaminated procedures (OR 0.86, 95% CI 0.84-0.88, p variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean-contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Hospitals that used surgical antibiotic prophylaxis appropriately for clean-contaminated procedures were likely to use surgical antibiotic prophylaxis inappropriately for clean procedures. More variation was seen in hospital level guideline compliance for clean-contaminated procedures. Copyright © 2017 American Urological

  11. Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010.

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    Benjamin P George

    Full Text Available Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States.Using the Nationwide Inpatient Sample (NIS from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study.In the U.S. from 2000-2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1-7.6. Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000 and those 65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%, followed by Other Specified causes (32.5%, which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR]  = 1.70; 95% CI: 1.30-2.22 and OR = 2.26; 95% CI: 1.88-2.71, respectively. Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis.While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st Century, the reported demographics of hospitalized

  12. An Evaluation and Ranking of Children’s Hospital Websites in the United States

    Science.gov (United States)

    Walker, Daniel M; Ford, Eric W

    2016-01-01

    Background Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals. PMID:27549074

  13. The effect of gun control laws on hospital admissions for children in the United States.

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    Tashiro, Jun; Lane, Rebecca S; Blass, Lawrence W; Perez, Eduardo A; Sola, Juan E

    2016-10-01

    Gun control laws vary greatly between states within the United States. We hypothesized that states with strict gun laws have lower mortality and resource utilization rates from pediatric firearms-related injury admissions. Kids' Inpatient Database (1997-2012) was searched for accidental (E922), self-inflicted (E955), assault (E965), legal intervention-related (E970), or undetermined circumstance (E985) firearm injuries. Patients were younger than 20 years and admitted for their injuries. Case incidence trends were examined for the study period. Propensity score-matched analyses were performed using 38 covariates to compare outcomes between states with strict or lenient gun control laws. Overall, 38,424 cases were identified, with an overall mortality of 7%. Firearm injuries were most commonly assault (64%), followed by accidental (25%), undetermined circumstance (7%), or self-inflicted (3%). A small minority involved military-grade weapons (0.2%). Most cases occurred in lenient gun control states (48%), followed by strict (47%) and neutral (6%).On 1:1 propensity score-matched analysis, in-hospital mortality by case was higher in lenient (7.5%) versus strict (6.5%) states, p = 0.013. Lenient states had a proportionally higher rate of accidental (31%) and self-inflicted injury (4%) versus strict states (17% and 1.6%, respectively), p gun control contributes not only to worse outcomes per case, but also to a more significant and detrimental impact on public health. Epidemiologic study, level III.

  14. Changes in critical care beds and occupancy in the United States 1985-2000: Differences attributable to hospital size.

    Science.gov (United States)

    Halpern, Neil A; Pastores, Stephen M; Thaler, Howard T; Greenstein, Robert J

    2006-08-01

    To determine the relationship between hospital size and changes in the number of critical care medicine (CCM) beds, proportion of hospital beds allocated to CCM, and CCM occupancy in acute care hospitals in the United States from 1985 to 2000. A 16-yr (1985 to 2000) retrospective analysis was performed using the Hospital Cost Report Information System (Centers for Medicare and Medicaid Services, Baltimore, MD) on U.S. acute care hospitals that provided CCM. Hospitals were stratified into four groups (small, 1-100 beds; medium, 101-300 beds; large 301-500 beds; and extra large, >500 beds). Nonfederal, acute care hospitals with CCM units in the United States. None. None. Changes in the number of hospitals, non-CCM and CCM beds, the proportion of CCM to hospital beds, and their occupancy rates. Between 1985 and 2000, the number of hospitals providing CCM decreased overall (4,150 to 3,581, -13.7%). The greatest decreases were seen in large (-39%) and extra-large (-40%) hospitals. Small hospitals increased minimally (3.3%). The number of non-CCM beds decreased (820,300 to 566,900, -30.9%), most prominently in large (-44.2%) and extra-large (-46.1%) hospitals. In contrast, CCM beds increased overall (69,300 to 87,400, 26.1%), especially in small (27%) and medium (44.2%) hospitals. The proportion of total hospital beds assigned to CCM increased (71.8%), most markedly in large (93.5%) and extra-large (85.7%) hospitals. Non-CCM occupancy decreased (-6.4%), particularly in small (-7.5%) and extra-large (-5.8%) hospitals. However, regardless of hospital size, CCM occupancy changed negligibly (0.4%). At every time point studied, CCM occupancy was greater than non-CCM occupancy within each size group. As hospital size increased, occupancy rates increased. Across hospitals of all sizes, CCM bed numbers are increasing, whereas non-CCM bed numbers are decreasing. Although the CCM bed capacity is increasing at a greater percentage rate in smaller hospitals, the assignment of

  15. Microwave oven-related injuries treated in hospital EDs in the United States, 1990 to 2010.

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    Thambiraj, Dana F; Chounthirath, Thiphalak; Smith, Gary A

    2013-06-01

    The widespread availability of microwave ovens has sparked interest in injuries resulting from their use. Using a retrospective cohort design, the objective of this study is to investigate the epidemiology of microwave oven-related injuries treated in United States emergency departments (EDs) from 1990 through 2010 by analyzing data from the National Electronic Injury Surveillance System. An estimated 155959 (95% confidence interval [CI], 133515-178402) individuals with microwave oven-related injuries were treated in US hospital EDs from 1990 through 2010, which equals an average of 21 individuals per day; 60.7% were female; 63.3% were adults (≥18 years); 98.1% of injury events occurred at home; and 3.9% of patients were hospitalized. During the 21-year study period, the number and rate of microwave oven-related injuries increased significantly by 93.3% and 50.0%, respectively. The most common mechanism of injury was a spill (31.3%), and the most common body region injured was the hand and fingers (32.4%). Patients younger than 18 years were more likely to sustain an injury to their head and neck (relative risk: 1.65; 95% CI, 1.39-1.96) than adults. To our knowledge, this is the first study to investigate microwave oven-related injuries on a national scale. Microwave ovens are an important source of injury in the home in the United States. The large increases in the number and rate of these injuries underscore the need for increased prevention efforts, especially among young children. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Mortality and Morbidity During Delivery Hospitalization Among Pregnant Women With Epilepsy in the United States

    Science.gov (United States)

    MacDonald, Sarah C.; Bateman, Brian T.; McElrath, Thomas F.; Hernández-Díaz, Sonia

    2016-01-01

    IMPORTANCE Between 0.3% and 0.5% of all pregnancies occur among women with epilepsy. Evidence suggests an increase in perinatal morbidity and mortality among women with epilepsy. However, these risks have not been quantified in large population-based samples. OBJECTIVE To report on the risk for death and adverse outcomes at the time of delivery for women with epilepsy in the United States. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of pregnant women identified through delivery hospitalization records from the 2007-2011 Nationwide Inpatient Sample. From this representative sample of 20% of all US hospitals, we obtained a weighted sample of delivery hospitalizations from 69 385 women with epilepsy and 20 449 532 women without epilepsy. MAIN OUTCOMES AND MEASURES Obstetrical outcomes including maternal death, cesarean delivery, length of stay, preeclampsia, preterm labor, and stillbirth. RESULTS Women with epilepsy had a risk of death during delivery hospitalization of 80 deaths per 100 000 pregnancies, significantly higher than the 6 deaths per 100 000 pregnancies found among women without epilepsy (adjusted odds ratio [OR], 11.46 [95% CI, 8.64-15.19]). Women with epilepsy were also at a heightened risk for other adverse outcomes, including preeclampsia (adjusted OR, 1.59 [95% CI, 1.54-1.63]), preterm labor (adjusted OR, 1.54 [95% CI, 1.50-1.57]), and stillbirth (adjusted OR, 1.27 [95% CI, 1.17-1.38]), and had increased health care utilization, including an increased risk of cesarean delivery (adjusted OR, 1.40 [95% CI, 1.38-1.42]) and prolonged length of hospital stay (>6 days) among both women with cesarean deliveries (adjusted OR, 2.13 [95% CI, 2.03-2.23]) and women with vaginal deliveries (adjusted OR, 2.60 [95% CI, 2.41-2.80]). CONCLUSIONS AND RELEVANCE Findings suggest that women with epilepsy are at considerably heightened risk for many adverse outcomes during their delivery hospitalization, including a more than 10-fold increased risk of

  17. Influenza-Related Hospitalizations and Poverty Levels - United States, 2010-2012.

    Science.gov (United States)

    Hadler, James L; Yousey-Hindes, Kimberly; Pérez, Alejandro; Anderson, Evan J; Bargsten, Marisa; Bohm, Susan R; Hill, Mary; Hogan, Brenna; Laidler, Matt; Lindegren, Mary Lou; Lung, Krista L; Mermel, Elizabeth; Miller, Lisa; Morin, Craig; Parker, Erin; Zansky, Shelley M; Chaves, Sandra S

    2016-02-12

    Annual influenza vaccine is recommended for all persons aged ≥6 months in the United States, with recognition that some persons are at risk for more severe disease (1). However, there might be previously unrecognized demographic groups that also experience higher rates of serious influenza-related disease that could benefit from enhanced vaccination efforts. Socioeconomic status (SES) measures that are area-based can be used to define demographic groups when individual SES data are not available (2). Previous surveillance data analyses in limited geographic areas indicated that influenza-related hospitalization incidence was higher for persons residing in census tracts that included a higher percentage of persons living below the federal poverty level (3-5). To determine whether this association occurs elsewhere, influenza hospitalization data collected in 14 FluSurv-NET sites covering 27 million persons during the 2010-11 and 2011-12 influenza seasons were analyzed. The age-adjusted incidence of influenza-related hospitalizations per 100,000 person-years in high poverty (≥20% of persons living below the federal poverty level) census tracts was 21.5 (95% confidence interval [CI]: 20.7-22.4), nearly twice the incidence in low poverty (poverty level) census tracts (10.9, 95% CI: 10.3-11.4). This relationship was observed in each surveillance site, among children and adults, and across racial/ethnic groups. These findings suggest that persons living in poorer census tracts should be targeted for enhanced influenza vaccination outreach and clinicians serving these persons should be made aware of current recommendations for use of antiviral agents to treat influenza (6).

  18. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact.

    Directory of Open Access Journals (Sweden)

    Keith S Kaye

    Full Text Available The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States.We performed a retrospective cross-sectional analysis (years 2005-2011 of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics.A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend ranging from 1.6% (in 2005 to 2.0% (in 2011. Mean hospital length of stay (LOS decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001 with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI, 5.80-5.83 and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410. Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs.Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI that could shift management from

  19. Out-of-hospital pediatric airway management in the United States.

    Science.gov (United States)

    Hansen, Matthew; Lambert, William; Guise, Jeanne-Marie; Warden, Craig R; Mann, N Clay; Wang, Henry

    2015-05-01

    The objective of this study was to characterize pediatric out-of-hospital airway management interventions, success rates, and complications in the United States using the 2012 National Emergency Medical Services Information System (NEMSIS) dataset. In 2012, NEMSIS collected data from Emergency Medical Services (EMS) encounters in 40 states. We included all patients less than 18 years of age and identified all patients who had airway interventions including endotracheal intubation (ETI), bag-valve-mask ventilation (BVM), continuous positive airway pressure/bilevel positive airway pressure (CPAP/BiPAP) and alternate airways (Combitube, King LT, Laryngeal Mask Airway (LMA), esophageal obturator airway, and cricothyroidotomy). Success and complication rates were analyzed and compared across pediatric age groups, by race, ethnicity, clinical condition, and geographic region. We identified a total of 949,301 pediatric patient care events in the NEMSIS 2012 dataset. 4.5% had airway management procedures (42,936 events). Invasive airway management or ventilation (ETI, cricothyroidotomy, alternate airway, CPAP/BiPAP, BVM and other ventilation) took place in 1.5% of patient care events (14,107). Of those who had invasive airway management, 29.9% were less than 1 year of age, 58.1% were male, 42.3% were white, and 83.6% were in urban areas. ETI occurred in 3124 of patient care events (329 per 100,000; 95% CI 318-341). Overall success of ETI was 81.1% (95% CI 79.7-82.6). Lower success was noted in patients with cardiac arrest (75.5%, 95% CI 72.6-78.3) and those aged 1-12 months (72.1%, 95% CI 68.3-75.6). Out-of-hospital pediatric advanced airway procedures were infrequently performed. Success rates are lowest in patients aged 1-12 months. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Clinical pharmacy services, pharmacy staffing, and adverse drug reactions in United States hospitals.

    Science.gov (United States)

    Bond, C A; Raehl, Cynthia L

    2006-06-01

    Adverse drug reactions (ADRs) were examined in 1,960,059 hospitalized Medicare patients in 584 United States hospitals in 1998. A database was constructed from the MedPAR database and the National Clinical Pharmacy Services survey. The 584 hospitals were selected because they provided specific information on 14 clinical pharmacy services and on pharmacy staffing; they also had functional ADR reporting systems. The study population consisted of 35,193 Medicare patients who experienced an ADR (rate of 1.8%). Of the 14 clinical pharmacy services, 12 were associated with reduced ADR rates. The most significant reductions occurred in hospitals offering pharmacist-provided admission drug histories (odds ratio [OR] 1.864, 95% confidence interval [CI] 1.765-1.968), drug protocol management (OR 1.365, 95% CI 1.335-1.395), and ADR management (OR 1.360, 95% CI 1.328-1.392). Multivariate analysis, performed to further evaluate these findings, showed that nine variables were associated with ADR rate: pharmacist-provided in-service education (slope -0.469, p=0.018), drug information (slope -0.488, p=0.005), ADR management (slope -0.424, p=0.021), drug protocol management (slope -0.732, p=0.002), participation on the total parenteral nutrition team (slope 0.384, p=0.04), participation on the cardiopulmonary resuscitation team (slope -0.506, p=0.008), medical round participation (slope -0.422, p=0.037), admission drug histories (slope -0.712, p=0.008), and increased clinical pharmacist staffing (slope -4.345, p=0.009). As clinical pharmacist staffing increased from the 20th to the 100th percentile (from 0.93+/-0.77/100 to 5.16+/-4.11/100 occupied beds), ADRs decreased by 47.88%. In hospitals without pharmacist-provided ADR management, the following increases were noted: mean number of ADRs/100 admissions by 34.90% (OR 1.360, 95% CI 1.328-1.392), length of stay 13.64% (Mann-Whitney U test [U]=11047367, p=0.017), death rate 53.64% (OR 1.574, 95% CI 1.423-1.731), total Medicare

  1. Decreasing Clostridium Difficile-Associated Fatality Rates among Hospitalized Patients in the Unites States: 2004-2014.

    Science.gov (United States)

    Shrestha, Manish P; Bime, Christian; Taleban, Sasha

    2017-08-08

    Clostridium difficile infection has emerged as a major public health problem in the United States over the last two decades. Several strategies have been implemented at the hospital, community, state and national levels to combat this infection. We examined the trends in the Clostridium difficile-associated fatality rate, hospital length of stay and hospital charges over the last decade. We used data from the National Inpatient Sample to identify patients with a principal diagnosis of Clostridium difficile infection from 2004-2014. Outcomes included in-hospital fatality rate, hospital length of stay and hospital charges. For each outcome, trends were also stratified by age categories as the risk of infection and associated mortality increase with age. Clostridium difficile infection discharges increased from 19.9/100,000 persons in 2004 to 33.8/100,000 persons in 2014. Clostridium difficile-associated fatality decreased from 3.6% in 2004 to 1.6% in 2014 (linear trend PClostridium difficile infection in the United States has decreased over two fold in the last decade despite increasing infection rates. Despite decreasing length of stay, the hospital charges of Clostridium difficile infection are increasing. Copyright © 2017. Published by Elsevier Inc.

  2. The United States does a poor job of evaluating Medicare hospitals: perhaps Australia can help.

    Science.gov (United States)

    Bogart, G

    1992-01-01

    The United States spends more money per person on healthcare than does any other country in the world, and this rate of spending is increasing. Healthcare expenses currently absorb more than 12 percent of the American gross national product, and recent projections indicate that such expenses will exceed 16 percent by the year 2000. By the year 2005, the U.S. Medicare program is expected to absorb more of the national budget than either Social Security or defense. One justification for the high rate of spending has been that, for those who receive it, U.S. healthcare is the best in the world. There is, however, no way to validate this view because no national or international agreed-upon set of criteria for measuring quality of care exists. Proponents of the American system seem to assume that if it costs more, it must be better. If this is true, it is certainly not reflected in American consumer satisfaction: a recent poll of citizens of ten developed countries indicated that Americans were by far the least satisfied with their healthcare system. This article focuses on the American oversight of Medicare hospitals to determine it, in this narrow area, dissatisfied American consumers are justified.

  3. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States

    Science.gov (United States)

    Safavi, Kyan C.; Dharmarajan, Kumar; Kim, Nancy; Strait, Kelly M.; Li, Shu-Xia; Chen, Serene I.; Lagu, Tara; Krumholz, Harlan M.

    2013-01-01

    Background Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. Methods and Results We identified 166,224 HF discharges from 341 hospitals in the 2009–10 Premier Perspective® database. We excluded hospitals with transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top-quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (Interquartile Range 6% to 16%; range 0% to 88%). In top-quartile hospitals, treatments requiring an ICU were used less often: percentage of ICU days receiving mechanical ventilation (6% top quartile versus 15% others), non-invasive positive pressure ventilation (8% versus 19%), vasopressors and/or inotropes (9% versus 16%), vasodilators (6% versus 12%), and any of these interventions (26% versus 51%). Overall HF in-hospital risk standardized mortality was similar (3.4% versus 3.5%; P = 0.2). Conclusions ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes. PMID:23355624

  4. Mortality Analysis of Trauma Patients in General Intensive Care Unit of a State Hospital

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    İskender Kara

    2015-08-01

    Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting

  5. Inpatient resource utilization, disease severity, mortality and insurance coverage for patients hospitalized for hepatitis C virus in the United States.

    Science.gov (United States)

    Younossi, Z M; Otgonsuren, M; Henry, L; Arsalla, Z; Stepnaova, M; Mishra, A; Venkatesan, C; Hunt, S

    2015-02-01

    Although the incidence of new hepatitis C virus (HCV) infection has fallen, HCV-related complications are on the rise. Our aim was to assess and describe the 2005-2009 national inpatient mortality and resource utilization trends for patients with HCV. Data from the National Inpatient Sample (NIS) and the National Hospital Discharge Survey (NHDS) between 2005 and 2009 were analyzed. Included were all adult hospital discharges with HCV-related ICD-9 codes. Incremental hospital charge, in-hospital mortality and length of stay (LOS) were estimated using n = 1000 bootstrap replicates clustered by unique hospital identifier. A total of 123 939 (0.38%) discharges were related to HCV (primary or secondary diagnosis). In-hospital mortality increased from 1.7% (2005) to 2.6% (2009) (P hospital costs ($6500) remaining stable while at the same time, hospital-to-hospital transfer admissions and disposition to home health care increased. HCV-related hepatocellular carcinoma predicted longer hospital stay and death; older age predicted death; and receiving more procedures predicted higher hospital costs. The percentage of patients with private insurance significantly decreased (4.7%), while government-sponsored insurance and uninsured increased by 2.5% and 2.1%, respectively (P hospitalization than those with government-sponsored insurance. HCV-related inpatient mortality and resource utilization have increased. HCC was the largest predictor for mortality and resource utilization. These data are consistent with the rising clinical and societal burden of chronic hepatitis C in the United States. © 2014 John Wiley & Sons Ltd.

  6. Recovery of cost of hospital and medical care and treatment furnished by the United States; delegation of authority. Final rule.

    Science.gov (United States)

    2010-03-01

    This rule amends Department of Justice regulations to increase the settlement and waiver authority delegated to heads of departments and agencies of the United States responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the increase in medical costs since 1992, when the current level of delegated settlement and waiver authority was established, and will further the efficient operation of the government.

  7. Hospital website rankings in the United States: expanding benchmarks and standards for effective consumer engagement.

    Science.gov (United States)

    Huerta, Timothy R; Hefner, Jennifer L; Ford, Eric W; McAlearney, Ann Scheck; Menachemi, Nir

    2014-02-25

    these scores, rank order calculations for the top 100 websites are presented. Additionally, a link to raw data, including AHA ID, is provided to enable researchers and practitioners the ability to further explore relationships to other dynamics in health care. This census assessment of US hospitals and their health systems provides a clear indication of the state of the sector. While stakeholder engagement is core to most discussions of the role that hospitals must play in relation to communities, management of an online presence has not been recognized as a core competency fundamental to care delivery. Yet, social media management and network engagement are skills that exist at the confluence of marketing and technical prowess. This paper presents performance guidelines evaluated against best-demonstrated practice or independent standards to facilitate improvement of the sector's use of websites and social media.

  8. United States

    Directory of Open Access Journals (Sweden)

    Stephen Bernow

    1998-12-01

    Full Text Available This paper presents and discusses an integrated set of policies designed to reduce U.S. carbon emissions over the next four decades. This innovation path also aims to promote environmental quality, particularly by reducing emissions of criteria air pollutants, to reduce U.S. dependence on imported oil, and to induce technological innovation and diffusion in energy production and consumption. The innovation path would reduce economy-wide carbon emissions by 26% below baseline projections for 2010 and by 62% below baseline projections for 2030; this translates into 10% below 1990 levels in 2010 and 45% below 1990 levels in 2030. Emissions of criteria pollutants also would be significantly reduced, as would petroleum imports by the United States. Moreover, the innovation path would yield cumulative net savings for the United States of $218 billion (1993 dollars through 2010, or $19 billion on a leveled annual basis, and would result in 800,000 additional jobs nationwide by 2010. Although the overall findings from the innovation path analysis are robust, the results should be taken as indicative, rather than precisely predictive, owing to uncertainties in future costs, prices, technology performance, and consumer behavior.

  9. Pediatric vancomycin use in 421 hospitals in the United States, 2008.

    Directory of Open Access Journals (Sweden)

    Tamar Lasky

    Full Text Available BACKGROUND: Recommendations to prevent the spread of vancomycin resistance have been in place since 1995 and include guidelines for inpatient pediatric use of vancomycin. The emergence of large databases allows us to describe variation in pediatric vancomycin across hospitals. We analyzed a database with hospitalizations for children under 18 at 421 hospitals in 2008. METHODOLOGY/PRINCIPAL FINDINGS: The Premier hospital 2008 database, consisting of records for 877,201 pediatric hospitalizations in 421 hospitals, was analyzed. Stratified analyses and logistic mixed effects models were used to calculate the probability of vancomycin use while considering random effects of hospital variation, hospital fixed effects and patient effects, and the hierarchical structure of the data. Most hospitals (221 had fewer than 10 hospitalizations with vancomycin use in the study period, and 47 hospitals reported no vancomycin use in 17,271 pediatric hospitalizations. At the other end of the continuum, 21 hospitals (5.6% of hospitals each had over 200 hospitalizations with vancomycin use, and together, accounted for more than 50% of the pediatric hospitalizations with vancomycin use. The mixed effects modeling showed hospital variation in the probability of vancomycin use that was statistically significant after controlling for teaching status, urban or rural location, size, region of the country, patient ethnic group, payor status, and APR-mortality and severity codes. CONCLUSIONS/SIGNIFICANCE: The number and percentage of pediatric hospitalizations with vancomycin use varied greatly across hospitals and was not explained by hospital or patient characteristics in our logistic models. Public health efforts to reduce vancomycin use should be intensified at hospitals with highest use.

  10. Multidisciplinary case management for patients at high risk of hospitalization: comparison of virtual ward models in the United kingdom, United States, and Canada.

    Science.gov (United States)

    Lewis, Geraint; Wright, Lorraine; Vaithianathan, Rhema

    2012-10-01

    Virtual wards are a model for delivering multidisciplinary case management to people who are at high predicted risk of unplanned acute care hospitalization. First introduced in Croydon, England, in 2006, this concept has since been adopted and adapted by health care organizations in other parts of the United Kingdom and internationally. In this article, the authors review the model of virtual wards as originally described-with its twin pillars of (1) using a predictive model to identify people who are at high risk of future emergency hospitalization, and (2) offering these individuals a period of intensive, multidisciplinary preventive care at home using the systems, staffing, and daily routines of a hospital ward. The authors then describe how virtual wards have been modified and implemented in 6 sites in the United Kingdom, United States, and Canada where they are subject to formal evaluation. Like hospital wards, virtual wards vary in terms of patient selection, ward configuration, staff composition, and ward processes. Policy makers and researchers should be aware of these differences when considering the evaluation results of studies investigating the cost-effectiveness of virtual wards.

  11. The impact of chaplaincy services in selected hospitals in the eastern United States.

    Science.gov (United States)

    Parkum, K H

    1985-09-01

    Surveys a stratified sample of patients in six different hospitals and compares their perceptions of hospital chaplaincy and other pastoral care efforts with related hospital services. Reports the presence of a strong impact of pastoral care services and discusses these findings from the perspective of a theory of expressive and instrumental social orientations as explicated by the sociologist Talcott Parsons.

  12. The rise of pathophysiologic research in the United States: the role of two Harvard hospitals.

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    Tishler, Peter V

    2013-01-01

    Pathophysiologic research, the major approach to understanding and treating disease, was created in the 20th century, and two Harvard-affiliated hospitals, the Peter Bent Brigham Hospital and Boston City Hospital, played a key role in its development. After the Flexner Report of 1910, medical students were assigned clinical clerkships in teaching hospitals. Rockefeller-trained Francis Weld Peabody, who was committed to investigative, pathophysiologic research, was a critical leader in these efforts. At the Brigham, Harvard medical students observed patients closely and asked provocative questions about their diseases. Additionally, physicians returned from World War I with questions concerning the pathophysiology of wartime injuries. At the Boston City Hospital's new Thorndike Memorial Laboratory, Peabody fostered investigative question-based research by physicians. These physicians expanded pathophysiologic investigation from the 1920s. Post-war, Watson and Crick's formulation of the structure of DNA led shortly to modern molecular biology and new research approaches that are being furthered at the Boston Hospitals.

  13. Geographic disparities in chronic obstructive pulmonary disease (COPD hospitalization among Medicare beneficiaries in the United States

    Directory of Open Access Journals (Sweden)

    Holt JB

    2011-06-01

    Full Text Available James B Holt, Xingyou Zhang, Letitia Presley-Cantrell, Janet B CroftNational Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USABackground: Hospitalizations for persons with chronic obstructive pulmonary disease (COPD result in significant health care resource use and excess expenditures. Despite well-documented sociodemographic disparities in COPD outcomes, no study has characterized geographic variations in COPD hospitalization across the US.Methods: Almost 3.8 million COPD hospitalization records were extracted from Medicare claims for 1995–2006, and the total population of eligible Medicare beneficiaries was extracted from the Medicare enrollment records to calculate COPD hospitalization rates by Health Service Area (HSA, (n = 949. Spatial cluster analysis and Bayesian hierarchical spatial modeling were used to characterize the geography of COPD hospitalizations.Results: The overall COPD hospitalization rate was 11.30 per 1,000 beneficiaries for the aggregated period 1995–2006. HSA-level COPD hospitalization rates had a median of 11.7 and a range of 3.0 (Cache, UT to 76.3 (Pike, KY. Excessive hospitalization risk was concentrated in Appalachia, the southern Great Lakes, the Mississippi Delta, the Deep South, and west Texas. In the Bayesian spatial mixture model, 73% of variability of COPD hospitalization relative risk was attributed to unidentified regional social and physical environments shared by HSAs rather than to unique local HSA factors (27%.Conclusion: We discovered distinct geographic patterns in COPD hospitalization rates and risks attributed to both regionally-shared environmental risk factors and HSA-unique environmental contexts. The correlates of these geographic patterns remain to be determined. Geographic comparisons of COPD hospitalization risk provide insights for better public health practice, policies, and programs for COPD prevention

  14. Training for terrorism-related conditions in hospitals: United States, 2003-04.

    Science.gov (United States)

    Niska, Richard W; Burt, Catharine W

    2006-12-11

    This study estimates baseline data to determine which hospital characteristics are associated with providing terrorism preparedness training to clinical staff. Information from a Bioterrorism and Mass Casualty Supplement to the 2003 and 2004 National Hospital Ambulatory Medical Care Surveys was used to provide national estimates of variations in terrorism preparedness training by eight hospital characteristics. Of 874 hospitals in scope, 739 (84.6 percent) responded. Estimates are presented with 95 percent confidence intervals. Hospitals with Joint Commission accreditation were more likely to provide terrorism preparedness training to all types of clinical staff (staff physicians, residents, nurse practitioners, physician assistants, and laboratory staff). Teaching hospitals, medical school affiliation, bed capacity, and urban location were also associated with training staff physicians, residents, nurse practitioners, and physician assistants. Hospitals with residency programs were associated with training only staff physicians and residents. There was more parity across hospital characteristics in training nurses and laboratory staff than for physicians, residents, nurse practitioners, and physician assistants. Joint Commission accreditation was the most consistent factor associated with providing training for all nine exposures studied (smallpox, anthrax, chemical and radiological exposures, botulism, plague, tularemia, viral encephalitis, and hemorrhagic fever).

  15. Trends in Bronchiolitis Hospitalizations in the United States, 2000–2009

    Science.gov (United States)

    Tsugawa, Yusuke; Brown, David F.M.; Mansbach, Jonathan M.; Camargo, Carlos A.

    2013-01-01

    OBJECTIVE: To examine temporal trend in the national incidence of bronchiolitis hospitalizations, use of mechanical ventilation, and hospital charges between 2000 and 2009. METHODS: We performed a serial, cross-sectional analysis of a nationally representative sample of children hospitalized with bronchiolitis. The Kids Inpatient Database was used to identify children bronchiolitis by International Classification of Diseases, Ninth Revision, Clinical Modification code 466.1. Primary outcome measures were incidence of bronchiolitis hospitalizations, mechanical ventilation (noninvasive or invasive) use, and hospital charges. Temporal trends were evaluated accounting for sampling weights. RESULTS: The 4 separated years (2000, 2003, 2006, and 2009) of national discharge data included 544 828 weighted discharges with bronchiolitis. Between 2000 and 2009, the incidence of bronchiolitis hospitalization decreased from 17.9 to 14.9 per 1000 person-years among all US children aged bronchiolitis hospitalizations among US children. By contrast, use of mechanical ventilation and hospital charges for bronchiolitis significantly increased over this same period. PMID:23733801

  16. Characterization of nasal and blood culture isolates of methicillin-resistant Staphylococcus aureus from patients in United States Hospitals.

    Science.gov (United States)

    Tenover, Fred C; Tickler, Isabella A; Goering, Richard V; Kreiswirth, Barry N; Mediavilla, José R; Persing, David H

    2012-03-01

    A total of 299 nares and 194 blood isolates of methicillin-resistant Staphylococcus aureus (MRSA), each recovered from a unique patient, were collected from 23 U.S. hospitals from May 2009 to March 2010. All isolates underwent spa and staphylococcal cassette chromosome mec element (SCCmec) typing and antimicrobial susceptibility testing; a subset of 84 isolates was typed by pulsed-field gel electrophoresis (PFGE) using SmaI. Seventy-six spa types were observed among the isolates. Overall, for nasal isolates, spa type t002-SCCmec type II (USA100) was the most common strain type (37% of isolates), while among blood isolates, spa type t008-SCCmec type IV (USA300) was the most common (39%). However, the proportion of all USA100 and USA300 isolates varied by United States census region. Nasal isolates were more resistant to tobramycin and clindamycin than blood isolates (55.9% and 48.8% of isolates versus 36.6% and 39.7%, respectively; for both, P United States, were observed along with several unusual PFGE types, including CMRSA9, EMRSA15, and the PFGE profile associated with sequence type 239 (ST239) isolates. Typing data from this convenience sample suggest that in U.S. hospitalized patients, USA100 isolates of multiple spa types, while still common in the nares, have been replaced by USA300 isolates as the predominant MRSA strain type in positive blood cultures.

  17. Annual Burden of Occupationally-Acquired Influenza Infections in Hospitals and Emergency Departments in the United States.

    Science.gov (United States)

    Jones, Rachael M; Xia, Yulin

    2017-07-11

    Infections among health-care personnel (HCP) occur as a result of providing care to patients with infectious diseases, but surveillance is limited to a few diseases. The objective of this study is to determine the annual number of influenza infections acquired by HCP as a result of occupational exposures to influenza patients in hospitals and emergency departments (EDs) in the United States. A risk analysis approach was taken. A compartmental model was used to estimate the influenza dose received in a single exposure, and a dose-response function applied to calculate the probability of infection. A three-step algorithm tabulated the total number of influenza infections based on: the total number of occupational exposures (tabulated in previous work), the total number of HCP with occupational exposures, and the probability of infection in an occupational exposure. Estimated influenza infections were highly dependent upon the dose-response function. Given current compliance with infection control precautions, we estimated 151,300 and 34,150 influenza infections annually with two dose-response functions (annual incidence proportions of 9.3% and 2.1%, respectively). Greater reductions in infectious were achieved by full compliance with vaccination and IC precautions than with patient isolation. The burden of occupationally-acquired influenza among HCP in hospitals and EDs in the United States is not trivial, and can be reduced through improved compliance with vaccination and preventive measures, including engineering and administrative controls. © 2017 Society for Risk Analysis.

  18. The professional training of future specialists for Industry of hospitality in the United States of America.

    Directory of Open Access Journals (Sweden)

    Vindyk A.V.

    2010-12-01

    Full Text Available The analysis of the USA's scientists publications on the professional training of specialists of hospitality is presented. The couteuts of curricula of Conrad Hilton's college, University Johnson and Wales has been analyzed. It is found out that the feature of training future specialists for Industry of hospitality consists in close connection with a society, enterprises. The associations of hotels take part in the discussion, adjustments of curricula, quality determination of training of graduating students, giving grants to higher educational establishments of hospitality.

  19. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States.

    Science.gov (United States)

    Sills, Marion R; Hall, Matthew; Fieldston, Evan S; Hain, Paul D; Simon, Harold K; Brogan, Thomas V; Fagbuyi, Daniel B; Mundorff, Michael B; Shah, Samir S

    2011-09-01

    Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.

  20. Hospitalizations in pediatric patients with immune thrombocytopenia in the United States

    Science.gov (United States)

    Tarantino, Michael D.; Danese, Mark; Klaassen, Robert J.; Duryea, Jennifer; Eisen, Melissa; Bussel, James

    2016-01-01

    Abstract To examine utilization and outcomes in pediatric immune thrombocytopenia (ITP) hospitalizations, we used ICD-9 code 287.31 to identify hospitalizations in patients with ITP in the 2009 HCUP KID, an all-payer sample of pediatric hospitalizations from US community hospitals. Diagnosis and procedure codes were used to estimate rates of ITP-related procedures, comorbidity prevalence, costs, length of stay (LOS), and mortality. In 2009, there were an estimated 4499 hospitalizations in children aged 6 months–17 years with ITP; 43% in children aged 1–5 years; and 47% with emergency department encounters. The mean hospitalization cost was $5398, mean LOS 2.0 days, with 0.3% mortality (n = 13). With any bleeding (15.2%, including gastrointestinal 2.0%, hematuria 1.3%, intracranial hemorrhage [ICH] 0.6%), mean hospitalization cost was $7215, LOS 2.5 days, with 1.5% mortality. For ICH (0.6%, n = 27), mean cost was $40 209, LOS 8.5 days, with 21% mortality. With infections (14%, including upper respiratory 5.2%, viral 4.9%, bacterial 1.9%), the mean cost was $6928, LOS 2.9 days, with 0.9% mortality. Septic shock was reported in 0.3% of discharges. Utilization included immunoglobulin administration (37%) and splenectomies (2.3%). Factors associated with higher costs included age >6 years, ICH, hematuria, transfusion, splenectomy, and bone marrow diagnostics (p < 0.05). In conclusion, of the 4499 hospitalizations with ITP, mortality rates of 1.5%, 21%, and 0.9% were seen with any bleeding, ICH, and infection, respectively. Higher costs were associated with clinically significant bleeding and procedures. Future analyses may reveal effects of the implementation of more recent ITP guidelines and use of additional treatments. PMID:26941022

  1. Survey of pharmacy involvement in hospital medication reconciliation programs across the United States

    Directory of Open Access Journals (Sweden)

    Gregory R Stein

    2015-11-01

    Full Text Available Objective: The objective of this study is to conduct a review of pertinent literature, assess pharmacy involvement in medication reconciliation, and offer insight into best practices for hospitals to implement and enhance their medication reconciliation programs. Method: Pharmacists in hospitals nationwide were asked to complete an anonymous survey via the American College of Clinical Pharmacy online database. The multiple choice survey analyzed the roles that healthcare professionals play in medication reconciliation programs at hospitals. Results: Of the survey responses received, 32/91 (35% came from pharmacists at hospitals with a pharmacy-led medication reconciliation program. Of these pharmacy-led programs, 17/32 (53% have a dedicated pharmacist or pharmacy staff to perform medication reconciliation. Conclusion: A comprehensive review of literature suggests that pharmacy involvement has the potential to reduce medication reconciliation errors and may improve patient satisfaction. Focused, full-time medication reconciliation pharmacists can help hospitals save time and money, improve outcomes, and meet higher standards issued by the Joint Commission. Data obtained in this study show the extent to which pharmacists contribute to achieving these goals in healthcare systems nationwide. This baseline study provides a strong case for hospitals to implement a pharmacy-led medication reconciliation program.

  2. Job satisfaction and turnover intent among hospital social workers in the United States.

    Science.gov (United States)

    Pugh, Greg L

    2016-08-01

    Feelings of job satisfaction and turnover intentions among social workers affect work quality for both social workers and the people for whom they provide services. Existing literature on job satisfaction among hospital social workers is limited, and is overly focused on issues of compensation. There is job satisfaction research with hospital nurses available for comparison. Other informative social work research on job satisfaction and turnover exists in mental health and generally, across settings. Research on turnover intent in social work is primarily from child welfare settings and may not generalize. The literature notes gaps and contradictions about predictors of job satisfaction and turnover intent. Using a large national dataset of hospital social workers, this research clarifies and fills gaps regarding hospital social workers, and explores how Herzberg's theory of work can clarify the difference between sources of job dissatisfaction and job satisfaction. Findings include hospital social workers reporting high job satisfaction and that demographics do not contribute to the predictive models. The findings do support centralized social work departments and variety in the job functions of hospital social workers, and are consistent with the theoretical framework.

  3. Risk factors associated with calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States.

    Science.gov (United States)

    Okafor, Chika C; Lefebvre, Sandra L; Pearl, David L; Yang, Mingyin; Wang, Mansen; Blois, Shauna L; Lund, Elizabeth M; Dewey, Cate E

    2014-08-01

    Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths.

  4. Epidemiological trends and geographic variation in hospital admissions for diverticulitis in the United States

    Institute of Scientific and Technical Information of China (English)

    Geoffrey C Nguyen; Justina Sam; Nitasha Anand

    2011-01-01

    AIM: To characterize the increasing incidence and geographic variation of acute diverticulitis. METHODS: Using the nationwide inpatient sample (NIS) we identified a cohort who had been admitted with diverticulitis between 1998 and 2005. We calculated age-, sex-, and region-specific rates of hospitalizations for diverticulitis over time. RESULTS: The age-adjusted hospitalization rate for diverticulitis increased from 61.8 per 100 000 to 75.5 per 100 000 between 1998 and 2005, and increased similarly in both sexes. Diverticulitis-associated admissions were male-predominant in those younger than age 45 years but were female-predominant thereafter. Admission rates increased the most among those < 45 years, while remaining unchanged for those ≥ 65 years. By 2005, the majority of hospitalized patients were < 65 years. Age-adjusted rates of diverticulitis-associated hospitalizations were lower in the West (50.4/100 000) compared to the Northeast (77.7/100 000), South (73.9/100 000), and Midwest (71.0/100 000). CONCLUSION: Diverticulitis-associated hospitalizations have steeply risen, especially in young adults. These epidemiological trends vary by geographic region and warrant further investigation into potential dietary and environmental etiologies.

  5. Internet and technology transfer in acute care hospitals in the United States: survey-2000.

    Science.gov (United States)

    Hatcher, M

    2001-12-01

    This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals. (1) Thefirst article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2)

  6. Out-of-hospital births in the United States 2009-2014.

    Science.gov (United States)

    Grunebaum, Amos; Chervenak, Frank A

    2016-10-01

    To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014. We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009-2014 through the interactive data tool, VitalStats. Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%-1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.

  7. Attribution of foodborne illnesses, hospitalizations, and deaths to food commodities by using outbreak data, United States, 1998-2008.

    Science.gov (United States)

    Painter, John A; Hoekstra, Robert M; Ayers, Tracy; Tauxe, Robert V; Braden, Christopher R; Angulo, Frederick J; Griffin, Patricia M

    2013-03-01

    Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998-2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.

  8. Trends in Hospitalization and Incidence Rate for Syphilitic Uveitis in the United States From 1998 to 2009.

    Science.gov (United States)

    Albini, Thomas; Callaway, Natalia F; Pershing, Suzann; Wang, Sean K; Moshfeghi, Andrew A; Moshfeghi, Darius M

    2017-08-01

    This study evaluates the annual incidence of syphilitic uveitis in the US and trends in hospital admissions over time. Retrospective, longitudinal incidence rate analysis of the National Inpatient Sample (NIS) data from 1998 to 2009. The NIS is a de-identified, random sample dataset of inpatient hospitalizations from 46 states. The number of cases of syphilitic uveitis was defined by (1) International Classification of Diseases, 9th Revision (ICD-9) code for syphilis and uveitis or (2) ICD-9 code for syphilitic uveitis. Annual case count, incidence rate, and trend over time were calculated. Multivariate logistic regression was used to evaluate associated factors for a syphilitic uveitis diagnosis. The study included 455 310 286 hospitalizations during a 12-year study period with a mean of 37 942 524 patients annually. Syphilis and uveitis was recorded for 1861 patients (155 annually) and syphilitic uveitis was diagnosed in 204 subjects (average of 17 cases annually). There was no change in the incidence of syphilitic uveitis, using either definition, over the study period (P for trend = .46). The mean annual incidence of syphilis and uveitis was 0.0004%, or 4 per million. Syphilitic uveitis had an annual incidence of 0.000045%, or 0.45 per million. The odds of syphilitic uveitis were lower among women (odds ratio [OR] 0.40, CI 0.28-0.57) and increased with comorbid acquired immunodeficiency syndrome (OR 4.52, CI 3.01-6.79). We report the first incidence of syphilitic uveitis in the United States. Fortunately, this remains a rare condition. The results demonstrate no change in the number of inpatient admissions for syphilitic uveitis during the study period. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Impact of El Niño Southern Oscillation on infectious disease hospitalization risk in the United States.

    Science.gov (United States)

    Fisman, David N; Tuite, Ashleigh R; Brown, Kevin A

    2016-12-20

    Although the global climate is changing at an unprecedented rate, links between weather and infectious disease have received little attention in high income countries. The "El Niño Southern Oscillation" (ENSO) occurs irregularly and is associated with changing temperature and precipitation patterns. We studied the impact of ENSO on infectious diseases in four census regions in the United States. We evaluated infectious diseases requiring hospitalization using the US National Hospital Discharge Survey (1970-2010) and five disease groupings that may undergo epidemiological shifts with changing climate: (i) vector-borne diseases, (ii) pneumonia and influenza, (iii) enteric disease, (iv) zoonotic bacterial disease, and (v) fungal disease. ENSO exposure was based on the Multivariate ENSO Index. Distributed lag models, with adjustment for seasonal oscillation and long-term trends, were used to evaluate the impact of ENSO on disease incidence over lags of up to 12 mo. ENSO was associated more with vector-borne disease [relative risk (RR) 2.96, 95% confidence interval (CI) 1.03-8.48] and less with enteric disease (0.73, 95% CI 0.62-0.87) in the Western region; the increase in vector-borne disease was attributable to increased risk of rickettsioses and tick-borne infectious diseases. By contrast, ENSO was associated with more enteric disease in non-Western regions (RR 1.12, 95% CI 1.02-1.15). The periodic nature of ENSO may make it a useful natural experiment for evaluation of the impact of climatic shifts on infectious disease risk. The impact of ENSO suggests that warmer temperatures and extreme variation in precipitation events influence risks of vector-borne and enteric disease in the United States.

  10. Bortezomib Inpatient Prescribing Practices in Free-Standing Children's Hospitals in the United States.

    Directory of Open Access Journals (Sweden)

    Amanda M DiNofia

    Full Text Available This study is a pharmacoepidemiologic description of pediatric bortezomib use. Exposure was identified through billing codes in patients admitted to US children's hospitals that participated with the Pediatric Health Information System between 2004 and 2013. Associated information on underlying diseases, demographics, institutional use, mortality, and physician type was collected. Exposure to bortezomib was identified in 314 patients. Hematologist/Oncologists prescribed half of the bortezomib used. Use increased during the study period. Inpatient volume was positively correlated with bortezomib utilization. Bortezomib use in pediatrics is increasing for a variety of diseases. Variation in use exists across institutions. Further studies are needed to characterize bortezomib's efficacy in pediatric diseases.

  11. Patterns of financing for the largest hospital systems in the United States.

    Science.gov (United States)

    Cleverley, William O; Baserman, Sarah Jane

    2005-01-01

    The ten large systems reviewed in this column have greater degrees of financial leverage than do most freestanding hospitals. Larger firms typically have both greater capital access and lower costs of financing. Both voluntary and IO systems make extensive use of variable rate financing, but the percentage of variable rate financing is slightly higher for voluntary systems. This difference may be attributable to larger yield curve spreads for tax-exempt versus taxable securities. Interest rate swaps were used by 70 percent of the systems, but the actual amount swapped was relatively minor. This may change in the future as financial officers become more comfortable and familiar with interest rate swap arrangements. When compared to IO systems, voluntary systems have extensive levels of cash relative to their debt positions. Cash balances are more critical in the bond-rating process for voluntary hospitals, and the ability to raise new equity is much more limited in the voluntary sector. Very little capital leasing was used in any of the systems.

  12. Coding of Electronic Laboratory Reports for Biosurveillance, Selected United States Hospitals, 2011.

    Science.gov (United States)

    Dhakal, Sanjaya; Burrer, Sherry L; Winston, Carla A; Dey, Achintya; Ajani, Umed; Groseclose, Samuel L

    2015-01-01

    Objective Electronic laboratory reporting has been promoted as a public health priority. The Office of the U.S. National Coordinator for Health Information Technology has endorsed two coding systems: Logical Observation Identifiers Names and Codes (LOINC) for laboratory test orders and Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for test results. Materials and Methods We examined LOINC and SNOMED CT code use in electronic laboratory data reported in 2011 by 63 non-federal hospitals to BioSense electronic syndromic surveillance system. We analyzed the frequencies, characteristics, and code concepts of test orders and results. Results A total of 14,028,774 laboratory test orders or results were reported. No test orders used SNOMED CT codes. To describe test orders, 77% used a LOINC code, 17% had no value, and 6% had a non-informative value, "OTH". Thirty-three percent (33%) of test results had missing or non-informative codes. For test results with at least one informative value, 91.8% had only LOINC codes, 0.7% had only SNOMED codes, and 7.4% had both. Of 108 SNOMED CT codes reported without LOINC codes, 45% could be matched to at least one LOINC code. Conclusion Missing or non-informative codes comprised almost a quarter of laboratory test orders and a third of test results reported to BioSense by non-federal hospitals. Use of LOINC codes for laboratory test results was more common than use of SNOMED CT. Complete and standardized coding could improve the usefulness of laboratory data for public health surveillance and response.

  13. Depression prevalence in Intensive Care Unit nursing workers: a study at hospitals in a northwestern city of São Paulo State

    OpenAIRE

    de Vargas, Divane; Dias,Ana Paula Vieira

    2011-01-01

    This study aimed to estimate the prevalence of depression in nursing staff working in Intensive Care Units of hospitals from a city in Northwestern São Paulo State - Brazil, examining its association with participants' socio-demographic characteristics. The Beck Depression Inventory was applied to a sample of 67 nursing workers from three general hospitals, showing an 28.4% prevalence of depression. The analysis based on the multiple model showed a significant association between depressi...

  14. 42 CFR 412.25 - Excluded hospital units: Common requirements.

    Science.gov (United States)

    2010-10-01

    ... hospital is transferred to the unit. (5) Meet applicable State licensure laws. (6) Have utilization review... 42 Public Health 2 2010-10-01 2010-10-01 false Excluded hospital units: Common requirements. 412... HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital...

  15. The Compliance Rates of Hand Hygiene in Intensive Care Unit and Surgical Services at a State Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Serap Süzük

    2015-12-01

    Full Text Available Objective: The most efficient and most cost effective method for preventing health care associated infections is hand hygiene. Although hand hygiene is the most effective and simple method, compliance rates are very low among health care workers. It was aimed to evaluate the rates of compliance of healthcare workers in a state hospital. Material and Method: In this study, totally 112 healthcare workers (31 doctors and 81 nurses were evaluated with the 5-indication observation method in a period between January and July 2013. Results: A total of 754 (65.9% out of 1.144 cases were resulted in accurate hand washing and hand-rubbing. When the intensive care unit and surgical clinics were evaluated together, it was found that hand hygiene compliance rates were 51.26% in 199 cases and 66.85% in 591 cases for doctors and nurses, respectively. Conclusion: Consequently, we think that pre-informed observations are important training instruments for hand hygiene compliance.

  16. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes.

    Science.gov (United States)

    Perman, Sarah M; Stanton, Emily; Soar, Jasmeet; Berg, Robert A; Donnino, Michael W; Mikkelsen, Mark E; Edelson, Dana P; Churpek, Matthew M; Yang, Lin; Merchant, Raina M

    2016-09-29

    In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; Plocations. Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  17. Hospitals, finance, and health system reform in Britain and the United States, c. 1910-1950: historical revisionism and cross-national comparison.

    Science.gov (United States)

    Gorsky, Martin

    2012-06-01

    Comparative histories of health system development have been variously influenced by the theoretical approaches of historical institutionalism, political pluralism, and labor mobilization. Britain and the United States have figured significantly in this literature because of their very different trajectories. This article explores the implications of recent research on hospital history in the two countries for existing historiographies, particularly the coming of the National Health Service in Britain. It argues that the two hospital systems initially developed in broadly similar ways, despite the very different outcomes in the 1940s. Thus, applying the conceptual tools used to explain the U.S. trajectory can deepen appreciation of events in Britain. Attention focuses particularly on working-class hospital contributory schemes and their implications for finance, governance, and participation; these are then compared with Blue Cross and U.S. hospital prepayment. While acknowledging the importance of path dependence in shaping attitudes of British bureaucrats toward these schemes, analysis emphasizes their failure in pressure group politics, in contrast to the United States. In both countries labor was also crucial, in the United States sustaining employment-based prepayment and in Britain broadly supporting system reform.

  18. Malaria Treatment (United States)

    Science.gov (United States)

    ... a CDC Malaria Branch clinician. malaria@cdc.gov Malaria Treatment (United States) Recommend on Facebook Tweet Share Compartir Treatment of Malaria: Guidelines For Clinicians (United States) Download PDF version ...

  19. An Examination of Information Technology and Its Perceived Quality Issues in Single System Hospitals in the United States

    Science.gov (United States)

    Byrd, Linda W.

    2009-01-01

    The safety and quality of healthcare is of great concern in the United States. The positive effects of information technology reported in past research, especially case studies, has encouraged expectations that information technology may increase the quality of healthcare while reducing costs of healthcare. The goals of this study was to examine…

  20. Depression prevalence in Intensive Care Unit nursing workers: a study at hospitals in a northwestern city of São Paulo State.

    Science.gov (United States)

    de Vargas, Divane; Dias, Ana Paula Vieira

    2011-01-01

    This study aimed to estimate the prevalence of depression in nursing staff working in Intensive Care Units of hospitals from a city in Northwestern São Paulo State - Brazil, examining its association with participants' socio-demographic characteristics. The Beck Depression Inventory was applied to a sample of 67 nursing workers from three general hospitals, showing an 28.4% prevalence of depression. The analysis based on the multiple model showed a significant association between depression and marital status (OR=1.52), night work (OR=1.46) and double shifts (OR=2.11). Also, there were significant percentages of workers who reported discouragement, sadness and hopelessness. In conclusion, the prevalence of depression is significant and more attention should be paid to this problem workers at these units face. Further studies are needed in the attempt to broaden knowledge on the subject, which can support strategies to guarantee attention to ICU nursing workers' physical and mental health needs.

  1. Variation in neoadjuvant chemotherapy utilization for epithelial ovarian cancer at high volume hospitals in the United States and associated survival.

    Science.gov (United States)

    Barber, Emma L; Dusetzina, Stacie B; Stitzenberg, Karyn B; Rossi, Emma C; Gehrig, Paola A; Boggess, John F; Garrett, Joanne M

    2017-06-01

    To estimate variation in the use of neoadjuvant chemotherapy by high volume hospitals and to determine the association between hospital utilization of neoadjuvant chemotherapy and survival. We identified incident cases of stage IIIC or IV epithelial ovarian cancer in the National Cancer Database from 2006 to 2012. Inclusion criteria were treatment at a high volume hospital (>20 cases/year) and treatment with both chemotherapy and surgery. A logistic regression model was used to predict receipt of neoadjuvant chemotherapy based on case-mix predictors (age, comorbidities, stage etc). Hospitals were categorized by the observed-to-expected ratio for neoadjuvant chemotherapy use as low, average, or high utilization hospitals. Survival analysis was performed. We identified 11,574 patients treated at 55 high volume hospitals. Neoadjuvant chemotherapy was used for 21.6% (n=2494) of patients and use varied widely by hospital, from 5%-55%. High utilization hospitals (n=1910, 10 hospitals) had a median neoadjuvant chemotherapy rate of 39% (range 23-55%), while low utilization hospitals (n=2671, 14 hospitals) had a median rate of 10% (range 5-17%). For all ovarian cancer patients adjusting for clinical and socio-demographic factors, treatment at a hospital with average or high neoadjuvant chemotherapy utilization was associated with a decreased rate of death compared to treatment at a low utilization hospital (HR 0.90 95% CI 0.83-0.97 and HR 0.85 95% CI 0.75-0.95). Wide variation exists in the utilization of neoadjuvant chemotherapy to treat stage IIIC and IV epithelial ovarian cancer even among high volume hospitals. Patients treated at hospitals with low rates of neoadjuvant chemotherapy utilization experience decreased survival. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Investigating hospital heterogeneity with a multi-state frailty model: application to nosocomial pneumonia disease in intensive care units

    Directory of Open Access Journals (Sweden)

    Liquet Benoit

    2012-06-01

    Full Text Available Abstract Background Multistate models have become increasingly useful to study the evolution of a patient’s state over time in intensive care units ICU (e.g. admission, infections, alive discharge or death in ICU. In addition, in critically-ill patients, data come from different ICUs, and because observations are clustered into groups (or units, the observed outcomes cannot be considered as independent. Thus a flexible multi-state model with random effects is needed to obtain valid outcome estimates. Methods We show how a simple multi-state frailty model can be used to study semi-competing risks while fully taking into account the clustering (in ICU of the data and the longitudinal aspects of the data, including left truncation and right censoring. We suggest the use of independent frailty models or joint frailty models for the analysis of transition intensities. Two distinct models which differ in the definition of time t in the transition functions have been studied: semi-Markov models where the transitions depend on the waiting times and nonhomogenous Markov models where the transitions depend on the time since inclusion in the study. The parameters in the proposed multi-state model may conveniently be computed using a semi-parametric or parametric approach with an existing R package FrailtyPack for frailty models. The likelihood cross-validation criterion is proposed to guide the choice of a better fitting model. Results We illustrate the use of our approach though the analysis of nosocomial infections (ventilator-associated pneumonia infections: VAP in ICU, with “alive discharge” and “death” in ICU as other endpoints. We show that the analysis of dependent survival data using a multi-state model without frailty terms may underestimate the variance of regression coefficients specific to each group, leading to incorrect inferences. Some factors are wrongly significantly associated based on the model without frailty terms. This

  3. 31 CFR 535.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 535.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof including the Trust Territory...

  4. 31 CFR 515.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 515.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including the Trust Territory...

  5. 31 CFR 500.321 - United States; continental United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States; continental United... General Definitions § 500.321 United States; continental United States. The term United States means the United States and all areas under the jurisdiction or authority thereof, including U.S. trust...

  6. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

    Science.gov (United States)

    Pan, I-Jen; Yi, Hsiao-ye

    2013-05-01

    To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

  7. Patterns of scheduled follow-up appointments following hospitalization for heart failure: insights from an urban medical center in the United States

    Science.gov (United States)

    Goyal, Parag; Sterling, Madeline R; Beecy, Ashley N; Ruffino, John T; Mehta, Sonal S; Jones, Erica C; Lachs, Mark S; Horn, Evelyn M

    2016-01-01

    Objectives Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge. Patients and methods This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014. Patient demographics, administrative data, clinical parameters, echocardiographic indices, and scheduled postdischarge outpatient follow-up appointments were collected. Results Of the 796 patients hospitalized for heart failure, just over half of the cohort had a scheduled follow-up appointment upon discharge. Follow-up appointments were less likely among patients who were white and had heart failure with preserved ejection fraction and more likely among patients with Medicaid and chronic obstructive pulmonary disease. In an adjusted multivariable regression model, age ≥65 years was inversely associated with a scheduled follow-up appointment upon hospital discharge, despite higher rates of several cardiovascular and noncardiovascular comorbidities. Conclusion Just half of the patients discharged home following a hospitalization for heart failure had a follow-up appointment scheduled, representing a missed opportunity to provide a recommended care transition intervention. Despite a greater burden of both cardiovascular and noncardiovascular comorbidities, older adults (age ≥65 years) were less likely to have a follow-up appointment scheduled upon discharge compared with younger adults, revealing a disparity that warrants further investigation. PMID:27713623

  8. 20 CFR 404.462 - Nonpayment of hospital and medical insurance benefits of alien outside United States for more...

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Nonpayment of hospital and medical insurance... SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE (1950- ) Deductions; Reductions; and Nonpayments of Benefits § 404.462 Nonpayment of hospital and medical insurance benefits of...

  9. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010

    Data.gov (United States)

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  10. Uptake and Utilization of Practice Guidelines in Hospitals in the United States: the Case of Routine Episiotomy.

    Science.gov (United States)

    Kozhimannil, Katy B; Karaca-Mandic, Pinar; Blauer-Peterson, Cori J; Shah, Neel T; Snowden, Jonathan M

    2017-01-01

    The gap between publishing and implementing guidelines differs based on practice setting, including hospital geography and teaching status. On March 31, 2006, a Practice Bulletin published by the American College of Obstetricians and Gynecologists (ACOG) recommended against the routine use of episiotomy and urged clinicians to make judicious decisions to restrict the use of the procedure. This study investigated changes in trends of episiotomy use before and after the ACOG Practice Guideline was issued in 2006, focusing on differences by hospital geographic location (rural/urban) and teaching status. In a retrospective analysis of discharge data from the Nationwide Inpatient Sample (NIS)-a 20% sample of US hospitals-5,779,781 hospital-based births from 2002 to 2011 (weighted N = 28,067,939) were analyzed using multivariable logistic regression analysis to measure odds of episiotomy and trends in episiotomy use in vaginal deliveries. The overall episiotomy rate decreased from 20.3% in 2002 to 9.4% in 2011. Across all settings, a comparatively larger decline in episiotomy rates preceded the issuance of the ACOG Practice Guideline (34.0% decline), rather than following it (23.9% decline). The episiotomy rate discrepancies between rural, urban teaching, and urban nonteaching hospitals remained steady prior to the guideline's release; however, differences between urban nonteaching and urban teaching hospitals narrowed between 2007 and 2011 after the guideline was issued. Teaching status was a strong predictor of odds of episiotomy, with urban nonteaching hospitals having the highest rates of noncompliance with evidence-based practice. Issuance of clinical guidelines precipitated a narrowing of this discrepancy. Copyright © 2016 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  11. Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-10-01

    This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

  12. Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population

    Directory of Open Access Journals (Sweden)

    Eric M. Foote

    2015-11-01

    Full Text Available Background: The lower respiratory tract infection (LRTI-associated hospitalization rate in American Indian and Alaska Native (AI/AN children aged <5 years declined during 1998–2008, yet remained 1.6 times higher than the general US child population in 2006–2008. Purpose: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. Methods: A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009–2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998–1999 rates prior to pneumococcal conjugate vaccine introduction. Results: The average annual LRTI-associated hospitalization rate declined from 1998–1999 to 2009–2011 in AI/AN (35%, p<0.01 and the general US child population (19%, SE: 4.5%, p<0.01. The 2009–2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6–14.8. The Alaska (38.9 and Southwest regions (27.3 had the highest rates. The disparity was greatest for infant (<1 year pneumonia-associated and 2009–2010 H1N1 influenza-associated hospitalizations. Conclusions: Although the LRTI-associated hospitalization rate declined, the 2009–2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.

  13. Hospitalizations of the elderly in the United States for non-specific gastrointestinal diseases: A search for etilogical clues

    Science.gov (United States)

    Nonspecific gastrointestinal (GI) disease is a common cause of GI-related hospitalizations in U.S. elderly (82.9% of all cases) and it peaks concurrently with viral enteritis, suggesting a lack of diagnostic testing. The lack of etiological specificity in the current coding syste...

  14. The potential influence of common viral infections diagnosed during hospitalization among critically ill patients in the United States.

    Directory of Open Access Journals (Sweden)

    Makesha Miggins

    Full Text Available Viruses are the most common source of infection among immunocompetent individuals, yet they are not considered a clinically meaningful risk factor among the critically ill. This work examines the association of viral infections diagnosed during the hospital stay or not documented as present on admission to the outcomes of ICU patients with no evidence of immunosuppression on admission. This is a population-based retrospective cohort study of University HealthSystem Consortium (UHC academic centers in the U.S. from the years 2006 to 2009. The UHC is an alliance of over 90% of the non-profit academic medical centers in the U.S. A total of 209,695 critically ill patients were used in this analysis. Eight hospital complications were examined. Patients were grouped into four cohorts: absence of infection, bacterial infection only, viral infection only, and bacterial and viral infection during same hospital admission. Viral infections diagnosed during hospitalization significantly increased the risk of all complications. There was also a seasonal pattern for viral infections. Specific viruses associated with poor outcomes included influenza, RSV, CMV, and HSV. Patients who had both viral and bacterial infections during the same hospitalization had the greatest risk of mortality RR 6.58, 95% CI (5.47, 7.91; multi-organ failure RR 8.25, 95% CI (7.50, 9.07; and septic shock RR 271.2, 95% CI (188.0, 391.3. Viral infections may play a significant yet unrecognized role in the outcomes of ICU patients. They may serve as biological markers or play an active role in the development of certain adverse complications by interacting with coincident bacterial infection.

  15. United States Attorney Prosecutions

    Science.gov (United States)

    1993-10-01

    Berceda, 572 F.2d 630 (9th Cir. 1978).. A mere request, such as that made by the defendant, is not sufficient; United States v. Trejo- Zambrano , 582 F.2d...a mere request and more than mere speculation that disclosure will be helpful. United States v. Trejo- Zambrano , 582 F.2d 460 (9th Cir. 1978), eect. dt...both known and unknown to the Grand Jury, including Lane Boudreau, Scott Willard Holland, James Allen Halperin, Maria Ximena Erlandsen, Derek Adrian

  16. Adherence to antiretroviral treatment and correlation with risk of hospitalization among commercially insured HIV patients in the United States.

    Directory of Open Access Journals (Sweden)

    Paul E Sax

    Full Text Available PURPOSE: A lower daily pill burden may improve adherence to antiretroviral treatment (ART and clinical outcomes in patients with human immunodeficiency virus (HIV. This study assessed differences in adherence using the number of pills taken per day, and evaluated how adherence correlated with hospitalization. METHODOLOGY: Commercially insured patients in the LifeLink database with an HIV diagnosis (International Classification of Diseases, 9th Revision, Clinical Modification code 042.xx between 6/1/2006 and 12/31/2008 and receipt of a complete ART regimen were selected for inclusion. Patients were grouped according to their daily pill count and remained on ART for at least 60 days. Outcomes included adherence and rates of hospitalization. Adherence was measured as the proportion of days between the start and end of the regimen in which the patient maintained supply of all initiated ART components. Logistic regressions assessed the relationship between pills per day, adherence, and hospitalization, controlling for demographics, comorbidities, and ART-naïve (vs. experienced status. RESULTS: 7,073 patients met the study inclusion criteria, and 33.4%, 5.8%, and 60.8% received an ART regimen comprising one, two, or three or more pills per day, respectively. Regression analysis showed patients receiving a single pill per day were significantly more likely to reach a 95% adherence threshold versus patients receiving three or more pills per day (odds ratio [OR] = 1.59; P<0.001. Regardless of the number of pills received per day, patients were over 40% less likely to have a hospitalization if they were adherent to therapy (OR = 0.57; P<0.001. Patients receiving a single pill per day were 24% less likely to have a hospitalization versus patients receiving three or more pills per day (OR = 0.76; P = 0.003. CONCLUSIONS: ART consisting of a single pill per day was associated with significantly better adherence and lower risk of hospitalization in patients

  17. Trends in hospitalization of preterm infants with intraventricular hemorrhage and hydrocephalus in the United States, 2000-2010.

    Science.gov (United States)

    Christian, Eisha A; Jin, Diana L; Attenello, Frank; Wen, Timothy; Cen, Steven; Mack, William J; Krieger, Mark D; McComb, J Gordon

    2016-03-01

    OBJECT Even with improved prenatal and neonatal care, intraventricular hemorrhage (IVH) occurs in approximately 25%-30% of preterm infants, with a subset of these patients developing hydrocephalus. This study was undertaken to describe current trends in hospitalization of preterm infants with posthemorrhagic hydrocephalus (PHH) using the Nationwide Inpatient Sample (NIS) and the Kids' Inpatient Database (KID). METHODS The KID and NIS were combined to generate data for the years 2000-2010. All neonatal discharges with ICD-9-CM codes for preterm birth with IVH alone or with IVH and hydrocephalus were included. RESULTS There were 147,823 preterm neonates with IVH, and 9% of this group developed hydrocephalus during the same admission. Of patients with Grade 3 and 4 IVH, 25% and 28%, respectively, developed hydrocephalus in comparison with 1% and 4% of patients with Grade 1 and 2 IVH, respectively. Thirty-eight percent of patients with PHH had permanent ventricular shunts inserted. Mortality rates were 4%, 10%, 18%, and 40%, respectively, for Grade 1, 2, 3, and 4 IVH during initial hospitalization. Length of stay has been trending upward for both groups of IVH (49 days in 2000, 56 days in 2010) and PHH (59 days in 2000, 70 days in 2010). The average hospital cost per patient (adjusted for inflation) has also increased, from $201,578 to $353,554 (for IVH) and $260,077 to $495,697 (for PHH) over 11 years. CONCLUSIONS The number of neonates admitted with IVH has increased despite a decrease in the number of preterm births. Rates of hydrocephalus and mortality correlated closely with IVH grade. The incidence of hydrocephalus in preterm infants with IVH remained stable between 8% and 10%. Over an 11-year period, there was a progressive increase in hospital cost and length of stay for preterm neonates with IVH and PHH that may be explained by a concurrent increase in the proportion of patients with congenital cardiac anomalies.

  18. Economic burden and comorbidities of attention-deficit/hyperactivity disorder among pediatric patients hospitalized in the United States

    Directory of Open Access Journals (Sweden)

    Wietecha Linda

    2010-12-01

    Full Text Available Abstract Background This retrospective database analysis used data from the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS to examine common primary diagnoses among children and adolescents hospitalized with a secondary diagnosis of attention- deficit/hyperactivity disorder (ADHD and assessed the burden of ADHD. Methods Hospitalized children (aged 6-11 years and adolescents (aged 12-17 years with a secondary diagnosis of ADHD were identified. The 10 most common primary diagnoses (using the first 3 digits of the ICD-9-CM code were reported for each age group. Patients with 1 of these conditions were selected to analyze demographics, length of stay (LOS, and costs. Control patients were selected if they had 1 of the 10 primary diagnoses and no secondary ADHD diagnosis. Patient and hospital characteristics were reported by cohort (i.e., patients with ADHD vs. controls, and LOS and costs were reported by primary diagnosis. Multivariable linear regression analyses were undertaken to adjust LOS and costs based on patient and hospital characteristics. Results A total of 126,056 children and 204,176 adolescents were identified as having a secondary diagnosis of ADHD. Among children and adolescents with ADHD, the most common diagnoses tended to be mental health related (i.e., affective psychoses, emotional disturbances, conduct disturbances, depressive disorder, or adjustment reaction. Other common diagnoses included general symptoms, asthma (in children only, and acute appendicitis. Among patients with ADHD, a higher percentage were male, white, and covered by Medicaid. LOS and costs were higher among children with ADHD and a primary diagnosis of affective psychoses (by 0.61 days and $51, adjustment reaction (by 1.71 days and $940, or depressive disorder (by 0.41 days and $124 versus controls. LOS and costs were higher among adolescents with ADHD and a primary diagnosis of affective psychoses (by 1.04 days and $352

  19. The push to increase the use of EHR technology by hospitals and physicians in the United States through the HITECH Act and the Medicare incentive program.

    Science.gov (United States)

    Pipersburgh, Jessica

    2011-01-01

    This article reviews key health care spending and electronic health records (EHR) statistics in the United States (Section II); highlights positive and negative aspects of EHR technology (Sections III and IV); briefly reviews the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) (Section V); discusses the rule passed by the Office of the National Coordinator for Health Information Technology (ONCHIT) and to implement the goals of HITECH (Section VI); discusses the rule passed by the Centers for Medicare & Medicaid Services (CMS) to implement the goals of HITECH and focuses on significant requirements of the Medicare incentive program rule as it applies to hospitals and physicians (Section VII); and finally, concludes by highlighting certain issues that have been raised regarding the goals of HITECH (Section VIII).

  20. Benchmarking of Percutaneous Injuries at the Ministry of Health Hospitals of Saudi Arabia in Comparison with the United States Hospitals Participating in Exposure Prevention Information Network (EPINet™

    Directory of Open Access Journals (Sweden)

    ZA Memish

    2015-01-01

    Full Text Available Background: Exposure to blood-borne pathogens from needle-stick and sharp injuries continues to pose a significant risk to health care workers. These events are of concern because of the risk to transmit blood-borne diseases such as hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus.Objective: To benchmark different risk factors associated with needle-stick incidents among health care workers in the Ministry of Health hospitals in the Kingdom of Saudi Arabia compared to the US hospitals participating in Exposure Prevention Information Network (EPINet ™.Methods: Prospective surveillance of needle-stick and sharp incidents carried out during the year 2012 using EPINet™ ver 1.5 that provides uniform needle stick and sharp injury report form.Results: The annual percutaneous incidents (PIs rate per 100 occupied beds was 3.2 at the studied MOH hospitals. Nurses were the most affected job category by PIs (59.4%. Most PIs happened in patients' wards in the Ministry of Health hospitals (34.6%. Disposable syringes were the most common cause of PIs (47.20%. Most PIs occurred during use of the syringes (36.4%.Conclusion: Among health care workers, nurses and physicians appear especially at risk of exposure to PIs. Important risk factors of injuries include working in patient room, using disposable syringes, devices without safety features. Preventive strategies such as continuous training of health care workers with special emphasis on nurses and physicians, encouragement of reporting of such incidents, observation of sharp handling, their use and implementation of safety devices are warranted.

  1. A Comparison of Nurse Staffing Methods Used by the United States Air Force and Selected Civilian Hospitals

    Science.gov (United States)

    1989-09-01

    especiai ly critica , on 59 units with thirty or forty patients. On the other hand, ciassification by a charge nurse relieves the staff nurses of...han . a w lirmum 73 costs less, but increases the potential of a staffing crisis if census rises sharply in a short period of time. To arrive a: a

  2. Patterns of scheduled follow-up appointments following hospitalization for heart failure: insights from an urban medical center in the United States

    Directory of Open Access Journals (Sweden)

    Goyal P

    2016-09-01

    Full Text Available Parag Goyal,1 Madeline R Sterling,2 Ashley N Beecy,2 John T Ruffino,2 Sonal S Mehta,3 Erica C Jones,1 Mark S Lachs,3 Evelyn M Horn1 1Division of Cardiology, Department of Medicine, 2Department of Medicine, 3Division of Geriatrics, Department of Medicine, Weill Cornell Medicine, New York, NY, USA Objectives: Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge.Patients and methods: This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014. Patient demographics, administrative data, clinical parameters, echocardiographic indices, and scheduled postdischarge outpatient follow-up appointments were collected.Results: Of the 796 patients hospitalized for heart failure, just over half of the cohort had a scheduled follow-up appointment upon discharge. Follow-up appointments were less likely among patients who were white and had heart failure with preserved ejection fraction and more likely among patients with Medicaid and chronic obstructive pulmonary disease. In an adjusted multivariable regression model, age ≥65 years was inversely associated with a scheduled follow-up appointment upon hospital discharge, despite higher rates of several cardiovascular and noncardiovascular comorbidities.Conclusion: Just half of the patients discharged home following a hospitalization for heart failure had a follow-up appointment scheduled, representing a missed opportunity to provide a recommended care transition intervention. Despite a greater

  3. Healthcare Data Analytics for Parkinson’s Disease Patients: A Study of Hospital Cost and Utilization in the United States

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson’s Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients. PMID:28269954

  4. Healthcare Data Analytics for Parkinson's Disease Patients: A Study of Hospital Cost and Utilization in the United States.

    Science.gov (United States)

    Mukherjee, Sunanda; Wu, Huanmei; Jones, Josette

    2016-01-01

    Parkinson's Disease (PD), a prevalent problem, especially for the aged populations, is a progressive but non-fatal nervous system disorder. PD patients have special motor as well as non-motor symptoms over time. There are several limitations in the study of PD such as unavailability of data, proper diagnosis and treatment methods. These limitations significantly reduce the quality of PD patient life quality, either directly or indirectly. PD also imposes great financial burdens to PD patients and their family. This project aims to analyze the most common reasons for PD patient hospitalization, review complications that occur during inpatient stays, and measure the costs associated with PD patient characteristics. Using the HCUP NIS data, comprehensive data analysis has been performed. The results are customized visualized using Tableau and other software systems. The preliminary findings sheds light into how to improve the life quality of PD patients.

  5. [Crisis unit at the general hospital: Determinants of further hospitalization].

    Science.gov (United States)

    Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

    2016-10-10

    The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

  6. Respiratory syncytial virus genomic load and disease severity among children hospitalized with bronchiolitis: multicenter cohort studies in the United States and Finland.

    Science.gov (United States)

    Hasegawa, Kohei; Jartti, Tuomas; Mansbach, Jonathan M; Laham, Federico R; Jewell, Alan M; Espinola, Janice A; Piedra, Pedro A; Camargo, Carlos A

    2015-05-15

    We investigated whether children with a higher respiratory syncytial virus (RSV) genomic load are at a higher risk of more-severe bronchiolitis. Two multicenter prospective cohort studies in the United States and Finland used the same protocol to enroll children aged bronchiolitis and collect nasopharyngeal aspirates. By using real-time polymerase chain reaction analysis, patients were classified into 3 genomic load status groups: low, intermediate, and high. Outcome measures were a length of hospital stay (LOS) of ≥3 days and intensive care use, defined as admission to the intensive care unit or use of mechanical ventilation. Of 2615 enrolled children, 1764 (67%) had RSV bronchiolitis. Children with a low genomic load had a higher unadjusted risk of having a length of stay of ≥3 days (52%), compared with children with intermediate and those with high genomic loads (42% and 51%, respectively). In a multivariable model, the risk of having a length of stay of ≥3 days remained significantly higher in the groups with intermediate (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20-1.69) and high (OR, 1.58; 95% CI, 1.29-1.94) genomic loads. Similarly, children with a high genomic load had a higher risk of intensive care use (20%, compared with 15% and 16% in the groups with low and intermediate genomic loads, respectively). In a multivariable model, the risk remained significantly higher in the group with a high genomic load (OR, 1.43; 95% CI, 1.03-1.99). Children with a higher RSV genomic load had a higher risk for more-severe bronchiolitis. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  7. Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States.

    Science.gov (United States)

    Bonis, Peter A; Pickens, Gary T; Rind, David M; Foster, David A

    2008-11-01

    Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes. We compared hospitals with online access to UpToDate with other acute care hospitals included in the Thomson 100 Top Hospitals Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume. Hospitals with access to UpToDate (n=424) were associated with significantly better performance than other hospitals in the Thomson database (n=3091) on risk-adjusted measures of patient safety (P=0.0163) and complications (P=0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, PUpToDate was used at each hospital. Mortality was not significantly different between UpToDate and non-UpToDate hospitals. The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes. An electronic clinical knowledge support system (UpToDate was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals.

  8. Configurations of Leadership Practices in Hospital Units

    DEFF Research Database (Denmark)

    Meier, Ninna

    2015-01-01

    shows leadership practices to be primarily embedded in the clinical work and often shared across organizational or professional boundaries. Originality/value: – This paper demonstrated how leadership practices are embedded in the everyday work in hospital units. Moreover, the analysis shows how...... and interviews with ten interdisciplinary clinical managers. Findings: – Comparing leadership as configurations of practices across four different clinical settings, the author shows how flexible and often shared leadership practices were embedded in and central to the core clinical work in all units studied...

  9. Announcement of ruling: implementing United States v.Windsor for purposes of entitlement and enrollment in Medicare hospital insurance and supplementary medical insurance. Notice of CMS ruling.

    Science.gov (United States)

    2015-02-13

    This document announces a CMS Ruling that states the CMS policies for implementing United States v. Windsor ("Windsor''), in which the Supreme Court held that section 3 of the Defense of Marriage Act (DOMA), enacted in 1996, is unconstitutional. Section 3 of DOMA defined ``marriage'' and "spouse'' as excluding same-sex marriages and same-sex spouses, and effectively precluded the Federal government from recognizing same-sex marriages and spouses.

  10. 7 CFR 1160.104 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1160.104 Section 1160.104 Agriculture... Definitions § 1160.104 United States. United States means the 48 contiguous states in the continental United States and the District of Columbia, except that United States means the 50 states of the United......

  11. CONSUMPTION TRENDS OF RESCUE ANTI-PSYCHOTICS FOR DELIRIUM IN INTENSIVE CARE UNITS (ICU DELIRIUM) SHOW INFLUENCE OF CORRESPONDING LUNAR PHASE CYCLES: A RETROSPECTIVE AUDIT STUDY FROM ACADEMIC UNIVERSITY HOSPITAL IN THE UNITED STATES.

    Science.gov (United States)

    Gupta, Deepak; Pallekonda, Vinay; Thomas, Ronald; Mckelvey, George; Ghoddoussi, Farhad

    2015-02-01

    The etiology of delirium in intensive care units (ICU) is usually multi-factorial. There is common "myth" that lunar phases affect human body especially human brains (and minds). In the absence of any pre-existing studies in ICU patients, the current retrospective study was planned to investigate whether lunar phases play any role in ICU delirium by assessing if lunar phases correlate with prevalence of ICU delirium as judged by the corresponding consumptions of rescue anti-psychotics used for delirium in ICU. After institutional review board approval with waived consent, the daily census of ICU patients from the administrative records was accessed at an academic university's Non-Cancer Hospital in a Metropolitan City of United States. Thereafter, the ICU pharmacy's electronic database was accessed to obtain data on the use of haloperidol and quetiapine over the two time periods for patients aged 18 years or above. Subsequently the data was analyzed for whether the consumption of haloperidol or quetiapine followed any trends corresponding to the lunar phase cycles. A total of 5382 pharmacy records of haloperidol equivalent administrations were analyzed for this study. The cumulative prevalence of incidents of haloperidol equivalent administrations peaked around the full moon period and troughed around the new moon period. As compared to male patients, female patients followed much more uniform trends of haloperidol equivalent administrations' incidents which peaked around the full moon period and troughed around the new moon period. Further sub-analysis of 70-lunar cycles across the various solar months of the total 68-month study period revealed that haloperidol equivalent administrations' incidents peaked around the full moon periods during the months of November-December and around the new moon periods during the month of July which all are interestingly the major holiday months (a potential confounding factor) in the United States. Consumption trends of rescue

  12. Filicide in the United States.

    Science.gov (United States)

    Resnick, Phillip J

    2016-12-01

    In the United States the Accreditation Council of Graduate Medical Education determines the curriculum required for fellows in forensic psychiatry to become board certified as a subspecialist. Areas that must be covered during the one year fellowship include criminal issues, such as insanity; civil issues, such as tort law and Workers' Compensation; legal regulation of psychiatry, such as confidentiality and involuntary hospitalization; and correctional psychiatry issues, such as dual agency and prisoner's rights. Fellows are also expected to have knowledge about juvenile courts, the structure of the legal system, and child custody issues. In addition, fellows are required to analyze complex cases and write forensic reports which are well reasoned. Teaching methods include lectures, storytelling, use of video vignettes, and mock trials. Additional teaching methodologies include group supervision of fellows in their report writing and direct observation of giving testimony. During the year we see fellows evolve and shift their orientation from being an advocate for patients to perceiving their role as serving justice.

  13. 31 CFR 800.225 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 800.225 Section 800... TAKEOVERS BY FOREIGN PERSONS Definitions § 800.225 United States. The term United States or U.S. means the United States of America, the States of the United States, the District of Columbia, and any...

  14. 7 CFR 1220.129 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.129 Section 1220.129... CONSUMER INFORMATION Soybean Promotion and Research Order Definitions § 1220.129 State and United States. The terms State and United States include the 50 States of the United States of America, the...

  15. 7 CFR 1220.615 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1220.615 Section 1220.615... CONSUMER INFORMATION Procedures To Request a Referendum Definitions § 1220.615 State and United States. State and United States include the 50 States of the United States of America, the District of...

  16. 75 FR 5373 - United States Mint

    Science.gov (United States)

    2010-02-02

    ... United States Mint ACTION: Notification of Pricing for 2010 United States Mint Presidential $1 Coin Proof Set. \\TM\\ SUMMARY: The United States Mint is announcing the price of the 2010 United States Mint Presidential $1 Coin Proof Set. The 2010 United States Mint Presidential $1 Coin Proof Set, featuring $1...

  17. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all......, there is a substantial inpatient financial burden of AD in the United States....

  18. Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003-2010.

    Science.gov (United States)

    Sharma, Mayur; Sonig, Ashish; Ambekar, Sudheer; Nanda, Anil

    2014-02-01

    The aim of this study was to analyze the incidence of adverse outcomes and inpatient mortality following resection of intramedullary spinal cord tumors by using the US Nationwide Inpatient Sample (NIS) database. The overall complication rate, length of the hospital stay, and the total cost of hospitalization were also analyzed from the database. This is a retrospective cohort study conducted using the NIS data from 2003 to 2010. Various patient-related (demographic categories, complications, comorbidities, and median household income) and hospital-related variables (number of beds, high/low case volume, rural/urban location, region, ownership, and teaching status) were analyzed from the database. The adverse discharge disposition, in-hospital mortality, and the higher cost of hospitalization were taken as the dependent variables. A total of 15,545 admissions were identified from the NIS database. The mean patient age was 44.84 ± 19.49 years (mean ± SD), and 7938 (52%) of the patients were male. Regarding discharge disposition, 64.1% (n = 9917) of the patients were discharged to home or self-care, and the overall in-hospital mortality rate was 0.46% (n = 71). The mean total charges for hospitalization increased from $45,452.24 in 2003 to $76,698.96 in 2010. Elderly patients, female sex, black race, and lower income based on ZIP code were the independent predictors of other than routine (OTR) disposition (p cost incurred to the hospitals (p cost incurred to the hospitals (p cost incurred to the hospitals were as follows: young patients, higher median household income, nonprivate insurance, presence of complications, higher comorbidity index, hospitals with high volume and a large number of beds, West region, teaching hospitals, and weekend and nonelective admissions.

  19. Agricultural Water Pricing: United States

    OpenAIRE

    2010-01-01

    In summary, irrigation costs and prices are rising in most regions of the United States, due to a combination of increasing scarcity, changes in public preferences regarding water allocation among competing uses, increasing budget scrutiny in the national and state legislatures, rising energy prices, and increasing awareness of climate change and the potential implications for rainfall and the availability of surface water resources. These issues likely will continue encouraging public offici...

  20. 7 CFR 1250.308 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1250.308 Section 1250.308 Agriculture... Research and Promotion Order Definitions § 1250.308 United States. United States means the 48 contiguous States of the United States of America and the District of Columbia....

  1. 31 CFR 592.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 592.311 Section 592... § 592.311 United States. The term United States, when used in the geographic sense, means the several States, the District of Columbia, and any commonwealth, territory, or possession of the United States....

  2. 7 CFR 1205.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.23 Section 1205.23 Agriculture... Procedures for Conduct of Sign-up Period Definitions § 1205.23 United States. The term United States means the 50 states of the United States of America. Procedures...

  3. 7 CFR 1205.313 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1205.313 Section 1205.313 Agriculture... Research and Promotion Order Definitions § 1205.313 United States. United States means the 50 States of the United States of America....

  4. 22 CFR 120.13 - United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false United States. 120.13 Section 120.13 Foreign... United States. United States, when used in the geographical sense, includes the several states, the Commonwealth of Puerto Rico, the insular possessions of the United States, the District of Columbia,...

  5. 7 CFR 1219.26 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1219.26 Section 1219.26 Agriculture..., AND INFORMATION Hass Avocado Promotion, Research, and Information Order Definitions § 1219.26 United States. United States means collectively the several 50 States of the United States, the District...

  6. 7 CFR 1150.106 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 9 2010-01-01 2009-01-01 true United States. 1150.106 Section 1150.106 Agriculture... Order Definitions § 1150.106 United States. United States means the 48 contiguous States in the continental United States....

  7. Education in the United States

    Institute of Scientific and Technical Information of China (English)

    钱富奎

    2009-01-01

    As might be expected,educational institutions in the United States reflect the nation's basic values,especially the ideal of equality of opportunity.From elementary school through college,Americans believe that everyone deserves an equal opportunity to get a good education.

  8. United States Navy DL Perspective

    Science.gov (United States)

    2010-08-10

    United States Navy DL Perspective CAPT Hank Reeves Navy eLearning Project Director 10 August 2010 Report Documentation Page Form ApprovedOMB No...Marine Corps (USMC) Navy eLearning Ongoing Shared with USMC, Coast Guard 9 NeL Help Site https://ile-help.nko.navy.mil/ile/ https://s-ile

  9. Norovirus in the United States

    Centers for Disease Control (CDC) Podcasts

    2013-09-09

    Dr. Aron Hall, a CDC epidemiologist specializing in norovirus, discusses the impact of norovirus in the United States.  Created: 9/9/2013 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/17/2013.

  10. Cholera in the United States

    Centers for Disease Control (CDC) Podcasts

    2011-11-08

    Anna Newton, Surveillance Epidemiologist at CDC, discusses cholera that was brought to the United States during an outbreak in Haiti and the Dominican Republic (Hispaniola).  Created: 11/8/2011 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 11/8/2011.

  11. 7 CFR 1209.21 - State and United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false State and United States. 1209.21 Section 1209.21... Definitions § 1209.21 State and United States. (a) State means any of the several States, the District of Columbia, and the Commonwealth of Puerto Rico. (b) United States means collectively the several States...

  12. The Association of Gasoline Prices With Hospital Utilization and Costs for Motorcycle and Nonmotorcycle Motor Vehicle Injuries in the United States.

    Science.gov (United States)

    Zhu, He; Wilson, Fernando A; Stimpson, Jim P; Araz, Ozgur M; Kim, Jungyoon; Chen, Baojiang; Wu, Li-Tzy

    2016-09-01

    This study examined the association between gasoline prices and hospitalizations for motorcycle and nonmotorcycle motor vehicle crash (MVC) injuries. Data on inpatient hospitalizations were obtained from the 2001 to 2010 Nationwide Inpatient Sample. Panel feasible generalized least squares models were used to estimate the effects of monthly inflation-adjusted gasoline prices on hospitalization rates for MVC injuries and to predict the impact of increasing gasoline taxes. On the basis of the available data, a $1.00 increase in the gasoline tax was associated with an estimated 8348 fewer annual hospitalizations for nonmotorcycle MVC injuries, and reduced hospital costs by $143 million. However, the increase in the gasoline tax was also associated with an estimated 3574 more annual hospitalizations for motorcycle crash injuries, and extended hospital costs by $73 million. This analysis of some existing data suggest that the increased utilization and costs of hospitalization from motorcycle crash injuries associated with an increase in the price of gasoline are likely to substantially offset reductions in nonmotorcycle MVC injuries. A policy decision to increase the gasoline tax could improve traffic safety if the increased tax is paired with public health interventions to improve motorcycle safety.

  13. A Comparative Study of United States Service Members With and Without a History of Inpatient Psychiatric Hospitalization on Post Deployment Trauma, Depression, and Hazardous Alcohol Use Symptoms

    Science.gov (United States)

    2014-01-01

    34! Post-Deployment Health Reassessment (PDHRA) ....................................... 36! Human Subjects Protection...this thesis. The Methods section outlines the research design, sample, measures, procedures, human subjects protection, and data analytic approach...disorder hospitalization rates were greater than the hospitalization rates reported for diagnostic categories associated with pregnancy and childbirth (4

  14. Randomized trial of a patient-centered hospital unit.

    Science.gov (United States)

    Martin, D P; Diehr, P; Conrad, D A; Davis, J H; Leickly, R; Perrin, E B

    1998-06-01

    Patient-centered hospital units have grown out of the national trend to greater consumerism, but few of these units have been evaluated rigorously. We used a randomized controlled trial to compare patient outcomes on the Planetree Model Hospital Unit with other medical-surgical units in the hospital. Planetree patients were significantly more satisfied than controls with their hospital stay, the unit's environment and nursing care, but did not differ in ratings of physician care. Planetree patients reported more involvement in their care while hospitalized and higher satisfaction with the education they received. There were few differences between Planetree and controls in health behaviors. While Planetree patients reported better mental health status and role functioning after discharge, their health status was similar to controls after 3 to 6 months. There were no differences in length of stay and charges for the index hospitalization, readmissions or outpatient care during the following year.

  15. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  16. 75 FR 25925 - United States Mint

    Science.gov (United States)

    2010-05-10

    ... United States Mint ACTION: Notification of Citizens Coinage Advisory Committee May 25, 2010 Public Meeting. SUMMARY: Pursuant to United States Code, Title 31, section 5135(b)(8)(C), the United States Mint...: May 25, 2010. Time: 9 a.m. to 12 p.m. Location: 8th Floor Board Room, United States Mint, 801...

  17. 31 CFR 560.307 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 560.307 Section 560.307 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 560.307 United States. The term United States means the United States, including its territories...

  18. 31 CFR 547.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 547.310 Section 547.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 547.310 United States. The term United States means the United States,...

  19. 31 CFR 548.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 548.310 Section 548.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  20. 31 CFR 586.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 586.318 Section 586...) KOSOVO SANCTIONS REGULATIONS General Definitions § 586.318 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  1. 7 CFR 1212.31 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1212.31 Section 1212.31 Agriculture..., Consumer Education, and Industry Information Order Definitions § 1212.31 United States. “United States... territories and possessions of the United States....

  2. 31 CFR 543.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 543.310 Section 543.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 543.310 United States. The term United States means the United States, its territories...

  3. 31 CFR 546.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 546.310 Section 546.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  4. 31 CFR 538.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 538.314 Section 538.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 538.314 United States. The term United States means the United States, its territories and...

  5. 31 CFR 594.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 594.313 Section 594.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 594.313 United States. The term United States means the United States, its territories...

  6. 31 CFR 588.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 588.310 Section 588.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 588.310 United States. The term United States means the United States, its territories...

  7. 31 CFR 593.311 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 593.311 Section 593.311 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 593.311 United States. The term United States means the United States,...

  8. 31 CFR 537.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 537.318 Section 537.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....318 United States. The term United States means the United States, its territories and...

  9. 31 CFR 575.319 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 575.319 Section 575.319 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....319 United States. The term United States means the United States, its territories and...

  10. 31 CFR 595.314 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 595.314 Section 595.314 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 595.314 United States. The term United States means the United States, its territories and...

  11. 31 CFR 596.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 596.312 Section 596.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 596.312 United States. The term United States means the United States, including...

  12. 31 CFR 587.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 587.310 Section 587...) MILOSEVIC SANCTIONS REGULATIONS General Definitions § 587.310 United States. The term United States means the United States, its territories and possessions, and all areas under the jurisdiction or...

  13. 31 CFR 542.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 542.310 Section 542.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....310 United States. The term United States means the United States, its territories and...

  14. 31 CFR 540.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 540.313 Section 540.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 540.313 United States. The term United States means the United States,...

  15. 31 CFR 597.318 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 597.318 Section 597.318 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 597.318 United States. The term United States means the United States,...

  16. 31 CFR 544.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 544.310 Section 544.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... REGULATIONS General Definitions § 544.310 United States. The term United States means the United States,...

  17. 31 CFR 545.313 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 545.313 Section 545.313 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 545.313 United States. The term United States means the United States, its territories...

  18. 31 CFR 585.316 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 585.316 Section 585.316 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... General Definitions § 585.316 United States. The term United States means the United States,...

  19. 7 CFR 65.255 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false United States. 65.255 Section 65.255 Agriculture..., PEANUTS, AND GINSENG General Provisions Definitions § 65.255 United States. United States means the 50... United States....

  20. 31 CFR 536.315 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 536.315 Section 536.315 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 536.315 United States. The term United States means the United States, its territories...

  1. 31 CFR 541.310 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 541.310 Section 541.310 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... § 541.310 United States. The term United States means the United States, its territories and...

  2. 31 CFR 598.317 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 598.317 Section 598.317 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF... Definitions § 598.317 United States. The term United States means the United States, its territories...

  3. 31 CFR 551.309 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 551.309 Section 551.309 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF....309 United States. The term United States means the United States, its territories and...

  4. Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997-2012.

    Directory of Open Access Journals (Sweden)

    Abigail Doucette

    Full Text Available Respiratory syncytial virus (RSV causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB hospitalization rates from 1997‒2012 among US high-risk infants.The Kids' Inpatient Database (KID infant annual RSV (ICD-9 079.6, 466.11, 480.1 and UB (ICD-9 466.19, 466.1 hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]; congenital airway anomalies (CAA; congenital heart disease (CHD; Down syndrome (DS; and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$. Poisson and linear regression were used to test statistical significance of trends.RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%.Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high

  5. Masturbation in the United States.

    Science.gov (United States)

    Das, Aniruddha

    2007-01-01

    Using data from the nationally representative National Health and Social Life Survey, this study queried the correlates of masturbation in the United States in 1992. Among those aged 18-60, 38% (CI, 35-41) of women and 61% (CI, 57-65) of men reported any masturbation over the preceding year. The system of factors underlying masturbation was similar for both genders, consistent with a convergence in gender patterns of sexual expression in the United States. Among both women and men, masturbation responded to a stable sexualized personality pattern, catalyzed by early-life factors and manifested in current sexual traits. Strikingly, the masturbation-partnered sex linkage, often conceptualized either as compensating for unsatisfying sex or complementing a satisfactory sex life, appeared to be bimodal for both genders. For some, masturbation complemented an active and pleasurable sex life, while among others, it compensated for a lack of partnered sex or satisfaction in sex.

  6. 77 FR 48542 - United States

    Science.gov (United States)

    2012-08-14

    ... outside of the `reaches of the public interest'''); see generally United States v. SBC Commc'ns, Inc., 489... judicial power.'' SBC ] Commc'ns, 489 F. Supp. 2d at 14-15 (citing Microsoft, 56 F.3d at 1462). With... effect of proposed remedies. See, e.g., KeySpan, 763 F. Supp. 2d at 642; SBC Commc'ns, 489 F. Supp. 2d...

  7. President of the United States

    Institute of Scientific and Technical Information of China (English)

    蔡东丽

    2005-01-01

    President of the United States is the chief executive officer of the federal government, the leader of the executive branch1, and the corn man der-in-chief of the armed forces2. The president has the power to make treaties with other nations, with the advice and consent of two-thirds of the Senate3. The president also appoints4, with Senate's consent, diplomatic representatives ,Supreme Court judges5, and many other officials.

  8. Environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' effort to manage its environment including air, water nature, and biodiversity to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 40 figs., 21 tabs.

  9. Examination of the Comorbidity of Mental Illness and Somatic Conditions in Hospitalized Children in the United States Using the Kids' Inpatient Database, 2009.

    Science.gov (United States)

    Sztein, Dina M; Lane, Wendy G

    2016-03-01

    To examine the associations between mental and physical illness in hospitalized children. The data for this analysis came from the 2009 Kids' Inpatient Database (KID). Any child with an International Classification of Diseases, Ninth Revision code indicative of depressive, anxiety, or bipolar disorders or a diagnosis of sickle cell disease, diabetes mellitus type 1 or 2, asthma, or attention-deficit/hyperactivity disorder (ADHD) were included. Using SAS software, we performed χ(2) tests and multivariable logistic regression to determine degrees of association. Children discharged with sickle cell disease, asthma, diabetes mellitus type 1, diabetes mellitus type 2, and ADHD were 0.94, 2.76, 3.50, 6.37, and 38.39 times more likely to have a comorbid anxiety, depression, or bipolar disorder diagnosis than other hospitalized children, respectively. Children with several chronic physical illnesses (asthma, diabetes mellitus type 1, diabetes mellitus type 2) and mental illnesses (ADHD) have higher odds of being discharged from the hospital with a comorbid mood or anxiety disorder compared with other children discharged from the hospital. It is therefore important to screen children hospitalized with chronic medical conditions for comorbid mental illness to ensure optimal clinical care, to improve overall health and long-term outcomes for these children. Copyright © 2016 by the American Academy of Pediatrics.

  10. HIV Testing in the United States

    Science.gov (United States)

    ... HIV/AIDS HIV Testing in the United States HIV Testing in the United States Jun 23, 2017 ... States or for refugees. 27 Insurance Coverage of HIV Testing HIV testing that is “medically necessary” – recommended ...

  11. Drought in Southwestern United States

    Science.gov (United States)

    2007-01-01

    The southwestern United States pined for water in late March and early April 2007. This image is based on data collected by the Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite from March 22 through April 6, 2007, and it shows the Normalized Difference Vegetation Index, or NDVI, for the period. In this NDVI color scale, green indicates areas of healthier-than-usual vegetation, and only small patches of green appear in this image, near the California-Nevada border and in Utah. Larger areas of below-normal vegetation are more common, especially throughout California. Pale yellow indicates areas with generally average vegetation. Gray areas appear where no data were available, likely due to persistent clouds or snow cover. According to the April 10, 2007, update from the U.S. Drought Monitor, most of the southwestern United Sates, including Utah, Nevada, California, and Arizona, experienced moderate to extreme drought. The hardest hit areas were southeastern California and southwestern Arizona. Writing for the Drought Monitor, David Miskus of the Joint Agricultural Weather Facility reported that March 2007 had been unusually dry for the southwestern United States. While California's and Utah's reservoir storage was only slightly below normal, reservoir storage was well below normal for New Mexico and Arizona. In early April, an international research team published an online paper in Science noting that droughts could become more common for the southwestern United States and northern Mexico, as these areas were already showing signs of drying. Relying on the same computer models used in the Intergovernmental Panel on Climate Change (IPCC) report released in early 2007, the researchers who published in Science concluded that global warming could make droughts more common, not just in the American Southwest, but also in semiarid regions of southern Europe, Mediterranean northern Africa, and the Middle East.

  12. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

    NARCIS (Netherlands)

    Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.

    2012-01-01

    OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in

  13. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

    NARCIS (Netherlands)

    Aiken, L.H.; Sermeus, W.; Heede, K. Van den; Sloane, D.M.; Busse, R.; McKee, M.; Bruyneel, L.; Rafferty, A.M.; Griffiths, P.; Moreno-Casbas, M.T.; Tishelman, C.; Scott, A.; Brzostek, T.; Kinnunen, J.; Schwendimann, R.; Heinen, M.M.; Zikos, D.; Sjetne, I.S.; Smith, H.L.; Kutney-Lee, A.

    2012-01-01

    OBJECTIVE: To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. DESIGN: Cross sectional surveys of patients and nurses. SETTING: Nurses were surveyed in gen

  14. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    Science.gov (United States)

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  15. Pegfilgrastim prophylaxis is associated with a lower risk of hospitalization of cancer patients than filgrastim prophylaxis: a retrospective United States claims analysis of granulocyte colony-stimulating factors (G-CSF

    Directory of Open Access Journals (Sweden)

    Naeim Arash

    2013-01-01

    Full Text Available Abstract Background Myelosuppressive chemotherapy can lead to dose-limiting febrile neutropenia. Prophylactic use of recombinant human G-CSF such as daily filgrastim and once-per-cycle pegfilgrastim may reduce the incidence of febrile neutropenia. This comparative study examined the effect of pegfilgrastim versus daily filgrastim on the risk of hospitalization. Methods This retrospective United States claims analysis utilized 2004–2009 data for filgrastim- and pegfilgrastim-treated patients receiving chemotherapy for non-Hodgkin’s lymphoma (NHL or breast, lung, ovarian, or colorectal cancers. Cycles in which pegfilgrastim or filgrastim was administered within 5 days from initiation of chemotherapy (considered to represent prophylaxis were pooled for analysis. Neutropenia-related hospitalization and other healthcare encounters were defined with a “narrow” criterion for claims with an ICD-9 code for neutropenia and with a “broad” criterion for claims with an ICD-9 code for neutropenia, fever, or infection. Odds ratios (OR for hospitalization and 95% confidence intervals (CI were estimated by generalized estimating equation (GEE models and adjusted for patient, tumor, and treatment characteristics. Per-cycle healthcare utilization and costs were examined for cycles with pegfilgrastim or filgrastim prophylaxis. Results We identified 3,535 patients receiving G-CSF prophylaxis, representing 12,056 chemotherapy cycles (11,683 pegfilgrastim, 373 filgrastim. The mean duration of filgrastim prophylaxis in the sample was 4.8 days. The mean duration of pegfilgrastim prophylaxis in the sample was 1.0 day, consistent with the recommended dosage of pegfilgrastim - a single injection once per chemotherapy cycle. Cycles with prophylactic pegfilgrastim were associated with a decreased risk of neutropenia-related hospitalization (narrow definition: OR = 0.43, 95% CI: 0.16–1.13; broad definition: OR = 0.38, 95% CI: 0.24–0.59 and all

  16. 7 CFR 1206.23 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1206.23 Section 1206.23 Agriculture... INFORMATION Mango Promotion, Research, and Information Order Definitions § 1206.23 United States. United... Rico, and the territories and possessions of the United States....

  17. Clinical and economic burden of chemotherapy-induced nausea and vomiting among patients with cancer in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the overall burden of illness of chemotherapy-induced nausea and vomiting (CINV) and associated all-cause costs from a hospital's perspective (costs to the hospital) in patients with cancer treated with chemotherapy (CT) in the US hospital outpatient setting. Patients with a cancer diagnosis aged ≥18 years initiating CT in a hospital outpatient setting for the first time between April 1 2007 and March 31 2009 were extracted from the Premier Perspective Database. Patients were followed through eight CT cycles or 6 months post-index date, whichever occurred first. Within each CT cycle, the follow-up time for CINV event estimation was from day 1 (except rescue medication use that was identified from day 2) to cycle end. A multivariate regression model was developed to predict the CINV event rate per CT cycle in the study follow-up period. Associated total all-cause costs of managing CINV from a hospital's perspective were analyzed descriptively. Event rate and associated costs were estimated in the entire hospital setting (outpatient, inpatient, and emergency room). All-cause costs included inpatient, hospital outpatient, and ER visit costs (identified through a primary or secondary diagnosis code for nausea, vomiting, and/or volume depletion) and pharmacy cost (rescue medications for CINV treatment). All physician costs and non CINV-related treatment (pharmacy) costs were excluded from the analyses. Among 11,495 study patients, 8,806 patients (76.6%) received prophylaxis for all cycles in the follow-up period. The overall base population had an average age of 63.3 years, was 51.0% female, and 72.7% White. The distribution of emetogenicity for cycle 1 CT cycle was 26.0% HEC, 46.1% MEC, and 26.4% LEC/MinEC combined. In the follow-up period, a total of 47,988 CINV events with an associated total all-cause treatment cost of $89 million were observed. Average daily treatment cost for all care settings was $1854.7. The regression model predicted a 20

  18. 7 CFR 1280.127 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1280.127 Section 1280.127 Agriculture... INFORMATION ORDER Lamb Promotion, Research, and Information Order Definitions § 1280.127 United States. United States means collectively the 50 States and the District of Columbia....

  19. 7 CFR 1218.22 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1218.22 Section 1218.22 Agriculture... INFORMATION ORDER Blueberry Promotion, Research, and Information Order Definitions § 1218.22 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  20. 7 CFR 1215.20 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1215.20 Section 1215.20 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... United States. United States means all of the States. Popcorn Board...

  1. 7 CFR 1260.108 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1260.108 Section 1260.108 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... Promotion and Research Order Definitions § 1260.108 United States. United States means the 50 States and...

  2. 7 CFR 1216.30 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1216.30 Section 1216.30 Agriculture... INFORMATION ORDER Peanut Promotion, Research, and Information Order Definitions § 1216.30 United States. United States means collectively the 50 states, the District of Columbia, the Commonwealth of Puerto...

  3. 7 CFR 1221.32 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1221.32 Section 1221.32 Agriculture... INFORMATION ORDER Sorghum Promotion, Research, and Information Order Definitions § 1221.32 United States. United States or U.S. means collectively the 50 States, the District of Columbia, the Commonwealth...

  4. Acute Infections, Cost per Infection and Turnaround Time in Three United States Hospital Laboratories Using Fourth-Generation Antigen-Antibody Human Immunodeficiency Virus Immunoassays.

    Science.gov (United States)

    Wesolowski, Laura G; Nasrullah, Muazzam; Coombs, Robert W; Rosenberg, Eric; Ethridge, Steven F; Hutchinson, Angela B; Dragavon, Joan; Rychert, Jennifer; Nolte, Frederick S; Madory, James E; Werner, Barbara G

    2016-01-01

    Background.  To improve clinical and public health outcomes through early human immunodeficiency virus (HIV) detection, fourth-generation antigen/antibody immunoassay (4IA) and supplemental testing results must be returned rapidly. Methods.  We examined HIV testing data at Harborview Medical Center (HMC), Massachusetts General Hospital (MGH), and the Medical University of South Carolina (MUSC), which used 4IA and supplemental antibody and nucleic acid tests (NATs). At MGH and MUSC, HIV-1 Western blot (WB) and HIV-2 testing were conducted at a reference laboratory. We compared time from specimen collection to laboratory result for established (positive WB) and acute infections (reactive 4IA, negative/indeterminate WB, detectable NAT), and we calculated testing cost per positive-test result. Results.  From 3731 (MUSC) to 19 774 (MGH) tests were conducted; 0.01% (MGH) to 0.05% (HMC) were acute infections. Each laboratory had reactive 4IA, WB-negative, or indeterminate specimens without NAT (ie, potential acute infections). Time to result was 1.5 (HMC) to 5.2 days (MGH) for acute and 1.0 (HMC) to 5.2 days (MGH) for established infections. Costs were $1054 (MGH) to $1521 (MUSC). Conclusions.  Conducting supplemental testing in-house lowered turnaround times, which may be further reduced with rapid HIV-1/HIV-2 differentiation tests. Hospitals may benefit from quantitative NATs not requiring physician orders, so all potential acute infections receive NAT.

  5. 7 CFR 1210.315 - United States.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States. 1210.315 Section 1210.315 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS... PLAN Watermelon Research and Promotion Plan Definitions § 1210.315 United States. United States...

  6. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  7. Reflections: Mexico and the United States.

    Science.gov (United States)

    Paz, Octavio

    1980-01-01

    Illustrates how Mexico and the United States represent two versions of Western civilization that are profoundly different from one another. Concludes that the United States has always ignored minorities in foreign and domestic policy. Suggests that, to conquer its enemies, the United States must first conquer its historical attitude toward…

  8. Malaria Surveillance - United States, 2014.

    Science.gov (United States)

    Mace, Kimberly E; Arguin, Paul M

    2017-05-26

    Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. The majority of malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. However, malaria is occasionally acquired by persons who have not traveled out of the country through exposure to infected blood products, congenital transmission, laboratory exposure, or local mosquitoborne transmission. Malaria surveillance in the United States is conducted to identify episodes of local transmission and to guide prevention recommendations for travelers. This report summarizes cases in persons with onset of illness in 2014 and trends during previous years. Malaria cases diagnosed by blood film, polymerase chain reaction, or rapid diagnostic tests are reported to local and state health departments by health care providers or laboratory staff. Case investigations are conducted by local and state health departments, and reports are transmitted to CDC through the National Malaria Surveillance System, National Notifiable Diseases Surveillance System, or direct CDC consultations. CDC conducts antimalarial drug resistance marker testing on blood samples submitted by health care providers or local or state health departments. Data from these reporting systems serve as the basis for this report. CDC received reports of 1,724 confirmed malaria cases, including one congenital case and two cryptic cases, with onset of symptoms in 2014 among persons in the United States. The number of confirmed cases in 2014 is consistent with the number of confirmed cases reported in 2013 (n = 1,741; this number has been updated from a previous publication to account for delayed reporting for persons with symptom onset occurring in late 2013). Plasmodium falciparum, P. vivax, P. ovale, and P. malariae were identified in 66.1%, 13.3%, 5.2%, and 2.7% of cases, respectively

  9. [Protein-calorie nutritional state in elderly patients hospitalized in Lomé Campus university hospital: pilot study about 33 patients versus 30 reference cases registered in three care units].

    Science.gov (United States)

    Kouassi, K C; Lamboni, C

    2013-01-01

    Objective. The aim of this study was to determine the protein-calorie nutritional status of elderly hospitalized patients admitted to the hepato-gastroenterology, cardiology and internal medicine departments of the Lomé Campus University Hospital and identify the endogenous and mixed undernutrition to provide patients with better nutrition and assistance. Methodology. This cross-sectional study conducted between April 1 and July 31, 2009, included 33 hospitalized case patients aged at least 55 years and 30 age-matched outpatient control subjects. Patients were evaluated according to body mass index (BMI), the Mini Nutritional Assessment (MNA), and their serum albumin, serum prealbumin and orosomucoid levels. Results. Among the hospitalized case patients, 37% had protein-calorie undernutrition (low serum albumin), and 73% were at risk of this undernutrition (low serum prealbumin). Five patients (16%) were endogenously undernourished and 17 (57%) exogenously undernourished. Six to 13% of the oupatient controls were undernourished and 33% at risk of undernutrition according to the MNA scale. A significant difference existed between the mean albumin values of case patients and controls (38 ± 9 g/L vs 46 ± 7 g/L, p = 0.002). Conclusion. Our results confirm that the elderly inpatients were regularly malnourished. Knowledge of their nutritional profile has allowed us to launch an improved nutritional assistance program and to supervise it properly.

  10. State-ing the Facts: Exploring the United States.

    Science.gov (United States)

    Bay, Jennifer M.; Bledsoe, Ann M.; Reys, Robert E.

    1998-01-01

    Presents activities on estimation, scaling, area of nonstandard shapes, algebraic thinking, and real-life situations using the United States of America. These activities make it possible to integrate mathematics and social studies. Uses technology by employing geometry software packages such as The Geometer's Sketchpad, Cabri, and Geometric…

  11. United States Stateplane Zones - NAD27

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1927) represents the State Plane Coordinate System (SPCS) Zones for the 1927 North American Datum within United States.

  12. United States Stateplane Zones - NAD83

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — U.S. State Plane Zones (NAD 1983) represents the State Plane Coordinate System (SPCS) Zones for the 1983 North American Datum within United States.

  13. Death in the United States, 2011

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Death in the United States, 2011 Recommend on Facebook ... 2011 SOURCE: National Vital Statistics System, Mortality. Do death rates vary by state? States experience different mortality ...

  14. Do hospitals need oncological critical care units?

    OpenAIRE

    Koch, Abby; Checkley, William

    2017-01-01

    Since the inception of critical care as a formal discipline in the late 1950s, we have seen rapid specialization to many types of intensive care units (ICUs) to accommodate evolving life support technologies and novel therapies in various disciplines of medicine. Indeed, the field has expanded such that specialized ICUs currently exist to address critical care problems in medicine, cardiology, neurology and neurosurgery, trauma, burns, organ transplant and cardiothoracic surgeries. Specializa...

  15. STATE OF BUSINESS IN HOSPITALITY IN CHINA

    Directory of Open Access Journals (Sweden)

    Yi Yu

    2014-01-01

    Full Text Available The article deals with the state of business in the hospitality industry in China, domestic tourism, inbound tourism in China as entrepreneurial activity, outbound tourism from China to other countries. Hospitalityis one of the most important parts of thevast services market, and is a fast-growingand highly profitable industry that coulddirectly, indirectly, so as to infl uence the formation of conditions for sustainable socio-economic growth.

  16. Mobility decline in patients hospitalized in an intensive care unit

    Science.gov (United States)

    de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz

    2016-01-01

    Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406

  17. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel

    2014-08-01

    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  18. United States Department of State Strategic Plan

    Science.gov (United States)

    1998-01-01

    targets for worldwide reduction or elimination of the cultiva- tion, production, and commercial-scale import of cocaine, opium, heroin, mari- juana ...international sanctions against state sponsors of terrorism and urges their strict enforcement. State presses state spon- sors to abandon their support for

  19. Achieving Strong Teamwork Practices in Hospital Labor and Delivery Units

    Science.gov (United States)

    2010-01-01

    express, suggest, and consequences DoD U.S. Department of Defense HSOPS Hospital Survey on Patient Safety Culture ICU intensive-care unit I’M SAFE...approaches for measuring teamwork Patient and staff satisfaction AHRQ surveys on patient - safety culture Patient and staff satisfaction Team behavior...Appendix B). The questions in the matrix related to the following major topic areas: • hospital environment for quality and safety • patient - safety culture in

  20. Improving the smoking patterns in a general hospital psychiatric unit

    OpenAIRE

    Celso Iglesias García; María José Alonso Villa; Juan Carlos Bernaldo de Quirós; Elena Bocanegra Suárez; Julia Cueta Gonzalo; Rosario García del Valle; José Manuel González González; Álvaro Miranda García; Ana Belén Palacio Bande

    2009-01-01

    Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement) with two mild behavioural inc...

  1. The United States in the 1980's

    Directory of Open Access Journals (Sweden)

    D. Conradie

    2012-02-01

    Full Text Available The era of optimism which prevailed in the United States since the Korean War, came to an abrupt end after the debacle in Vietnam. By the end of the Seventies the United States was no longer the dominant military power. American foreign policy lacked consistence, coherence and a strategic sense. The United States became indecisive. Under these circumstances the Soviet Union successfully enforced its imperialistic designs upon countries far from its shores.

  2. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Vahedian Azimi

    2015-05-01

    Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.

  3. Mycobacterium tuberculosis testing practices in hospital, commercial and state laboratories in the New England states.

    Science.gov (United States)

    Livingston, K A; Lobato, M N; Sosa, L E; Budnick, G E; Bernardo, J

    2011-09-01

    The mycobacterial laboratory is assuming an increasingly important role in tuberculosis (TB) control in the United States today. To assess mycobacterial laboratory capacity and practices in the New England states, USA. We surveyed 143 hospital and commercial laboratories and five of the six state public health laboratories in New England that offer testing services for Mycobacterium tuberculosis. The survey captured information on types of services offered and volume of testing, use of state laboratories for testing, and promptness of reporting results to TB control programs. State laboratories perform the majority of testing services, particularly for more specialized tests. All state laboratories surveyed perform species identification of acid-fast isolates, culture and first-line drug susceptibility testing. Less than 20% of hospital and commercial laboratories offer these services, and 78.6% of hospitals and commercial laboratories refer specimens to state laboratories for culture. Surveys of M. tuberculosis testing capacities in a region can help decision makers ensure maintenance of essential services. Hospital and commercial laboratories with lower testing volume might increase efficiency by referring more specimens to state laboratories. State health departments might consider organizing regional laboratory service networks to monitor the provision of services, improve efficiency and oversee quality improvement initiatives.

  4. Centralization of Intensive Care Units: Process Reengineering in a Hospital

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2010-03-01

    Full Text Available Centralization of intensive care units (ICUs is a concept that has been around for several decades and the OECD countries have led the way in adopting this in their operations. Singapore Hospital was built in 1981, before the concept of centralization of ICUs took off. The hospital's ICUs were never centralized and were spread out across eight different blocks with the specialization they were associated with. Coupled with the acquisitions of the new concept of centralization and its benefits, the hospital recognizes the importance of having a centralized ICU to better handle major disasters. Using simulation models, this paper attempts to study the feasibility of centralization of ICUs in Singapore Hospital, subject to space constraints. The results will prove helpful to those who consider reengineering the intensive care process in hospitals.

  5. Abortion Surveillance - United States, 2013.

    Science.gov (United States)

    Jatlaoui, Tara C; Ewing, Alexander; Mandel, Michele G; Simmons, Katharine B; Suchdev, Danielle B; Jamieson, Denise J; Pazol, Karen

    2016-11-25

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2013. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2013, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2004-2013. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 664,435 abortions were reported to CDC for 2013. Of these abortions, 98.2% were from the 47 reporting areas that provided data every year during 2004-2013. Among these 47 reporting areas, the abortion rate for 2013 was 12.5 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 200 abortions per 1,000 live births. From 2012 to 2013, the total number, rate, and ratio of reported abortions decreased 5%. From 2004 to 2013, the total number, rate, and ratio of reported abortions decreased 20%, 21%, and 17%, respectively. In 2013, all three measures reached their lowest level for the entire period of analysis (2004-2013). In 2013 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2013, women aged 20-24 and 25-29 years accounted for 32.7% and 25.9% of all abortions, respectively, and had abortion rates of 21.8 and 18.2 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.8%, 9.2%, and 3.6% of all abortions, respectively, and had abortion rates of 11.8, 7.0, and 2

  6. Abortion Surveillance - United States, 2012.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Jamieson, Denise J

    2015-11-27

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2012. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2012, data were received from 49 reporting areas. For trend analysis, abortion data were evaluated from 47 areas that reported data every year during 2003-2012. Census and natality data, respectively, were used to calculate abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 699,202 abortions were reported to CDC for 2012. Of these abortions, 98.4% were from the 47 reporting areas that provided data every year during 2003-2012. Among these same 47 reporting areas, the abortion rate for 2012 was 13.2 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 210 abortions per 1,000 live births. From 2011 to 2012, the total number and ratio of reported abortions decreased 4% and the abortion rate decreased 5%. From 2003 to 2012, the total number, rate, and ratio of reported abortions decreased 17%, 18%, and 14%, respectively, and reached their lowest level in 2012 for the entire period of analysis (2003-2012). In 2012 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates; women in their 30s and older accounted for a much smaller percentage of abortions and had lower abortion rates. In 2012, women aged 20-24 and 25-29 years accounted for 32.8% and 25.4% of all abortions, respectively, and had abortion rates of 23.3 and 18.9 abortions per 1,000 women aged 20-24 and 25-29 years, respectively. In contrast, women aged 30-34, 35-39, and ≥40 years accounted for 16.4%, 9.1%, and 3.7% of all abortions, respectively, and had abortion rates of

  7. Addressing the United States Debt and Deficit

    Science.gov (United States)

    2010-03-01

    current government approach to the economy , then examining the current projections for United States’ spending from 2009 through 2019 and examining...manner and thereby strengthen the economy of the United States, this paper concludes with three examples that are predicated on the synergistic benefits associated with small reforms.

  8. United States Strategy for Mexico

    Science.gov (United States)

    2005-03-18

    17 March 2005. 2 Homero Aridjis, "Survival of Indigenous Cultures in Mexico," 9 April 1998; available from <http://www.klys.se/worldconference/papers...HomeroAridjis.htm>;Internet; accessed 21 November 2004. 3Tania Carrasco, "Indigenous Peoples in the States of Chiapas, Guerrero and Oaxaca ," 2005...analysis by the State representatives from Chiapas, Guerrero and Oaxaca (3 Southern States). The plan reviewed possible options to reduce poverty and

  9. State Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the State boundaries of the United States, and the boundaries of Puerto Rico and the U.S. Virgin Islands. The map layer was created by...

  10. Climatography of the United States

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Numbered series of NOAA publications that contain environmental information climate summaries and station normals. Each series contains a volume for each state,...

  11. USEEIO: a New and Transparent United States ...

    Science.gov (United States)

    National-scope environmental life cycle models of goods and services may be used for many purposes, not limited to quantifying impacts of production and consumption of nations, assessing organization-wide impacts, identifying purchasing hot spots, analyzing environmental impacts of policies, and performing streamlined life cycle assessment. USEEIO is a new environmentally extended input-output model of the United States fit for such purposes and other sustainable materials management applications. USEEIO melds data on economic transactions between 389 industry sectors with environmental data for these sectors covering land, water, energy and mineral usage and emissions of greenhouse gases, criteria air pollutants, nutrients and toxics, to build a life cycle model of 385 US goods and services. In comparison with existing US input-output models, USEEIO is more current with most data representing year 2013, more extensive in its coverage of resources and emissions, more deliberate and detailed in its interpretation and combination of data sources, and includes formal data quality evaluation and description. USEEIO was assembled with a new Python module called the IO Model Builder capable of assembling and calculating results of user-defined input-output models and exporting the models into LCA software. The model and data quality evaluation capabilities are demonstrated with an analysis of the environmental performance of an average hospital in the US. All USEEIO f

  12. Unit cost analysis in a university hospital: an example from Srinagarind Hospital, Khon Kaen.

    Science.gov (United States)

    Vatanasapt, V; Kosuwon, W; Pengsaa, P

    1993-12-01

    This is the first analytic study to identify the unit cost in the University Hospital using the standard method of analysis in health economics. The unit costs in the report can be used to calculate the cost of each service for any disease. The costs of the hospital administration cost center and the supportive cost center were both allocated to the patient care service center by the simultaneous allocation method. The cost of teaching personnel was excluded from the analysis because it is quite difficult to estimate and differentiate the ratio of teaching costs to service costs. The hotel cost of the inpatient ward varied from 77.81 baht to 604.7 baht per day. The unit cost per service per day is different from the charge which is presently used at Srinagarind Hospital. Some services, such as in-house transportation are not included in the charge. This study was conducted to identify the unit cost of each service. The decision to establish charges can depend partly on this data and partly on the administrator's judgement. Other factors, such as patient poverty can dictate the final decision. In any case, the hospital and health service center should identify their own unit costs to be able to plan for effective budget management.

  13. [Development of performance measure indicators in hospital nursing units].

    Science.gov (United States)

    Kang, Kyeong-Hwa; Kim, In-Sook

    2005-06-01

    The purpose of this study was to develop performance measure indicators for hospital nursing units based on a Balanced Scorecard (BSC). This study was a methodological study. The development process consisted of 3 stages. The first stage was setting up strategies for nursing units from a nursing department's mission and vision. The second stage was developing performance measure indicators after a validity check. The third stage was modifying developed performance measure indicators and classifying them. 7 strategies were set up according to 4 perspectives of a BSC. 15 performance measure indicators for hospital nursing units were developed, and the indicators were divided into 8 independent indicators and 7 shared indicators according to the degree of performance responsibility. In addition, they were classified into two groups, 7 leading indicators and lagging indicators. The result of this study suggests that performance measure indicators for hospital nursing units provide a framework and method for nursing organizations' performance management. Also, the developed indicators are expected to provide valuable information for successful organization management.

  14. Sizing of Staff of Neonatal Units in a University Hospital

    Directory of Open Access Journals (Sweden)

    Gabriela Ramos Ferreira Curan

    2015-03-01

    Full Text Available The aim was to evaluate the size of the nursing neonatal units of a university hospital regarding the education and professional experience of the nursing staff and the adequacy of existing legislation professional staff. Descriptive, quantitative study, conducted at the Intensive Care Unit and Neonatal Intermediate Care. We used two instruments to collect data with the nursing staff and the professional relationship and bed occupancy. Employees had an average experience in neonatal units of 14 years; most had more than one vocational training (59.3%. The number of nurses was below the recommended by current professional legislation (12.5% and nursing assistants above (56.2%; 51.9% were employees in other sectors doing overtime. It was concluded that although qualified, which can determine a differentiated service, the team does not meet the recommended sizing standards for professional assistance in these specialized units.

  15. 2010 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2010 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  16. Mineral operations outside the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Mineral facilities and operations outside the United States compiled by the National Minerals Information Center of the USGS. This representation combines source...

  17. CNPC Exports Drilling Equipment to United States

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ Beijing Petroleum Machinery Plant(BPM) of CNPC and Rowan Drilling Company Inc, one of the most powerful drilling service and driller manufacturing companies in the United States signed a petroleum equipment contract on December 9 in Beijing.

  18. Rest Areas in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Rest areas in the western United States. Data was collected from various data sources including georeferenced locations obtained from other agencies, digitizied...

  19. United States Interagency Elevation Inventory (USIEI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The U.S. Interagency Elevation Inventory displays high-accuracy topographic and bathymetric data for the United States and its territories. The project is a...

  20. Health, United States, 2012: Men's Health

    Science.gov (United States)

    ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook NCHS Health, United States, 2015 - Men's Health ... Disparities Report Healthy People Older Americans Health Report Rural-Urban Chartbook File Formats Help: How do I view ...

  1. Agricultural Land in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Agricultural land cover for the western United States. This dataset was developed from Sagestitch, the Eastern Washington Shrubsteppe Mapping Project, and several...

  2. Hydrologic landscape regions of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Hydrologic landscape regions (HLRs) in the United States were delineated by using geographic information system (GIS) tools and statistical methods including...

  3. The Grand Strategy of the United States

    Science.gov (United States)

    2014-10-01

    United States both militarily and by setting the terms of trade. While cultural and ideological affinities with European democra- cies played...military establishments (Japan, Russia, India, South Korea, Vietnam, Taiwan, Indonesia , Malaysia, Singapore) can check possible military expansion when

  4. TB in Children in the United States

    Science.gov (United States)

    ... in Children Treatment Vaccines Statistics Related Links TB in Children in the United States TB disease in children under ... person with infectious TB disease. Testing for TB in Children In the absence of symptoms, usually the ...

  5. 2014 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2014 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  6. 2009 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2009 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  7. 2011 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2011 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  8. 2012 United States Automatic Identification System Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The 2012 United States Automatic Identification System Database contains vessel traffic data for planning purposes within the U.S. coastal waters. The database is...

  9. Terrestrial Ecosystems of the Conterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The U.S. Geological Survey (USGS) modeled the distribution of terrestrial ecosystems for the contiguous United States using a standardized, deductive approach to...

  10. Anthropogenic Fragmentation in the western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — We evaluated the fragmentation of the western United States by anthropogenic features. The addition of roads, railroads, and power lines to wildlands, and the...

  11. Improving the smoking patterns in a general hospital psychiatric unit

    Directory of Open Access Journals (Sweden)

    Celso Iglesias García

    2009-01-01

    Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.

  12. Association Between Intensive Care Unit Utilization During Hospitalization and Costs, Use of Invasive Procedures, and Mortality.

    Science.gov (United States)

    Chang, Dong W; Shapiro, Martin F

    2016-10-01

    Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ ≥ 0.90 for all comparisons; P utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. For medical

  13. Social Studies: United States. Grade 5.

    Science.gov (United States)

    Kellogg, E. G.

    This teachers guide attempts to facilitate the study of the United States through a conceptual approach and multimedia instruction in a spiral curriculum. There are five units: 1) Natural Setting --location, climate, terrain, water, soil, and economic and esthetic value, and conservation; 2) Historial Development --North American Indian cultures,…

  14. Clinical pathway for thoracic surgery in the United States

    OpenAIRE

    Wei, Benjamin; Cerfolio, Robert J.

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations.

  15. Clinical pathway for thoracic surgery in the United States

    Science.gov (United States)

    Wei, Benjamin

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations. PMID:26941967

  16. Party Formation in the United States

    OpenAIRE

    2013-01-01

    This dissertation is about how political parties formed in the world's first mass democracy, the United States. I trace the process of party formation from the bottom up. First, I ask: How do individuals become engaged in politics and develop political affiliations? In most states, throughout the antebellum era, the county was the primary unit of political administration and electoral representation. Owing to their small size, contiguity, and economic homogeneity, I expect that each county's ...

  17. Drought in Southeastern United States

    Science.gov (United States)

    2007-01-01

    May 2007 was a record-setting month in Georgia. Typically a dry month in this southern state, May 2007 was exceptionally so, with many locations setting record-low rainfall records and some receiving no rain at all, said state climatologist David Emory Stooksbury on GeorgiaDrought.org. The lack of rain slowed plant growth, as shown in this vegetation index image. The Moderate Resolution Imaging Spectroradiometer (MODIS) on NASA's Terra satellite collected the data used to make this image between May 9 and May 24, 2007. The image shows vegetation conditions compared to average conditions observed from 2000 through 2006. Areas in which plants are more sparse or are growing more slowly than average are brown, while better-than-average growth is green. Georgia and its neighbors (South Carolina, Alabama, and Florida) are all brown, an indication that the lack of rainfall is suppressing plant growth. The gray area in southern Georgia and northern Florida shows where MODIS could not collect valid vegetation measurements, either because of clouds or smoke. In this case, the area corresponds with land that burned during this period and was probably masked by smoke. NASA image created by Jesse Allen, Earth Observatory, using data provided by Inbal Reshef, Global Agricultural Monitoring Project.

  18. 31 CFR 596.313 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 596.313 Section... General Definitions § 596.313 United States person. The term United States person means any United States... States, or any person in the United States....

  19. State of malnutrition in hospitals of Ecuador

    Directory of Open Access Journals (Sweden)

    Sylvia Gallegos Espinosa

    2014-08-01

    Full Text Available Rationale: Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. Objectives: To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. Materials and methods: The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women. 37.5%; Ages ≥ 60 years. 35.1%; Length of stay ≤ 15 days. 91.2% admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Results: Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Conclusions: Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care

  20. Estimated United States Transportation Energy Use 2005

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Simon, A J; Belles, R D

    2011-11-09

    A flow chart depicting energy flow in the transportation sector of the United States economy in 2005 has been constructed from publicly available data and estimates of national energy use patterns. Approximately 31,000 trillion British Thermal Units (trBTUs) of energy were used throughout the United States in transportation activities. Vehicles used in these activities include automobiles, motorcycles, trucks, buses, airplanes, rail, and ships. The transportation sector is powered primarily by petroleum-derived fuels (gasoline, diesel and jet fuel). Biomass-derived fuels, electricity and natural gas-derived fuels are also used. The flow patterns represent a comprehensive systems view of energy used within the transportation sector.

  1. DIRECTORY OF RESIDENTIAL FACILITIES FOR THE MENTALLY RETARDED, A NATIONAL DIRECTORY OF PUBLIC AND PRIVATE RESIDENTIAL FACILITIES (SCHOOLS, HOSPITALS, HOMES) FOR THE MENTALLY RETARDED IN THE UNITED STATES AND CANADA.

    Science.gov (United States)

    MILLIGAN, GLENN E.; NISONGER, HERSCHEL W.

    PUBLIC RESIDENTIAL FACILITIES (138 IN THE UNITED STATES AND 10 IN CANADA) RESPONDED TO A MAIL INQUIRY FORM. INFORMATIVE DATA ARE LISTED REGARDING (1) THE HISTORICAL DEVELOPMENT OF PRESENTLY OPERATIONAL INSITUTIONS, (2) RATED CAPACITIES AND ACTUAL POPULATION, (3) ADMISSION POLICIES, (4) CHARACTERISTICS OF RESIDENT POPULATION, (5) RESIDENT PROGRAMS,…

  2. Hospitalizations for Suicide-Related Drug Poisonings and Co-Occurring Alcohol Overdoses in Adolescents (Ages 12-17) and Young Adults (Ages 18-24) in the United States, 1999-2008: Results from the Nationwide Inpatient Sample

    Science.gov (United States)

    White, Aaron M.; MacInnes, Erin; Hingson, Ralph W.; Pan, I-Jen

    2013-01-01

    Drug poisoning is the leading method of suicide-related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide-related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates…

  3. Hospitalizations for Suicide-Related Drug Poisonings and Co-Occurring Alcohol Overdoses in Adolescents (Ages 12-17) and Young Adults (Ages 18-24) in the United States, 1999-2008: Results from the Nationwide Inpatient Sample

    Science.gov (United States)

    White, Aaron M.; MacInnes, Erin; Hingson, Ralph W.; Pan, I-Jen

    2013-01-01

    Drug poisoning is the leading method of suicide-related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide-related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates…

  4. Investigation of inhalation anthrax case, United States.

    Science.gov (United States)

    Griffith, Jayne; Blaney, David; Shadomy, Sean; Lehman, Mark; Pesik, Nicki; Tostenson, Samantha; Delaney, Lisa; Tiller, Rebekah; DeVries, Aaron; Gomez, Thomas; Sullivan, Maureen; Blackmore, Carina; Stanek, Danielle; Lynfield, Ruth

    2014-02-01

    Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.

  5. Medication reconciliation in patients hospitalized in a cardiology unit.

    Science.gov (United States)

    Magalhães, Gabriella Fernandes; Santos, Gláucia Noblat de Carvalho; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  6. Medication reconciliation in patients hospitalized in a cardiology unit.

    Directory of Open Access Journals (Sweden)

    Gabriella Fernandes Magalhães

    Full Text Available To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies.This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies.A total of 181 discrepancies were found in 50 patients (86%. Of these discrepancies, 149 (82.3% were justified changes to the patient's home medication regimen; however, 32 (17.7% discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2% were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%. Of the unintentional discrepancies 13 (40.6% were classified as error without harm, 11 (34.4% were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4% as errors could have resulted in harm and 5 (15.6% were classified as circumstances or events that have the capacity to cause harm.The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  7. 31 CFR 560.314 - United States person.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States person. 560.314 Section... § 560.314 United States person. The term United States person means any United States citizen, permanent resident alien, entity organized under the laws of the United States (including foreign branches), or...

  8. Toll Facilities in the United States - Toll Facilities in the United States

    Data.gov (United States)

    Department of Transportation — Biennial report containing selected information on toll facilities in the United States that has been provided to FHWA by the States and/or various toll authorities...

  9. Analysis of United States’ Broadband Policy

    Science.gov (United States)

    2007-03-01

    glass fiber. The light signals are then decoded at the end of the fiber by a special optic decoder /encoder. This allows for the light signal to be...CDMA technology while Cingular offers it through the HSDPA/ GSM technology. One quarter of the United States’ Internet users have a cell phone that...well Cingular 900 Kbps 100 Kbps $79.00 HSDPA/ GSM 1 yr contract Table 13. Unlimited Cellular Broadband Plans in the United States (From PCWorld.com

  10. Natural aggregates of the conterminous United States

    Science.gov (United States)

    Langer, William H.

    1988-01-01

    Crushed stone and sand and gravel are the two main sources of natural aggregates. These materials are commonly used construction materials and frequently can be interchanged with one another. They are widely used throughout the United States, with every State except two producing crushed stone. Together they amount to about half the mining volume in the United States. Approximately 96 percent of sand and gravel and 77 percent of the crushed stone produced in the United States are used in the construction industry. Natural aggregates are widely distributed throughout the United States in a variety of geologic environments. Sand and gravel deposits commonly are the results of the weathering of bedrock and subsequent transportation and deposition of the material by water or ice (glaciers). As such, they commonly occur as river or stream deposits or in glaciated areas as glaciofluvial and other deposits. Crushed stone aggregates are derived from a wide variety of parent bedrock materials. Limestone and other carbonates account for approximately three quarters of the rocks used for crushed stone, with granite and other igneous rocks making up the bulk of the remainder. Limestone deposits are widespread throughout the Central and Eastern United States and are scattered in the West. Granites are widely distributed in the Eastern and Western United States, with few exposures in the Midwest. Igneous rocks (excluding granites) are largely concentrated in the Western United States and in a few isolated localities in the East. Even though natural aggregates are widely distributed throughout the United States, they are not universally available for consumptive use. Some areas are devoid of sand and gravel, and potential sources of crushed stone may be covered with sufficient unconsolidated material to make surface mining impractical. In some areas many aggregates do not meet the physical property requirements for certain uses, or they may contain mineral constituents that react

  11. Understanding human trafficking in the United States.

    Science.gov (United States)

    Logan, T K; Walker, Robert; Hunt, Gretchen

    2009-01-01

    The topic of modern-day slavery or human trafficking has received increased media and national attention. However, to date there has been limited research on the nature and scope of human trafficking in the United States. This article describes and synthesizes nine reports that assess the U.S. service organizations' legal representative knowledge of, and experience with, human trafficking cases, as well as information from actual cases and media reports. This article has five main goals: (a) to define what human trafficking is, and is not; (b) to describe factors identified as contributing to vulnerability to being trafficked and keeping a person entrapped in the situation; (c) to examine how the crime of human trafficking differs from other kinds of crimes in the United States; (d) to explore how human trafficking victims are identified; and, (e) to provide recommendations to better address human trafficking in the United States.

  12. Pakistan: Can the United States Secure an Insecure State?

    Science.gov (United States)

    2010-01-01

    Ethnocentrism is a problem. Pakistan lost Bangladesh in its 1971 civil war in part because West Pakistanis viewed Bengalis, who are the dominant ethnic...137. 64 Pakistan: Can the United States Secure an Insecure State? in the last few years of rapid growth, consumer price inflation surged to 25

  13. The United States confronts Ebola: suasion, executive action and fragmentation.

    Science.gov (United States)

    Greer, Scott L; Singer, Phillip M

    2017-01-01

    The United States' experience with the Ebola virus in 2014 provides a window into US public health politics. First, the United States provided a case study in the role of suasion and executive action in the management of public health in a fragmented multi-level system. The variable capacity of different parts of the United States to respond to Ebola on the level of hospitals or state governments, and their different approaches, show the limitations of federal influence, the importance of knowledge and executive energy, and the diversity of both powerful actors and sources of power. Second, the politics of Ebola in the United States is a case study in the politics of partisan blame attribution. The outbreak struck in the run-up to an election that was likely to be good for the Republican party, and the election dominated interest in and opinions of Ebola in both the media and public opinion. Democratic voters and media downplayed Ebola while Republican voters and media focused on the outbreak. The media was a key conduit for this strategic politicization, as shown in the quantity, timing and framing of news about Ebola. Neither fragmentation nor partisanship appears to be going away, so understanding the politics of public health crises will remain important.

  14. Employers mexican migrants in the United States

    Directory of Open Access Journals (Sweden)

    Eduardo Fernández Guzmán

    2013-09-01

    Full Text Available You might think that by definition the migrant labor plays in less profitable niches and meager social mobility. However, a large group of migrants in different economically developed countries have successfully launched businesses of diverse nature and volume. This is why entrepreneurship of migrants is an issue that has received increasing attention in recent years. Compared to other immigrant groups in the United States, Mexicans show low levels of entrepreneurial activity. The aim of this paper is to, through a general literature review of official statistical data, a preliminary analysis of mexican migrant entrepreneurship in the United States, that is to say in recent years has been growing in importance.

  15. Hospital care and capacity in the tri-state region of Indiana, Kentucky, and Ohio: analysis and insights.

    Science.gov (United States)

    Burns, David J; Chinta, Ravi; Kashyap, Vishal; Manolis, Chris; Sen, Amit

    2008-01-01

    Hospitals are a significant part of the burgeoning healthcare sector in the United States (U.S.) economy. Despite the availability of what some describe as the world's best healthcare, the U.S. suffers from wide discrepancies in healthcare provision across hospitals and regions of the country. Specifically, capacity, utilization, quality, and even financial performance of hospitals vary widely. Based on secondary data from 533 hospitals in the adjoining states of Indiana, Kentucky, and Ohio, this study develops several comparative metrics that enable benchmarking, which, in turn, leads to several inferences and implications for hospital administrators. The paper concludes with implications for hospital administrators and suggestions for future research.

  16. United States Military Presence in Central Asia: Implications of United States Basing for Central Asian Stability

    Science.gov (United States)

    2006-06-01

    Europe and reducing the number of military personnel by 40,000 to 60,000. According to United States Air Force General Charles Wald , there are...The Deputy Secretary of Defense Paul Wolfowitz is quoted as saying United States presence “…may be more political than actually military” and that

  17. Estimated Water Flows in 2005: United States

    Energy Technology Data Exchange (ETDEWEB)

    Smith, C A; Belles, R D; Simon, A J

    2011-03-16

    Flow charts depicting water use in the United States have been constructed from publicly available data and estimates of water use patterns. Approximately 410,500 million gallons per day of water are managed throughout the United States for use in farming, power production, residential, commercial, and industrial applications. Water is obtained from four major resource classes: fresh surface-water, saline (ocean) surface-water, fresh groundwater and saline (brackish) groundwater. Water that is not consumed or evaporated during its use is returned to surface bodies of water. The flow patterns are represented in a compact 'visual atlas' of 52 state-level (all 50 states in addition to Puerto Rico and the Virgin Islands) and one national water flow chart representing a comprehensive systems view of national water resources, use, and disposition.

  18. Eurabia: Strategic Implications for the United States

    Science.gov (United States)

    2010-03-01

    states of North Africa and the Middle East.5 Eurabia was the name of a journal published in the mid-1970s by the European Committee for...have her extradited to Switzerland so she could be prosecuted under Swiss anti- racism statute, Islamic groups successfully prevailed to have her...options. The United States can forge new relationships with emerging powers such as Brazil, Russia, India and China, the so called BRIC countries

  19. Medicare Hospital Spending Per Patient - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

  20. ebony] state university teaching hospital abakaliki, nigeria

    African Journals Online (AJOL)

    Abakakliki were studied to determine the antimicrobial susceptibility pattern. Between ... the organnisn is very necessary in the formulation of a sound antibiotic policy in the hospital ... Lactamase (ESBL) producing K£4l)Si€llll pneumoniae.

  1. Following Zhang Wenjin to the United States

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    In 1937,Zhang Ying studied at the Lu Xun Art Institute in Yan’an.After graduation she began working in the art world under Zhou Enlai’s direction.In 1983, she followed her husband Zhang Wenjin to the United States as wife of the ambassador.During her two-year stay in the U.S., she came into close contact with many American women while working to promote mutual understanding and friendship between the people of the two countries.After her retirement in 1991,she sponsored the production of a 10-episode documentary TV program,"Zhou Enlai and the Arts."She also wrote a book about her experience in the United States,Called,Following Zhang Wenjin to the United States—Notes of an Ambassador’s Wife.The following are extracts from the book.

  2. Managing nuclear weapons in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Miller, G.

    1993-03-16

    This report discusses the management and security of nuclear weapons in the post-cold war United States. The definition of what constitutes security is clearly changing in the US. It is now a much more integrated view that includes defense and the economy. The author tries to bring some semblance of order to these themes in this brief adaptation of a presentation.

  3. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Multilocus DNA sequence data was used to retrospectively assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically dist...

  4. CTS United States experiments. A progress report

    Science.gov (United States)

    Robbins, W. H.; Donoughe, P. L.

    1976-01-01

    The results are presented of the United States experiments activity to date. Wide segments of the population are involved in the Experiments Program including the scientific community, other government agencies, industry, and the education and health entities. The experiments are associated with both technological objectives and the demonstration of new community and social services via satellite.

  5. Color Vision Deficiencies in Children. United States.

    Science.gov (United States)

    National Center for Health Statistics (DHEW/PHS), Hyattsville, MD.

    Presented are prevalence data on color vision deficiencies (color blindness) in noninstitutionalized children, aged 6-11, in the United States, as estimated from the Health Examination Survey findings on a representative sample of over 7,400 children. Described are the two color vision tests used in the survey, the Ishihara Test for Color…

  6. Characterizing Hospice Services in the United States

    Science.gov (United States)

    Smith, Maureen A.; Seplaki, Christopher; Biagtan, Mark; DuPreez, Amanda; Cleary, James

    2008-01-01

    Purpose: Although caregivers desire specific information about hospice programs, there is little descriptive information available. We characterized agencies that provide formal or informal hospice care in the United States according to four types of services considered important by caregivers: medications and treatments; rehabilitative care;…

  7. United States Air Force Annual Financial Statements

    Science.gov (United States)

    2002-01-01

    gains and losses NRV = Net Realizable Value O = Other Inventory, Gross Value Revaluation Allowance Inventory, Net 2002 2001 United States Air Force...losses NRV = Net Realizable Value O = Other For the most part, DMAG is using the consumption method of accounting for OM&S, since OM&S is defined in the

  8. Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows major ports in the United States, Puerto Rico, and the U.S. Virgin Islands. A port is a city, town, or urban area with a harbor where ships load...

  9. Surveillance for Viral Hepatitis - United States, 2014

    Science.gov (United States)

    ... and Programs Resource Center Viral Hepatitis Surveillance for Viral Hepatitis – United States, 2014 Recommend on Facebook Tweet Share ... Cases Hepatitis A Hepatitis B Hepatitis C Discussion Hepatitis A virus Index PAGE DESCRIPTION Table 2.1 Reported ...

  10. Major land uses in the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a polygon coverage of major land uses in the United States. The source of the coverage is the map of major land uses in the National Atlas, pages 158-159,...

  11. EC 92 and the United States

    Science.gov (United States)

    1992-04-15

    34 Rheinischer Merkur (Bonn), January 17, 1992, 5. 17. Robert J. Samuelson, "Europe’s Boom Has Come and Cone," Washington Post, February 12, 1992, A23...34 Rheinischer Merkur (Bonn), January 17, 1992, 5. Riemer, Blanca. "’United States of Europe’? Don’t Hold Your Breath." Business Week, June 17, 1991, 50

  12. Airports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes airports in the United States, Puerto Rico and the U.S. Virgin Islands. The data were derived from an extract of the Public-Use Airports...

  13. AIDS Pandemic in the United States

    Science.gov (United States)

    Erickson, Amy H.; Melendez, Barbra S.; Ball, Daniel L.; Morse, Steven T.; Phillips, Geoffrey P.

    2010-01-01

    This project is one of four that were issued to first semester sophomore undergraduates at the United States Military Academy as part of an integrated learning experience at the end of their Calculus II course work. This project was used during a short, seven lesson block of instruction that was intended to capitalize on their recent academic…

  14. Orienteering: Growth Patterns in the United States.

    Science.gov (United States)

    Jeffery, Charles F.

    The history of orienteering in the United States includes both military and civilian interest, with the period of greatest growth between 1970 and 1980. To investigate growth patterns in orienteering, questionnaires were mailed to 42 civilian orienteering clubs and 286 universities supporting senior Reserve Office Training Corps (ROTC)…

  15. 31 CFR 539.312 - United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States. 539.312 Section 539.312 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY WEAPONS OF MASS DESTRUCTION TRADE CONTROL...

  16. Malignant Hyperthermia Association of the United States

    Science.gov (United States)

    ... Videos Blog Get Involved Shop Ask a question right here... MHAUS On Facebook Now view more On Twitter Now view more Tweets by @ ... Malignant Hyperthermia Association of the United States. All rights reserved. ... advertiser and not necessarily the views or opinions of MHAUS, its staff or its ...

  17. The United States and VIetnam: 1787 - 1941

    Science.gov (United States)

    1990-01-01

    almost totally unproductive ceremony and haggling with the Cochinchinese authorities. During his stay there, White developed an appreciation of the...British and French involvement with the warring sides in the United States and with French adventures in Mexico , not with events in far-off

  18. Social science findings in the United States

    Science.gov (United States)

    Sarah McCaffrey; Eric Toman; Melanie Stidham; Bruce. Shindler

    2015-01-01

    The rising number of acres burned annually and growing number of people living in or adjacent to fire-prone areas in the United States make wildfire management an increasingly complex and challenging problem. Given the prominence of social issues in shaping the current challenges and determining paths forward, it will be important to have an accurate understanding of...

  19. United States: Exploring the Marriage Debate

    Science.gov (United States)

    Carter, Julie H.

    2004-01-01

    As citizens of the United States respond to legislative and judicial actions that have challenged the prohibition against same-sex couples receiving marriage licenses, schools have a timely opportunity to engage students on this most important debate. Educators can help their students understand the full significance of this issue by encouraging…

  20. Geology of the Coterminous United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — A digital version of the Geologic Map of the United States, originally published at a scale of 1:2,500,000 (King and Beikman, 1974b). It excludes Alaska and Hawaii.

  1. Immigration, parasitic infection, and United States religiosity.

    Science.gov (United States)

    Wall, Jaimie N; Shackelford, Todd K

    2012-04-01

    Fincher & Thornhill (F&T) present a powerful case for the relationship between parasite-stress and religiosity. We argue, however, that the United States may be more religious than can be accounted for by parasite-stress. This greater religiosity might be attributable to greater sensitivity to immigration, which may hyperactivate evolved mechanisms that motivate avoidance of potential carriers of novel parasites.

  2. Women's Music in the United States.

    Science.gov (United States)

    Lont, Cynthia M.

    The purpose of this presentation was to: (1) describe the history of women's music in the United States; (2) define women's music; (3) report on the status of the large women's recording companies; and (4) focus on a recent controversy in the women's music industry involving the desire for political purity versus the need for economic security.…

  3. Nursing continuing education in the united states

    OpenAIRE

    Robert, B.

    1981-01-01

    THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  4. Nursing continuing education in the united states

    Directory of Open Access Journals (Sweden)

    B Robert

    1981-09-01

    Full Text Available THE discussion of nursing continuing education in the United States is approached by a consideration of the following aspects: Definition and Background Evolution of the Concept Administration of the Process Teaching Techniques Range of Subjects Evaluation of the Program Issues and Problems: Mandatory vs. Voluntary Participation Control of the Accreditation Process Responsibility for Participation Program Cost/Availability

  5. Dengue Fever in the United States

    Centers for Disease Control (CDC) Podcasts

    2012-04-09

    Dr. Amesh Adalja, an associate at the Center for Biosecurity and clinical assistant professor at the University of Pittsburgh School, of Medicine, discusses dengue fever outbreaks in the United States.  Created: 4/9/2012 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 4/16/2012.

  6. Fragmentation of eastern United States forest types

    Science.gov (United States)

    Kurt H. Riitters; John W. Coulston

    2013-01-01

    Fragmentation is a continuing threat to the sustainability of forests in the Eastern United States, where land use changes supporting a growing human population are the primary driver of forest fragmentation (Stein and others 2009). While once mostly forested, approximately 40 percent of the original forest area has been converted to other land uses, and most of the...

  7. CPAFFC Working Group Visits the United States

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    <正>From April 13 to 21, a CPAFFC working group led by Yao Mingyu, director general of the Department of American and Oceanian Affairs of the CPAFFC, visited the United States, attended the 18th Forum on US-China Relations sponsored by the US-China Peoples Friendship Association (USCPFA) and had talks with the USCPFA, the Richard Nixon Library & Birthplace Foundation, the Richard Nixon Centre, the Sister Cities International of the U.S., the National Conference of State Legislatures, the Council of State

  8. Hospitals

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  9. Infection control resources in New York State hospitals, 2007.

    Science.gov (United States)

    Stricof, Rachel L; Schabses, Karolina A; Tserenpuntsag, Boldtsetseg

    2008-12-01

    In July 2005, New York State legislation requiring the mandatory reporting of specific hospital-associated infections (HAIs) was passed by the legislature and signed by the governor. In an effort to measure the impact of this legislation on infection control resources, the New York State Department of Health (NYSDOH) conducted a baseline survey in March 2007. This report presents an overview of the methods and results of this survey. An electronic survey of infection control resources and responsibilities was conducted by the NYSDOH on their secure data network. The survey contained questions regarding the number and percent time for infection prevention and control professional (ICP) and hospital epidemiologist (HE) staff members, ICP/HE educational background and certification, infection control program support services, activities and responsibilities of infection prevention and control program staff, and estimates of time dedicated to various activities, including surveillance. Practitioners in 222 of 224 acute care hospitals (99%) responded. The average number of ICPs per facility depended on the average daily census of acute care beds and ranged from a mean of 0.64 full-time equivalent (FTE) ICP in facilities with an average daily census of or = 900 beds. Averaging the ICP resources over the health care settings for which they were responsible revealed that the "average full-time ICP" was responsible for 151 acute care facility beds, 1.3 intensive care units (ICUs) (average, 16 ICU beds), 21 long-term care facility beds, 0.6 dialysis centers, 0.5 ambulatory surgery centers, 4.8 ambulatory/outpatient clinics, and 1.1 private practice offices. The ICPs reported that 45% of their time is dedicated to surveillance. Other activities for which ICPs reported at least partial responsibility include staff education, quality assurance, occupational health, emergency preparedness, construction, central supply/processing, and risk management. This survey was designed to

  10. A survey of rotational use of biocides in hospital pharmacy aseptic units.

    Science.gov (United States)

    Murtough, S M; Hiom, S J; Palmer, M; Russell, A D

    2002-03-01

    A postal survey of biocide rotation in UK hospital pharmacy aseptic units was carried out. Seventy per cent of respondents stated that biocides were rotated, most frequently in areas outside critical work zones. High-level disinfection was employed when 'aseptic' conditions were required. Decisions on frequency of rotation were most often based on in-house validation or consultation with colleagues. Toxicity and corrosiveness were the criteria rated most important in a rotation policy. Microbiological monitoring was carried out most frequently in critical work zones but less often for handwashing. Most QC hospital pharmacists supported rotation and would prefer a standard period for all applications (monthly). Guidelines need to be clarified to assist staff in decisions regarding biocide rotation. Copyright 2002 The Hospital Infection Society.

  11. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units.

    Science.gov (United States)

    Aragon, Stephen J; Richardson, Liana J; Lawrence, Wanda; Gesell, Sabina B

    2013-01-01

    Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.

  12. Nurses’ Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Directory of Open Access Journals (Sweden)

    Stephen J. Aragon

    2013-01-01

    Full Text Available Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients’ satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n=300 each from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients’ ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses’ patient-centeredness increased by one standard deviation, patients’ satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients’ satisfaction in hospital obstetrical units.

  13. Nurses' Patient-Centeredness and Perceptions of Care among Medicaid Patients in Hospital Obstetrical Units

    Science.gov (United States)

    Aragon, Stephen J.; Richardson, Liana J.; Lawrence, Wanda; Gesell, Sabina B.

    2013-01-01

    Objective. This study examined to what degree patient-centeredness—measured as an underlying ability of obstetrical nurses—influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units. PMID:24027634

  14. Antiabortion violence in the United States.

    Science.gov (United States)

    Russo, Jennefer A; Schumacher, Kristin L; Creinin, Mitchell D

    2012-11-01

    This study was conducted to determine if an association exists between the amount of harassment and violence directed against abortion providers and the restrictiveness of state laws relating to family planning. We used responses from a July 2010 survey of 357 abortion providers in 50 states to determine their experience of antiabortion harassment and violence. Their responses were grouped and analyzed in relation to a published grading of state laws in the United States (A, B, C, D and F) as they relate to restrictions on family planning services. Group by group comparison of respondents illustrates that the difference in the number of reported incidents of minor vandalism by group is statistically significant (A vs. C, p=.07; A vs. D, p=.017; A vs. F, p=.0002). Incidents of harassment follow a similar pattern. There were no differences noted overall for violence or major vandalism. Major violence, including eight murders, is a new occurrence in the last two decades. Harassment of abortion providers in the United States has an association with the restrictiveness of state abortion laws. In the last two decades, murder of abortion providers has become an unfortunate part of the violence. Copyright © 2012 Elsevier Inc. All rights reserved.

  15. 45 CFR 212.7 - Repayment to the United States.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 2 2010-10-01 2010-10-01 false Repayment to the United States. 212.7 Section 212... UNITED STATES CITIZENS RETURNED FROM FOREIGN COUNTRIES § 212.7 Repayment to the United States. (a) An..., any or all of the cost of such assistance to the United States, except insofar as it is...

  16. 31 CFR 592.305 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... General Definitions § 592.305 Importation into the United States. The term importation into the United States means the bringing of goods into the United States....

  17. 20 CFR 416.215 - You leave the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false You leave the United States. 416.215 Section... Eligible § 416.215 You leave the United States. You lose your eligibility for SSI benefits for any month during all of which you are outside of the United States. If you are outside of the United States for...

  18. 78 FR 32356 - United States-Korea Free Trade Agreement

    Science.gov (United States)

    2013-05-30

    ... 178 RIN 1515-AD86 United States-Korea Free Trade Agreement AGENCIES: U.S. Customs and Border... United States-Korea Free Trade Agreement entered into by the United States and the Republic of Korea... ``Korea'') signed the United States-Korea Free Trade Agreement (hereinafter ``UKFTA'' or the ``Agreement...

  19. 7 CFR 1212.32 - United States Customs Service.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 10 2010-01-01 2010-01-01 false United States Customs Service. 1212.32 Section 1212... § 1212.32 United States Customs Service. “United States Customs Service” or “Customs” means the United States Customs and Border Protection, an agency of the Department of Homeland Security. Honey Packers...

  20. 32 CFR 575.6 - Catalogue, United States Military Academy.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 3 2010-07-01 2010-07-01 true Catalogue, United States Military Academy. 575.6... ADMISSION TO THE UNITED STATES MILITARY ACADEMY § 575.6 Catalogue, United States Military Academy. The latest edition of the catalogue, United States Military Academy, contains additional information...

  1. 75 FR 13345 - Pricing for Certain United States Mint Products

    Science.gov (United States)

    2010-03-19

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY United States Mint Pricing for Certain United States Mint Products AGENCY: United States Mint, Department of the Treasury. ACTION: Notice. SUMMARY: The United States Mint is announcing the price of...

  2. 77 FR 27612 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK11 Modifications to Definition of United States Property... or clearing agency do not constitute United States property. These regulations affect United States...)) that invests certain earnings and profits in United States property (U.S. property) ``on the...

  3. The State of Homeless Children in the United States

    Science.gov (United States)

    Kabler, Brenda; Weinstein, Elana

    2009-01-01

    Across America, the numbers of homeless children and families are growing as a result of many factors including the recent economic crisis, home foreclosures, and natural disasters. Because of an increase in the number of homeless children throughout the United States, this population has unmet needs that can be targeted in school settings under…

  4. Disaster Planning: Financing a Burn Disaster, Where Do You Turn and What Are Your Options When Your Hospital Has Been Impacted by a Burn Disaster in the United States?

    Science.gov (United States)

    Kearns, Randy D; Hubble, Michael W; Lord, Graydon C; Holmes, James H; Cairns, Bruce A; Helminiak, Clare

    2016-01-01

    The cost associated with a single burn injured patient can be significant. The American healthcare system functions in part based on traditional market forces which include supply and demand. In addition, there are a variety of payer sources with disparate payment for the same services. Thus, when a group of patients with serious injuries needing complicated care are underinsured or uninsured, or lacks the ability to pay, the financial health of the organization providing the care can be undermined. When a medical disaster with significant numbers of burn injured patients occurs, the financial concerns can be compounded with this singular event. It is critical to be cognizant of the disaster-related financial resources available. Knowing where to turn and what may be available can help assure that the institution caring for this group of high cost patients does not simultaneously take on significant financial risk in the aftermath of the disaster. This article includes national (United States) financial data with respect to burn injury, and focuses on (United States) governmental financial resources during and after a disaster. This review includes identifying and discussing traditional financial support, as well as atypical but established programs where, during a disaster, health care institutions may be eligible for assistance to cover part or all of the associated costs.

  5. [Undocumented migrant labor in the United States].

    Science.gov (United States)

    Dinand, J

    1985-09-01

    The author identifies two factors contributing to the increase in the number of illegal migrant workers in the United States. The first is the complex system of legal immigration, which contributes to massive evasion. The second is the preference by many employers for hiring illegal aliens. The author concludes that the proposed changes in U.S. immigration laws, even though they include employer sanctions, are likely to prove as ineffective as previous measures adopted in several states some 10 years ago that also penalized employers hiring illegal aliens. It is suggested that the economic pressures leading to large-scale labor immigration will prove stronger than political pressures to control such immigration

  6. Inclusive Education in the United States

    OpenAIRE

    C. Kenneth Tanner; Deborah Jan Vaughn Linscott; Susan Allan Galis

    1996-01-01

    School reform issues addressing inclusive education were investigated in this nationwide (United States) study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive ed...

  7. Summary of Notifiable Diseases, United States, 1993.

    Science.gov (United States)

    2007-11-02

    incidence of drug-resistant Streptococcus pneumoniae (DRSP) strains in the United States has created an emerging public health challenge. CDC...only 1,280 cases of Legionnaires’ disease were reported through NNDSS in 1993, data from recent prospective pneumonia studies suggest that between...surveillance data from 1992 indicated that the prevalence of pneumococcal strains that are highly resistant to penicillin increased 60-fold (from 0.02% to 1.3

  8. The United States Military and Humanitarian Operations

    Science.gov (United States)

    1995-01-01

    stated that, "The wave of the future will be putting together task forces that will be able to respond to crisis management or humanitarian...examine three options for the military’s role in humanitaria operations at home and abroad. Option 1: Virtually Eliminate Anv Military Role This is the...humanitarian aid in almost any crisis .36 The military resists the creation of specially designated units because such specialization reduces the

  9. Energy Security in the United States

    Science.gov (United States)

    2012-05-01

    increase the domestic price of those 41. Coal gasification is a process that converts solid coal—through several energy-intensive steps—into gasoline and...for switching to other fuels or reducing consumption of transportation fuels . In con- trast, electricity can be produced from several sources of...the prices of those fuels in the United States. Although the global nature of the market for oil makes U.S. consumers vulnerable to price

  10. West Coast, United States and Mexico

    Science.gov (United States)

    1990-01-01

    This view shows the west coast of the United States and Mexico (32.5N, 118.0W) and gives an indication of the range of view from orbital altitude. The visual range of this particular scene is from Skammon's Lagoon on Baja to the northern tip of California's Central Valley and Sierra Nevada, a range of over 15 degrees of latitude. Coastal fog drapes over southern California and northern Baja California. White Sands, New Mexico is at far right center.

  11. Continental United States Military Housing Inspections Southeast

    Science.gov (United States)

    2015-09-24

    standards. 3. Work with the privatized housing partner to ensure that fire protection inspection and maintenance plans are achieved. Deputy Assistant...Secretary stated that Hunt Military Communities and Patrick AFB civil engineers were working to correct all of the other fire protection system...create a plan for the performance of ongoing inspection and maintenance of all housing units to applicable electrical codes and standards. 3. Work

  12. United States of Europe, Dream or Possibility?

    Science.gov (United States)

    1966-04-08

    center between the United States and the Soviet Union. The method chosen to examine this trend is to review three major politico-military problems...de France, pp. 3-7. ൫ Supra-nationalism must go! De Gaulle’s heir presumptive, Georges Pompidou , has given voice to de Gaulle’s thoughts on... Pompidou said: Certainly we do not believe in integration as a method of approach to European unity, precisely because we believe that there can be no

  13. OECD environmental performance reviews: United States

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2006-01-15

    This book presents OECD assessments and recommendations regarding the United States' efforts to manage its environment including air, water, nature, and biodiversity; to do this in a sustainable manner; and to do this in co-operation with its global neighbours. In particular, it assesses progress made since 1996, when OECD's previous review on the US was done. 47 figs., 20 tabs.

  14. Toxic plants of the Northeastern United States.

    Science.gov (United States)

    Bischoff, Karyn; Smith, Mary C

    2011-07-01

    This article lists commonly encountered toxic plants that affect ruminants in the Northeastern United States. Livestock are at risk for ingestion of a large variety of toxic plants. Plant poisonings are likely to be underdiagnosed because tests for most plant toxins are not routinely available at veterinary diagnostic laboratories. Prevention of access to poisonous plants is usually more effective and economical than treatment of plant poisonings. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. PERMITTING LEADERSHIP IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Ken Nemeth

    2002-09-01

    In accordance with the Southern States Energy Board (SSEB) proposal, as incorporated into NETL/DE-FC26-97FT34199, the objective of this agreement is to streamline the environmental technology permitting process site-to-site, state-to-state, and industry-to-industry to achieve remediation and waste processing faster, better and cheaper. SSEB is working with member Governors, legislators and regulators to build consensus on streamlining the permitting process for new and innovative technologies for addressing the legacy of environmental problems from 50 years of weapons research, development and production. This report reviews mechanisms whereby industry consortiums and the Department of Energy (DOE) have been working with State regulators and other officials in technology deployment decisions within the DOE complex. The historic development of relationships with State regulators is reviewed and the current nature of the relationships examined. The report contains observations from internal DOE reviews as well as recommendations from the General Accounting Office (GAO) and other external organizations. The report discusses reorganization initiatives leading up to a DOE Top-to-Bottom review of the Environmental Management (EM) Program and highlights points of consideration for maintaining effective linkages with State regulators. It notes how the proposed changes will place new demands upon the National Energy Technology Laboratory (NETL) and how NETL can leverage its resources by refocusing existing EM efforts specifically to states that have DOE facilities within their borders (host-states). Finally, the report discusses how SSEB's Permitting Leadership in the United States (PLUS) program can provide the foundation for elements of NETL's technical assistance program that are delivered to regulators and other decision- makers in host-states. As a regional compact commission, SSEB provides important direct linkages to regulators and stakeholders who need

  16. [Drug use in neonatology units of 6 Spanish hospitals].

    Science.gov (United States)

    Feal Cortizas, B; Barroso Pérez, C; Carcelen Andrés, J; Fábrega Bosacoma, C; Gallego Lago, V; Hidalgo Albert, E; Pozas Del Río, M T; Puy Goyache, M; Revert Molina-Niñirola, A; Valverde Molina, E; Wood Wood, M A

    2003-01-01

    To determine the status of drug use in Neonatology units regarding: 1. Frequency of use for drugs unauthorised by DirecciA(3)n General de Farmacia y Productos Sanitarios. 2. Suitability of commercial presentations regarding actual needs of patients. Two cut-off points were established for 100% of patients admitted to Neonatology Units in 6 Spanish hospitals. Data on demography and therapeutic drug profile were collected, as well as on whether doses were or not prepared by Pharmacy departments. Approval for each drug regarding indication, age range, dosage and administration route was assessed. The number of patients included was 346. In all, 17.6% of patients were under treatment with unauthorised drugs, the reason being age in 78.7% and indication in 21.3%. Master formula preparation was needed for 22% of patients because of a lack of commercial preparations suited for paediatric age. Pharmacy departments prepared 25% of prescribed drugs. The use of unauthorised drugs in Neonatology is a common fact. Pharmacy departments are actively involved in Neonatology-related drug therapies: counselling and/or processing for compassionate unauthorised drug use, master formula preparation, intravenous mixtures, etc. Therapeutics in Neonatology benefits from specialised pharmaceutical involvement.

  17. Human prion diseases in the United States.

    Directory of Open Access Journals (Sweden)

    Robert C Holman

    Full Text Available BACKGROUND: Prion diseases are a family of rare, progressive, neurodegenerative disorders that affect humans and animals. The most common form of human prion disease, Creutzfeldt-Jakob disease (CJD, occurs worldwide. Variant CJD (vCJD, a recently emerged human prion disease, is a zoonotic foodborne disorder that occurs almost exclusively in countries with outbreaks of bovine spongiform encephalopathy. This study describes the occurrence and epidemiology of CJD and vCJD in the United States. METHODOLOGY/PRINCIPAL FINDINGS: Analysis of CJD and vCJD deaths using death certificates of US residents for 1979-2006, and those identified through other surveillance mechanisms during 1996-2008. Since CJD is invariably fatal and illness duration is usually less than one year, the CJD incidence is estimated as the death rate. During 1979 through 2006, an estimated 6,917 deaths with CJD as a cause of death were reported in the United States, an annual average of approximately 247 deaths (range 172-304 deaths. The average annual age-adjusted incidence for CJD was 0.97 per 1,000,000 persons. Most (61.8% of the CJD deaths occurred among persons >or=65 years of age for an average annual incidence of 4.8 per 1,000,000 persons in this population. Most deaths were among whites (94.6%; the age-adjusted incidence for whites was 2.7 times higher than that for blacks (1.04 and 0.40, respectively. Three patients who died since 2004 were reported with vCJD; epidemiologic evidence indicated that their infection was acquired outside of the United States. CONCLUSION/SIGNIFICANCE: Surveillance continues to show an annual CJD incidence rate of about 1 case per 1,000,000 persons and marked differences in CJD rates by age and race in the United States. Ongoing surveillance remains important for monitoring the stability of the CJD incidence rates, and detecting occurrences of vCJD and possibly other novel prion diseases in the United States.

  18. Taxation of United States general aviation

    Science.gov (United States)

    Sobieralski, Joseph Bernard

    General aviation in the United States has been an important part of the economy and American life. General aviation is defined as all flying excluding military and scheduled airline operations, and is utilized in many areas of our society. The majority of aircraft operations and airports in the United States are categorized as general aviation, and general aviation contributes more than one percent to the United States gross domestic product each year. Despite the many benefits of general aviation, the lead emissions from aviation gasoline consumption are of great concern. General aviation emits over half the lead emissions in the United States or over 630 tons in 2005. The other significant negative externality attributed to general aviation usage is aircraft accidents. General aviation accidents have caused over 8000 fatalities over the period 1994-2006. A recent Federal Aviation Administration proposed increase in the aviation gasoline tax from 19.4 to 70.1 cents per gallon has renewed interest in better understanding the implications of such a tax increase as well as the possible optimal rate of taxation. Few studies have examined aviation fuel elasticities and all have failed to study general aviation fuel elasticities. Chapter one fills that gap and examines the elasticity of aviation gasoline consumption in United States general aviation. Utilizing aggregate time series and dynamic panel data, the price and income elasticities of demand are estimated. The price elasticity of demand for aviation gasoline is estimated to range from -0.093 to -0.185 in the short-run and from -0.132 to -0.303 in the long-run. These results prove to be similar in magnitude to automobile gasoline elasticities and therefore tax policies could more closely mirror those of automobile tax policies. The second chapter examines the costs associated with general aviation accidents. Given the large number of general aviation operations as well as the large number of fatalities and

  19. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

    Science.gov (United States)

    Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

    2017-09-19

    Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

  20. Hospitals in the state of Louisiana, Geographic NAD83, LDHH (2007) [hospitals_06_07_pub_LDHH_2007

    Data.gov (United States)

    Louisiana Geographic Information Center — Hospitals in the state of Louisiana. This database contains the responses provided by the hospitals to the "Emergency Response Hospital Data Verification Form" that...

  1. Proposed standards for professional health sciences library services in hospitals of New York State.

    Science.gov (United States)

    Hutchinson, A P; O'Connell, M; Richards, B B; Thompson, J L; Wheeler, R A

    1981-07-01

    Hospital libraries are considered to be the basic unit of the medical information system. A major statewide effort was begun in 1978 to introduce and support legislation in the New York State Legislature which would encourage hospitals to establish and maintain libraries that meet minimum services standards. Included in this legislation is the concept that the Commissioner of Education in consultation with the Commissioner of Health shall have the power to establish standards for hospital libraries. The Ad Hoc Committee for the Promotion of Hospital Library Services, Western New York Library Resources Council, proposes The Standards for Professional Health Sciences Library Services in Hospitals of New York State to clarify and to strengthen existing hospital library standards. These standards differ specifically from the Joint Commission on Accreditation of Hospitals standards in that they place equal and specific emphasis on eleven points: administration, qualifications of library staff, continuing education of library staff, requirement for a library advisory committee, required library services, required library resources, library space requirements, library budget, library network and consortium membership, documentation of library policy, and continued evaluation of the needs of the hospital for library service. Detailed interpretations are provided. An appendix describes the qualifications of a hospital library consultant.

  2. [An evaluation of the services of state hospital pharmacies in Rio de Janeiro, Brazil].

    Science.gov (United States)

    da Silva, Mario Jorge Sobreira; Magarinos-Torres, Rachel; Oliveira, Maria Auxiliadora; Osorio-de-Castro, Claudia Garcia Serpa

    2013-12-01

    This article presents an evaluation of state-run hospital pharmacies in Rio de Janeiro. For the regulatory evaluation, 62 indicators of structure and procedures were used in order to establish the adequacy of the activities of the hospital pharmacy. The services were then stratified by level of complexity of the hospital. A scaled rating algorithm was applied to each stratum in accordance with the activities carried out. The hospitals were then hierarchically grouped for each stratum and the best and worst services at each level of complexity were chosen for the multiple case study, resulting in a total of six units. In these units 16 result indicators were applied and analysis of the resulting data was conducted by cross-case synthesis. The performance evaluation revealed that only one unit performed management and forecasting activities satisfactorily. Four units administered medication procurement inadequately. The worst results in terms of performance in the six hospitals studied were related to stock management and the best to distribution activities. The data are a cause for concern, since these are considered the core activities of the hospital pharmacy.

  3. Life Change Units (LCU) rating as stressors in Iranian hospitals' nurses.

    Science.gov (United States)

    Dargahi, Hossein; Shaham, Golsa

    2012-01-01

    Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses' cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses' occupational stress level, the maintaining their work ability.

  4. The state of amphibians in the United States

    Science.gov (United States)

    Muths, E.; Adams, M.J.; Grant, E.H.C.; Miller, D.; Corn, P.S.; Ball, L.C.

    2012-01-01

    More than 25 years ago, scientists began to identify unexplained declines in amphibian populations around the world. Much has been learned since then, but amphibian declines have not abated and the interactions among the various threats to amphibians are not clear. Amphibian decline is a problem of local, national, and international scope that can affect ecosystem function, biodiversity, and commerce. This fact sheet provides a snapshot of the state of the amphibians and introduces examples to illustrate the range of issues in the United States.

  5. 22 CFR 22.3 - Remittances in the United States.

    Science.gov (United States)

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Remittances in the United States. 22.3 Section...-DEPARTMENT OF STATE AND FOREIGN SERVICE § 22.3 Remittances in the United States. (a) Type of remittance. Remittances shall be in the form of: (1) Check or bank draft drawn on a bank in the United States; (2)...

  6. Maximum floodflows in the conterminous United States

    Science.gov (United States)

    Crippen, John R.; Bue, Conrad D.

    1977-01-01

    Peak floodflows from thousands of observation sites within the conterminous United States were studied to provide a guide for estimating potential maximum floodflows. Data were selected from 883 sites with drainage areas of less than 10,000 square miles (25,900 square kilometers) and were grouped into regional sets. Outstanding floods for each region were plotted on graphs, and envelope curves were computed that offer reasonable limits for estimates of maximum floods. The curves indicate that floods may occur that are two to three times greater than those known for most streams.

  7. United States/Canada electricity exchanges

    Energy Technology Data Exchange (ETDEWEB)

    1979-02-01

    The United States and Canada have been cooperating in all areas of energy exchange for many years. Electrical energy has been chosen to be the focus of this study because substantial means for exchanges offer benefits that have not yet been fully exploited. There may be some bilateral benefits from additional interconnections because of the buffers which they represent against domestic imbalances. After the history of the electricity exchanges between the two countries is reviewed, opportunities and incentives and obstacles and constraints are discussed in the next two chapters. The final chapter examines procedures to resolve obstacles and minimize constraints. (MCW)

  8. Coordinating the United States Interagency Partnering Effort

    Science.gov (United States)

    2013-03-01

    stage over the last 6 years.7 The DoD is on the cutting edge of partnering and there have been valuable lessons learned at the tactical and...global stage . “3D are the three pillars that provide the foundation for promoting and protecting U.S. national security interests abroad.”33 DoD, DoS...operations now will mean throwing 18 away hard-fought gains, and expose the United States to new risks from across the globalising

  9. Contraceptive failure in the United States.

    Science.gov (United States)

    Trussell, James

    2011-05-01

    This review provides an update of previous estimates of first-year probabilities of contraceptive failure for all methods of contraception available in the United States. Estimates are provided of probabilities of failure during typical use (which includes both incorrect and inconsistent use) and during perfect use (correct and consistent use). The difference between these two probabilities reveals the consequences of imperfect use; it depends both on how unforgiving of imperfect use a method is and on how hard it is to use that method perfectly. These revisions reflect new research on contraceptive failure both during perfect use and during typical use.

  10. Mobile satellite service in the United States

    Science.gov (United States)

    Agnew, Carson E.; Bhagat, Jai; Hopper, Edwin A.; Kiesling, John D.; Exner, Michael L.; Melillo, Lawrence; Noreen, Gary K.; Parrott, Billy J.

    1988-05-01

    Mobile satellite service (MSS) has been under development in the United States for more than two decades. The service will soon be provided on a commercial basis by a consortium of eight U.S. companies called the American Mobile Satellite Consortium (AMSC). AMSC will build a three-satellite MSS system that will offer superior performance, reliability and cost effectiveness for organizations requiring mobile communications across the U.S. The development and operation of MSS in North America is being coordinated with Telesat Canada and Mexico. AMSC expects NASA to provide launch services in exchange for capacity on the first AMSC satellite for MSAT-X activities and for government demonstrations.

  11. Wind Lidar Activities in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, Andrew; Newman, Jennifer; St. Pe, Alexandra; Iungo, G. Valerio; Wharton, Sonia; Herges, Tommy; Filippelli, Matthew; Pontbriand, Philippe; Osler, Evan

    2017-06-28

    IEA Wind Task 32 seeks to identify and mitigate the barriers to the adoption of lidar for wind energy applications. This work is partly achieved by sharing experience across researchers and practitioners in the United States and worldwide. This presentation is a short summary of some wind lidar-related activities taking place in the country, and was presented by Andrew Clifton at the Task 32 meeting in December 2016 in his role as the U.S. Department of Energy-nominated country representative to the task.

  12. Geothermal power generation in United States

    Science.gov (United States)

    Braun, Gerald W.; McCluer, H. K.

    1993-03-01

    Geothermal energy is an indigenous environmentally benign heat source with the potential for 5000-10,000 GWe of power generation in the United States. Approximately 2535 MWe of installed capacity is currently operating in the U.S. with contracted power costs down to 4.6 cents/kWh. This paper summarizes: 1) types of geothermal resources; 2) power conversion systems used for geothermal power generation; 3) environmental aspects; 4) geothermal resource locations, potential, and current power plant development; 5) hurdles, bottlenecks, and risks of geothermal power production; 6) lessons learned; and 7) ongoing and future geothermal research programs.

  13. Complications of cesarean deliveries among HIV-infected women in the United States

    Science.gov (United States)

    Kourtis, Athena P.; Ellington, Sascha; Pazol, Karen; Flowers, Lisa; Haddad, Lisa; Jamieson, Denise J.

    2015-01-01

    Objective To compare rates of complications associated with cesarean delivery in HIV-infected and HIV-uninfected women in the United States and to investigate trends in such complications across four study cycles spanning the implementation of HAART in the United States (1995–1996, 2000–2001, 2005–2006, 2010–2011). Design The Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project is the largest all-payer hospital inpatient care database in the United States; when weighted to account for the complex sampling design, nationally representative estimates are derived. After restricting the study sample to women aged 15–49 years, our study sample consisted of approximately 1 090 000 cesarean delivery hospitalizations annually. Methods Complications associated with cesarean deliveries were categorized as infection, hemorrhage, or surgical trauma, based on groups of specific International Classification of Diseases 9th revision codes. Length of hospitalization, hospital charges, and in-hospital deaths were also examined. Results The rate of complications significantly decreased during the study periods for HIV-infected and HIV-uninfected women. However, rates of infectious complications and surgical trauma associated with cesarean deliveries remained higher among HIV-infected, compared with HIV-uninfected women in 2010–2011, as did prolonged hospital stay and in-hospital deaths. Length of hospitalization decreased over time for cesarean deliveries of HIV-infected women to a greater extent compared with HIV-uninfected women. Conclusion In the United States, rates of cesarean delivery complications decreased from 1995 to 2011. However, rates of infection, surgical trauma, hospital deaths, and prolonged hospitalization are still higher among HIV-infected women. Clinicians should remain alert to this persistently increased risk of cesarean delivery complications among HIV-infected women. PMID:25574961

  14. Corporate Welfare: The Third Stage of Welfare in the United States.

    Science.gov (United States)

    Stoesz, David

    1986-01-01

    Corporate involvement in social welfare represents a third stage in the evolution of welfare institutions in the United States, following the voluntary sector and the welfare state. Examining health and welfare corporations reveals rapid growth and consolidation in nursing homes, hospital management, health maintenance organizations, child care,…

  15. Do we need autoimmune disease units in hospitals?

    Science.gov (United States)

    Vasconcelos, Carlos

    2009-09-01

    Autoimmune diseases are increasing worldwide, and associated morbidity, mortality, and health care costs are high. Biological therapies, however, have brought physicians an extraordinary opportunity to change natural disease history, although these therapies can also have high associated iatrogenic costs. These factors point to the necessity of having physicians that are dedicated to autoimmunology. The question regarding the creation of a new specialty, the autoimmunologist, should be addressed after an inquiry into the current practice in this field of medicine. This includes many classical specialties, such as internal medicine, rheumatology, and neurology, as well as clinical immunology. In clinical immunology, not counting the specialists in allergology and clinical immunology that mainly work only with allergies, heterogeneity is high in clinical practice, as the European Union of Medical Specialists documented some years ago. I am, at least for now, in favor of the creation of a transversal competency to which the different physicians working in the area could apply to in order to standardize the clinical practice in autoimmunology. It will be necessary to define a core curriculum, and in the end we shall have classical specialists and clinical immunologists with or without the competency of autoimmunology. Of utmost importance is that this new field of medicine should not be translated, as in the past happened with other areas, by walls between medical specialties. Instead it should help standardize and harmonize clinical practice. The time for autoimmunology is now, and, indeed, hospitals must have autoimmune disease units.

  16. State of stress in the conterminous United States

    Science.gov (United States)

    Zoback, Mary Lou; Zoback, Mark

    1980-11-01

    Inferring principal stress directions from geologic data, focal mechanisms, and in situ stress measurements, we have prepared a map of principal horizontal stress orientations for the conterminous United States. Stress provinces with linear dimensions which range between 100 and 2000 km were defined on the basis of the directions and relative magnitude of principal stresses. Within a given province, stress orientations appear quite uniform (usually within the estimated range of accuracy of the different methods used to determine stress). Available data on the transition in stress direction between the different stress provinces indicate that these transitions can be abrupt, occurring over characterized by high levels of seismicity and generally high heat flow, the stress pattern is complex, but numerous stress provinces can be well delineated. Despite relative tectonic quiescence in the eastern and central United States, a major variation in principal stress orientation is apparent between the Atlantic Coast and midcontinent areas. Most of the eastern United States is marked by predominantly compressional tectonism (combined thrust and strike slip faulting), whereas much of the region west of the southern Great Plains is characterized by predominantly extensional tectonism (combined normal and strike slip faulting). Deformation along the San Andreas fault and in parts of the Sierra Nevada is nearly pure strike slip. Exceptions to this general pattern include areas of compressional tectonics in the western United States (the Pacific Northwest, the Colorado Plateau interior, and the Big Bend segment of the San Andreas fault) and the normal growth faulting along the Gulf Coastal Plain. Sources of stress are constrained not only by the orientation and relative magnitude of the stresses within a given province but also by the manner of transition of the stress field from one province to another. Much of the modern pattern of stress in the western United States can be

  17. Regional and State Level Water Scarcity Report: Northeast United States

    Science.gov (United States)

    Nicoletti, C. K.; Lopez-Morales, C. A.; Hoover, J. H.; Voigt, B. G.; Vorosmarty, C. J.; Mohammed, I. N.

    2010-12-01

    There are an abundance of large-scale, coarse resolution global water scarcity studies, but the existing literature fails to address regional and state specific scarcity measures. Moreover, while environmental water requirements are an integral factor in the development and implementation of sustainable water management practices, only recently has this notion been introduced to water scarcity research. In this paper, we argue that developing a preliminary measure of water scarcity, at the regional and state levels, will allow for more informed policy development. The goal of this study is to generate a more comprehensive understanding of water scarcity in the Northeast, by gathering fine scale data, applying a consistent methodology to the calculation of a scarcity index, and analyzing the results to see relative trends in spatio-temporal water scarcity. Public supply, irrigation, rural, industrial and thermo-power withdrawals have been compiled from USGS state water use publications from 1950 to 1985. Using the WBMplus water model runoff data, state specific in-stream environmental water requirements were calculated using the accepted hydro-ecological methodology. Water scarcity was then calculated as a ratio of water withdrawals to total available water minus environmental flow requirements for the system. In so doing, this study generates a spatially explicit and temporally varying water scarcity indicator (WSI) for the Northeastern United States between 1950 and 2000 at the regional and state levels at a five-year time interval. Calculation of a spatial and temporal water scarcity indicator enabled us to identify regions and specific states that were: slightly exploited (WSI 1.0). The minimum environmental water requirements to maintain in-stream aquatic and riparian ecosystems for the Northeastern states ranged between 27.5 to 36.3 percent of the mean annual runoff within Vermont and Maryland, respectively. The regional WSI values ranged between 0.199 in 1950

  18. Western United States beyond the Four Corners

    Science.gov (United States)

    2002-01-01

    The breathtaking beauty of the western United States is apparent in this image from the Multi-angle Imaging SpectroRadiometer on NASA's Terra spacecraft. Data from 16 different swaths acquired between April 2000 and September 2001by MISR's vertical-viewing (nadir) camera were used to create this cloud-free natural-color image mosaic. The image is draped over a 100-meter (328-foot)shaded relief Digital Terrain Elevation Model from the United States Geological Survey.Among the prominent features are the snow-capped Rocky Mountains traversing Montana, Wyoming, Colorado and New Mexico. In the northern portion of the image, the Columbia Plateau stretches across Washington, Oregon and Idaho. Many major rivers originate in this region, including the Missouri to the east of the Continental Divide, the Snake to the west, and the Colorado which wends across Utah and Arizona. The Colorado Plateau and vibrant red-colored rocks of the Painted Desert extend south from Utah into Arizona. In the southwestern portion of the image, California's San Joaquin Valley and the Mojave Desert of California and Nevada give way to the Los Angeles basin and the Pacific Ocean.The Terra spacecraft is part of NASA's Earth Science Enterprise, a long-term research and technology program designed to examine Earth's land, oceans, atmosphere, ice and life as a total integrated system.

  19. Renewable energy atlas of the United States.

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J.A.; Hlava, K.Greenwood, H.; Carr, A. (Environmental Science Division)

    2012-05-01

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. It is designed for the U.S. Department of Agriculture Forest Service (USFS) and other federal land management agencies to evaluate existing and proposed renewable energy projects. Much of the content of the Atlas was compiled at Argonne National Laboratory (Argonne) to support recent and current energy-related Environmental Impact Statements and studies, including the following projects: (1) West-wide Energy Corridor Programmatic Environmental Impact Statement (PEIS) (BLM 2008); (2) Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2010); (3) Supplement to the Draft PEIS for Solar Energy Development in Six Southwestern States (DOE/BLM 2011); (4) Upper Great Plains Wind Energy PEIS (WAPA/USFWS 2012, in progress); and (5) Energy Transport Corridors: The Potential Role of Federal Lands in States Identified by the Energy Policy Act of 2005, Section 368(b) (in progress). This report explains how to add the Atlas to your computer and install the associated software; describes each of the components of the Atlas; lists the Geographic Information System (GIS) database content and sources; and provides a brief introduction to the major renewable energy technologies.

  20. The relationship of illness management and recovery to state hospital readmission.

    Science.gov (United States)

    Bartholomew, Tom; Zechner, Michelle

    2014-09-01

    The current study examined the association between number of hours attended of the Illness Management and Recovery (IMR) program and psychiatric readmission rates after discharge from a state psychiatric hospital. The study used archival data, N = 1186, from a large northeastern state psychiatric hospital in the United States. A Cox's regression survival analyses was conducted, adjusting for extreme outliers and controlling for sociodemographic covariates, to examine the association between different amounts of IMR and the risk for returning to the hospital. After controlling for the client characteristics of age, sex, marital status, psychiatric diagnosis, and Global Assessment of Functioning score at discharge, as well as controlling for mean daily dose of generic hospital programming and the number of days of hospitalization, it was found that, for each hour of IMR, there was an associated 1.1% reduction in the risk for returning to the hospital. This suggests that participation in IMR while in inpatient settings may assist individuals in reducing their risk for returning to the hospital.

  1. Specialty education in periodontics in Japan and the United States: comparison of programs at Nippon Dental University Hospital and the University of Texas Health Science Center at San Antonio.

    Science.gov (United States)

    Osawa, Ginko; Nakaya, Hiroshi; Mealey, Brian L; Kalkwarf, Kenneth; Cochran, David L

    2014-03-01

    Japan has institutions that train qualified postdoctoral students in the field of periodontics; however, Japan does not have comprehensive advanced periodontal programs and national standards for these specialty programs. To help Japanese programs move toward global standards in this area, this study was designed to describe overall differences in periodontics specialty education in Japan and the United States and to compare periodontics faculty members and residents' characteristics and attitudes in two specific programs, one in each country. Periodontal faculty members and residents at Nippon Dental University (NDU) and the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School participated in the survey study: four faculty members and nine residents at NDU; seven faculty members and thirteen residents at UTHSCSA. Demographic data were collected as well as respondents' attitudes toward and assessment of their programs. The results showed many differences in curriculum structure and clinical performance. In contrast to the UTHSCSA respondents, for example, the residents and faculty members at NDU reported that they did not have enough subject matter and time to learn clinical science. Although the residents at NDU reported seeing more total patients in one month than those at UTHSCSA, they were taught fewer varieties of periodontal treatments. To provide high-quality and consistent education for periodontal residents, Japan needs to establish a set of standards that will have positive consequences for those in Japan who need periodontal treatment.

  2. United States 2030 Food Loss and Waste Reduction Goal

    Science.gov (United States)

    On September 16, 2015, the United States Department of Agriculture (USDA) and the United States Environmental Protection Agency (EPA) announced the first ever domestic goal to reduce food loss and waste by half by the year 2030.

  3. Average annual runoff in the United States, 1951-80

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a line coverage of average annual runoff in the conterminous United States, 1951-1980. Surface runoff Average runoff Surface waters United States

  4. 78 FR 61446 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2013-10-03

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... for services of FAA Flight Standards Aviation Safety Inspectors outside the United States....

  5. Coal Fields of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer shows the coal fields of Alaska and the conterminous United States. Most of the material for the conterminous United States was collected from James...

  6. Abortion Policy in Britain and the United States.

    Science.gov (United States)

    Francome, Colin

    1980-01-01

    Compares the number of legal abortions performed in the United States and Britain. Reveals that the rate of abortion in the United States is more than twice that of Britain. Analyzes the reasons for the different rates. (Author)

  7. Satellite View of the Conterminous United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — The Satellite View of the Conterminous United States map layer is a 200- meter-resolution simulated-natural-color image of the United States. Vegetation is generally...

  8. Comparison of Constitutional Spirit Between United States and China

    Institute of Scientific and Technical Information of China (English)

    杨琅琅

    2007-01-01

    This paper compares the differences in constitutional spirit between United States and China, and then brings out the influence of the constitutional spirit in United States to the constitutional spirit in China.

  9. Weather pattern climatology of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Barchet, W.R.; Davis, W.E.

    1984-01-01

    In this study the geographic domain covered the 48 conterminous states of the United States. The daily synoptic weather pattern was classified into nine types for the 10-year period January 1, 1969 to December 31, 1978. Weather pattern types were defined relative to the classical polar front model of a mid-latitude cyclonic storm system and its associated air masses. Guidelines for classifying weather patterns on an operational basis were developed. These were applied to 3652 daily surface weather maps to produce a time series of weather pattern type at 120 grid points of a 160 point, 3/sup 0/ latitude by 4/sup 0/ longitude array over the United States. Statistics on the frequency of occurrence, persistence and alternation of weather patterns were calculated for each grid point. Summary statistics for the entire grid and for six regions were also presented. Frequency of occurrence and persistence were found to depend on the size and speed of movement of the weather pattern. Large, slow moving air masses had higher frequency of occurrence and longer persistence than small (fronts) or rapidly moving (or changing) features (fronts, storm centers). Some types showed distinct regional preferences. The subtropical maritime high occurred mainly in the south central and southeast. An indeterminate weather pattern type accounted for those weather patterns that did not fit the polar front model or were too disorganized to be classified. The intermountain thermal low of the desert southwest was one such feature that dominated both frequency of occurrence and persistence in this region. Alternation from one weather pattern to another followed the polar front model of a moving cyclonic storm. The tendency for anticyclonic weather patterns to become disorganized as they weakened was seen in the high percentage of these patterns that changed to an indeterminate pattern as they aged.

  10. Tutorial on technology transfer and survey design and data collection for measuring Internet and Intranet existence, usage, and impact (survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-02-01

    This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.

  11. National attitudes concerning gun carrying in the United States.

    Science.gov (United States)

    Hemenway, D; Azrael, D; Miller, M

    2001-12-01

    To determine public attitudes in the United States concerning gun carrying. In the past 15 years, many state legislatures have passed laws making it easier for United States citizens to carry concealed firearms, not only on the street but into various locations, including churches and government buildings. National random digit dial telephone surveys conducted in 1996 and 1999 asked questions concerning the public's feelings of safety as more people in their community carry firearms, and whether, in the language of the question, respondents believe "regular" citizens should be allowed to carry guns into public or government buildings. Americans feel less safe rather than more safe as more people in their community begin to carry guns. By margins of at least nine to one, Americans do not believe that "regular" citizens should be allowed to bring their guns into restaurants, college campuses, sports stadiums, bars, hospitals, or government buildings. The public believes that increased gun carrying by others reduces rather than increases their safety. Overwhelmingly, the public believes that in many venues gun carrying should be prohibited.

  12. 27 CFR 479.89 - Transfers to the United States.

    Science.gov (United States)

    2010-04-01

    ... Transfers to the United States. A firearm may be transferred to the United States or any department... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Transfers to the United States. 479.89 Section 479.89 Alcohol, Tobacco Products, and Firearms BUREAU OF ALCOHOL,...

  13. 46 CFR 67.97 - United States built.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false United States built. 67.97 Section 67.97 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) DOCUMENTATION AND MEASUREMENT OF VESSELS DOCUMENTATION OF VESSELS Build Requirements for Vessel Documentation § 67.97 United States built. To be considered built in the United States a vessel...

  14. 26 CFR 1.993-7 - Definition of United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Definition of United States. 1.993-7 Section 1... (CONTINUED) INCOME TAXES Domestic International Sales Corporations § 1.993-7 Definition of United States. Under section 993(g), the term “United States” includes the States, the District of Columbia,...

  15. 31 CFR 593.411 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... TAYLOR SANCTIONS REGULATIONS Interpretations § 593.411 Importation into the United States. With respect to the prohibitions set forth in § 593.205, the term importation into the United States...

  16. 32 CFR 150.21 - Appeals by the United States.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Appeals by the United States. 150.21 Section 150... the United States. (a) Restricted filing. Only a representative of the government designated by the Judge Advocate General of the respective service may file an appeal by the United States under...

  17. 31 CFR 545.304 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... REGULATIONS General Definitions § 545.304 Importation into the United States. (a) With respect to goods, software, or technology, the term importation into the United States means the bringing of any...

  18. 26 CFR 1.953-2 - Actual United States risks.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 10 2010-04-01 2010-04-01 false Actual United States risks. 1.953-2 Section 1... (CONTINUED) INCOME TAXES Controlled Foreign Corporations § 1.953-2 Actual United States risks. (a) In general. For purposes of paragraph (a) of § 1.953-1, the term “United States risks” means risks described...

  19. 31 CFR 539.307 - Importation into the United States.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Importation into the United States... CONTROL REGULATIONS General Definitions § 539.307 Importation into the United States. The term importation into the United States means: (a) With respect to goods or technology, the bringing of any goods...

  20. 78 FR 70275 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... United States Travel and Tourism Advisory Board. SUMMARY: The Department of Commerce is currently seeking applications for membership on the United States Travel and Tourism Advisory Board (Board). The purpose of the...

  1. 78 FR 77103 - United States Travel and Tourism Advisory Board

    Science.gov (United States)

    2013-12-20

    ... International Trade Administration United States Travel and Tourism Advisory Board AGENCY: International Trade... on the United States Travel and Tourism Advisory Board. SUMMARY: On November 25, 2013, the Department... 70275) soliciting applications for membership on the United States Travel and Tourism Advisory Board...

  2. Framework for Naval Cooperation between Vietnam and the United States

    Science.gov (United States)

    2017-06-09

    the Vietnam-United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership... platform for future relationship between Vietnam and the United States. Finally, this research suggests a framework for naval cooperation between Vietnam...United States relationship has taken giant steps forward in virtually every aspect, especially solidified by a Comprehensive Partnership Agreement signed

  3. 31 CFR 515.334 - United States national.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States national. 515.334 Section 515.334 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE... of the United States, and which has its principal place of business in the United States....

  4. 76 FR 68067 - United States-Peru Trade Promotion Agreement

    Science.gov (United States)

    2011-11-03

    ... to trade in textile and apparel goods between Peru and the United States. The provisions within...] RIN 1515-AD79 United States-Peru Trade Promotion Agreement AGENCIES: U.S. Customs and Border... of the United States- Peru Trade Promotion Agreement. DATES: Interim rule effective November 3, 2011...

  5. 77 FR 27669 - Modifications to Definition of United States Property

    Science.gov (United States)

    2012-05-11

    ... Internal Revenue Service 26 CFR Part 1 RIN 1545-BK10 Modifications to Definition of United States Property... clearing agency do not constitute United States property. The text of the temporary regulations also serves... Federal Register establish an exception to the definition of United States property (within the meaning...

  6. China, Southeast Asia, and the United States

    Directory of Open Access Journals (Sweden)

    Lowell Dittmer

    2016-04-01

    Full Text Available Southeast Asia has historically been a meeting point between East Asia and South Asia before Western colonialism opened the region to the West and to the winds of global modernization. Since Japan’s coercive decolonization during the Second World War, the dominant outside influences have come from the United States and from the People’s Republic of China. The post-Cold War era began with a withdrawal of both China’s and US power projection from Southeast Asia, facilitating the configuration of a triangular ménage à trios, with ASEAN expanding to include all of Southeast Asia and introducing a number of extended forums intended to socialize the rest of East Asia into the ASEAN way. The “rise of China” occurred within this friendly context, though beginning around 2010 its strategic implications began to appear more problematic with the mounting dispute over the issue of the South China Sea.

  7. Inclusive Education in the United States

    Directory of Open Access Journals (Sweden)

    C. Kenneth Tanner

    1996-12-01

    Full Text Available School reform issues addressing inclusive education were investigated in this nationwide (United States study. A total of 714 randomly selected middle school principals and teachers responded to concerns about inclusion, "degree of change needed in" and "importance of" collaborative strategies of teaching, perceived barriers to inclusion, and supportive activities and concepts for inclusive education. There was disagreement among teachers and principals regarding some aspects of inclusive education and collaborative strategies. For example, principals and special education teachers were more positive about inclusive education than regular education teachers. Collaboration as an instructional strategy for "included" students was viewed as a high priority item. Responders who had taken two or more courses in school law rated the identified barriers to inclusive education higher than those with less formal training in the subject.

  8. Detailed gravimetric geoid for the United States.

    Science.gov (United States)

    Strange, W. E.; Vincent, S. F.; Berry, R. H.; Marsh, J. G.

    1972-01-01

    A detailed gravimetric geoid was computed for the United States using a combination of satellite-derived spherical harmonic coefficients and 1 by 1 deg mean gravity values from surface gravimetry. Comparisons of this geoid with astrogeodetic geoid data indicate that a precision of plus or minus 2 meters has been obtained. Translations only were used to convert the NAD astrogeodetic geoid heights to geocentric astrogeodetic heights. On the basis of the agreement between the geocentric astrogeodetic geoid heights and the gravimetric geoid heights, no evidence is found for rotation in the North American datum. The value of the zero-order undulation can vary by 10 to 20 meters, depending on which investigator's station positions are used to establish it.

  9. Electric trade in the United States 1994

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-08-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1994, the wholesale trade market totaled 1.9 trillion kilowatthours, about 66% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1994 (ELECTRA), is the fifth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1994.

  10. Renewable Energy Atlas of the United States

    Energy Technology Data Exchange (ETDEWEB)

    Kuiper, J. [Environmental Science Division; Hlava, K. [Environmental Science Division; Greenwood, H. [Environmentall Science Division; Carr, A. [Environmental Science Division

    2013-12-13

    The Renewable Energy Atlas (Atlas) of the United States is a compilation of geospatial data focused on renewable energy resources, federal land ownership, and base map reference information. This report explains how to add the Atlas to your computer and install the associated software. The report also includes: A description of each of the components of the Atlas; Lists of the Geographic Information System (GIS) database content and sources; and A brief introduction to the major renewable energy technologies. The Atlas includes the following: A GIS database organized as a set of Environmental Systems Research Institute (ESRI) ArcGIS Personal GeoDatabases, and ESRI ArcReader and ArcGIS project files providing an interactive map visualization and analysis interface.

  11. Industry economics in the United States.

    Science.gov (United States)

    2004-04-01

    Demand for medical equipment in the United States (US) is projected to grow by 8% between 2001 and 2006, to reach 105 billion dollars. In 2001,the market was valued at 71.4 billion dollars, based on an annual growth of 7.5% between 1996 and 2001, according to The Freedonia Group. Product innovation and the growing ageing population is driving the industry, despite health-care cost containment measures. Medical and surgical instruments continue to be the largest sector, which is expected to grow to 30.5 billion dollars in 2006. However, electromedical/electrotherapeutic apparatus will remain the fastest growing sector, with annual gains of 10.8% predicted for this period.

  12. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2016-07-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on USimports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  13. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  14. Eye on China and United States

    Directory of Open Access Journals (Sweden)

    Milad Mahyari

    2011-10-01

    Full Text Available United States strives to force the Chinese into agreement of increasing the value of their exchange rate to help the USA avoid inflation As China did not come into an agreement with the USA, Tariffs are being put on Chinese products entering USA. However China as began to add tariff on poultry received from the US as well. China was previously not named in the legislation permitting US to add tariff on their goods. But recently a bill was passed giving the commerce department the ability to place important tariffs on all countries to undervalue their currency. The bill passed in legislation had the support of 99 republicans. China has been managing their currency in a manner that makes their goods cheaper to sell and American goods more expensive. The Chinese manipulation of their currency has been quite expensive for the USA, as it has cost them $1.5 billion jobs increasing the percentage of unemployment greatly and significantly. This imposition of tariffs on Chinese goods could result in effecting $300 billion dollars worth of their products. It is obvious that the Americans are attempting to improve and acknowledge their growth and power. As predictions have developed over this conflict, arguing the fact that China will not negotiate with the USA at this point rather fight back and also approach in adding tariffs on US
    imports. However, this reaction by the Chinese will only worsen the scenario and result in the possible inflation of the US economy or worldwide trade war. This is a very sensitive time for the United States as their biggest hopes are dependent on the Chinese. But it doesn’t look like they will be too satisfied with the outcome.

  15. Wet deposition in the northeastern United States

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, J; Mohnen, V; Kadlecek, J

    1980-12-01

    Attempts are made to examine concentration and wet deposition of pollutant material at selected stations within the northeastern United States and to characterize as many events as possible with respect to air mass origin. Further attempts are made to develop a regional pattern for the deposition of dominant ion species. MAP3S (US Multistate Atmospheric Power Production Pollution Study) data for 1977 to 1979 are used to determine concentration and deposition on an event basis from which monthly, seasonal, annual, and cumulative averages are developed. The ARL-ATAD trajectory model is used to characterize individual events as to air mass origin. Case studies are examined to illustrate variability in the chemical composition of precipitation originating from distinctly different air mass trajectories. A difference in concentration of pollution-related ions in precipitation is noted between Midwest/Ohio Valley and Great Lakes/Canadian air mass origins for carefully selected cases. Total deposition of the major ions is examined in an effort to develop a regional pattern for deposition over a period of at least one year. For that purpose, total deposition is normalized to remove the variability in precipitation amounts for inter-station comparison. No marked gradient is noted in the normalized deposition totals within the northeast of the United States. The Adirondack region exhibited the lowest normalized ion deposition value, while the Illinois station showed the highest of the MAP3S network. The data analysis suggest that the acid rain phenomena covers the entire northeast. The concept of large scale mixing emerges to account for the lack of a significant gradient in the normalized deposition.

  16. Observation-status patients in children's hospitals with and without dedicated observation units in 2011.

    Science.gov (United States)

    Macy, Michelle L; Hall, Matthew; Alpern, Elizabeth R; Fieldston, Evan S; Shanley, Leticia A; Hronek, Carla; Hain, Paul D; Shah, Samir S

    2015-06-01

    Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observation-status stays have not been evaluated in relation to the presence of a dedicated OU in the hospital. To compare observation-status stay outcomes in hospitals with and without a dedicated OU. Cross-sectional analysis of hospital administrative data. Observation-status stay outcomes were compared in hospitals with and without a dedicated OU across 4 categories: (1) LOS, (2) standardized costs, (3) conversion to inpatient status, and (4) return care. Observation-status stays in 31 free-standing children's hospitals contributing observation patient data to the Pediatric Health Information System database, 2011. Fifty-one percent of the 136,239 observation-status stays in 2011 occurred in 14 hospitals with a dedicated OU; the remainder were in 17 hospitals without. The percentage of observation-status same-day discharges was higher in hospitals with a dedicated OU compared with hospitals without (23.8 vs 22.1, P observation-status stays without impacting other hospital-level outcomes. Inclusion of location of care (eg, dedicated OU, inpatient unit, emergency department) in hospital administrative datasets would allow for more meaningful comparisons of models of hospital care. © 2015 Society of Hospital Medicine.

  17. Hospitalization process and its progress on overseas——case study on Epworth Freemasons hospital in Australian, Emory College Hospital and Maine Hospital in United States%案例:国外医院入院过程及其新的改革动向——以澳大利亚Epworth Freemasons医院、美国Emory大学医院和缅因州医院为例

    Institute of Scientific and Technical Information of China (English)

    刘秀明; 陈洁

    2012-01-01

    Hospitalization process in Epworth Freemasons hospital in Australian is introduced in aspects of patient hospitalization format,hospital provided data and hospitalization preparation. When comes to Emory College Hospital, besides of general process, translation, pain management consultation, priest service, social service and patient communication service are also provided. Details of hospitalization process and its progress in Maine Hospital are also introduced to give reference for hospital management in China.%笔者从患者人院注册表格、医院提供的资料、入院预备等三方面介绍了澳大利亚Epworth Freemasons医院的人院过程,并介绍了美国Emory大学医院除了一般的入院过程外,还提供翻译服务、疼痛管理咨询、牧师服务、社会服务、患者公关等特殊服务,以及缅因州医院入院过程的一些细节规定及其改革动向,以期为中国医院的相关管理提供一些借鉴.

  18. 78 FR 3398 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-01-16

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). The Board will meet to present...

  19. 78 FR 70274 - United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism...

    Science.gov (United States)

    2013-11-25

    ... International Trade Administration United States Travel and Tourism Advisory Board: Meeting of the United States Travel and Tourism Advisory Board AGENCY: International Trade Administration, U.S. Department of Commerce... meeting of the United States Travel and Tourism Advisory Board (Board). This will be the last meeting of...

  20. Comparison of alterations in frequency and cost of antibiotic use in neonatal and pediatric intensive care units of a hospital following protocol to an education and research hospital

    Directory of Open Access Journals (Sweden)

    Mustafa Dogan

    2015-04-01

    Full Text Available AiM: The objective of this study is to show the alterations in frequency and cost of antibiotic use in neonatal and pediatric intensive care units of a state hospital after it started to service as an education and research hospital. We also aimed to raise an awareness related to rational antibiotic use. METHODS: The surveillance of antibiotic use and comparison of costs were evaluated in 392 patients in between August 2013-January 2014. The rate and cost of antibiotic use during last 90 days before the protocol of state hospital to research and education hospital and the first 90 days after protocol were evaluated. Antibiotics were assessed according to the treatment protocols of the Committee of Rational Drug Use, Infection Control Committee and Antibiotic Control Committee. Antibiotics were provided from administrative system and the data related to costs were obtained from Ministry of Health and Ministry of Finance. The demographic data and the data related to indication for admission to intensive care units, antibiotic dosages and pathogens causing infections were also obtained. For statistical analysis, SPSS program was used and descriptive analysis were made. In comparison of the groups, Mann Whitney U and chi-square tests were used. The data were evaluated within a 95% confidence interval. RESULTS: In first and second period, 143 patients were hospitalized for 3.18+/-1.13 days and 105 patients were hospitalized for 2.69+/-4.14 days in pediatric intensive care unit(PICU; 79 patients were hospitalized for 17.29+/-3.61 days and 65 patients stayed for 21.29+/-3.29 days in neonatal intensive care unit(NICU, respectively. In the first and second period, cost of antibiotics in PICU was found 341.81+/-744.49 (med:14.91 and 585.35+/-796.62 (med:256.44 (p=0.02 Turkish Liras (TL; in NICU 137.92+/-178.78 (med:14.59 and 247.40+/-370.13(med:19.23 (p=0.76 TL respectively. CONCLUSiON: In the second period, in PICU, duration of hospitalization was found

  1. Brackish groundwater in the United States

    Science.gov (United States)

    Stanton, Jennifer S.; Anning, David W.; Brown, Craig J.; Moore, Richard B.; McGuire, Virginia L.; Qi, Sharon L.; Harris, Alta C.; Dennehy, Kevin F.; McMahon, Peter B.; Degnan, James R.; Böhlke, John Karl

    2017-04-05

    For some parts of the Nation, large-scale development of groundwater has caused decreases in the amount of groundwater that is present in aquifer storage and that discharges to surface-water bodies. Water supply in some areas, particularly in arid and semiarid regions, is not adequate to meet demand, and severe drought is affecting large parts of the United States. Future water demand is projected to heighten the current stress on groundwater resources. This combination of factors has led to concerns about the availability of freshwater to meet domestic, agricultural, industrial, mining, and environmental needs. To ensure the water security of the Nation, currently [2016] untapped water sources may need to be developed.Brackish groundwater is an unconventional water source that may offer a partial solution to current and future water demands. In support of the national census of water resources, the U.S. Geological Survey completed the national brackish groundwater assessment to better understand the occurrence and characteristics of brackish groundwater in the United States as a potential water resource. Analyses completed as part of this assessment relied on previously collected data from multiple sources; no new data were collected. Compiled data included readily available information about groundwater chemistry, horizontal and vertical extents and hydrogeologic characteristics of principal aquifers (regionally extensive aquifers or aquifer systems that have the potential to be used as a source of potable water), and groundwater use. Although these data were obtained from a wide variety of sources, the compiled data are biased toward shallow and fresh groundwater resources; data representing groundwater that is at great depths and is saline were not as readily available.One of the most important contributions of this assessment is the creation of a database containing chemical characteristics and aquifer information for the known areas with brackish groundwater

  2. Evaluation of a pulsed xenon ultraviolet light device for isolation room disinfection in a United Kingdom hospital.

    Science.gov (United States)

    Hosein, Ian; Madeloso, Rosie; Nagaratnam, Wijayaratnam; Villamaria, Frank; Stock, Eileen; Jinadatha, Chetan

    2016-09-01

    Pathogen transmission from contaminated surfaces can cause hospital-associated infections. Although pulsed xenon ultraviolet (PX-UV) light devices have been shown to decrease hospital room bioburden in the United States, their effectiveness in United Kingdom (UK) hospitals is less understood. Forty isolation rooms at the Queens Hospital (700 beds) in North London, UK, were sampled for aerobic bacteria after patient discharge, after manual cleaning with a hypochlorous acid-troclosene sodium solution, and after PX-UV disinfection. PX-UV device efficacy on known organisms was tested by exposing inoculated agar plates in a nonpatient care area. Turnaround times for device usage were recorded, and a survey of hospital staff for perceptions of the device was undertaken. After PX-UV disinfection, the bacterial contamination measured in colony forming units (CFU) decreased by 78.4%, a 91% reduction from initial bioburden levels prior to terminal cleaning. PX-UV exposure resulted in a 5-log CFU reduction for multidrug-resistant organisms (MDROs) on spiked plates. The average device turnaround time was 1 hour, with minimal impact on patient throughput. Ward staff were enthusiastic about device deployment, and device operators reported physical comfort in usage. PX-UV use decreased bioburden in patient discharge rooms and on agar plates spiked with MDROs. The implementation of the PX-UV device was well received by hospital cleaning and ward staff, with minimal disruption to patient flow. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

  3. Characterization of floods in the United States

    Science.gov (United States)

    Saharia, Manabendra; Kirstetter, Pierre-Emmanuel; Vergara, Humberto; Gourley, Jonathan J.; Hong, Yang

    2017-05-01

    Floods have gained increasing global significance in the recent past due to their devastating nature and potential for causing significant economic and human losses. Until now, flood characterization studies in the United States have been limited due to the lack of a comprehensive database matching flood characteristics such as peak discharges and flood duration with geospatial and geomorphologic information. The availability of a representative and long archive of flooding events spanning 78 years over a variety of hydroclimatic regions results in a spatially and temporally comprehensive flood characterization over the continental U.S. This study, for the first time, employs a large-event database that is based on actual National Weather Service (NWS) definitions of floods instead of the frequently-adopted case study or frequentist approach, allowing us to base our findings on real definitions of floods. It examines flooding characteristics to identify how space and time scales of floods vary with climatic regimes and geomorphology. Flood events were characterized by linking flood response variables in gauged basins to spatially distributed variables describing climatology, geomorphology, and topography. The primary findings of this study are that the magnitude of flooding is highest is regions such as West Coast and southeastern U.S. which experience the most extraordinary precipitation. The seasonality of flooding varies greatly from maxima during the cool season on the West Coast, warm season in the desert Southwest, and early spring in the Southeast. The fastest responding events tend to be in steep basins of the arid Southwest caused by intense monsoon thunderstorms and steep terrain. The envelope curves of unit peak discharge are consistent with those reported for Europe and worldwide. But significant seasonal variability was observed in floods of the U.S. compared to Europe that is attributed to the diversity of causative rainfall ranging from synoptic

  4. Palonosetron versus other 5-HT₃ receptor antagonists for prevention of chemotherapy-induced nausea and vomiting in patients with hematologic malignancies treated with emetogenic chemotherapy in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Craver, Chris; Gayle, Julie; Balu, Sanjeev; Buchner, Deborah

    2011-01-01

    This study evaluated the rate of uncontrolled chemotherapy-induced nausea and vomiting (CINV) after initiating antiemetic prophylaxis with palonosetron versus other 5-HT₃ receptor antagonists (RAs) in patients diagnosed with hematologic malignancies (lymphoma and leukemia) and receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC) in a hospital outpatient setting. Patients aged ≥ 18 years and diagnosed with hematologic malignancies initiating HEC or MEC and antiemetic prophylaxis with palonosetron (Group 1) and other 5-HT₃ RAs (Group 2) for the first time in a hospital outpatient setting between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective Database. Within each cycle, CINV events were identified (in the hospital outpatient, inpatient, and emergency room settings) through ICD-9 codes for nausea, vomiting, and/or volume depletion (from each CT administration day 1 until the end of the CT cycle), or use of rescue medications (day 2 until the end of the CT cycle). Negative binomial distribution generalized linear multivariate regression model estimating the CINV event rate on CT, specific CT cycles, and cancer diagnosis (leukemia/lymphoma)-matched groups in the follow-up period (first of 8 cycles or 6 months) was developed. Of 971 identified patients, 211 initiated palonosetron (Group 1). Group 1 patients comprised of more females [50.2 vs. 41.4%; p = 0.0226], Whites [74.4 vs. 70.4%, and Hispanics [7.6 vs. 6.3%; all races p = 0.0105], received more HEC treatments [89.6 vs. 84.2%; all CT types p = 0.0129], and had more lymphoma diagnosed patients [89.6 vs. 76.3%; all cancer types p = 0.0033] at baseline. After controlling for differences in several demographic and clinical variables, the regression model predicted a 20.4% decrease in CINV event rate per CT cycle for Group 1 versus Group 2 patients. Study limitations include potential lack of generalizability, absence of data on certain

  5. Reliability assessment of a hospital quality measure based on rates of adverse outcomes on nursing units.

    Science.gov (United States)

    Staggs, Vincent S

    2015-12-31

    The purpose of this study was to develop methods for assessing the reliability of scores on a widely disseminated hospital quality measure based on nursing unit fall rates. Poisson regression interactive multilevel modeling was adapted to account for clustering of units within hospitals. Three signal-noise reliability measures were computed. Squared correlations between the hospital score and true hospital fall rate averaged 0.52 ± 0.18 for total falls (0.68 ± 0.18 for injurious falls). Reliabilities on the other two measures averaged at least 0.70 but varied widely across hospitals. Parametric bootstrap data reflecting within-unit noise in falls were generated to evaluate percentile-ranked hospital scores as estimators of true hospital fall rate ranks. Spearman correlations between bootstrap hospital scores and true fall rates averaged 0.81 ± 0.01 (0.79 ± 0.01). Bias was negligible, but ranked hospital scores were imprecise, varying across bootstrap samples with average SD 11.8 (14.9) percentiles. Across bootstrap samples, hospital-measure scores fell in the same decile as the true fall rate in about 30% of cases. Findings underscore the importance of thoroughly assessing reliability of quality measurements before deciding how they will be used. Both the hospital measure and the reliability methods described can be adapted to other contexts involving clustered rates of adverse patient outcomes. © The Author(s) 2015.

  6. Invasive cancer incidence - United States, 2010.

    Science.gov (United States)

    Henley, S Jane; Singh, Simple; King, Jessica; Wilson, Reda; Ryerson, Blythe

    2014-03-28

    Cancer has many causes, some of which can, at least in part, be avoided through interventions known to reduce cancer risk. Healthy People 2020 objectives call for reducing colorectal cancer incidence to 38.6 per 100,000 persons, reducing late-stage breast cancer incidence to 41.0 per 100,000 women, and reducing cervical cancer incidence to 7.1 per 100,000 women. To assess progress toward reaching these Healthy People 2020 targets, CDC analyzed data from U.S. Cancer Statistics (USCS) for 2010. USCS includes incidence data from CDC's National Program of Cancer Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and mortality data from the National Vital Statistics System. In 2010, a total of 1,456,496 invasive cancers were reported to cancer registries in the United States (excluding Arkansas and Minnesota), an annual incidence rate of 446 cases per 100,000 persons, compared with 459 in 2009. Cancer incidence rates were higher among men (503) than women (405), highest among blacks (455), and ranged by state from 380 to 511 per 100,000 persons. Many factors, including tobacco use, obesity, insufficient physical activity, and human papilloma virus (HPV) infection, contribute to the risk for developing cancer, and differences in cancer incidence indicate differences in the prevalence of these risk factors. These differences can be reduced through policy approaches such as the Affordable Care Act, which could increase access for millions of persons to appropriate and timely cancer preventive services, including help with smoking cessation, cancer screening, and vaccination against HPV.

  7. 20 CFR 404.1093 - Possession of the United States.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Possession of the United States. 404.1093... Income § 404.1093 Possession of the United States. In using the exclusions from gross income provided under section 931 of the Code (relating to income from sources within possessions of the United...

  8. 26 CFR 400.5-1 - Redemption by United States.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Redemption by United States. 400.5-1 Section... by United States. (a) Scope. The purpose of this section is to prescribe rules with respect to the provisions contained in section 7425(d), relating to redemption of real property by the United...

  9. 75 FR 41927 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2010-07-19

    ... United States Sentencing Commission is an independent agency in the judicial branch of the United States..., and judicial branches of government, and other interested parties, to study the manner in which United... might be appropriate in light of the information obtained from that study. (12) Resolution of...

  10. 2011 floods of the central United States

    Science.gov (United States)

    ,

    2013-01-01

    The Central United States experienced record-setting flooding during 2011, with floods that extended from headwater streams in the Rocky Mountains, to transboundary rivers in the upper Midwest and Northern Plains, to the deep and wide sand-bedded lower Mississippi River. The U.S. Geological Survey (USGS), as part of its mission, collected extensive information during and in the aftermath of the 2011 floods to support scientific analysis of the origins and consequences of extreme floods. The information collected for the 2011 floods, combined with decades of past data, enables scientists and engineers from the USGS to provide syntheses and scientific analyses to inform emergency managers, planners, and policy makers about life-safety, economic, and environmental-health issues surrounding flood hazards for the 2011 floods and future floods like it. USGS data, information, and scientific analyses provide context and understanding of the effect of floods on complex societal issues such as ecosystem and human health, flood-plain management, climate-change adaptation, economic security, and the associated policies enacted for mitigation. Among the largest societal questions is "How do we balance agricultural, economic, life-safety, and environmental needs in and along our rivers?" To address this issue, many scientific questions have to be answered including the following: * How do the 2011 weather and flood conditions compare to the past weather and flood conditions and what can we reasonably expect in the future for flood magnitudes?

  11. Building the United States National Vegetation Classification

    Science.gov (United States)

    Franklin, S.B.; Faber-Langendoen, D.; Jennings, M.; Keeler-Wolf, T.; Loucks, O.; Peet, R.; Roberts, D.; McKerrow, A.

    2012-01-01

    The Federal Geographic Data Committee (FGDC) Vegetation Subcommittee, the Ecological Society of America Panel on Vegetation Classification, and NatureServe have worked together to develop the United States National Vegetation Classification (USNVC). The current standard was accepted in 2008 and fosters consistency across Federal agencies and non-federal partners for the description of each vegetation concept and its hierarchical classification. The USNVC is structured as a dynamic standard, where changes to types at any level may be proposed at any time as new information comes in. But, because much information already exists from previous work, the NVC partners first established methods for screening existing types to determine their acceptability with respect to the 2008 standard. Current efforts include a screening process to assign confidence to Association and Group level descriptions, and a review of the upper three levels of the classification. For the upper levels especially, the expectation is that the review process includes international scientists. Immediate future efforts include the review of remaining levels and the development of a proposal review process.

  12. Derecho Hazards in the United States.

    Science.gov (United States)

    Ashley, Walker S.; Mote, Thomas L.

    2005-11-01

    Convectively generated wind-storms occur over broad temporal and spatial scales; however, the more widespread and longer lived of these windstorms have been given the name "derecho." Utilizing an integrated derecho database, including 377 events from 1986 to 2003, this investigation reveals the amount of insured property losses, fatalities, and injuries associated with these windstorms in the United States. Individual derechos have been responsible for up to 8 fatalities, 204 injuries, forest blow-downs affecting over 3,000 km2 of timber, and estimated insured losses of nearly a $500 million. Findings illustrate that derecho fatalities occur more frequently in vehicles or while boating, while injuries are more likely to happen in vehicles or mobile homes. Both fatalities and injuries are most common outside the region with the highest derecho frequency. An underlying synthesis of both physical and social vulnerabilities is suggested as the cause of the unexpected casualty distribution. In addition, casualty statistics and damage estimates from hurricanes and tornadoes are contrasted with those from derechos to emphasize that derechos can be as hazardous as many tornadoes and hurricanes.

  13. Romantic Love in the United States

    Directory of Open Access Journals (Sweden)

    Victor C. de Munck

    2016-01-01

    Full Text Available We seek to advance cultural models theory by contributing to issues related to theory, methods, and testing the external validity of a cultural model. We propose that cultural models are learned as if they were truly properties of collectivities but have no primary existence except in individual representations of them. The shared aspect of cultural models also implies collective awareness of the if–then entailments of cultural models. We use inductive ethnographic methods of freelisting (n = 80 and pile sorting (n = 39 to derive a cultural model of romantic love in the United States. From these tasks, we developed a cultural model of successful romantic love consisting of normative scenarios. For successful romantic love relations, a person would feel excited about meeting their beloved; make passionate and intimate love as opposed to only physical love; feel comfortable with the beloved, behaving in a companionable, friendly way with one’s partner; listen to the other’s concerns, offering to help out in various ways if necessary; and, all the while, keeping a mental ledger of the degree to which altruism and passion are mutual. Our model is supported through an examination of two extended case studies. Further research is required, of course, but we believe we have a rather novel and dynamic cultural model that is falsifiable and predictive of successful love relationships. The model is unique in that it combines passion with comfort and friendship as properties of romantic love.

  14. Health System Reform in the United States

    Directory of Open Access Journals (Sweden)

    John E McDonough

    2014-01-01

    Full Text Available In 2010, the United States adopted its first-ever comprehensive set of health system reforms in the Affordable Care Act (ACA. Implementation of the law, though politically contentious and controversial, has now reached a stage where reversal of most elements of the law is no longer feasible. The controversial portions of the law that expand affordable health insurance coverage to most U.S. citizens and legal residents do not offer any important lessons for the global community. The portions of the law seeking to improve the quality, effectiveness, and efficiency of medical care as delivered in the U.S., hold lessons for the global community as all nations struggle to gain greater value from the societal resources they invest in medical care for their peoples. Health reform is an ongoing process of planning, legislating, implementing, and evaluating system changes. The U.S. set of delivery system reforms has much for reformers around the globe to assess and consider.

  15. United States and world energy sources

    Energy Technology Data Exchange (ETDEWEB)

    Berg, L.L.; Baird, L.M.; Varanini, E.E. III (eds.)

    1982-01-01

    This volume examines the economic, political, and social implications of the oil-dependence dilemma facing the United States. Most of the contributors are energy consultants in the public or private sector. Their analyses of the changing oil situation and its impact on other energy policies reflect either an international, national, or regional perspective with a unique combination of pragmatic insights and academic analyses of these complex issues. While examining the various aspects of the energy dependence dilemma presented here, one critical theme will probably recur to the reader. That is, given the inadequate nature of the US response to the 1973 and 1979 shortfalls in foreign oil supplies, how will we manage the projected future shortages in foreign oil supplies. The 18 papers of this volume were presented at a conference at Los Angeles in July 1980 and cosponsored by the University of Southern California and the California Energy Commission; a separate abstract was prepared for each paper. See also EAPA 7:3231 and Energy Research Abstracts (ERA) 6:18036.

  16. The United Mexican States: an update.

    Science.gov (United States)

    Hakkert, R; Aguirre, E J

    1988-09-01

    Although the popular North American opinion of Mexico is one that paints a picture of a poor, disadvantaged country, South America sees Mexico has a richer more prosperous nation. It is observed that only in the Latin American countries of Venezuela, Suriname and Trinidad and Tobago do consumers have higher incomes than Mexican consumers. Moreover, while millions of Mexicans migrate to the United States to seek a better standard of living, several thousand Central American refugees illegally migrate to Mexico in search of a better life. This better life includes an increased age of lie expectancy from 51 years in the 1950s to 64 years in the late 1970s. There have also been improvements in health care and school enrollments and in the low cost availability of education. Tourism and the prospect of the manufacturing of energy are significant, positive factors working in favor of an improved Mexican economy and a higher overall quality of life. However, Mexico faces serious problems such as a mounting foreign debt. Also rising is Mexico's population which has doubled since 1964 and which continues to grow at a rate of 1.9%. Economic programs and reforms and family development planning have been instituted in response to the countries' current recession and population growth and have begun to show positive results.

  17. United States Holocaust Museums: Pathos, Possession, Patriotism

    Directory of Open Access Journals (Sweden)

    Rob Baum

    2011-12-01

    Full Text Available This article examines the role of United States holocaust museums in directing (American knowledge and memory of World War II, and demonstrates how signifiers of race, colour and Jewishness are played out and theatricalised. Erected in two principal U.S. cities of Los Angeles and Washington, D.C., the Holocaust Museum and Museum of Tolerance uphold very different mandates: the first dedicated to revealing European civilian tragedies during WWII; the latter dealing with Jewish persecution and the L.A. Riots of 1991, with references to other cultural catastrophes. While these projects are different, they are not opposed; both museums locate the American perspective of events and their meanings at the forefront. American holocaust museums seem to challenge spaces between memory and its direction, vision and revision. Within the gruesome context of holocaust portrayal, interrogate the valences of memory’s play and expose American holocaust museums as theatres of pornographic memory. The seduction of feeling does not invite change so much as purgation, what Aristotle identified as catharsis — an emotional and physical release, unfortunately replicating the seductive techniques used by Goebbels for the glorification of Hitler. Through manipulation of viewers as automatic audiences, these museums function as centres for pathos I question the policy and polity of presenting genocide as an entertainment leading to catharsis, recognizing that the final act of purgation is all too easily negation.

  18. Electric trade in the United States, 1996

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-12-01

    Wholesale trade in electricity plays an important role for the US electric utility industry. Wholesale, or bulk power, transactions allow electric utilities to reduce power costs, increase power supply options, and improve reliability. In 1996, the wholesale trade market totaled 2.3 trillion kilowatthours, over 73% of total sales to ultimate consumers. This publication, Electric Trade in the United States 1996 (ELECTRA), is the sixth in a series of reports on wholesale power transactions prepared by the Office of Coal, Nuclear, Electric and Alternate Fuels, Energy Information Administration (EIA). The electric trade data are published biennially. The first report presented 1986 data, and this report provides information on the electric power industry during 1996. The electric trade data collected and presented in this report furnish important information on the wholesale structure found within the US electric power industry. The patterns of interutility trade in the report support analyses of wholesale power transactions and provide input for a broader understanding of bulk power market issues that define the emerging national electric energy policies. The report includes information on the quantity of power purchased, sold, exchanged, and wheeled; the geographical locations of transactions and ownership classes involved; and the revenues and costs. 1 fig., 43 tabs.

  19. United States orbital transfer vehicle programs

    Science.gov (United States)

    Gunn, Charles R.

    The United States will rely on five orbital transfer vehicles to carry spacecraft to higher energy orbits than achievable by the Space Shuttle or various Expendable Launch Vehicles (ELV). These vehicles are the Payload Assist Module-Delta (PAM-D), an upgraded version designated PAM-DII, the Inertial Upper Stage (IUS), the Transfer Orbit Stage (TOS), and the Orbital Maneuvering Vehicle (OMV). Development of these vehicles have evolved through contrasting cultures of government and commercial management. The spectrum of their capabilities range from providing spacecraft with only a preprogrammed perigee velocity additions to man-in-the-loop remote controlled spacecraft rendezvous, docking, retrieval and return to a space base; either the Shuttle or the Space Station Freedom. The PAM-D, PAM-DII, and IUS are now nearing maturity. Their characteristics, flight record, costs, and projected future uses are defined. The TOS and OMV are currently in development with first uses scheduled in 1992 and 1993, respectively. The TOS is being commercially developed while the OMV is government developed. The TOS and OMV capabilities, constraints, and costs are reviewed.

  20. Russian: United States Environmental Restoration Workshop

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    The Russian - United States Environmental Restoration Workshop, held in Washington, D.C., and Richland, Washington, from April 5 through 18, 1993, was the first extended collaborative information exchange between the US Department of Energy (DOE) and Russian scientists at the site level. In addition to the Russian scientists, workshop participants included scientists and staff from DOE, Pacific Northwest Laboratory (PNL), Westinghouse Hanford Company (WHC), the US Environmental Training Institute (USETI), universities, and the private sector. The first week (April 5 through 10) of the workshop took place in Washington, D.C., where the Russian and US participants were presented with a US perspective on environmental restoration and remediation issues from representatives in DOE and the US Environmental Protection Agency (EPA). The second week (April 11 through 18) occurred in Richland, Washington, where the participants were presented with site-specific environmental restoration and remediation issues related to Hanford Site cleanup. This report is a compilation of the presentations, discussions, and experiences shared during the second week of the workshop in Richland, Washington.

  1. Postoperative mortality after surgery for brain tumors by patient insurance status in the United States

    NARCIS (Netherlands)

    Momin, E.N.; Adams, H.; Shinohara, R.T.; Frangakis, C.; Brem, H.; Quinones-Hinojosa, A.

    2012-01-01

    OBJECTIVE To examine whether being uninsured is associated with higher in-hospital postoperative mortality when undergoing surgery in the United States for a brain tumor. DESIGN Retrospective cohort study using the Nationwide Inpatient Sample, January 1, 1999, through December 31, 2008. SETTING The

  2. Patient safety culture in two Finnish state-run forensic psychiatric hospitals.

    Science.gov (United States)

    Kuosmanen, Anssi; Tiihonen, Jari; Repo-Tiihonen, Eila; Eronen, Markku; Turunen, Hannele

    2013-01-01

    Safety culture refers to the way patient safety is regarded and implemented within an organization and the structures and procedures in place to support this. The aim of this study was to evaluate patient safety culture, identify areas for improvement, and establish a baseline for improving state hospitals in Finland. Cross-sectional design data were collected from two state-run forensic hospitals in Finland using an anonymous, Web-based survey targeted to hospital staff based on the Hospital Survey on Patient Safety Culture questionnaire. The response rate was 43% (n = 283). The overall patient safety level was rated as excellent or very good by 58% of respondents. The highest positive grade was for "teamwork within units" (72%). The lowest rating was for "nonpunitive response to errors" (26% positive). Good opportunities for supplementary education had a statistically significant (p ≤ 0.05) effect on 9 of 12 Hospital Survey on Patient Safety Culture dimensions. Statistically significant (p ≤ 0.05) differences in patient safety culture were also found in the staff's educational background, manager status, and between the two hospitals. These findings suggest there are a number of patient safety problems related to cultural dimensions. Supplementary education was shown to be a highly significant factor in transforming patient safety culture and should therefore be taken into account alongside sufficient resources.

  3. [Psychological characteristics of obese patients hospitalized at the obesity unit of the 4th Internal Medicine Clinic of the Medical School Hospital in Prague].

    Science.gov (United States)

    Slabá, S; Cepická, B

    1998-01-01

    This study presents the results of a psychological survey carried out in 1995 and 1996 in the Obesity Unit of IVth Department of Internal Medicine, General Faculty Hospital in Prague. There were 86 patients examined. The patients underwent a series of tests and questionnaires--Raven's Progressive Matrices, STAI, Miniscripts, Body Image. No significant differences were found between men and women. On the basis of this screening the general characteristics of obese patients hospitalized in this Unit can be described as follows: average to above average level of mental capacity for the general population, a need to "be strong and have everything under control", a need for recognition from other people, slightly increased level of anxiety. In their perception of their bodies they see themselves as overweight, unattractive and in a poor state of health.

  4. A Study to Determine if Ethics Committees Should be a Decision-Making and Review Mechanism for Matters Relating to No-Code Orders in the Continental United States Army Medical Department Hospitals with over One Hundred Total Operating Beds

    Science.gov (United States)

    1984-08-01

    Mexico Air Force hospitals on DNR procedures with inclosures of the Air Force’s general policy and Wilford Hall USAF Medical Center’s DNR guidelines are at...with a request for "assisted suicide" or voluntary euthanasia . "Do Not .:Lsuscitate" does not mean that the medical staff will take any affirmative steps...practice in responding to issues raised in the management of terminally ill patients. 4. The New Mexico Right to Die Act (the "Act", 24-7-1 to 24-7-11

  5. Morbidity and Mortality Weekly Report. Volume 43, Number 53. Summary of Notifiable Diseases, United States, 1994.

    Science.gov (United States)

    2007-11-02

    VII Drug-resi stant Streptococcus pneumoniae In the United States, the prevalence of drug-resistant Streptococcus pneumoniae (DRSP) has increased...hospitals indicate the proportion of invasive disease (bacteremia and meningitis) caused by penicillin -resistant pneumococci ranges from 3% to 30% and shows...from noncritical care units, suggesting that vancomy- cin-resistant enterococci are spreading from their focus in ICUs. Pneumonia of unknown etiology

  6. Assessment of core and support functions of casebased surveillance of meningitis in hospitals in Khartoum State in 2015.

    Science.gov (United States)

    Baghdadi, I A A

    2016-07-10

    Case-based surveillance of meningitis was implemented in Khartoum State in February 2013 but its implementation has not been evaluated. This study assessed some core (case confirmation) and support (case reporting and investigation resources) functions of case-based surveillance of meningitis at hospital level in Khartoum State, Sudan, from January to March 2015. An interview questionnaire and checklist were used to collect data from 31 hospitals. A poster containing the case definition of meningitis was fixed to the wall in 18% of the hospitals. Bacteriological culture of cerebrospinal fluid (CSF) and antibiotic sensitivity testing of the cultured bacteria were available in one-third of the hospitals. Laboratory personnel trained in CSF examination were present in 29% of the hospitals, while trained reporting unit personnel were present in 52%. A telephone for reporting was present in 74% of the hospitals. The system for casebased surveillance of meningitis needs to be strengthened, particularly the functions related to case confirmation.

  7. Neurological Sequels and Their Causes in Patients Hospitalized in the Toxicology Intensive Care Unit of Bahraloo Hospital, Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Taghadosi Nejad

    2015-05-01

    Full Text Available Background The occurrence of neurologic complications in the intensive care units (ICUs is one of the major risks in management of patients. These sequels may be caused by structural or metabolic disorders. The same phenomenon can be seen in the toxicology ICUs, although the toxicological effects of drugs and poisons may also cause the neurological complications. Objectives This study aimed to determine the frequency of neurological sequels and their causes in patients hospitalized in the toxicology ICUs. Patients and Methods In this descriptive study, the data of patients admitted in toxicology ICU of Baharloo Hospital, Tehran, Iran, were investigated during a 2-year period (2010 ‒ 2011 and the patients with neurological sequels, based on neurological examination or brain computed tomography (CT scan findings, were included. Data recorded in questionnaires were analyzed by means of SPSS software, with a significance level at P < 0.05. Results Out of 1571 patients admitted in toxicology ICU during this period, 56 patients (3.56%, with the mean ± SD age of 36 ± 13.01 years, were included. The most common finding in neurological examination was the Babinski sign (67.9%. Ischemic encephalopathy with brain edema was the most common finding on the brain CT scans of these patients (33.9%. The mortality rate was 58.9% (33 out of 56. Thirteen patients (23.2% were discharged with vegetative state. The most common cause of neurological sequel, in this study, was hypoxia (64.3% Conclusions This study, for the first time in Iran, investigated the frequency and cause of neurological sequels in toxicology ICUs. The findings can improve the prophylaxis and diagnostic programs for the patients in this field.

  8. 77 FR 60005 - Schedule of Charges Outside the United States

    Science.gov (United States)

    2012-10-01

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION Federal Aviation Administration Schedule of Charges Outside the United States AGENCY: Federal Aviation... of charges for services of FAA Flight Standards Aviation Safety Inspectors outside the United...

  9. Continental Divide of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the Continental Divide of the United States. The map layer was created by extracting Hydrologic Unit Boundary line features from an existing...

  10. Global Map: Ports of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes Global Map data showing ferry ports in the United States and Puerto Rico. The data are a modified version of the National Atlas of the United...

  11. Cities and Towns of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer includes cities in the United States, Puerto Rico and the U.S. Virgin Islands. These cities were collected from the 1970 National Atlas of the United...

  12. The anatomy of health care in the United States.

    Science.gov (United States)

    Moses, Hamilton; Matheson, David H M; Dorsey, E Ray; George, Benjamin P; Sadoff, David; Yoshimura, Satoshi

    2013-11-13

    Health care in the United States includes a vast array of complex interrelationships among those who receive, provide, and finance care. In this article, publicly available data were used to identify trends in health care, principally from 1980 to 2011, in the source and use of funds ("economic anatomy"), the people receiving and organizations providing care, and the resulting value created and health outcomes. In 2011, US health care employed 15.7% of the workforce, with expenditures of $2.7 trillion, doubling since 1980 as a percentage of US gross domestic product (GDP) to 17.9%. Yearly growth has decreased since 1970, especially since 2002, but, at 3% per year, exceeds any other industry and GDP overall. Government funding increased from 31.1% in 1980 to 42.3% in 2011. Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the United States trailing peer nations. The findings from this analysis contradict several common assumptions. Since 2000, (1) price (especially of hospital charges [+4.2%/y], professional services [3.6%/y], drugs and devices [+4.0%/y], and administrative costs [+5.6%/y]), not demand for services or aging of the population, produced 91% of cost increases; (2) personal out-of-pocket spending on insurance premiums and co-payments have declined from 23% to 11%; and (3) chronic illnesses account for 84% of costs overall among the entire population, not only of the elderly. Three factors have produced the most change: (1) consolidation, with fewer general hospitals and more single-specialty hospitals and physician groups, producing financial concentration in health systems, insurers, pharmacies, and benefit managers; (2) information technology, in which investment has occurred but value is elusive; and (3) the patient as consumer, whereby influence is sought outside traditional channels, using social media, informal networks, new public sources

  13. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. Fewer than 1 in

  14. United States Military in Central Asia: Beyond Operation Enduring Freedom

    Science.gov (United States)

    2009-10-23

    Malinowski , advocacy director for Human Rights Watch, stated, “the United States is most effective in promoting liberty around the world when people...26 U.S. President, The National Security Strategy of the United States of America, page? 27 Thomas Malinowski , “Testimony

  15. Environmental Assessment: Interim Western United States C-17 Landing Zone

    Science.gov (United States)

    2008-05-01

    RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENEGGER GOVERNOR January 7, 2008 Doug Allbright U.S. Air Force Headquarters Air...STATE OF CALIFORNIA GoVERNOR’S OFFICE of PLANNING AND RESEARCH STATE CLEARINGHOUSE AND PLANNING UNIT ARNOLD SCHWARZENBGGER. CYNTHJABRYANT DIRECTOR

  16. 26 CFR 31.3121(e)-1 - State, United States, and citizen.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 15 2010-04-01 2010-04-01 false State, United States, and citizen. 31.3121(e)-1... § 31.3121(e)-1 State, United States, and citizen. (a) When used in the regulations in this subpart, the... is used in a geographical sense. The term “citizen of the United States” includes a citizen of the...

  17. Hospital Care for Frail Elderly Adults: From Specialized Geriatric Units to Hospital-Wide Interventions

    NARCIS (Netherlands)

    Bakker, F.C.; Olde Rikkert, M.G.M.

    2015-01-01

    Much of the acute care provided in hospitals is for elderly people. Frailty is a common clinical condition among these patients. Frail patients are vulnerable to undergoing adverse events, to developing geriatric syndromes and to experiencing functional decline during or due to hospitalization. The

  18. Airport geomagnetic surveys in the United States

    Science.gov (United States)

    Berarducci, A.

    2006-01-01

    The Federal Aviation Administration (FAA) and the United States military have requirements for design, location, and construction of compass calibration pads (compass roses), these having been developed through collaboration with US Geological Survey (USGS) personnel. These requirements are detailed in the FAA Advisory Circular AC 150/5300-13, Appendix 4, and in various military documents, such as Handbook 1021/1, but the major requirement is that the range of declination measured within 75 meters of the center of a compass rose be less than or equal to 30 minutes of arc. The USGS Geomagnetism Group has developed specific methods for conducting a magnetic survey so that existing compass roses can be judged in terms of the needed standards and also that new sites can be evaluated for their suitability as potentially new compass roses. First, a preliminary survey is performed with a total-field magnetometer, with differences over the site area of less than 75nT being sufficient to warrant additional, more detailed surveying. Next, a number of survey points are established over the compass rose area and nearby, where declination is to be measured with an instrument capable of measuring declination to within 1 minute of arc, such as a Gurley transit magnetometer, DI Flux theodolite magnetometer, or Wild T-0. The data are corrected for diurnal and irregular effects of the magnetic field and declination is determined for each survey point, as well as declination range and average of the entire compass rose site. Altogether, a typical survey takes about four days to complete. ?? 2006 Springer.

  19. Veterinary Fusarioses within the United States

    Science.gov (United States)

    Sutton, Deanna A.; Wiederhold, Nathan; Robert, Vincent A. R. G.; Crous, Pedro W.; Geiser, David M.

    2016-01-01

    Multilocus DNA sequence data were used to assess the genetic diversity and evolutionary relationships of 67 Fusarium strains from veterinary sources, most of which were from the United States. Molecular phylogenetic analyses revealed that the strains comprised 23 phylogenetically distinct species, all but two of which were previously known to infect humans, distributed among eight species complexes. The majority of the veterinary isolates (47/67 = 70.1%) were nested within the Fusarium solani species complex (FSSC), and these included 8 phylospecies and 33 unique 3-locus sequence types (STs). Three of the FSSC species (Fusarium falciforme, Fusarium keratoplasticum, and Fusarium sp. FSSC 12) accounted for four-fifths of the veterinary strains (38/47) and STs (27/33) within this clade. Most of the F. falciforme strains (12/15) were recovered from equine keratitis infections; however, strains of F. keratoplasticum and Fusarium sp. FSSC 12 were mostly (25/27) isolated from marine vertebrates and invertebrates. Our sampling suggests that the Fusarium incarnatum-equiseti species complex (FIESC), with eight mycoses-associated species, may represent the second most important clade of veterinary relevance within Fusarium. Six of the multilocus STs within the FSSC (3+4-eee, 1-b, 12-a, 12-b, 12-f, and 12-h) and one each within the FIESC (1-a) and the Fusarium oxysporum species complex (ST-33) were widespread geographically, including three STs with transoceanic disjunctions. In conclusion, fusaria associated with veterinary mycoses are phylogenetically diverse and typically can only be identified to the species level using DNA sequence data from portions of one or more informative genes. PMID:27605713

  20. Geographic access to gynecologic cancer care in the United States.

    Science.gov (United States)

    Shalowitz, David I; Vinograd, Alexandra M; Giuntoli, Robert L

    2015-07-01

    Women who live distant from the closest subspecialty treatment center are at risk of failing to utilize high-quality care for gynecologic cancers. There has not yet been a comprehensive, national investigation of populations affected by geographic barriers to gynecologic cancer care. Geographic Information Systems (GIS) were used to identify United States counties farther than 50miles from the closest gynecologic oncologist, and hospital referral regions (HRRs) that do not contain the primary professional address of at least one gynecologic oncologist. US Census data were used to analyze counties' demographic characteristics. County-level cancer incidence was estimated using the Centers for Disease Control and Prevention's State Cancer Profiles. Thirty-six percent (1125/3143) of counties are further than 50miles from the nearest gynecologic oncologist. A total of 14.8 million women live in low-access counties (LACs). Annually, approximately 7663 women with gynecologic cancers may experience geography-related disparities in access. Residents of LACs have lower median household income, are more likely to be White and/or Hispanic, and less likely to be Black. Forty percent (123/306) of HRRs do not contain the primary address of a gynecologic oncologist. Approximately 9% of the female population of the United States may experience geographic barriers to access high-quality care for gynecologic malignancies. Future investigations should assess whether residents of low-access counties utilize high-quality care less often, and whether there is a disparity in clinical outcomes. Disparities might be addressed by ensuring subspecialty care in low-access regions, and/or adjusting system structures to minimize the burdens of traveling long distances for cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Indonesian and United States of American Economic Partnership Agreement Effect

    Directory of Open Access Journals (Sweden)

    Tajerin Tajerin

    2011-09-01

    Full Text Available The paper analyzes fisheries trade effects from the implementation of Indonesian and the UnitedStates of American Economic Partnership Agreement (IUSEPA. The analysis is performed on theintegrated world trade databases owned by World Trade Organization, United Nations Conferenceon Trade and Development, and United Nations Statistics Division, using Wits software packagedeveloped by the World Bank. The result indicates that in the future, Indonesian government as aparty that will conduct bilateral economic partnership agreement with the United states, needs topropose or negotiate fishery import tariffs that imposed by the United States ranges from 0 to 7percent.Keywords: Bilateral economic agreement, fisheries, trade effect

  2. United States Federal Guidance on Witness Protection in Human Trafficking

    Science.gov (United States)

    2015-06-12

    UNITED STATES FEDERAL GUIDANCE ON WITNESS PROTECTION IN HUMAN TRAFFICKING A thesis presented to the Faculty of the U.S. Army...JUN 2015 4. TITLE AND SUBTITLE United States Federal Guidance on Witness Protection in Human Trafficking 5a. CONTRACT NUMBER 5b. GRANT NUMBER...United States needs overarching federal guidance on witness protection for human trafficking victims/witnesses in order to enhance their safety and

  3. ICU Occupancy and mechanical ventilator use in the United States

    Science.gov (United States)

    Wunsch, Hannah; Wagner, Jason; Herlim, Maximilian; Chong, David; Kramer, Andrew; Halpern, Scott D.

    2013-01-01

    Objectives Detailed data on occupancy and use of mechanical ventilators in United States intensive care units (ICU) over time and across unit types, are lacking. We sought to describe the hourly bed occupancy and use of ventilators in US ICUs to improve future planning of both the routine and disaster provision of intensive care. Design Retrospective cohort study. We calculated mean hourly bed occupancy in each ICU and hourly bed occupancy for patients on mechanical ventilators. We assessed trends in overall occupancy over the three years. We also assessed occupancy and mechanical ventilation rates across different types and sizes of ICUs. Setting 97 US ICUs participating in Project IMPACT from 2005–07. Patients 226,942 consecutive admissions to ICUs. Interventions None. Measurements and Main Results Over the three years studied, total ICU occupancy ranged from 57.4% to 82.1% and the number of beds filled with mechanically ventilated patients ranged from 20.7% to 38.9%. There was no change in occupancy across years and no increase in occupancy during influenza seasons. Mean hourly occupancy across ICUs was 68.2% SD ± 21.3, and was substantially higher in ICUs with fewer beds (mean 75.8% (± 16.5) for 5–14 beds versus 60.9% (± 22.1) for 20+ beds, P = 0.001), and in academic hospitals (78.7% (± 15.9) versus 65.3% (± 21.3) for community not-for profit hospitals, P beds available more than half the time. The mean percentage of ICU patients receiving mechanical ventilation in any given hour was 39.5% (± 15.2), and a mean of 29.0% (± 15.9) of ICU beds were filled with a patient on a ventilator. Conclusions Occupancy of US ICUs was stable over time, but there is uneven distribution across different types and sizes of units. Only three out of ten beds were filled at any time with mechanically ventilated patients, suggesting substantial surge capacity throughout the system to care for acutely critically ill patients. PMID:23963122

  4. Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study

    Directory of Open Access Journals (Sweden)

    Rubenfeld Gordon D

    2008-11-01

    Full Text Available Abstract Background Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States. Methods We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions. Results We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers. Conclusion Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care.

  5. Does the United States economy affect heart failure readmissions? A single metropolitan center analysis.

    Science.gov (United States)

    Thompson, Keith A; Morrissey, Ryan P; Phan, Anita; Schwarz, Ernst R

    2012-08-01

    To determine the effects of the US economy on heart failure hospitalization rates. The recession was associated with worsening unemployment, loss of private insurance and prescription medication benefits, medication nonadherence, and ultimately increased rates of hospitalization for heart failure. We compared hospitalization rates at a large, single, academic medical center from July 1, 2006 to February 28, 2007, a time of economic stability, and July 1, 2008 to February 28, 2009, a time of economic recession in the United States. Significantly fewer patients had private medical insurance during the economic recession than during the control period (36.5% vs 46%; P = 0.04). Despite this, there were no differences in the heart failure hospitalization or readmission rates, length of hospitalization, need for admission to an intensive care unit, in-hospital mortality, or use of guideline-recommended heart failure medications between the 2 study periods. We conclude that despite significant effects on medical insurance coverage, rates of heart failure hospitalization at our institution were not significantly affected by the recession. Additional large-scale population-based research is needed to better understand the effects of fluctuations in the US economy on heart failure hospitalization rates. © 2012 Wiley Periodicals, Inc.

  6. Skinner boxes for psychotics: Operant conditioning at Metropolitan state hospital

    OpenAIRE

    Rutherford, Alexandra

    2003-01-01

    Between 1953 and 1965, Ogden Lindsley and his associates conducted free-operant research with psychiatric inpatients and normal volunteers at Metropolitan State Hospital in Waltham, Massachusetts. Their project, originally named “Studies in Behavior Therapy,” was renamed “Harvard Medical School Behavior Research Laboratory” in 1955. This name change and its implications were significant. The role of the laboratory in the history of the relationship between the experimental analysis of behavio...

  7. 1:2,000,000-scale Hydrologic Units of the United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set has been superseded by huc2m. This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii,...

  8. (SUPERSEDED) 1:2,000,000-scale Hydrologic Units of the United States (SUPERSEDED)

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This file contains hydrologic unit boundaries and codes for the conterminous United States along with Alaska, Hawaii, Puerto Rico and the U.S. Virgin Islands. It was...

  9. Kidney Disease Statistics for the United States

    Science.gov (United States)

    ... High blood pressure and diabetes are the main causes of CKD. Almost half of individuals with CKD also have ... without CKD. However, rates of both overall and cause-specific admissions increased with advancing stages of CKD. Hospitalizations increased among CKD patients with the presence ...

  10. Abortion surveillance--United States, 2009.

    Science.gov (United States)

    Pazol, Karen; Creanga, Andreea A; Zane, Suzanne B; Burley, Kim D; Jamieson, Denise J

    2012-11-23

    Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States. 2009. Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, the District of Columbia, and New York City). The reporting areas provide this information voluntarily. For 2009, data were received from 48 reporting areas. For the purpose of trend analysis, abortion data were evaluated from the 45 areas that reported data every year during 2000-2009. Census and natality data, respectively, were used to calculated abortion rates (number of abortions per 1,000 women) and ratios (number of abortions per 1,000 live births). A total of 784,507 abortions were reported to CDC for 2009. Of these abortions, 772,630 (98.5%) were from the 45 reporting areas that provided data every year during 2000-2009. Among these same 45 reporting areas, the abortion rate for 2009 was 15.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 227 abortions per 1,000 live births. Compared with 2008, the total number and rate of reported abortions for 2009 decreased 5%, representing the largest single year decrease for the entire period of analysis. The abortion ratio decreased 2%. From 2000 to 2009, the total number, rate, and ratio of reported abortions decreased 6%, 7%, and 8%, respectively, to the lowest levels for 2000-2009. In 2009 and throughout the period of analysis, women in their 20s accounted for the majority of abortions and had the highest abortion rates, whereas women aged ≥30 years accounted for a much smaller percentage of abortions and had lower abortion rates. In 2009, women aged 20-24 and 25-29 years accounted for 32.7% and 24.4% of all abortions, respectively, and had an abortion rate of 27.4 abortions per 1,000 women aged 20-24 years and 20.4 abortions per 1,000 women aged 25-29 years. In contrast, women aged 30-34, 35-39, and ≥40 years

  11. The United States of America country update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W.; Bloomquist, R. Gordon; Boyd, Tonya L.; Renner, Joel

    2005-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  12. The United States of America Country Update

    Energy Technology Data Exchange (ETDEWEB)

    Lund, John W. (1); Bloomquist, R. Gordon (2); Boyd, Tonya L. (1); Renner, Joel (3); (1) Geo-Heat Center, Oregon Institute of Technology, Klamath Falls, OR; (2) Washington State University Energy Program, Olympia, WA; (3) Idaho National Engineering and Environmental Laboratory, Idaho Falls, ID

    0001-01-01

    Geothermal energy is used for electric power generation and direct utilization in the United States. The present installed capacity (gross) for electric power generation is 2,534 MWe with about 2,000 MWe net delivering power to the grid producing approximately 17,840 GWh per year for a 80.4% gross capacity factor. Geothermal electric power plants are located in California, Nevada, Utah and Hawaii. The two largest concentrations of plants are at The Geysers in northern California and the Imperial Valley in southern California. The latest development at The Geysers, starting in 1998, is injecting recycled wastewater from two communities into the reservoir, which presently has recovered about 100 MWe of power generation. The second pipeline from the Santa Rosa area has just come on line. The direct utilization of geothermal energy includes the heating of pools and spas, greenhouses and aquaculture facilities, space heating and district heating, snow melting, agricultural drying, industrial applications and groundsource heat pumps. The installed capacity is 7,817 MWt and the annual energy use is about 31,200 TJ or 8,680 GWh. The largest application is ground-source (geothermal) heat pumps (69% of the energy use), and the next largest direct-uses are in space heating and agricultural drying. Direct utilization (without heat pumps) is increasing at about 2.6% per year; whereas electric power plant development is almost static, with only about 70 MWe added since 2000 (there were errors in the WGC2000 tabulation). A new 185-MWe plant being proposed for the Imperial Valley and about 100 MWe for Glass Mountain in northern California could be online by 2007-2008. Several new plants are proposed for Nevada totaling about 100 MWe and projects have been proposed in Idaho, New Mexico, Oregon and Utah. The total planned in the next 10 years is 632 MWe. The energy savings from electric power generation, direct-uses and ground-source heat pumps amounts to almost nine million tonnes

  13. [The role of the psychologist in hospitals and maternity wards in the state of Sergipe].

    Science.gov (United States)

    Santos, Lyvia de Jesus; Vieira, Maria Jésia

    2012-05-01

    This article seeks to reflect on the professional activity of the psychologist in the hospital context by examining the role of psychologists working in hospitals and maternity wards in the State of Sergipe. It seeks to identify the specific role of these professionals in hospitals and maternity wards, as well as their motivating forces and the difficulties encountered. This work is part of a broader project that sought to study not only the activity per se, but also training aspects of these professionals. The sample was analyzed using a qualitative and quantitative approach for thematic analysis. Results revealed that the characterization of the role of psychologists has a focus on psychotherapeutic work with patients before and after surgery, as well as the caregivers and family members of critically ill patients in the following units: ICU, ICC, oncology, dialysis and surgical wards, offering support, especially at the pre- and post-surgery phase.

  14. The Human Rights Record of the United States in 2006

    Institute of Scientific and Technical Information of China (English)

    THE INFORMATION OFFICE OF THE STATE COUNCIL OF THE

    2007-01-01

    @@ EDITOR'S NOTE: On March 8, the Information Office of the State Council of the People's Republic of China published a document entitled the Human Rights Record of the United States in 2006. Following is the full text.

  15. 1990 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 1990 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  16. Major Roads of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This data set portrays the major roads in the United States, Puerto Rico, and the U.S. Virgin Islands. The file was produced by joining the individual State roads...

  17. NCHS - Births and General Fertility Rates: United States

    Data.gov (United States)

    U.S. Department of Health & Human Services — This dataset includes crude birth rates and general fertility rates in the United States since 1909. The number of states in the reporting area differ historically....

  18. 2000 County Boundaries of the United States - Direct Download

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This map layer portrays the 2000 State and county boundaries of the United States, Puerto Rico, and the U.S. Virgin Islands. The map layer was created by extracting...

  19. Landfills in the Western United States

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — Locations of landfills and waste transfer stations in 11 western states. Data was obtained from state and federal agencies in GIS, tabular, and map format.

  20. Hypophosphatemia in children hospitalized within an intensive care unit.

    Science.gov (United States)

    de Menezes, Fernanda Souza; Leite, Heitor Pons; Fernandez, Juliana; Benzecry, Silvana Gomes; de Carvalho, Werther Brunow

    2006-01-01

    The aims of this study were to estimate the occurrence of hypophosphatemia and to identify potential risk factors and outcome measures associated with this disturbance in children admitted to a pediatric intensive care unit. Data concerning 42 children admitted consecutively to 1 pediatric intensive care unit over a 1-year period were examined. Serum phosphorus levels were measured on the third day of admission, where levels below 3.8 mg/dL were considered indicative of hypophosphatemia. Hypophosphatemia was found in 32 children (76%), and there was a significant association between this disturbance and malnutrition (P = .04). Of the potential risk factors such as sepsis, diuretic/steroid therapy, starvation (over 3 days), and Pediatric Index of Mortality, none discriminated for hypophosphatemia. There were no associations between hypophosphatemia and mortality, length of stay in the pediatric intensive care unit, or time on mechanical lung ventilation. Hypophosphatemia was a common finding in critically ill children and was associated with malnutrition.

  1. Principal thorium resources in the United States

    Science.gov (United States)

    Staatz, Mortimer Hay; Armbrustmacher, T.J.; Olson, J.C.; Brownfield, I.K.; Brock, M.R.; Lemons, J.F.; Coppa, L.V.; Clingan, B.V.

    1979-01-01

    Resources were assessed for thorium in the higher grade and better known deposits in the United States in: (1) veins, (2) massive carbonatites, (3) stream placers of North and South Carolina, and (4) disseminated deposits. Thorium resources for the first three categories were divided into reserves and probable potential resources. Each of these then were separated into the following cost categories: (1) the amount of ThO2 producible at less than $15 per pound, (2) the amount producible at between $15 and $30 per pound, and (3) the amount producible at more than $50 per pound. The type of mining and milling needed at each deposit determines the capital, operating, and fixed costs of both mining and milling. Costs start with the clearing of land and are carried through to the final product, which for all deposits is ThO2. Capital costs of mining are affected most by the type of mining and the size of the mine. Those of milling are affected most by the kind of mill, its size, and whether or not extra circuits are needed for the separation of rare earths or some other byproduct. Veins, massive carbonatites, and stream placers of North and South Carolina have reserves of 188,000 short tons of ThO2 and probable potential resources of 505,000 tons of ThO2. Approximately half of the reserves and probable potential resources can be produced at less than $30 per pound of ThO2. Veins are the highest grade source in the United States and have total reserves of 142,000 tons of ThO2 and probable potential resources of 343,000 tons. About 90 percent of the reserves and 91 percent of the probable potential resources can be produced at less than $15 per pound of ThO2. Seven vein districts were evaluated: (1) Lemhi Pass, Mont.-Idaho, (2) Wet Mountains, Colo., (3) Powderhorn, Colo., (4) Hall Mountain, Idaho, (5) Diamond Creek, Idaho, (6) Bear Lodge Mountains, Wyo. and (7) Mountain Pass, Calif. Eighty-seven percent of the total reserves and probable potential resources are in the

  2. Hospital nurses' individual priorities, internal psychological states and work motivation.

    Science.gov (United States)

    Toode, K; Routasalo, P; Helminen, M; Suominen, T

    2014-09-01

    This study looks to describe the relationships between hospital nurses' individual priorities, internal psychological states and their work motivation. Connections between hospital nurses' work-related needs, values and work motivation are essential for providing safe and high quality health care. However, there is insufficient empirical knowledge concerning these connections for the practice development. A cross-sectional empirical research study was undertaken. A total of 201 registered nurses from all types of Estonian hospitals filled out an electronic self-reported questionnaire. Descriptive statistics, Mann-Whitney, Kruskal-Wallis and Spearman's correlation were used for data analysis. In individual priorities, higher order needs strength were negatively correlated with age and duration of service. Regarding nurses' internal psychological states, central hospital nurses had less sense of meaningfulness of work. Nurses' individual priorities (i.e. their higher order needs strength and shared values with the organization) correlated with their work motivation. Their internal psychological states (i.e. their experienced meaningfulness of work, experienced responsibility for work outcomes and their knowledge of results) correlated with intrinsic work motivation. Nurses who prioritize their higher order needs are more motivated to work. The more their own values are compatible with those of the organization, the more intrinsically motivated they are likely to be. Nurses' individual achievements, autonomy and training are key factors which influence their motivation to work. The small sample size and low response rate of the study limit the direct transferability of the findings to the wider nurse population, so further research is needed. This study highlights the need and importance to support nurses' professional development and self-determination, in order to develop and retain motivated nurses. It also indicates a need to value both nurses and nursing in

  3. Chemotherapy-induced nausea and vomiting and antiemetic prophylaxis with palonosetron versus other 5-HT3 receptor antagonists in patients with cancer treated with low emetogenic chemotherapy in a hospital outpatient setting in the United States.

    Science.gov (United States)

    Schwartzberg, Lee; Morrow, Gary; Balu, Sanjeev; Craver, Chris; Gayle, Julie; Cox, David

    2011-08-01

    The incidence of overall (acute and delayed) chemotherapy-induced nausea and vomiting (CINV) events among patients treated with single- and multi-day low emetogenic chemotherapy (LEC) is not well established. We studied a cohort of patients receiving LEC and antiemetic prophylaxis with palonosetron (Group 1) versus other 5-HT(3) receptor antagonists (5-HT(3)-RAs) (Group 2), to determine the overall rate of CINV and the proportion of patients experiencing delayed CINV (days 2-7 of a CT cycle) in a hospital outpatient setting. Patients aged ≥18 years with cancer diagnosis initiating single-day and multi-day LEC for the first time between 4/1/2007 and 3/31/2009 were identified from the Premier Perspective database. CINV events (ICD-9-CM codes for nausea, vomiting, or volume depletion or CINV-related rescue medications) were assessed descriptively. A generalized linear multivariate regression model was developed, estimating the overall CINV event rate among Group 1 and 2 patients in the follow-up period (first of eight chemotherapy [CT] cycles or 6 months). In the follow-up period, out of a total of 10,137 overall CINV events (single-day and multi-day LEC), 8783 events (86.6%) were identified in single-day LEC treated patients. Within single-day LEC treated events, in the first cycle, of 3184 events, 2996 (94.1%) events were delayed. Average number of delayed events per patient remained consistent throughout the eight cycles (3.1 [1st cycle] vs. 2.9 [8th cycle]; P = 0.842]). Among 2439 patients on antiemetic prophylaxis with a 5-HT(3)-RA, 10.1% (n = 247) initiated palonosetron. Regression analysis indicated that Group 1 patients (versus Group 2) had a 15.2% reduction in CINV event rate per CT cycle; P = 0.0403. Study limitations include potential lack of generalizability, absence of data on certain confounders including alcohol consumption and prior history of motion sickness, potential underestimation of incidence of uncontrolled CINV, and inability to

  4. 78 FR 27857 - United States Standards for Wheat

    Science.gov (United States)

    2013-05-13

    ... Standards for Wheat AGENCY: Grain Inspection, Packers and Stockyards Administration, USDA. ACTION: Final... United States Standards for Wheat under the United States Grain Standards Act (USGSA) to change the definition of Contrasting classes (CCL) in the class Hard White wheat. This change will help facilitate the...

  5. 12 CFR 561.53 - United States Treasury General Account.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false United States Treasury General Account. 561.53 Section 561.53 Banks and Banking OFFICE OF THRIFT SUPERVISION, DEPARTMENT OF THE TREASURY DEFINITIONS FOR REGULATIONS AFFECTING ALL SAVINGS ASSOCIATIONS § 561.53 United States Treasury General Account. The...

  6. 76 FR 18198 - European Union-United States Atlantis Program

    Science.gov (United States)

    2011-04-01

    ... European Union-United States Atlantis Program AGENCY: Office of Postsecondary Education, Department of... (IFLE): Fund for the Improvement of Postsecondary Education (FIPSE)--Special Focus Competition: European Union-(EU) United States (U.S.) Atlantis Program Notice inviting applications for new awards for...

  7. 19 CFR 10.46 - Articles for the United States.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 1 2010-04-01 2010-04-01 false Articles for the United States. 10.46 Section 10... THE TREASURY ARTICLES CONDITIONALLY FREE, SUBJECT TO A REDUCED RATE, ETC. General Provisions Articles for Institutions § 10.46 Articles for the United States. Pursuant to subheadings 9808.00.10 and...

  8. Foreign Students and Scholars and the United States Tax System.

    Science.gov (United States)

    Williams, David, II.

    1994-01-01

    During the 1992-93 school year more than 425,000 foreign students were studying in the United States. In addition, hundreds of foreign nationals were in the United States as visiting research scholars, lecturers, and professors. Offers a guide to help foreign nationals comply with the tax system while affording them the least possible tax…

  9. Forest management and water in the United States [Chapter 13

    Science.gov (United States)

    Daniel G. Neary

    2017-01-01

    This chapter outlines a brief history of the United States native forests and forest plantations. It describes the past and current natural and plantation forest distribution (map, area, main species), as well as main products produced (timber, pulp, furniture, etc.). Integrated into this discussion is a characterization of the water resources of the United States and...

  10. The United States Today: An Atlas of Reproducible Pages.

    Science.gov (United States)

    World Eagle, Inc., Wellesley, MA.

    Black and white maps, graphs and tables that may be reproduced are presented in this volume focusing on the United States. Some of the features of the United States depicted are: size, population, agriculture and resources, manufactures, trade, citizenship, employment, income, poverty, the federal budget, energy, health, education, crime, and the…

  11. United States’ Interests in the Horn of Africa.

    Science.gov (United States)

    1986-04-23

    while Haile Selassie intended to ensure that the United States had a vested interest in the survival of his regime. "There was never an alliance between...company; and he sent troops to fight in Korea. Emperor Haile Selassie’s political manuevering achieved the establishment of a United States vested

  12. 7 CFR 65.260 - United States country of origin.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURAL MARKETING ACT OF 1946 AND THE EGG PRODUCTS INSPECTION ACT (CONTINUED) COUNTRY OF ORIGIN LABELING... 7 Agriculture 3 2010-01-01 2010-01-01 false United States country of origin. 65.260 Section 65.260..., PEANUTS, AND GINSENG General Provisions Definitions § 65.260 United States country of origin....

  13. Immigration to the United States: 1996 Update. Executive Summary.

    Science.gov (United States)

    Keuffel, Eric; Pemberton, Alissa

    Immigration, both legal and illegal, has a profound impact on the United States. The public policy implications of immigration include the impact on population growth, employment, wages, taxes, and social spending. In 1994, a net total of between 900,000 and 1.1 million immigrants were added to the foreign-born population of the United States.…

  14. 31 CFR 560.319 - United States depository institution.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false United States depository institution. 560.319 Section 560.319 Money and Finance: Treasury Regulations Relating to Money and Finance... associations, credit unions, trust companies and United States bank holding companies)....

  15. Civic Engagement in the United States: Roots and Branches

    Science.gov (United States)

    Imel, Susan

    2012-01-01

    The adult education and civic education movements are not synonymous, but the two were intertwined during the early years of adult education's formation as a field in the United States. This chapter traces the development of adult civic education in the United States, focusing on the 1920s through the 1950s. First, the roots of civic education…

  16. Pine Engraver, Ips pini, in the Western United States (FIDL)

    Science.gov (United States)

    Sandra J. Kegley; R. Ladd Livingston; Kenneth E. Gibson

    1997-01-01

    The pine engraver, Ips pini (Say), is one of the most common and widely distributed bark beetles in North America. It occurs from southern Appalachia north to Maine and Quebec, westward across the northern United States and Canada, into the interior of Alaska, throughout the Pacific Coast States and the Rocky Mountain region, to northern Mexico. In the western United...

  17. The Organization of Paralympic Sport in the United States

    Science.gov (United States)

    Walsh, Joe; Mushett, Mike

    2012-01-01

    In the United States, Paralympic sport is governed by the United States Olympic Committee (USOC), as set forth in the Ted Stevens Olympic and Amateur Sports Act of 1998. The USOC formed a dedicated Paralympic Division in 2001 to manage this responsibility in close cooperation with other USOC divisions and many of the sport-specific national…

  18. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  19. Preparation of School Psychologists in the United States

    Science.gov (United States)

    Joyce-Beaulieu, Diana; Rossen, Eric

    2014-01-01

    School psychology in the United States continues to evolve in response to shifts in the country's demographic characteristics, an increasing focus on the importance of child mental health, together with health and education reforms. The landscape of school psychological services in the United States also is shaped through the changing roles and…

  20. 78 FR 26425 - Sentencing Guidelines for United States Courts

    Science.gov (United States)

    2013-05-06

    ..., the simple movement of a stolen trade secret within a domestic multinational company (e.g., from a United States office to an overseas office of the same company) may not pose the same risks or harms. More generally, the Commission heard that foreign actors increasingly target United States companies...

  1. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  2. Does racism affect health? Evidence from the United States and the United Kingdom.

    Science.gov (United States)

    Muennig, Peter; Murphy, Michael

    2011-02-01

    Blacks have worse overall health than whites in both the United States and the United Kingdom. However, the relative difference in health between the two groups within each cultural context differs between each context. In this article, we attempt to glean insights into these health disparities. We do so by first examining what is currently known about differences in morbidity and mortality for blacks and whites in the United States and the United Kingdom. We then turn to medical examination data by race and country of birth in an attempt to further untangle the complex interplay of socioeconomic status (SES), race, and racism as determinants of health in the United States and the United Kingdom. We find that (1) longer exposure of blacks to the recipient country is a risk for mortality in the United States but not in the United Kingdom; (2) adjustment for SES matters a good deal for mortality in the United States, but less so in the United Kingdom; (3) morbidity indicators do not paint a clear picture of black disadvantage relative to whites in either context; and (4) were one to consider medical examination data alone, differences between the two groups exist only in the United States. Taken together, we conclude that it is possible that the "less racist" United Kingdom provides a healthier environment for blacks than the United States. However, there remain many mysteries that escape simple explanation. Our findings raise more questions than they answer, and the health risks and health status of blacks in the United States are much more complex than previously thought.

  3. Leveling of Tuberculosis Incidence - United States, 2013-2015.

    Science.gov (United States)

    Salinas, Jorge L; Mindra, Godwin; Haddad, Maryam B; Pratt, Robert; Price, Sandy F; Langer, Adam J

    2016-03-25

    After 2 decades of progress toward tuberculosis (TB) elimination with annual decreases of ≥0.2 cases per 100,000 persons (1), TB incidence in the United States remained approximately 3.0 cases per 100,000 persons during 2013-2015. Preliminary data reported to the National Tuberculosis Surveillance System indicate that TB incidence among foreign-born persons in the United States (15.1 cases per 100,000) has remained approximately 13 times the incidence among U.S.-born persons (1.2 cases per 100,000). Resuming progress toward TB elimination in the United States will require intensification of efforts both in the United States and globally, including increasing U.S. efforts to detect and treat latent TB infection, strengthening systems to interrupt TB transmission in the United States and globally, accelerating reductions in TB globally, particularly in the countries of origin for most U.S.

  4. Introduction of Eucalyptus spp. into the United States with Special Emphasis on the Southern United States

    Directory of Open Access Journals (Sweden)

    R. C. Kellison

    2013-01-01

    Full Text Available Introduction of Eucalyptus spp. into the United States from Australia on a significant scale resulted from the gold rush into California in 1849. Numerous species were evaluated for fuel, wood products, and amenity purposes. The first recorded entry of eucalyptus into the southern United Stated was in 1878. Subsequent performance of selected species for ornamental purposes caused forest industry to visualize plantations for fiber production. That interest led the Florida Forestry Foundation to initiate species-introduction trials in 1959. The results were sufficiently promising that a contingent of forest products companies formed a cooperative to work with the USDA Forest Service, Lehigh Acres, FL, USA, on genetic improvement of selected species for fiber production. The Florida initiative caused other industrial forestry companies in the upper South to establish plantations regardless of the species or seed source. The result was invariably the same: failure. Bruce Zobel, Professor of Forestry, North Carolina State University, initiated a concerted effort to assess the potential worth of eucalyptus for plantation use. The joint industrial effort evaluated 569 sources representing 103 species over a 14-year period. The three levels of testing, screening, in-depth, and semioperational trials led to identification of some species and sources that offered promise for adaptation, but severe winter temperatures in late 1983 and early 1984 and 1985 terminated the project. Despite the failed attempt valuable silvicultural practices were ascertained that will be beneficial to other researchers and practitioners when attempts are again made to introduce the species complex into the US South.

  5. Using hospital pharmacy technicians to check unit dose carts.

    Science.gov (United States)

    Spooner, S H; Emerson, P K

    1994-05-01

    This study was undertaken to evaluate the accuracy of technicians checking unit dose carts as compared with pharmacists checking unit dose carts. The final (after check) fill in both arms of the study was evaluated for accuracy on the same five criteria: 1) correct drug, 2) correct dose, 3) correct dosage form, 4) correct quantity, and 5) expiration date. In the technician arm, 7571 doses were checked with 10 errors, giving a 99.76% (1 error in 420) accuracy. In the pharmacist arm of the study, 3116 doses were checked with 34 total errors, giving a 98.91% (1 error in 92) accuracy. The results of this study indicate that technicians would have as high if not a higher accuracy rate than pharmacists. Using pharmacy technicians in this role should continue the same level of care by maintaining a high accuracy in medication dispensing and provide greater economic benefit to the organization by using technical rather than professional personnel.

  6. 从美国医师、医院、医保机构的制约关系探讨我国医药费用控制%Discussion on Medical Costs Control in China from the Perspective of the Relationship among Doctors, Hospitals and Health Insurance Institutions in the United States

    Institute of Scientific and Technical Information of China (English)

    宗毛毛; 尤晓敏; 赵瑞; 袁丽; 杨悦

    2016-01-01

    目的:为我国医药费用的控制提供参考。方法:运用信息不对称与委托代理、弗里德曼的消费理论,结合美国医疗卫生服务体系的主要特点,分析美国医师、医院、医保机构三者之间均衡的制约关系在控制医药费用和提高诊疗质量方面的优势;同时比较我国与美国在医药费用增长率、药占比等方面的差异,论证上述制约关系对医药费用控制的作用。结果与结论:美国的医疗服务实行分级诊疗与双向转诊制度、盈利性医院与非盈利性医院相互补充、不同性质的医保体系并存、实行不同的付费方式、实行严格的商业贿赂监管制度,其医师、医院、医保机构三者之间形成的是一种相互制约的均衡关系。其不仅在理论上存在诸多优势,在实际控制费用增长率、药占比等方面也优于我国,在一定程度上控制了医疗费用的快速增长。结合我国国情,有必要借鉴美国的经验,从降低信息不对称与规范支付审核、建立科学的混合型支付方式、加强医保机构对医师和医院的间接影响等方面,构建我国医师、医院、医保机构三者之间的均衡制约关系,从而有效控制我国医药费用的增长。%OBJECTIVE:To provide reference for medical costs control in China. METHODS:Based on main characteristics of the United States health service system,information asymmetry,principal-agent theory and Freedman’s consumption theory were used to analyze the advantages of restrictive relationship among doctors,hospitals and health insurance institutions in control-ling medical costs and improving the quality of diagnosis and treatment. The growth rate of medical cost,the percentage of drug ex-penditure and other aspects were compared between China and the United States;the effect of restrictive relationship on medical cost control was demonstrated. RESULTS & CONCLUSIONS:In the United States,there are

  7. Hospital mortality of adults admitted to Intensive Care Units in hospitals with and without Intermediate Care Units: a multicentre European cohort study.

    Science.gov (United States)

    Capuzzo, Maurizia; Volta, Carlo; Tassinati, Tania; Moreno, Rui; Valentin, Andreas; Guidet, Bertrand; Iapichino, Gaetano; Martin, Claude; Perneger, Thomas; Combescure, Christophe; Poncet, Antoine; Rhodes, Andrew

    2014-10-09

    The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days). One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002). The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment. Clinicaltrials.gov NCT01422070. Registered 19 August 2011.

  8. Sports-related shoulder dislocations: a state-hospital experience.

    Science.gov (United States)

    Hazmy, C H Wan; Parwathi, A

    2005-07-01

    This retrospective study was conducted in a state hospital set-up and aimed at identifying the incidence of sports-related shoulder dislocations and their characteristics and the sports events involved. All patients with shoulder dislocation related to sporting activities admitted to the hospital from January 1999 to December 2002 were included in the study. There were 18 sports-related shoulder dislocations out of 106 all shoulder dislocations admitted during this 4-year period. The average age of the patients was 25.4 years. All but two were male. All were anterior dislocations. Recurrent dislocation constitutes 78% of the cases with an average of 3 times re-dislocation. Rugby and badminton were the major contributors to the injuries followed by volleyball, soccer and swimming. Conservative treatment was successfully instituted for 88% of the patients and 12% opted for surgical intervention.

  9. Forest Resources of the United States, 2002

    Science.gov (United States)

    W. Brad Smith; Patrick D. Miles; John S. Vissage; Scott A. Pugh

    2004-01-01

    Forest resource growth, harvests, and land use conversion can change inventories within States, among regions, and even among countries, and can significantly influence the future performance of resources. This could affect the State, regional, and national economies that depend on the affected resources, as well as the resource environments. Periodic surveys provide...

  10. Competitive Electricity Market Regulation in the United States: A Primer

    Energy Technology Data Exchange (ETDEWEB)

    Flores-Espino, Francisco [National Renewable Energy Lab. (NREL), Golden, CO (United States); Tian, Tian [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Chernyakhovskiy, Ilya [National Renewable Energy Lab. (NREL), Golden, CO (United States); Miller, Mackay [National Grid, Warwick (United Kingdom)

    2016-12-01

    The electricity system in the United States is a complex mechanism where different technologies, jurisdictions and regulatory designs interact. Today, two major models for electricity commercialization operate in the United States. One is the regulated monopoly model, in which vertically integrated electricity providers are regulated by state commissions. The other is the competitive model, in which power producers can openly access transmission infrastructure and participate in wholesale electricity markets. This paper describes the origins, evolution, and current status of the regulations that enable competitive markets in the United States.

  11. Cataract surgery practices in the United States Veterans Health Administration.

    Science.gov (United States)

    Havnaer, Annika G; Greenberg, Paul B; Cockerham, Glenn C; Clark, Melissa A; Chomsky, Amy

    2017-04-01

    To describe current cataract surgery practices within the United States Veterans Health Administration (VHA). Veterans Health Administration hospitals in the U.S. Retrospective data analysis. An initial e-mail containing a link to an anonymous 32-question survey of cataract surgery practices was sent to participants in May 2016. Two reminder e-mails were sent to nonresponders 1 week and 2 weeks after the initial survey was sent; the remaining nonresponders were called twice over a 2-week period. The data were analyzed using descriptive statistics. The response rate was 75% (67/89). Cataract surgeons routinely ordered preoperative testing in 29 (45%) of 65 sections and preoperative consultations in 26 (39%) of 66 sections. In 22 (33%) of 66 sections, cataract surgeons administered intracameral antibiotics. In 61 (92%) of 66 sections, cataract surgeons used toric intraocular lenses (IOLs). In 20 (30%) of 66 sections, cataract surgeons used multifocal IOLs. Cataract surgeons in 6 (9%) of 66 sections performed femtosecond laser-assisted cataract surgery. In 6 (9%) of 66 sections, cataract surgeons performed immediate sequential bilateral cataract surgery. Forty-nine (74%) ophthalmology chiefs reported a high level of satisfaction with Veterans Affairs ophthalmology. The survey results indicate that in cataract surgery in the VHA, routine preoperative testing is commonly performed and emerging practices, such as femtosecond laser-assisted cataract surgery and immediate sequential bilateral cataract surgery, have limited roles. The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  12. North Atlantic Treaty Organization, the United States, and International Legitimacy

    Science.gov (United States)

    2014-05-22

    8. 42Following the signing of the Treaty of Versailles in 1919, the Albanian State was created but with only one-half of the Albanian population...NORTH ATLANTIC TREATY ORGANIZATION, THE UNITED STATES, AND INTERNATIONAL LEGITIMACY A Monograph by MAJ Mark Van Gelder...North Atlantic Treaty Organization, The United States, and International Legitimacy 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT

  13. The feasibility of hospital-based universal newborn hearing screening in the United Kingdom.

    Science.gov (United States)

    Albuquerque, W; Kemp, D T

    2001-01-01

    Current hearing screening programmes in the United Kingdom are performing unacceptably poorly. Davies et al. (1997) suggested that universal newborn hearing screening (UNHS) would be more effective and cheaper to run. However, there is concern that hospital-based UNHS would not be feasible because of early postnatal discharge, and thus babies not staying in hospital long enough to be screened. Two studies were designed to determine the viability of hospital-based UNHS in a district general hospital in the United Kingdom. Study 1 retrospectively determined the discharge age and time of discharge of all 3021 well babies born at St Helier hospital, Carshalton, and the number of babies born at home in the area, from 19 October 1997-18 October 1998. Most well babies were found to pass through hospital at a convenient time for predischarge hearing screening, and the optimal protocol was screening from 9 am-2 pm, 7 days a week. The predicted maximal screening coverage was 92.68%. Study 2 tested the calculated optimal protocol over 1 week. It was found that UNHS with otoacoustic emissions on the maternity ward from 9 am-2 pm, 7 days a week, achieved a coverage of 89.06%, with an acceptable false positive rate of 6.2%. It is likely that a similar protocol with slight modifications could be implemented successfully in other hospitals in the United Kingdom.

  14. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  15. Geothermal overviews of the western United States

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, D.N.; Axtell, L.H. (comps.)

    1972-01-01

    This compendium presents data on geothermal resources for all those western states with geothermal potential. Individual sections, which have been processed separately for inclusion in the EDB data base, are devoted to each of the following states: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. A separate section is also devoted to the U.S. Bureau of Reclamation Imperial Valley Project. Maps and references are included for each section. (JGB)

  16. United States Automotive Materials Partnership LLC (USAMP)

    Energy Technology Data Exchange (ETDEWEB)

    United States Automotive Materials Partnership

    2011-01-31

    The United States Automotive Materials Partnership LLC (USAMP) was formed in 1993 as a partnership between Chrysler Corporation, Ford Motor Company, and General Motors Corporation. Since then the U.S. Department of Energy (DOE) has supported its activities with funding and technical support. The mission of the USAMP is to conduct vehicle-oriented research and development in materials and materials processing to improve the competitiveness of the U.S. Auto Industry. Its specific goals are: (1) To conduct joint research to further the development of lightweight materials for improved automotive fuel economy; and (2) To work with the Federal government to explore opportunities for cooperative programs with the national laboratories, Federal agencies such as the DOE and universities. As a major component of the DOE's Office of FreedomCAR and Vehicle Technologies Program (FCVT) collaboration with the USAMP, the Automotive Lightweighting Materials (ALM) program focuses on the development and validation of advanced materials and manufacturing technologies to significantly reduce automotive vehicle body and chassis weight without compromising other attributes such as safety, performance, recyclability, and cost. The FCVT was announced in FY 2002 and implemented in FY 2003, as a successor of the Partnership for a New Generation of Vehicles (PNGV), largely addressed under the first Cooperative Agreement. This second USAMP Cooperative Agreement with the DOE has expanded a unique and valuable framework for collaboratively directing industry and government research efforts toward the development of technologies capable of solving important societal problems related to automobile transportation. USAMP efforts are conducted by the domestic automobile manufacturers, in collaboration with materials and manufacturing suppliers, national laboratories, universities, and other technology or trade organizations. These interactions provide a direct route for implementing newly

  17. Free living amoebae in water sources of critical units in a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    S Khurana

    2015-01-01

    Full Text Available Background: Isolation of free-living amoebae (FLA is reported sparsely from water taps, ventilators, air conditioners, haemodialysis units and dental irrigation systems of hospitals worldwide. Their prevalence in hospital environment especially in wards having immunocompromised patients may pose a risk to this group of susceptible population as they may cause disease themselves or may carry pathogens inside them. No study from India has performed such surveillance. Objective: To evaluate extent of FLA contamination in water sources of bone marrow transplant (BMT intensive care unit (ICU, transplant ICU, haemodialysis unit and high dependency unit in a tertiary care hospital in India. Materials and Methods: A total of hundred samples including fifty each of tap water samples and swabs from mouth of taps used for drinking, bathing and hand washing purposes in these units were collected according to standard procedure. Samples were inoculated onto non-nutrient agar plates at room temperature followed by morphological confirmation. Molecular identification including polymerase chain reaction (PCR and sequencing was performed in culture positive samples. Results: Four tap water samples and ten swab samples showed growth of trophozoites and cyst formation. Morphologically, four amoebae resembled Acanthamoeba spp. which was further confirmed by PCR and sequencing showed them to be of T3 and T4 genotypes. Conclusion: The presence of these FLA in hospital water sources emphasises the urgent need of implementing effective preventive measures. Further studies are required to estimate the true prevalence of FLA in Indian hospitals by taking larger number of samples.

  18. Toxaphene in the United States: 1. Usage gridding

    Science.gov (United States)

    Li, Y. F.

    2001-08-01

    Toxaphene, as a general-purpose insecticide, was widely used in the United States. The use of toxaphene in the United States can be divided into four different periods between 1947 and 1986, with total usage of about 490 kt, and total production around 720 kt. Inventories of gridded usage of toxaphene in the United States with 1/6° by 1/4° latitude/longitude resolution have been created by using different gridded cropland and cattle as surrogate data. The intensive use of toxaphene on croplands was concentrated in the southeastern part of the United States with the highest usage of 2 kt per grid cell. The results show that the state of Alabama was the largest user of toxaphene, reaching as much as 87 kt, followed by Mississippi at 60 kt. The total usage in the top 10 states is 410 kt, 84% of the national usage in the United States. The use in the first six states, Alabama, Mississippi, Georgia, Arkansas, Texas, and South Carolina, is 350 kt, 71% of the national usage in the United States.

  19. Suicides in national parks--United States, 2003-2009.

    Science.gov (United States)

    2010-12-03

    In 2007, the year for which the most recent national data on fatalities are available, 34,598 suicides occurred in the United States (rate: 11.3 per 100,000 population); 79% were among males. In 2009, an estimated 374,486 visits to hospital emergency departments occurred for self-inflicted injury, of which approximately 262,000 (70%) could be attributed to suicidal behavior. The majority (58%) were among females. Most suicides (77%) occur in the home, but many occur in public places, including national parks. In addition to the loss of life, suicides consume park resources and staff time and can traumatize witnesses. To describe the characteristics of and trends in suicides in national parks, CDC and the National Park Service (NPS) analyzed reports of suicide events (suicides and attempted suicides) occurring in the parks during 2003-2009. During this 7-year span, 84 national parks reported 286 suicide events, an average of 41 events per year. Of the 286 events, 68% were fatal. The two most commonly used methods were firearms and falls. Consistent with national patterns, 83% of suicides were among males. A comprehensive, multicomponent approach is recommended to prevent suicide events, including enhanced training for park employees, site-specific barriers, and collaboration with communities.

  20. Epidemiology of foodborne norovirus outbreaks, United States, 2001-2008.

    Science.gov (United States)

    Hall, Aron J; Eisenbart, Valerie G; Etingüe, Amy Lehman; Gould, L Hannah; Lopman, Ben A; Parashar, Umesh D

    2012-10-01

    Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 2001-2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish.

  1. Forecasting the Impact of Heart Failure in the United States

    Science.gov (United States)

    Heidenreich, Paul A.; Albert, Nancy M.; Allen, Larry A.; Bluemke, David A.; Butler, Javed; Fonarow, Gregg C.; Ikonomidis, John S.; Khavjou, Olga; Konstam, Marvin A.; Maddox, Thomas M.; Nichol, Graham; Pham, Michael; Piña, Ileana L.; Trogdon, Justin G.

    2013-01-01

    Background Heart failure (HF) is an important contributor to both the burden and cost of national healthcare expenditures, with more older Americans hospitalized for HF than for any other medical condition. With the aging of the population, the impact of HF is expected to increase substantially. Methods and Results We estimated future costs of HF by adapting a methodology developed by the American Heart Association to project the epidemiology and future costs of HF from 2012 to 2030 without double counting the costs attributed to comorbid conditions. The model assumes that HF prevalence will remain constant by age, sex, and race/ethnicity and that rising costs and technological innovation will continue at the same rate. By 2030, >8 million people in the United States (1 in every 33) will have HF. Between 2012 and 2030, real (2010$) total direct medical costs of HF are projected to increase from $21 billion to $53 billion. Total costs, including indirect costs for HF, are estimated to increase from $31 billion in 2012 to $70 billion in 2030. If one assumes all costs of cardiac care for HF patients are attributable to HF (no cost attribution to comorbid conditions), the 2030 projected cost estimates of treating patients with HF will be 3-fold higher ($160 billion in direct costs). Conclusions The estimated prevalence and cost of care for HF will increase markedly because of aging of the population. Strategies to prevent HF and improve the efficiency of care are needed. PMID:23616602

  2. Internal fixation at ECWA Hospital, Egbe, Kogi State, Nigeria.

    Science.gov (United States)

    Agaja, S B

    2002-01-01

    Forty two (42) cases of fractures treated by internal fixation at Egbe Hospital ECWA, Kogi State, Nigeria were analysed retrospectively. Most of the patients requiring internal fixation were young male patients in their reproductive years 26 patients were under 50 years of age out of which 22 patients were males (84.6%) whilst only 4 patients (15.4%) were females. Internal fixation was found to be commoner in males: 31 patients (73.8%) than in females: 11 patients (26.2%). Fractures requiring internal fixation are commoner in the lower limbs than in the upper limbs (Ratio 6:1). The femur is the commonest site of internal fixation, 22 cases (54.2%) followed by the tibia, 6 cases (14.3%). Majority of the patients, 28 cases (67%) left the hospital under 50 days whereas when treated conservatively most will be in the hospital for up to 100 days. Only about 60% of the cases require blood transfusion and even a more cautious approach could reduce this percentage. 13 (31%) of the cases had fever post-operatively which was not necessarily due to infection. Based on its advantages, internal fixation is therefore encouraged and should only be performed by a surgeon who has adequate experience, equipment, instruments and a good operating theatre setting.

  3. United States Geological Survey, programs in Nevada

    Science.gov (United States)

    ,

    1995-01-01

    The U.S. Geological Survey (USGS) has been collecting and interpreting natural-resources data in Nevada for more than 100 years. This long-term commitment enables planners to manage better the resources of a State noted for paradoxes. Although Nevada is one of the most sparsely populated States in the Nation, it has the fastest growing population (fig. 1). Although 90 percent of the land is rural, it is the fourth most urban State. Nevada is the most arid State and relies heavily on water resources. Historically, mining and agriculture have formed the basis of the economy; now tourism and urban development also have become important. The USGS works with more than 40 local, State, and other Federal agencies in Nevada to provide natural-resources information for immediate and long-term decisions.Subjects included in this fact sheet:Low-Level Radioactive-Waste DisposalMining and Water in the Humboldt BasinAquifer Systems in the Great BasinWater Allocation in Truckee and Carson BasinsNational Water-Quality Assessment ProgramMinerals Assessment for Land ManagementIrrigation DrainageGround-Water Movement at Nevada Test SiteOil and Gas ResourcesNational Mapping ProgramDigital Mapping and Aerial PhotographyCollection of Hydrologlc DataGeologic MappingEarthquake HazardsAssessing Mineral Resources of the SubsurfaceEarth Observation DataCooperative Programs

  4. Evaluation of cases with impaired state of consciousness: Gaziantep Children's Hospital experience.

    Science.gov (United States)

    Yiş, Uluç; Yüksel, Ciğdem Nükhet; Köse, Ahmet; Erdoğan, Serpil

    2012-01-01

    The aim of this study was to characterize the etiology, course and prognosis in children admitted to a pediatric intensive care unit (PICU) of Gaziantep Children's Hospital for impaired state of consciousness. Three hundred and eighty cases were evaluated. Convulsions (44%; n=170) were the leading cause of the impaired state of consciousness followed by poisonings, envenomation, infection, metabolic disease, electrical injury, hepatic encephalopathy, intracranial hemorrhage, brain tumor, and drowning. The diagnosis was definite in 95% (n=359) and probable in 5% (n=21) of cases. Twenty-seven (7%) patients died with impaired state of consciousness. We suggest that defining the causes of impaired state of consciousness in a specific region will help physicians to evaluate the patients faster and in a more systemic manner. Since most of the causes seem to be preventable, appropriate education programs and policies should be provided for improving sanitation and socioeconomic conditions.

  5. Progress toward sodium reduction in the United States.

    Science.gov (United States)

    Levings, Jessica; Cogswell, Mary; Curtis, Christine J; Gunn, Janelle; Neiman, Andrea; Angell, Sonia Y

    2012-10-01

    The average adult in the United States of America consumes well above the recommended daily limit of sodium. Average sodium intake is about 3 463 mg/day, as compared to the 2010 dietary guidelines for Americans recommendation of sodium reduction policies and programs in the United States at the federal, state, and local levels; efforts to monitor the health impact of sodium reduction; ways to assess consumer knowledge, attitudes, and behavior; and how these activities depend on and inform global efforts to reduce sodium intake. Reducing excess sodium intake is a public health opportunity that can save lives and health care dollars in the United States and globally. Future efforts, including sharing successes achieved and barriers identified in the United States and globally, may quicken and enhance progress.

  6. 76 FR 697 - United States-Oman Free Trade Agreement

    Science.gov (United States)

    2011-01-06

    ... States--Oman Free Trade Agreement AGENCY: U.S. Customs and Border Protection, Department of Homeland... Free Trade Agreement entered into by the United States and the Sultanate of Oman. DATES: Interim rule...'') entered into the U.S.--Oman Free Trade Agreement (``OFTA'' or ``Agreement''). The stated objectives of the...

  7. A Comparative Analysis of Indian Gaming in the United States

    Science.gov (United States)

    Ackerman, William V.; Bunch, Rick L.

    2012-01-01

    Previous research on Indian gaming in South Dakota discovered very restrictive and unfavorable tribal-state compacts that appear to border on economic racism. This article expands this previous research by exploring the influence of tribal-state Indian gaming compacts for the Indian casinos located in the contiguous United States. The purpose is…

  8. Babesiosis among Elderly Medicare Beneficiaries, United States, 2006–2008

    Science.gov (United States)

    Anderson, Steven A.; Izurieta, Hector S.; Kumar, Sanjai; Burwen, Dale R.; Gibbs, Jonathan; Kropp, Garner; Erten, Tugce; MaCurdy, Thomas E.; Worrall, Christopher M.; Kelman, Jeffrey A.; Walderhaug, Mark O.

    2012-01-01

    We used administrative databases to assess babesiosis among elderly persons in the United States by year, sex, age, race, state of residence, and diagnosis months during 2006–2008. The highest babesiosis rates were in Connecticut, Rhode Island, New York, and Massachusetts, and findings suggested babesiosis expansion to other states. PMID:22257500

  9. Long-term aridity changes in the western United States.

    Science.gov (United States)

    Cook, Edward R; Woodhouse, Connie A; Eakin, C Mark; Meko, David M; Stahle, David W

    2004-11-01

    The western United States is experiencing a severe multiyear drought that is unprecedented in some hydroclimatic records. Using gridded drought reconstructions that cover most of the western United States over the past 1200 years, we show that this drought pales in comparison to an earlier period of elevated aridity and epic drought in AD 900 to 1300, an interval broadly consistent with the Medieval Warm Period. If elevated aridity in the western United States is a natural response to climate warming, then any trend toward warmer temperatures in the future could lead to a serious long-term increase in aridity over western North America.

  10. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  11. Geothermal Energy Potential in Western United States

    Science.gov (United States)

    Pryde, Philip R.

    1977-01-01

    Reviews types of geothermal energy sources in the western states, including hot brine systems and dry steam systems. Conversion to electrical energy is a major potential use of geothermal energy, although it creates environmental disruptions such as noise, corrosion, and scaling of equipment. (AV)

  12. Forest Resources of the United States, 2007

    Science.gov (United States)

    W. Brad, tech. coord. Smith; Patrick D., data coord. Miles; Charles H., map coord. Perry; Scott A., Data CD coord. Pugh

    2009-01-01

    Forest resource statistics from the 2000 Resources Planning Act (RPA) Assessment were updated to provide current information on the Nation's forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data and trends are analyzed...

  13. Forest Resources of the United States, 1997

    Science.gov (United States)

    W. Brad Smith; John S. Vissage; David R. Darr; Raymond M. Sheffield

    2001-01-01

    Forest resource statistics from the 1987 Resources Planning Act (RPA) Assessment were updated to 1997 to provide current information on the Nation`s forests. Resource tables present estimates of forest area, volume, mortality, growth, removals, and timber products output in various ways, such as by ownership, region, or State. Current resource data are analyzed and...

  14. In-Patient Trends and Complications After Total Ankle Arthroplasty in the United States.

    Science.gov (United States)

    Zhou, Hanbing; Yakavonis, Mark; Shaw, Joshua J; Patel, Abhay; Li, Xinning

    2016-01-01

    The number of total ankle arthroplasties (TAAs) performed annually in the United States has increased. The purpose of this study was to evaluate the in-patient demographics, complications, and readmission rates of patients after TAA at academic medical centers in the United States. The University HealthSystems Consortium administrative database was searched for patients who underwent TAA in 2007 to 2011. A descriptive analysis of demographics was performed, followed by a similar analysis of clinical benchmarks, including hospital length of stay, hospital direct cost, in-hospital mortality, and 30-day readmission rates. The study included 2340 adult patients with a mean age of 62 years (47% men and 53% women) who underwent TAA. The majority of patients were Caucasian (2073; 88.5%). Average hospital length of stay was 2.2±1.26 days. Average total direct cost for the hospital was $16,212±7000 per case, with 49.7% of patients having private insurance. In-hospital mortality was less than 1%, and overall complications were 1.4%. Complications after discharge included deep venous thrombosis (2.3%), reoperation (0.7%), and infection (3.2%). A readmission rate of 2.7% within the first 30 days from the time of discharge occurred. Total ankle arthroplasty in the United States is a relatively safe procedure with low overall complication rates. Patients who are male, have a history of community-acquired pneumonia, and have a larger number of preoperative comorbidities had a significant increased risk of developing 1 complication within 30 days of surgery.

  15. [Application of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction].

    Science.gov (United States)

    Wang, Zhi-min; Wang, Peng; Chen, Jie; Luo, Dan-hong; Shen, Wang-ming

    2008-07-01

    To evaluate the efficacy of stroke rehabilitation unit in municipal hospitals during the acute phase of cerebral infarction. 77 acute cerebral infarction patients were randomly assigned to stroke rehabilitation unit group and 73 to ordinary group. The NIH stroke scale (NIHSS), activities of daily living (ADL) Barthel index and average hospitalized time were compared in two groups before and after the treatment. The average NIHSS in two groups before treatment were 9.26 and 9.12 respectively (P > 0.05) but became 2.62 and 7.64 after treatment (P 0.05) but 87.26 and 64.20 after the treatment (P stroke rehabilitation unit being applied in the acute phase of cerebral infarction, it showed positive results in the following aspects as: improving the neurological function, capabilities of managing daily life, and also shortening the days of hospitalization.

  16. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

    Science.gov (United States)

    Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

    2015-05-17

    Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

  17. Nosocomial infections in the Intesive care unit, University hospital for infectious and tropical diseases, Belgrade, Serbia

    OpenAIRE

    Milošević Ivana; Korać Miloš; Stevanović Goran; Jevtović Đorđe; Milošević Branko; Jovanović Milica; Dulović Olga; Pavlović Milorad

    2014-01-01

    Bacground/Aim. Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them. Methods. This prospective cohor...

  18. Unit 1 St Stephen's Hospital, Sarsfield Court, Glanmire, Cork.

    LENUS (Irish Health Repository)

    Mikkers, Misja

    2014-09-01

    A persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of \\'managed competition\\' based on the recent reforms in the Netherlands, which would replace many functions of Ireland\\'s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.

  19. Explaining the United States-Israel Relationship

    Science.gov (United States)

    2013-06-01

    influxes of Ethiopian Jews during and Soviet Jews after the Cold War. Loan guarantees have been 77...and Saudi Arabia .88 President Bill Clinton stated that America’s interests in the Middle East are: “pursuing a comprehensive breakthrough to Middle...been, at least to some extent, an asset to the Arab regimes, as a strategic counterweight to radicalism.”136 Saudi Arabia and the members of the Gulf

  20. [Tasks performed by nurses at inpatient units in a training hospital].

    Science.gov (United States)

    Costa, Rita de Almeida; Shimizu, Helena Eri

    2005-01-01

    The purpose of this study was to identify and analyze tasks performed by nurses at inpatient units in a large general hospital in Brasilia, Federal District, which also functions as a training hospital. A quantitative, exploratory, descriptive study was carried out and involved a total of 612 hours of direct observation of the activities performed by 18 nurses at the General Medicine, Surgical, Pediatric and Maternity units. The tasks observed were classified as: administration, nursing care delivery, education and related to information system. Nurses dedicate a large part of their time to administrative tasks, followed by tasks related to nursing care delivery and information system, performing almost no educative tasks.