RURAL/URBAN RESIDENCE, ACCESS, AND PERCEIVED NEED FOR TREATMENT AMONG AFRICAN AMERICAN COCAINE USERS

Science.gov (United States)

BORDERS, TYRONE F.; BOOTH, BRENDA M.; STEWART, KATHARINE E.; CHENEY, ANN M.; CURRAN, GEOFFREY M.

2014-01-01

Objective To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization. Study Design Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress). Principal Findings In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR=.23); at the lowest level, rural users had higher odds of perceived need (OR=2.74) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR=.64). Ease of access was negatively associated (OR=.71) whereas local treatment effectiveness (OR=1.47) and the acceptability of hospital-based treatment (OR=1.29) were positively associated with perceived need among all users. Conclusions Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking. PMID:25213603

Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK

OpenAIRE

Nove, Andrea; Berrington, Ann; Matthews, Zo?

2012-01-01

Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, an...

The “Ruin” Bars of Budapest: Urban Decay and the Development of a Genre of Hospitality

OpenAIRE

Lugosi, Peter; Lugosi, K.

2008-01-01

This paper examines the development and management of “rom” (ruin) bars: eating and drinking venues operating in dilapidated, urban buildings in Budapest, Hungary. The paper reviews and interrogates the evolution of the rom phenomenon and discusses three issues: 1) the relationship between hospitality, urban regeneration and urban space, 2) entrepreneurship and the production of rom bars as particular hospitality spaces, and 3) the relationship between symbolic forms of capital and hospitalit...

First-Case Operating Room Delays: Patterns Across Urban Hospitals of a Single Health Care System

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Callie M. Cox Bauer

2016-08-01

Full Text Available Purpose: Operating room delays decrease health care system efficiency and increase costs. To improve operating room efficiency in our system, we retrospectively investigated delay frequencies, causes and costs. Methods: We studied all first-of-the-day nonemergent surgical cases performed at three high-volume urban hospitals of a large health system from July 2012 to November 2013. Times for patient flow from arrival to procedure start and documented reasons for delay were obtained from electronic medical records. Delay was defined as patient placement in the operating room later than scheduled surgery time. Effects of patient characteristics, late patient arrival to the hospital, number of planned procedures, years of surgeon experience, service department and hospital facility on odds of delay were examined using logistic regression. Results: Of 5,598 cases examined, 88% were delayed. Patients arrived late to the hospital (surgery in 65% of first cases. Mean time from arrival to scheduled surgery and in-room placement was 104.6 and 127.4 minutes, respectively. Mean delay time was 28.2 minutes. Nearly 60% of delayed cases had no documented reason for delay. For cases with documentation, causes included the physician (52%, anesthesia (15%, patient (13%, staff (9%, other sources (6% and facility (5%. Regression analysis revealed age, late arrival, department and facility as significant predictors of delay. Estimated delay costs, based on published figures and representing lost revenue, were $519,388. Conclusions: To improve operating room efficiency, multidisciplinary strategies are needed for increasing patient adherence to recommended arrival times, documentation of delay by medical staff and consistency in workflow patterns among facilities and departments.

Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011.

Science.gov (United States)

Fu, Rong; Wang, Yupeng; Bao, Han; Wang, Zhiqiang; Li, Yongquan; Su, Shaofei; Liu, Meina

2014-01-01

To assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform. The data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively. The health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17-1.30), 1.06 (1.02-1.10) and 1.16 (1.10-1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed. The health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.

Vibrational-rotational model of odd-odd nuclei

International Nuclear Information System (INIS)

Afanas'ev, A.V.; Guseva, T.V.; Tamberg, Yu.Ya.

1988-01-01

The rotational vibrational (RV) model of odd nuclei is generalized to odd-odd nuclei. The hamiltonian, wave functions and matrix elements of the RV-model of odd-odd nuclei are obtained. The expressions obtained for matrix elements of the RV-model of odd-odd nuclei can be used to study the role of vibrational additions in low-lying two-particle states of odd-odd deformed nuclei. Such calculations permit to study more correctly the residual neutron-proton interaction of valent nucleons with respect to collectivization effects

Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography.

Science.gov (United States)

Maier, Daniel; Njoku, Innocent; Schmutzhard, Erich; Dharsee, Jaffer; Doppler, Magdalena; Härtl, Roger; Winkler, Andrea Sylvia

2014-01-01

In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania. HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected. The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P workplace is primarily urban or rural. Copyright © 2014 Elsevier Inc. All rights reserved.

Aetiologies of diarrhoea in adults from urban and rural treatment facilities in Bangladesh.

Science.gov (United States)

Ferdous, F; Ahmed, S; Farzana, F D; Das, J; Malek, M A; Das, S K; Salam, M A; Faruque, A S G

2015-05-01

The objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23-0·35, P economic and other progress made, conditions facilitating transmission of V. cholerae and Shigella prevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.

A case study investigation of the indoor environmental noise in four urban South African hospitals

CSIR Research Space (South Africa)

Van Reenen, CA

2015-11-01

Full Text Available This multiple case study was designed to investigate acoustics in multi-bed general wards in four urban South African hospitals. Evidence-based research shows that a quiet indoor environment has positive outcomes for hospital patients and staff...

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents.

Science.gov (United States)

Zanjani, Faika; Smith, Rachel; Slavova, Svetla; Charnigo, Richard; Schoenberg, Nancy; Martin, Catherine; Clayton, Richard

2016-07-01

Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.

Cataract surgery audit at an Australian urban teaching hospital.

Science.gov (United States)

Kahawita, Shyalle K; Goggin, Michael

2015-08-01

To provide local data on visual acuity and surgical outcomes for cataract surgery performed in an Australian teaching hospital. Continuous audit over 7 years in a public teaching hospital. A total of 3740 eyes had cataract surgery performed at The Queen Elizabeth Hospital, South Australia, from May 2006 to September 2013. Visual acuity and complication rates were recorded for cataract surgery cases operated on between May 2006 and September 2013 on a digital database with data entry contemporaneous with final follow-up. Visual acuity and surgical complications. Of the patients, 91.4% achieved postoperative best-measured vision better than preoperative best-measured vision. The rate of posterior capsular tear was 2.59%, endophthalmitis was 0.11% and the overall complication rate was 11.7%. This audit is the first to document modern cataract surgery, overwhelmingly dominated by phacoemulsification in an Australian population and can be used to benchmark cataract surgery outcome in an urban Australian population. © 2015 Royal Australian and New Zealand College of Ophthalmologists.

Dynamical symmetries for odd-odd nuclei

International Nuclear Information System (INIS)

Balantekin, A.B.

1986-01-01

Recent work for developing dynamical symmetries and supersymmetries is reviewed. An accurate description of odd-odd nuclei requires inclusion of the fermion-fermion force (the residual interaction) and the distinguishing of fermion configurations which are particle like and those which are hole like. A parabolic dependence of the proton-neutron multiplet in odd-odd nuclei is demonstrated. It is shown that a group structure for Bose-Fermi symmetries can be embedded in a supergroup. These methods are used to predict level schemes for Au-196 and Au-198. 11 refs., 3 figs

Odd things, in odd places, in odd races | Ferndale | South African ...

African Journals Online (AJOL)

Odd things, in odd places, in odd races. L Ferndale, R Wise, S R Thomson. Abstract. No Abstract. South African Gastroenterology Vol. 5 (3) 2007: pp. 9-12. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/sagr.v5i3.30737 · AJOL African Journals ...

Birth preparedness and complication readiness in pregnant women attending urban tertiary care hospital

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Vasundhara Kamineni

2017-01-01

Full Text Available Background: Birth preparedness and complication readiness (BP/CR is a strategy to promote the timely use of skilled maternal and neonatal care and is based on the theory that preparing for childbirth and being ready for complications reduce delay in obtaining care. Study Objective: The objective of this study was to evaluate the incidence and predictors of birth preparedness, knowledge on danger signs, and emergency readiness among pregnant women attending outpatient clinic of a tertiary care hospital. Patients and Methods: Six hundred pregnant women attending the outpatient department of a tertiary care hospital for the first time in an urban setting were interviewed using a tool adapted from the “Monitoring BP/CR-tools and indicators for maternal and new born health” of the “JHPIEGO.” The outcomes of the study were birth preparedness, knowledge of severe illness, and emergency readiness. Results: Six hundred pregnant women were in the study. Mean age of respondents was 25.2 (±4 years. The mean gestation at enrolment was 18.7 ± 8 weeks. Among the women who participated in the survey, 20% were illiterate, 70% were homemakers and nearly 70% had a monthly family income >Rs. 15,197 (n = 405. Three hundred and sixteen mothers (52% were primigravida. As defined in the study, 71.5% were birth prepared. However, 59 women (9.8% did not identify a place of delivery, 102 (17% had not started saving money, and 99 mothers (16.5% were not aware of purchasing materials needed for delivery. The predictors of birth preparedness are multiparity (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 1.4–3.1, registration in the antenatal clinic in the first trimester (OR: 3.7, 95% CI: 2.2–6.1, educational status of women (OR: 1.9, 95% CI: 1.2–3.0, and pregnancy supervison by a doctor (OR: 5, 95% CI: 2.8–6.6. One hundred and sixty-four women (27% made no arrangements in the event of an emergency, 376 women (63% were not aware of their blood group

Random interactions, isospin, and the ground states of odd-A and odd-odd nuclei

International Nuclear Information System (INIS)

Horoi, Mihai; Volya, Alexander; Zelevinsky, Vladimir

2002-01-01

It was recently shown that the ground state quantum numbers of even-even nuclei have a high probability to be reproduced by an ensemble of random but rotationally invariant two-body interactions. In the present work we extend these investigations to odd-A and odd-odd nuclei, considering in particular the isospin effects. Studying the realistic shell model as well as the single-j model, we show that random interactions have a tendency to assign the lowest possible total angular momentum and isospin to the ground state. In the sd shell model this reproduces correctly the isospin but not the spin quantum numbers of actual odd-odd nuclei. An odd-even staggering effect in probability of various ground state quantum numbers is present for even-even and odd-odd nuclei, while it is smeared out for odd-A nuclei. The observed regularities suggest the underlying mechanism of bosonlike pairing of fermionic pairs in T=0 and T=1 states generated by the off-diagonal matrix elements of random interactions. The relation to the models of random spin interactions is briefly discussed

Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

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Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

2010-01-01

Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

Needlestick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia

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Tsolmon Muugolog

2011-06-01

Full Text Available Abstract Background Needlestick and sharps injuries (NSSIs are one of the major risk factors for blood-borne infections at healthcare facilities. This study examines the current situation of NSSIs among health care workers at public tertiary hospitals in an urban community in Mongolia and explores strategies for the prevention of these injuries. Findings A survey of 621 health care workers was undertaken in two public tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-structured and self-administered questionnaire was distributed to study injection practices and the occurrence of NSSIs. A multiple logistic regression analysis was performed to investigate factors associated with experiencing NSSIs. Among the 435 healthcare workers who returned a completed questionnaire, the incidence of NSSIs during the previous 3 months was 38.4%. Health care workers were more likely to report NSSIs if they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95% confidence interval, CI: 1.31-4.66 and administered more than 10 injections per day (OR: 4.76; 95% CI: 1.97-11.49. The likelihood of self-reporting NSSIs significantly decreased if health care workers adhered to universal precautions (OR: 0.34; 95% CI: 0.17-0.68. Conclusions NSSIs are a common public health problem at public tertiary hospitals in Mongolia. The promotion of adequate working conditions, elimination of excessive injection use, and adherence to universal precautions will be important for the future control of potential infections with blood-borne pathogens due to occupational exposures to sharps in this setting.

Contribution of hospital effluents to the load of pharmaceuticals in urban wastewaters: identification of ecologically relevant pharmaceuticals.

Science.gov (United States)

Santos, Lúcia H M L M; Gros, Meritxell; Rodriguez-Mozaz, Sara; Delerue-Matos, Cristina; Pena, Angelina; Barceló, Damià; Montenegro, M Conceição B S M

2013-09-01

The impact of effluent wastewaters from four different hospitals: a university (1456 beds), a general (350 beds), a pediatric (110 beds) and a maternity hospital (96 beds), which are conveyed to the same wastewater treatment plant (WWTP), was evaluated in the receiving urban wastewaters. The occurrence of 78 pharmaceuticals belonging to several therapeutic classes was assessed in hospital effluents and WWTP wastewaters (influent and effluent) as well as the contribution of each hospital in WWTP influent in terms of pharmaceutical load. Results indicate that pharmaceuticals are widespread pollutants in both hospital and urban wastewaters. The contribution of hospitals to the input of pharmaceuticals in urban wastewaters widely varies, according to their dimension. The estimated total mass loadings were 306 g d(-1) for the university hospital, 155 g d(-1) for the general one, 14 g d(-1) for the pediatric hospital and 1.5 g d(-1) for the maternity hospital, showing that the biggest hospitals have a greater contribution to the total mass load of pharmaceuticals. Furthermore, analysis of individual contributions of each therapeutic group showed that NSAIDs, analgesics and antibiotics are among the groups with the highest inputs. Removal efficiency can go from over 90% for pharmaceuticals like acetaminophen and ibuprofen to not removal for β-blockers and salbutamol. Total mass load of pharmaceuticals into receiving surface waters was estimated between 5 and 14 g/d/1000 inhabitants. Finally, the environmental risk posed by pharmaceuticals detected in hospital and WWTP effluents was assessed by means of hazard quotients toward different trophic levels (algae, daphnids and fish). Several pharmaceuticals present in the different matrices were identified as potentially hazardous to aquatic organisms, showing that especial attention should be paid to antibiotics such as ciprofloxacin, ofloxacin, sulfamethoxazole, azithromycin and clarithromycin, since their hazard quotients

A case control study of differences in non-work injury and accidents among sawmill workers in rural compared to urban British Columbia, Canada

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Maggi Stefania

2009-01-01

Full Text Available Abstract Background Using a cohort of British Columbian male sawmill workers, we conducted a nested case-control study of the impact of rural compared to urban residence as well as rural/urban migration patterns in relation to hospitalization for non-work injury. We postulate that for many types of non-work injuries, rates will be higher in rural communities than in urban ones and that rates will also be higher for workers who migrate from urban to rural communities. Methods Using conditional logistic regression, univariate models were first run with each of five non-work injury outcomes. These outcomes were hospitalizations due to assault, accidental poisoning, medical mis-adventure, motor vehicle trauma, and other non-work injuries. In multivariate models marital status, ethnicity, duration of employment, and occupation were forced into the model and associations with urban, compared to rural, residence and various urban/migration patterns were tested. Results Urban or rural residence and migration status from urban to other communities, and across rural communities, were not associated with hospitalization for medical misadventure, assault, or accidental poisoning. The likelihood of a rural resident being hospitalized for motor vehicle trauma is higher than for an urban resident. The likelihood that a rural resident is hospitalized for "other" non-work injury is higher than for an urban resident. Conclusion In a relatively homogenous group of workers, and using a rigorous study design, we have demonstrated that the odds of other non-work injury are much higher for workers resident in and migrating to rural regions of Canada than they are for workers resident in or migrating to urban places.

Correlation of Secondary Organic Aerosol with Odd Oxygen in Mexico City

Energy Technology Data Exchange (ETDEWEB)

Herndon, Scott C.; Onasch, Timothy B.; Wood, Ezra C.; Kroll, Jesse H.; Canagaratna, M. R.; Jayne, John T.; Zavala, Miguel A.; Knighton, W. Berk; Mazzoleni, Claudio; Dubey, Manvendra K.; Ulbrich, Ingrid M.; Jimenez, Jose L.; Seila, Robert; de Gouw, Joost A.; de Foy, B.; Fast, Jerome D.; Molina, Luisa T.; Kolb, C. E.; Worsnop, Douglas R.

2008-08-05

Data collected from a mountain location within the Mexico City limits are used to demonstrate a correlation between secondary organic aerosol and odd-oxygen (O3 + NO2). Positive matrix factorization techniques are employed to separate organic aerosol components: hydrocarbon-like organic aerosol; oxidized-organic aerosol; and biomass burning organic aerosol. The measured hydrocarbon-like organic aerosol is correlated with urban CO (8±1) µg m-3 ppmv-1. The measured oxidized-organic aerosol is associated with photochemical oxidation products and correlates with odd-oxygen with an apparent slope of (70-120) µg m-3 ppmv-1. The dependence of the oxidized-organic aerosol to odd-oxygen correlation on the nature of the gas-phase hydrocarbon profile is discussed.

Mobility and Gender Aspects of Hospital Trips of the Urban Elderly in ...

African Journals Online (AJOL)

Accessibility to health care facilities is one characteristic that have the potential to impact the health and well-being of the elderly. Using data from a multistage sample survey of 378 elderly, this study examines intra- urban mobility and gender differences in hospital trips of elderly in the city of Ilesa, South-western, Nigeria.

Magnetic dipole moments of odd-odd lanthanides

International Nuclear Information System (INIS)

Sharma, S.D.; Gandhi, R.

1988-01-01

Magnetic dipole moments of odd-odd lanthanides. Collective model of odd-odd nuclei is applied to predict the magnetic dipole moments, (μ) of odd-odd lanthanides. A simplified version of expression for μ based on diagonalisation of Hamiltonian (subsequent use of eigenvectors to compute μ) is developed for cases of ground state as well as excited states using no configuration mixing and is applied to the cases of odd-odd lanthanides. The formulae applied to the eleven (11) cases of ground states show significant improvement over the results obtained using shell model. Configuration mixing and coriolis coupling is expected to cause further improvement in the results. On comparing the earlier work in this direction the present analysis has clarified that in the expression μ the projection factors have different signs for the case I=Ωp - Ωn and I=Ωn - Ωp, and sign of μ is negative in general in the second case while it is positive in all others of spin projection alignments. Although the general expression holds for excited states as well but in lanthanide region, the experimental reports of magnetic dipole moments of excite states (band heads of higher rational sequences) are not available except in case of five (5) neutron resonance states which cannot be handled on the basis of the present approach with no configuration mixing. Although in the present discussion, the model could not be applied to excited states but the systematics of change in its magnitude with increasing spin at higher rational states is very well understood. The particle part supressed under faster rotation of the nuclear core and thus finally at higher spin I, the value μ is given by μ=g c I (same as in case of even-even nuclei). These systematics are to be verified whenever enough data for higher excited states are available. (author). 11 refs

Conflicting coupling of unpaired nucleons in odd-odd nuclei

International Nuclear Information System (INIS)

Volkov, D.A.; Levon, A.I.

1990-01-01

Phenomenological approach is described, using it, energy spectra of odd-odd nucleus collective bands based on conflicting state of unpaired nucleons can be calculated. It is ascertained that in a conflicting bond unpaired nucleon acts as a spectator, i.e. energy spectra of collective bands in odd-odd nuclei are similar to the spectra of collective bands in heighbouring odd nuclei, which are based on the state of a strongly bound nucleon is included in the conflicting configuration

Coulomb Excitation of Odd-Mass and Odd-Odd Cu Isotopes using REX-ISOLDE and Miniball

CERN Multimedia

Lauer, M; Iwanicki, J S

2002-01-01

We propose to study the properties of the odd-mass and the odd-odd neutron-rich Cu nuclei applying the Coulomb excitation technique and using the REX-ISOLDE facility coupled to the Miniball array. The results from the Coulex experiments accomplished at REX-ISOLDE after its upgrade to 3 MeV/u during the last year have shown the power of this method and its importance in order to obtain information on the collective properties of even-even nuclei. Performing an experiment on the odd-mass and on the odd-odd neutron-rich Cu isotopes in the vicinity of N=40 should allow us to determine and interpret the effective proton and neutron charges in the region and to unravel the lowest proton-neutron multiplets in $^{68,70}$Cu. This experiment can take the advantage of the unique opportunity to accelerate isomerically separated beams using the RILIS ion source at ISOLDE.

The Impact of Hospital and Patient Factors on the Emergency Department Decision to Admit.

Science.gov (United States)

Warner, Leah S Honigman; Galarraga, Jessica E; Litvak, Ori; Davis, Samuel; Granovsky, Michael; Pines, Jesse M

2018-02-01

Substantial variation exists in rates of emergency department (ED) admission. We examine this variation after accounting for local and community characteristics. Elucidate the factors that contribute to admission variation that are amenable to intervention with the goal of reducing variation and health care costs. We conducted a retrospective cross-sectional study of 1,412,340 patient encounters across 18 sites from 2012-2013. We calculated the adjusted hospital-level admission rates using multivariate logistic regression. We adjusted for patient, provider, hospital, and community factors to compare admission rate variation and determine the influence of these characteristics on admission rates. The average adjusted admission rate was 22.9%, ranging from 16.1% (95% confidence interval [CI] 11.5-22%) to 32% (95% CI 26.0-38.8). There were higher odds of hospital admission with advancing age, male sex (odds ratio [OR] 1.20, 95% CI 1.91-1.21), and patients seen by a physician vs. mid-level provider (OR 2.26, 95% CI 2.23-2.30). There were increased odds of admission with rising ED volume, at academic institutions (OR 2.23, 95% CI 2.20-2.26) and at for-profit hospitals (OR 1.15, 95% CI 1.12-1.18). Admission rates were lower in communities with a higher per capita income, a higher rate of uninsured patients, and in more urban hospitals. In communities with the most primary providers, there were lower odds of admission (OR 0.60, 95% CI 0.57-0.68). Variation in hospital-level admission rates is associated with a number of local and community characteristics. However, the presence of persistent variation after adjustment suggests there are other unmeasured variables that also affect admission rates that deserve further study, particularly in an era of cost containment. Copyright © 2017 Elsevier Inc. All rights reserved.

Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

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Smith Patricia M

2012-04-01

Full Text Available Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269 via mail to the researchers. Results Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent Conclusions The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study.

LENUS (Irish Health Repository)

O'Farrell, I B

2014-10-15

Previous research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have been confined to urban centres, with few focusing on rural settings and even fewer studies carried out at a national level. Furthermore, no previous research has investigated if travel time to hospital services can explain the area-level variation in the incidence of hospital treated self-harm.

Predictors of Language Service Availability in U.S. Hospitals

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Melody K. Schiaffino

2014-10-01

Full Text Available Background Hispanics comprise 17% of the total U.S. population, surpassing African-Americans as the largest minority group. Linguistically, almost 60 million people speak a language other than English. This language diversity can create barriers and additional burden and risk when seeking health services. Patients with Limited English Proficiency (LEP for example, have been shown to experience a disproportionate risk of poor health outcomes, making the provision of Language Services (LS in healthcare facilities critical. Research on the determinants of LS adoption has focused more on overall cultural competence and internal managerial decision-making than on measuring LS adoption as a process outcome influenced by contextual or external factors. The current investigation examines the relationship between state policy, service area factors, and hospital characteristics on hospital LS adoption. Methods We employ a cross-sectional analysis of survey data from a national sample of hospitals in the American Hospital Association (AHA database for 2011 (N= 4876 to analyze hospital characteristics and outcomes, augmented with additional population data from the American Community Survey (ACS to estimate language diversity in the hospital service area. Additional data from the National Health Law Program (NHeLP facilitated the state level Medicaid reimbursement factor. Results Only 64%of hospitals offered LS. Hospitals that adopted LS were more likely to be not-for-profit, in areas with higher than average language diversity, larger, and urban. Hospitals in above average language diverse counties had more than 2-fold greater odds of adopting LS than less language diverse areas [Adjusted Odds Ratio (AOR: 2.26, P< 0.01]. Further, hospitals with a strategic orientation toward diversity had nearly 2-fold greater odds of adopting LS (AOR: 1.90, P< 0.001. Conclusion Our findings support the importance of structural and contextual factors as they relate to

The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

Directory of Open Access Journals (Sweden)

Amin Talebpour

2016-06-01

Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

Impact of urban atmospheric environment on hospital admissions in the elderly

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Edelci Nunes da Silva

2012-08-01

Full Text Available OBJECTIVE: To analyze the impact of intra-urban atmospheric conditions on circulatory and respiratory diseases in elder adults. METHODS: Cross-sectional study based on data from 33,212 hospital admissions in adults over 60 years in the city of São Paulo, southeastern Brazil, from 2003 to 2007. The association between atmospheric variables from Congonhas airport and bioclimatic index, Physiological Equivalent Temperature, was analyzed according to the district's socioenvironmental profile. Descriptive statistical analysis and regression models were used. RESULTS: There was an increase in hospital admissions due to circulatory diseases as average and lowest temperatures decreased. The likelihood of being admitted to the hospital increased by 12% with 1ºC decrease in the bioclimatic index and with 1ºC increase in the highest temperatures in the group with lower socioenvironmental conditions. The risk of admission due to respiratory diseases increased with inadequate air quality in districts with higher socioenvironmental conditions. CONCLUSIONS: The associations between morbidity and climate variables and the comfort index varied in different groups and diseases. Lower and higher temperatures increased the risk of hospital admission in the elderly. Districts with lower socioenvironmental conditions showed greater adverse health impacts.

Lower Mortality in Magnet Hospitals

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McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2014-01-01

Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

Bouncers, Brokers, and Glue: The Self-Described Roles of Social Workers in Urban Hospitals

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Craig, Shelley L.; Muskat, Barbara

2013-01-01

Social workers delivering services in health care settings face unique challenges and opportunities. The purpose of this study was to solicit input from social workers employed in urban hospitals about their perceptions of the roles, contribution, and professional functioning of social work in a rapidly changing health care environment. Using…

Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998-2006

International Nuclear Information System (INIS)

Mak, Kimberley S.; Lee, Leslie K.; Mak, Raymond H.; Wang, Shuang; Pile-Spellman, John; Abrahm, Janet L.; Prigerson, Holly G.; Balboni, Tracy A.

2011-01-01

Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding. Results: We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58). Conclusions: In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC

Improving Exclusive Breastfeeding in an Urban Academic Hospital.

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Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M

2017-02-01

Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

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Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

2009-01-01

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

Isomeric structures in neutron-rich odd-odd Pm (Z = 61) isotopes

International Nuclear Information System (INIS)

Sood, P.C.; Singh, B.; Jain, A.K.

2008-01-01

Each of the heavier odd-odd isotopes, namely, 152 Pm, 154 Pm and 156 Pm, have multiple low-lying isomers, almost all of them with undefined configuration and also undefined energy placement. Present investigations attempt credible characterization of the isomers using a simplified two-quasiparticle rotor model which has been widely employed for description of odd-odd deformed nuclei

Survey of odd-odd deformed nuclear spectroscopy

International Nuclear Information System (INIS)

Hoff, R.W.

1993-01-01

In this paper, we survey the current experimental data that support assignment of rotational bands in odd-odd deformed nuclear in the rare earth and actinide regions. We present the results of a new study of 170 Mt nuclear structure. In a comparing experimental and calculated Gallagher-Moszkowski matrix elements for rare earth-region nuclei, we have developed a new approach to the systematics of these matrix elements

Injuries treated in hospital among urban and rural inhabitants of eastern Poland.

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Kos, Marek; Drop, Bartłomiej; Dziewa, Agnieszka; Jędrych, Marian

2017-09-21

Injuries are a serious medical and social problem, especially when accompanied by distant or deferred effects, often causing serious dysfunctions and permanent disability for life. The study aimed at presenting the incidence of injuries of urban and rural population treated in a district hospital in eastern Poland. The study was carried out in the Independent Public Health Care Institution in Kraśnik in 2011 among patients hospitalized in the Department of Trauma Surgery and Orthopedic Unit who sustained injuries. Medical records of 795 patients - 326 women and 469 men, aged 10-99 years, were analyzed. During the period considered among those hospitalized due to injuries, men (59%), those aged 50-59 years (19.0%), and living in rural areas (72.7%) predominated. Injuries most commonly affected the head (18.87%), elbow and forearm (16.86%), knee and lower leg (16.60%), and the hip and thigh (13.96%). Average hospital stay was 5.65 days and was the longest for hip and thigh injuries (11.86 days). Injuries occurred most frequently in the population of patients living in rural areas, often among men, usually on weekdays and in the morning.

Low peak jump power is associated with elevated odds of dysmobility syndrome in community-dwelling elderly individuals: the Korean Urban Rural Elderly (KURE) study.

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Hong, Namki; Kim, Chang Oh; Youm, Yoosik; Kim, Hyeon Chang; Rhee, Yumie

2018-06-01

In a community-dwelling elderly cohort (Korean Urban Rural Elderly), low peak jump power was associated with elevated odds of dysmobility syndrome and its components, independent of age and comorbidities. Jump power measurement improved discrimination of individuals with dysmobility syndrome when added to conventional risk factors. Dysmobility syndrome was proposed to encompass the risks affecting musculoskeletal outcomes. Jump power measurement is a safe, reproducible high-intensity test for physical function in elderly. However, the relationship between jump power and dysmobility syndrome remains unknown. A total of 1369 subjects (mean 71.6 years; women, 66%) were analyzed from a community-based cohort. Dysmobility syndrome was defined as the presence of ≥ 3 factors among falls in the preceding year, low lean mass, high fat mass, osteoporosis, low grip strength, and low timed get-up-and-go (TUG) performance. Subjects were grouped into tertiles of jump power relative to weight based on sex-stratified cutoffs (32.4 and 27.6 W/kg in men; 23.9 and 19.9 W/kg in women) or into the failed-to-jump group. The prevalence of dysmobility syndrome was 20% overall, increasing from the highest (T1) to lowest (T3) jump power tertile (1, 11, 15% in men; 11, 16, 39% in women) and the failed-to-jump group (39% in men; 48% in women). Low jump power or failed-to-jump was associated with elevated odds of dysmobility syndrome (T3 vs. T1, adjusted odds ratio [aOR] 4.35, p jump vs. T1, aOR 7.60, p Jump power modestly discriminated dysmobility syndrome (area under the curve [AUC], 0.71, p jump power was associated with elevated odds of dysmobility syndrome and its components, independent of age and comorbidities.

History of postpartum depression and the odds of maternal corporal punishment.

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Knox, Michele; Rosenberger, Ryan; Sarwar, Sajjad; Mangewala, Vikas; Klag, Natalie

2015-12-01

Corporal punishment is closely related to physical abuse of children and is associated with several negative characteristics and experiences in children and youths. This study examined the relative unique contribution of 6 variables (social support, socioeconomic status, depression, self-efficacy, knowledge of child development, and history of postpartum depression) to maternal corporal punishment of children. A sample of 76 mothers was dichotomized into those who never spanked or hit with an object and those who have spanked or hit with an object. The mothers were recruited from a community mental health agency, an urban community center, and a court of common pleas. The measures in the present study were administered prior to mothers' participation in a parent training program. Mothers referred by the court of common pleas were mandated to participate in the parent training program, and the mothers from the community mental health agency and the urban community center volunteered to participate in the parent training program. However, all participants voluntarily completed the research measures. Binary logistic regression identified postpartum depression as the only variable to significantly increase the odds of corporal punishment (odds ratio = 6.307, 95% confidence interval = 1.098-36.214, p = .039). The findings demonstrate increased odds of corporal punishment among a high-risk sample of women with postpartum depression. The generalizability of these findings may be limited to low socioeconomic class and White and African American mothers enrolled in parent-training programs. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion.

Science.gov (United States)

Durand, Wesley M; Johnson, Joseph R; Li, Neill Y; Yang, JaeWon; Eltorai, Adam E M; DePasse, J Mason; Daniels, Alan H

2018-04-01

competitive intensity was associated with an increased total complication rate (odds ratio [OR] 1.52, p<.0001), device-related complications (OR 1.46, p=.0294), genitourinary complications (OR 2.15, p=.0091), infection (OR 3.48, p<.0001), neurologic complications (OR 1.69, p=.0422), total charges (+29%, p=.0034), and inpatient hospital length of stay (LOS) (+16%, p=.0012). The likelihood of complications at state-owned hospitals (OR 2.81, p=.0001) was more highly associated with HHI than at private, non-profit hospitals (OR 1.39, p=.0050). The occurrence of complications at urban teaching hospitals (OR 2.14, p<.0001) was generally more associated with HHI than at urban non-teaching hospitals (OR 1.19, p=.2457). Increased interhospital competitive intensity is associated with increased odds of complications, increased total charges, and prolonged LOS following lumbar spine fusion. These differences are generally highest among state-owned and urban teaching hospitals. Differences in outcome related to hospital competition may be due to suboptimal resource allocation. Identifying differences in perioperative outcomes associated with hospital market competition is important in the contemporary environment of health care reimbursement reform and hospital consolidation. Perioperative outcome disparities between highly competitive and minimally competitive areas should be monitored and further studied. Copyright © 2017 Elsevier Inc. All rights reserved.

Odd Structures Are Odd

Czech Academy of Sciences Publication Activity Database

Markl, Martin

2017-01-01

Roč. 27, č. 2 (2017), s. 1567-1580 ISSN 0188-7009 Institutional support: RVO:67985840 Keywords : graded vector space * monoidal structure * Odd endomorphism operad Subject RIV: BA - General Mathematics OBOR OECD: Pure mathematics Impact factor: 0.643, year: 2016 http://link.springer.com/article/10.1007%2Fs00006-016-0720-8

Quasiparticle features and level statistics of odd-odd nucleus

International Nuclear Information System (INIS)

Cheng Nanpu; Zheng Renrong; Zhu Shunquan

2001-01-01

The energy levels of the odd-odd nucleus 84 Y are calculated by using the axially symmetric rotor plus quasiparticles model. The two standard statistical tests of Random-Matrix Theory such as the distribution function p(s) of the nearest-neighbor level spacings (NNS) and the spectral rigidity Δ 3 are used to explore the statistical properties of the energy levels. By analyzing the properties of p(s) and Δ 3 under various conditions, the authors find that the quasiparticle features mainly affect the statistical properties of the odd-odd nucleus 84 Y through the recoil term and the Coriolis force in this theoretical mode, and that the chaotic degree of the energy levels decreases with the decreasing of the Fermi energy and the energy-gap parameters. The effect of the recoil term is small while the Coriolis force plays a major role in the spectral structure of 84 Y

Health-related lifestyle behaviors among male and female rural-to-urban migrant workers in Shanghai, China.

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Yang, Hua; He, Fang; Wang, Tianhao; Liu, Yao; Shen, Yao; Gong, Jian; Dai, Wei; Zhou, Jing; Gu, Jie; Tu, Yimin; Wang, Tianying; Shen, Lei; Wu, Yumiao; Xia, Xiuping; Xu, Donghao; Pan, Zhigang; Zhu, Shanzhu

2015-01-01

Lifestyle behaviors significantly impact health, yet remain poorly defined in Chinese rural-to-urban migrants. In a cross-sectional study of health-related behaviors of 5484 rural-to-urban migrants who had worked in Shanghai for at least six months, we assessed the contribution of demographics and physical and mental health to lifestyle behaviors in male and female participants by multiple stepwise cumulative odds logistic regression. Respondents were 51.3% male. 9.9% exhibited abnormal blood pressure; 27.0% were overweight or obese; 11.2% reported abnormal mental health; 36.9% reported healthy lifestyle. Multiple stepwise cumulative odds logistic regression indicated that men working in manufacturing reported less unhealthy lifestyle than those in hospitality (cumulative odds ratio (COR) = 1.806, 95%CI 1.275-2.559) or recreation/leisure (COR = 3.248, 95%CI 2.379-4.435); and women working in manufacturing and construction reported less unhealthy lifestyle than those in all other sectors. Unhealthy lifestyle was associated with small workplaces for men (COR = 1.422, 95%CI 1.154-1.752), working more than 8 or 11 hours per day for women and men, respectively, and earning over 3500 RMB in women (COR = 1.618, 95%CI 1.137-2.303). Single women and women who had previously resided in three or more cities were more likely to report unhealthy lifestyle (COR = 2.023, 95%CI 1.664-2.461, and COR = 1.311, 95%CI 1.072-1.602, respectively). Abnormal mental status was also correlated with unhealthy lifestyle in men (COR = 3.105, 95%CI 2.454-3.930) and women (COR = 2.566, 95%CI 2.024-3.252). There were different risk factors of unhealthy lifestyle score in male and female rural-to-urban migrants, especially in number of cities experienced, salary, marital status, work place scale. Several demographic groups: employment sectors (e.g. hospitality and recreation/leisure), working conditions (e.g. long hours) and abnormal mental status were associated with unhealthy lifestyle behaviors

Health-related lifestyle behaviors among male and female rural-to-urban migrant workers in Shanghai, China.

Directory of Open Access Journals (Sweden)

Hua Yang

Full Text Available Lifestyle behaviors significantly impact health, yet remain poorly defined in Chinese rural-to-urban migrants.In a cross-sectional study of health-related behaviors of 5484 rural-to-urban migrants who had worked in Shanghai for at least six months, we assessed the contribution of demographics and physical and mental health to lifestyle behaviors in male and female participants by multiple stepwise cumulative odds logistic regression.Respondents were 51.3% male. 9.9% exhibited abnormal blood pressure; 27.0% were overweight or obese; 11.2% reported abnormal mental health; 36.9% reported healthy lifestyle. Multiple stepwise cumulative odds logistic regression indicated that men working in manufacturing reported less unhealthy lifestyle than those in hospitality (cumulative odds ratio (COR = 1.806, 95%CI 1.275-2.559 or recreation/leisure (COR = 3.248, 95%CI 2.379-4.435; and women working in manufacturing and construction reported less unhealthy lifestyle than those in all other sectors. Unhealthy lifestyle was associated with small workplaces for men (COR = 1.422, 95%CI 1.154-1.752, working more than 8 or 11 hours per day for women and men, respectively, and earning over 3500 RMB in women (COR = 1.618, 95%CI 1.137-2.303. Single women and women who had previously resided in three or more cities were more likely to report unhealthy lifestyle (COR = 2.023, 95%CI 1.664-2.461, and COR = 1.311, 95%CI 1.072-1.602, respectively. Abnormal mental status was also correlated with unhealthy lifestyle in men (COR = 3.105, 95%CI 2.454-3.930 and women (COR = 2.566, 95%CI 2.024-3.252.There were different risk factors of unhealthy lifestyle score in male and female rural-to-urban migrants, especially in number of cities experienced, salary, marital status, work place scale. Several demographic groups: employment sectors (e.g. hospitality and recreation/leisure, working conditions (e.g. long hours and abnormal mental status were associated with unhealthy lifestyle

Tilted axis rotation in odd-odd {sup 164}Tm

Energy Technology Data Exchange (ETDEWEB)

Reviol, W.; Riedinger, L.L.; Wang, X.Z.; Zhang, J.Y. [Univ. of Tennessee, Knoxville, TN (United States)] [and others

1996-12-31

Ten band structures are observed in {sup 164}Tm, among them sets of parallel and anti-parallel couplings of the proton and neutron spins. The Tilted Axis Cranking scheme is applied for the first time to an odd-odd nucleus in a prominent region of nuclear deformation.

Neighborhood Environment and Disparities in Health Care Access Among Urban Medicare Beneficiaries With Diabetes: A Retrospective Cohort Study.

Science.gov (United States)

Ryvicker, Miriam; Sridharan, Sridevi

2018-01-01

Older adults' health is sensitive to variations in neighborhood environment, yet few studies have examined how neighborhood factors influence their health care access. This study examined whether neighborhood environmental factors help to explain racial and socioeconomic disparities in health care access and outcomes among urban older adults with diabetes. Data from 123 233 diabetic Medicare beneficiaries aged 65 years and older in New York City were geocoded to measures of neighborhood walkability, public transit access, and primary care supply. In 2008, 6.4% had no office-based "evaluation and management" (E&M) visits. Multilevel logistic regression indicated that this group had greater odds of preventable hospitalization in 2009 (odds ratio = 1.31; 95% confidence interval: 1.22-1.40). Nonwhites and low-income individuals had greater odds of a lapse in E&M visits and of preventable hospitalization. Neighborhood factors did not help to explain these disparities. Further research is needed on the mechanisms underlying these disparities and older adults' ability to navigate health care. Even in an insured population living in a provider-dense city, targeted interventions may be needed to overcome barriers to chronic illness care for older adults in the community.

Modeling level structures of odd-odd deformed nuclei

International Nuclear Information System (INIS)

Hoff, R.W.; Kern, J.; Piepenbring, R.; Boisson, J.P.

1984-01-01

A technique for modeling quasiparticle excitation energies and rotational parameters in odd-odd deformed nuclei has been applied to actinide species where new experimental data have been obtained by use of neutron-capture gamma-ray spectroscopy. The input parameters required for the calculation were derived from empirical data on single-particle excitations in neighboring odd-mass nuclei. Calculated configuration-specific values for the Gallagher-Moszkowski splittings were used. Calculated and experimental level structures for 238 Np, 244 Am, and 250 Bk are compared, as well as those for several nuclei in the rare-earth region. The agreement for the actinide species is excellent, with bandhead energies deviating 22 keV and rotational parameters 5%, on the average. Corresponding average deviations for five rare-earth nuclei are 47 keV and 7%. Several applications of this modeling technique are discussed. 18 refs., 5 figs., 4 tabs

Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

Science.gov (United States)

Rao, Aditi D.; Kumar, Aparna; McHugh, Matthew

2017-01-01

Research Purpose Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population. Study Design This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006–2007. Methods Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls. Findings Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p autonomy place their surgical patients at an increased risk for mortality and FTR. Clinical Relevance Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes. PMID:28094907

Structure and symmetries of odd-odd triaxial nuclei

Energy Technology Data Exchange (ETDEWEB)

Palit, R. [Tata Institute of Fundamental Research, Department of Nuclear and Atomic Physics, Colaba, Mumbai (India); Bhat, G.H. [University of Kashmir, Department of Physics, Srinagar (India); Govt. Degree College Kulgam, Department of Physics, Kulgam (India); Sheikh, J.A. [University of Kashmir, Department of Physics, Srinagar (India); Cluster University of Srinagar, Srinagar, Jammu and Kashmir (India)

2017-05-15

Rotational spectra of odd-odd Rh and Ag isotopes are investigated with the primary motivation to search for the spontaneous chiral symmetry breaking phenomenon in these nuclei. The experimental results obtained on the degenerate dipole bands of some of these isotopes using a large array of gamma detectors are discussed and studied using the triaxial projected shell (TPSM) approach. It is shown that, first of all, to reproduce the odd-even staggering of the known yrast bands of these nuclei, large triaxial deformation is needed. This large triaxial deformation also gives rise to doublet band structures in many of these studied nuclei. The observed doublet bands in these isotopes are shown to be reproduced reasonably well by the TPSM calculations. Further, the TPSM calculations for neutron-rich nuclei indicate that the ideal manifestation of the chirality can be realised in {sup 106}Rh and {sup 112}Ag, where the doublet bands have similar electromagnetic properties along with small differences in excitation energies. (orig.)

Hospitals Participating In ACOs Tend To Be Large And Urban, Allowing Access To Capital And Data.

Science.gov (United States)

Colla, Carrie H; Lewis, Valerie A; Tierney, Emily; Muhlestein, David B

2016-03-01

Relationships between physicians and hospitals have changed considerably over the past decade, as hospitals and physician groups have integrated and new public and private payment policies have created financial interdependence. The extent to which accountable care organizations (ACOs) involve hospitals in their operations may prove to be vitally important, because managing hospital care is a key part of improving health care quality and lowering cost growth. Using primary data on ACO composition and capabilities paired with hospital characteristics, we found that 20 percent of US hospitals were part of an ACO in 2014. Hospitals that were in urban areas, were nonprofit, or had a smaller share of Medicare patients were more likely to participate in ACOs, compared to hospitals that were in more rural areas, were for-profit or government owned, or had a larger share of Medicare patients, respectively. Qualitative data identified the following advantages of including a hospital in an ACO: the availability of start-up capital, advanced data sharing, and engagement of providers across the care continuum. Although the 63 percent of ACOs that included hospitals offered more comprehensive services compared to ACOs without hospitals, we found no differences between the two groups in their ability to manage hospital-related aspects of patient care. Project HOPE—The People-to-People Health Foundation, Inc.

Conflicting Coupling of Unpaired Nucleons and the Structure of Collective Bands in Odd-Odd Nuclei

International Nuclear Information System (INIS)

Levon, A.I.; Pasternak, A.A.

2011-01-01

The conflicting coupling of unpaired nucleons in odd-odd nuclei is discussed. A very simple explanation is suggested for the damping of the energy spacing of the lowest levels in the rotational bands in odd-odd nuclei with the 'conflicting' coupling of an odd proton and an odd neutron comparative to those of the bands based on the state of a strongly coupled particle in the neighboring odd nucleus entering the 'conflicting' configuration.

Association of positive responses to suicide screening questions with hospital admission and repeated emergency department visits in children and adolescents.

Science.gov (United States)

Ballard, Elizabeth D; Horowitz, Lisa M; Jobes, David A; Wagner, Barry M; Pao, Maryland; Teach, Stephen J

2013-10-01

Although validated suicide screening tools exist for use among children and adolescents presenting to emergency departments (EDs), the associations between screening positive for suicide risk and immediate psychiatric hospital admission or subsequent ED use, stratified by age, have not been examined. This is a retrospective cohort study of a consecutive case series of patients aged 8 to 18 years presenting with psychiatric chief complaints during a 9-month period to a single urban tertiary care pediatric ED. Eligible patients were administered a subset of questions from the Risk of Suicide Questionnaire. Outcomes included the odds of psychiatric hospitalization at the index visit and repeated ED visits for psychiatric complaints within the following year, stratified by age. Of the 568 patients presenting during the study period, responses to suicide screening questions were available for 442 patients (78%). A total of 159 (36%) of 442 were hospitalized and 130 (29%) of 442 had 1 or more ED visits within the following year. The proportion of patients providing positive responses to 1 or more suicide screening questions did not differ between patients aged 8 to 12 years and those aged 13 to 18 years (77/154 [50%] vs 137/288 [48%], P = 0.63). A positive response to 1 or more of the questions was significantly associated with increased odds of psychiatric hospitalization in the older age group [adjusted odds ratio, 3.82; 95% confidence interval, 2.24-6.54) and with repeated visits to the ED in the younger age group (adjusted odds ratio, 3.55 95% confidence interval, 1.68-7.50). Positive responses to suicide screening questions were associated with acute psychiatric hospitalization and repeated ED visits. Suicide screening in a pediatric ED may identify children and adolescents with increased need of psychiatric resources.

Enhanced T-odd, P-odd electromagnetic moments in reflection asymmetric nuclei

International Nuclear Information System (INIS)

Spevak, V.; Auerbach, N.; Flambaum, V.V.

1997-01-01

Collective P- and T-odd moments produced by parity and time invariance violating forces in reflection asymmetric nuclei are considered. The enhanced collective Schiff, electric dipole, and octupole moments appear due to the mixing of rotational levels of opposite parity. These moments can exceed single-particle moments by more than 2 orders of magnitude. The enhancement is due to the collective nature of the intrinsic moments and the small energy separation between members of parity doublets. In turn these nuclear moments induce enhanced T- and P-odd effects in atoms and molecules. A simple estimate is given and a detailed theoretical treatment of the collective T-, P-odd electric moments in reflection asymmetric, odd-mass nuclei is presented. In the present work we improve on the simple liquid drop model by evaluating the Strutinsky shell correction and include corrections due to pairing. Calculations are performed for octupole deformed long-lived odd-mass isotopes of Rn, Fr, Ra, Ac, and Pa and the corresponding atoms. Experiments with such atoms may improve substantially the limits on time reversal violation. copyright 1997 The American Physical Society

Social media: how hospitals use it, and opportunities for future use.

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Richter, Jason P; Muhlestein, David B; Wilks, Chrisanne E A

2014-01-01

When used effectively, social media benefits hospitals through increased revenue, employee recruitment, and increased customer satisfaction. Although 72% of adults who use the Internet engage in social media, little is known about its prevalence among hospitals and the ways in which hospitals use it. We examined hospital characteristics associated with social media use and how U.S. hospitals use Facebook. Through analysis of websites and Facebook pages, we found that seven in 10 hospitals use social media and that 9% of hospitals with a Facebook page do not provide a link to it from their web page. The odds of social media use were greater in large, urban, nonprofit hospitals; at hospitals affiliated with universities or health systems; and at hospitals that emphasize quality metrics or educational information. Hospitals use Facebook as a dissemination strategy to educate consumers, acknowledge staff, and share news of the hospital's awards. However, the majority of hospitals do not actively engage consumers on Facebook pages. We conclude that this lack of engagement is a lost opportunity to enhance customer service, improve quality of care, and build loyalty. For hospital executives, we illustrate that Facebook is underutilized and that considerable opportunity exists for consumer engagement at a low cost. For policymakers, there is a greater use of social media by nonprofit hospitals, compared to for-profit facilities. As Facebook is most commonly used as an educational tool, it is another example of nonprofit hospitals' heightened focus on health promotion and disease prevention.

Study on the high-spin states and signature inversion of odd-odd nucleus 170Ta

International Nuclear Information System (INIS)

Deng Fuguo; Zhou Hongyu; Sun Huibin; Lu Jingbin; Zhao Guangyi; Yin Lichang; Liu Yunzuo

2002-01-01

The high-spin states of odd-odd nucleus 170 Ta were populated via the 155 Gd( 19 F, 4n) 170 Ta reaction with beam energy of 97 MeV provided by the HI-13 tandem accelerator of China Institute of Atomic Energy. Three rotational bands have been pushed to higher spin states and the signature inversion point of the semidecoupled band based on the πh 9/2 1/2 - [541] direct x νi 13/2 configuration has been observed to be 19.5 ℎ. The systematic features of the signature inversion in semidecoupled bands in odd-odd rare earth nuclei were summarized. The systematic differences of signature inversion, especially the difference in the energy splitting between the yrast hands and the semidecoupled hands in odd-odd rare earth nuclei are pointed out and discussed for the first time. It seems that p-n interaction between the odd proton and odd neutron in the odd-odd nuclei plays an important role

Stillbirths in urban Guinea-Bissau: A hospital- and community-based study.

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Morten Bjerregaard-Andersen

Full Text Available Stillbirth rates remain high in many low-income settings, with fresh (intrapartum stillbirths accounting for a large part due to limited obstetrical care. We aimed to determine the stillbirth rate and identify potentially modifiable factors associated with stillbirth in urban Guinea-Bissau.The study was carried out by the Bandim Health Project (BHP, a Health and Demographic Surveillance System site in the capital Bissau. We assessed stillbirth rates in a hospital cohort consisting of all deliveries at the maternity ward at the National Hospital Simão Mendes (HNSM, and in a community cohort, which only included women from the BHP area. Stillbirth was classified as fresh (FSB if fetal movements were reported on the day of delivery.From October 1 2007 to April 15 2013, a total of 38164 deliveries were registered at HNSM, among them 3762 stillbirths (99/1000 births. Excluding deliveries referred to the hospital from outside the capital (9.6%, the HNSM stillbirth rate was 2786/34490 births (81/1000. During the same period, 15462 deliveries were recorded in the community cohort. Of these, 768 were stillbirths (50/1000. Of 11769 hospital deliveries among women from Bissau with data on fetal movement, 866 (74/1000 were stillbirths, and 609 (70.3% of these were FSB, i.e. potentially preventable. The hospital FSB rate was highest in the evening from 4 pm to midnight (P = 0.04. In the community cohort, antenatal care (ANC attendance correlated strongly with stillbirth reduction; the stillbirth rate was 71/1000 if the mother attended no ANC consultations vs. 36/1000 if she attended ≥7 consultations (P<0.001.In Bissau, the stillbirth rate is alarmingly high. The majority of stillbirths are preventable FSB. Improving obstetrical training, labour management (including sufficient intrapartum monitoring and timely intervention and hospital infrastructure is urgently required. This should be combined with proper community strategies and additional focus on

Hospitalization of nursing home residents: the effects of states' Medicaid payment and bed-hold policies.

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Intrator, Orna; Grabowski, David C; Zinn, Jacqueline; Schleinitz, Mark; Feng, Zhanlian; Miller, Susan; Mor, Vince

2007-08-01

Hospitalizations of nursing home residents are costly and expose residents to iatrogenic disease and social and psychological harm. Economic constraints imposed by payers of care, predominantly Medicaid policies, are hypothesized to impact hospitalizations. Federally mandated resident assessments were merged with Medicare claims and eligibility files to determine hospitalizations and death within 150 days of baseline assessment. Nursing home and market characteristics were obtained from the Online Survey Certification and Reporting, and the Area Resource File, respectively. States' average daily Medicaid nursing home payments and bed-hold policies were obtained independently. Prospective cohort study of 570,614 older (> or =65-year-old), non-MCO (Medicare Managed Care), long-stay (> or =90 days) residents in 8,997 urban, freestanding nursing homes assessed between April and June 2000, using multilevel models to test the impact of state policies on hospitalizations controlling for resident, nursing home, and market characteristics. Overall, 99,379 (17.4 percent) residents were hospitalized with rates varying from 8.4 percent in Utah to 24.9 percent in Louisiana. Higher Medicaid per diem was associated with lower odds of hospitalizations (5 percent lower for each $10 above average $103.5, confidence intervals [CI] 0.91-0.99). Hospitalization odds were higher by 36 percent in states with bed-hold policies (CI: 1.12-1.63). State Medicaid bed-hold policy and per-diem payment have important implications for nursing home hospitalizations, which are predominantly financed by Medicare. This study emphasizes the importance of properly aligning state Medicaid and federal Medicare policies in regards to the subsidy of acute, maintenance, and preventive care in the nursing home setting.

Travel Time to Hospital for Childbirth: Comparing Calculated Versus Reported Travel Times in France.

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Pilkington, Hugo; Prunet, Caroline; Blondel, Béatrice; Charreire, Hélène; Combier, Evelyne; Le Vaillant, Marc; Amat-Roze, Jeanne-Marie; Zeitlin, Jennifer

2018-01-01

Objectives Timely access to health care is critical in obstetrics. Yet obtaining reliable estimates of travel times to hospital for childbirth poses methodological challenges. We compared two measures of travel time, self-reported and calculated, to assess concordance and to identify determinants of long travel time to hospital for childbirth. Methods Data came from the 2010 French National Perinatal Survey, a national representative sample of births (N = 14 681). We compared both travel time measures by maternal, maternity unit and geographic characteristics in rural, peri-urban and urban areas. Logistic regression models were used to study factors associated with reported and calculated times ≥30 min. Cohen's kappa coefficients were also calculated to estimate the agreement between reported and calculated times according to women's characteristics. Results In urban areas, the proportion of women with travel times ≥30 min was higher when reported rather than calculated times were used (11.0 vs. 3.6%). Longer reported times were associated with non-French nationality [adjusted odds ratio (aOR) 1.3 (95% CI 1.0-1.7)] and inadequate prenatal care [aOR 1.5 (95% CI 1.2-2.0)], but not for calculated times. Concordance between the two measures was higher in peri-urban and rural areas (52.4 vs. 52.3% for rural areas). Delivery in a specialised level 2 or 3 maternity unit was a principal determinant of long reported and measured times in peri-urban and rural areas. Conclusions for Practice The level of agreement between reported and calculated times varies according to geographic context. Poor measurement of travel time in urban areas may mask problems in accessibility.

Alpha-cluster preformation factor within cluster-formation model for odd-A and odd-odd heavy nuclei

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Saleh Ahmed, Saad M.

2017-06-01

The alpha-cluster probability that represents the preformation of alpha particle in alpha-decay nuclei was determined for high-intensity alpha-decay mode odd-A and odd-odd heavy nuclei, 82 CSR) and the hypothesised cluster-formation model (CFM) as in our previous work. Our previous successful determination of phenomenological values of alpha-cluster preformation factors for even-even nuclei motivated us to expand the work to cover other types of nuclei. The formation energy of interior alpha cluster needed to be derived for the different nuclear systems with considering the unpaired-nucleon effect. The results showed the phenomenological value of alpha preformation probability and reflected the unpaired nucleon effect and the magic and sub-magic effects in nuclei. These results and their analyses presented are very useful for future work concerning the calculation of the alpha decay constants and the progress of its theory.

The readmission rates in patients with versus those without diabetes mellitus at an urban teaching hospital.

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Sonmez, Halis; Kambo, Varinder; Avtanski, Dimiter; Lutsky, Larry; Poretsky, Leonid

2017-12-01

We examined the 30-day hospital readmission rates and their association with the admission diagnosis and the length of stay (LOS) in patients with diabetes versus those without diabetes mellitus (DM) in an urban teaching hospital. In this retrospective study, we compared the 30-day readmission rates in patients with DM (n=16,266) versus those without DM (n=86,428) at an urban teaching hospital between January 1, 2013, and September 30, 2015. In individuals with a secondary diagnosis of DM, we analyzed the relationship between readmission rates and the ten most common Medicare Severity Diagnosis Related Groups (MS-DRGs). Additionally, we examined the relationship between the LOS and readmission rates in patients with diabetes and those without DM. The 30-day readmission rates adjusted for age and gender were higher in patients with DM compared to those without DM (15.3% vs. 8.4%, respectively, readmissions was present both in patients with a primary or a secondary diagnosis of DM. For the secondary diagnosis of DM, statistically significant difference was present for two out of the ten most common DRGs (DRG # 313 [chest pain], and # 392 [esophagitis, gastroenteritis, and miscellaneous digestive disorders], p=0.045 and 0.009, respectively). There was a direct correlation between LOS and readmission rates in both patients with diabetes and those without DM (preadmission rates are higher in patients with DM compared to patients without DM. DM is an independent risk factor for hospital readmissions. The readmission rates correlate directly with LOS in both patients with diabetes and those without DM. Copyright © 2017 Elsevier Inc. All rights reserved.

Lung cancer risk and pollution in an industrial region of Northern Spain: a hospital-based case-control study.

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López-Cima, María Felicitas; García-Pérez, Javier; Pérez-Gómez, Beatriz; Aragonés, Nuria; López-Abente, Gonzalo; Tardón, Adonina; Pollán, Marina

2011-01-25

Asturias, an Autonomous Region in Northern Spain with a large industrial area, registers high lung cancer incidence and mortality. While this excess risk of lung cancer might be partially attributable to smoking habit and occupational exposure, the role of industrial and urban pollution also needs to be assessed. The objective was to ascertain the possible effect of air pollution, both urban and industrial, on lung cancer risk in Asturias. This was a hospital-based case-control study covering 626 lung cancer patients and 626 controls recruited in Asturias and matched by ethnicity, hospital, age, and sex. Distances from the respective participants' residential locations to industrial facilities and city centers were computed. Using logistic regression, odds ratios (ORs) and 95% confidence intervals (95%CIs) for categories of distance to urban and industrial pollution sources were calculated, with adjustment for sex, age, hospital area, tobacco consumption, family history of cancer, and occupation. Whereas individuals living near industries displayed an excess risk of lung cancer (OR = 1.49; 95%CI = 0.93-2.39), which attained statistical significance for small cell carcinomas (OR = 2.23; 95%CI = 1.01-4.92), residents in urban areas showed a statistically significant increased risk for adenocarcinoma (OR = 1.92; 95%CI = 1.09-3.38). In the Gijon health area, residents in the urban area registered a statistically significant increased risk of lung cancer (OR = 2.17; 95%CI = 1.25-3.76), whereas in the Aviles health area, no differences in risk were found by area of exposure. This study provides further evidence that air pollution is a moderate risk factor for lung cancer.

Medical expenses of urban Chinese patients with stomach cancer during 2002-2011: a hospital-based multicenter retrospective study.

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Sun, Xiao-Jie; Shi, Ju-Fang; Guo, Lan-Wei; Huang, Hui-Yao; Yao, Neng-Liang; Gong, Ji-Yong; Sun, Ya-Wen; Liu, Guo-Xiang; Mao, A-Yan; Liao, Xian-Zhen; Bai, Ya-Na; Ren, Jian-Song; Zhu, Xin-Yu; Zhou, Jin-Yi; Mai, Ling; Song, Bing-Bing; Liu, Yu-Qin; Zhu, Lin; Du, Ling-Bin; Zhou, Qi; Xing, Xiao-Jing; Lou, Pei-An; Sun, Xiao-Hua; Qi, Xiao; Wang, Yuanzheng; Cao, Rong; Ren, Ying; Lan, Li; Zhang, Kai; He, Jie; Wang, Jia-Lin; Dai, Min

2018-04-17

In China, stomach cancer is the third most common cancer and the third leading cause of cancer death. Few studies have examined Chinese stomach cancer patients' medical expenses and their associated trends. The Cancer Screening Program in Urban China (CanSPUC) is a Major Public Health Project funded by the central government. Through this project, we have extracted patients' medical expenses from hospital billing data to examine the costs of the first course treatments (which refers to 2 months before and 10 months after the date of cancer diagnosis) in Chinese patients with stomach cancer and the associated trends. The expense data of 14,692 urban Chinese patients with stomach cancer were collected from 40 hospitals in 13 provinces. We estimated the inflation-adjusted medical expenses per patient during 2002-2011. We described the time trends of medical expenses at the country-level, and those trends by subgroup, and analyzed the compositions of medical expenses. We constructed the Generalized Linear Mixed (GLM) regression model with Poisson distribution to examine the factors that were associated with medical expenses per patient. The average medical expenses of the first course treatments were about 43,249 CNY (6851 USD) in 2011, more than twice of that in 2002. The expenses increased by an average annual rate of 7.4%. Longer stay during hospitalization and an increased number of episodes of care are the two main contributors to the expense increase. The upward trend of medical expenses was observed in almost all patient subgroups. Drug expenses accounted for over half of the medical expenses. The average medical expenses of the first course (2 months before and 10 months after the date of cancer diagnosis) treatments per stomach cancer patient in urban China in 2011 were doubled during the previous 10 years, and about twice as high as the per capita disposable income of urban households in the same year. Such high expenses indicate that it makes economic

Signature inversion of the semi-decoupled band in the odd-odd nucleus 170Ta

International Nuclear Information System (INIS)

Deng Fuguo; Yang Chunxiang; Zhou Hongyu; Sun Huibin; Lu Jingbin; Zhao Guangyi; Yin Lichang; Liu Yunzuo

2001-01-01

The high-spin states of the odd-odd nucleus 170 Ta have been studied by the 155 Gd( 19 F, 4n) 170 Ta reaction at the beam energy of 97 MeV. The α = 1 sequence of the semi-decoupled band has been pushed to higher-spin states and the signature inversion point was observed at 19.5 ℎ. the results are compared with those of the neighbouring odd-odd nuclei

Prevalence of psychological distress and associated factors in urban hospital outpatients in South Africa

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Karl Peltzer

2012-02-01

Full Text Available Objective. The aim of this study was to assess the prevalence of psychological distress and associated factors among outpatients in an urban hospital in South Africa. Method. A sample of 1 532 consecutively selected patients (56.4% men and 43.6% women from various hospital outpatient departments were interviewed with a structured questionnaire. Results. Based on assessment with the Kessler Psychological Distress Scale, a measure of psychological distress, 17.1% of the patients (15.5% of men and 19.4% of women had severe psychological distress. Logistic multiple regression identified no income, poor health status, migraine headache and tuberculosis as significant factors associated with severe psychological stress for men. For women the factors identified were lower education, no income, having been diagnosed with a sexually transmitted disease, stomach ulcer and migraine headache. Conclusion. The study found a high prevalence of psychological distress among hospital outpatients in South Africa. Brief psychological therapies for adult patients with anxiety, depression or mixed common mental health problems treated in hospital outpatient departments are indicated. Accurate diagnosis of co-morbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and optimising the management of somatic symptom burden.

Non-adiabatic description of proton emission from the odd-odd nucleus 130Eu

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Patial Monika

2014-03-01

Full Text Available We discuss the non-adiabatic quasiparticle approach for calculating the rotational spectra and decay width of odd-odd proton emitters. The Coriolis effects are incorporated in both the parent and daughter wave functions. Results for the two probable ground states (1+ and 2+ of the proton emitter 130Eu are discussed. With our calculations, we confirm the proton emitting state to be the Iπ = 1+ state, irrespective of the strength of the Coriolis interaction. This study provides us with an opportunity to look into the details of wave functions of deformed odd-odd nuclei to which the proton emission halflives are quite sensitive.

Epidemiology of Surgically Managed Mandibular Condylar Fractures at a Tertiary Referral Hospital in Urban Southwest China.

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Thapa, Swosti; Wang, Jun; Hu, Hong-Tao; Zhang, Fu-Gui; Ji, Ping

2017-01-01

Mandibular condylar fracture is one of the commonest maxillofacial fractures treated by maxillofacial surgeons. Demography of the patients, causation, and characteristics of the fracture depends on various socio-economic factors. Hence, maxillofacial surgeons should be familiar with epidemiology of mandibular condylar fracture. This study retrospectively describes the demography, etiology, fracture characteristics, and hospital utilization of surgically treated mandibular condylar fractures in a tertiary referral hospital in urban China in past five years. Data of all patients who underwent surgical management between 2011 and 2015 were collected. This included aetiology, characteristics of fracture, time, age, sex, associated injuries, and hospital utilization of 166 patients with 208 mandibular condylar fractures. These patients had undergone open reduction and internal fixation with either miniplates or lag screws. Among the fracture of head of mandibular condyle, 21.28% of the patients had the fracture segments removed. These data were statistically analyzed to describe the epidemiology of mandibular condylar fracture. Most of the patients had unilateral mandibular condylar fractures (74.7%). Male patients (76.51%) outnumbered female patients (23.49%) in this cohort. The average age of the patients was 37 years. The fractures were mostly caused by fall from height (60.84%) and were located at the condylar neck (53.61%). Most of the patients had other associated maxillofacial injuries (71.08%) which were mostly located at symphysis and parasymphysis (44.59%). It took 12.58 +/- 0.35 days of hospitalization for the treatment. Fall from height was the most prevalent cause of mandibular condylar injury in mountainous urban China. The people at highest risk were middle-aged men. Mandibular condylar fracture was mostly located at the condylar neck and was usually associated with fracture at the symphysis and parasymphysis.

Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana.

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Klutsey, Ellen Eyi; Ankomah, Augustine

2014-01-01

Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07-0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19-0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94-7.49 and OR 6.58, CI 2.58-16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39-15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. It was found that lack

A systematic study of odd-odd Gallium nuclei

International Nuclear Information System (INIS)

Allegro, P.R.P.; Medina, N.H.; Oliveira, J.R.B.; Ribas, R.V.; Cybulska, E.W.; Seale, W.A.; Zagatto, V.A.B.; Zahn, G.S.; Genezini, F.A.; Silveira, M.A.G.; Tabor, S.; Bender, P.; Tripathi, V.; Baby, L.

2012-01-01

Full text: Recently, many studies have been published attempting to explain the role of the 0g 9/2 orbital in the high spin excited states of nuclei in the region of the mass A=50-80, especially very neutron rich nuclei like, for example 59-66 Fe [1], 65,67 Cu [2], 70,80 Ge [3,4] nuclei and those with odd mass number like As, Ge and Ga [5]. Stefanescu et al. [6] demonstrated the presence of bands in the neutron-rich isotopes Ga formed from excitation of a proton to the 0g 9/2 orbital and Cheal et al. [7] revealed, from the study of the spins and moments of the ground state, changes in nuclear structure of the odd Ga isotopes between N = 40 and N 50, indicating a change in the energy gap between the 0g 9/2 orbital and the pf shell. In this work, we have performed a systematic study of odd-odd 64,66,68,70 Ga nuclei to examine the behavior of the 0g 9/2 orbital with an increasing number of neutrons. We have compared the predictions of the Large Scale Shell Model, obtained using the Antoine code [8] with the FPG [9] and JUN45 [10] effective interactions, with the experimental results obtained with in-beam gamma-ray spectroscopy experiments performed at University of Sao Paulo using SACI-PERERE spectrometer and at Florida State University using the Clover Array System. We have also performed calculations to study 67 Ge, an odd nucleus in the same mass region, in order to verify the behavior of the effective interactions in a nucleus without the proton-neutron interaction. [1] S. Lunardi. et al., Phys. Rev. C 76, 034303 (2007). [2] C. J. Chiara et al., Phys. Rev. C 85, 024309 (2012). [3] M. Sugawara et al., Phys. Rev. C 81, 024309 (2010). [4] H. Iwasaki.et al., Phys. Rev. C 78, 021304(R) (2008). [5] N. Yoshinaga et al. Phys. Rev. C 78, 044320 (2008). [6] I. Stefanescu et al., Phys. Rev. C 79, 064302 (2009). [7] B. Cheal et al. Phys. Rev. Lett. 104, 252502 (2010). [8] E. Caurier and F. Nowacki, Acta Phys. Polonica B 30, 705 (1999). [9] O. Sorlin et al., Phys. Rev. Lett

Influence of triaxiality on the signature inversion in odd-odd nuclei

International Nuclear Information System (INIS)

Zheng, R.R.; Luo, X.D.; Timar, J.; Sohler, S.; Nyako, B.M.; Zolnai, L.; Paul, E.S.

2004-01-01

Complete text of publication follows. Signature inversion in the A ∼ 100 region has been reported earlier only in the case of the odd-odd 98 Rh nucleus. Our studies on the 100-103 Rh isotopes and a close inspection of the known πg 9/2 νh 11/ 2 bands of the Rh (Z = 45) and Ag (Z = 47) isotopes revealed that the signature splitting effects, earlier considered as quenchings of signature splitting, are not only quenchings but signature inversions. Indeed, the energetically favored signature at low spins in these πg 9/2 νh 11/2 bands is the α = 1 branch (odd spins) instead of the expected α = 0 branch (even spins). The systematic occurrence of signature inversion in this mass region is discussed in Refs. together with attempts to understand its behavior qualitatively. Among many attempts for interpreting the mechanism of signature inversion in odd-odd nuclei, a model using an axially symmetric rotor plus two quasi-particles has already been successfully applied to describe the observed signature inversions in the A ∼ 80 and A ∼ 160 mass regions. According to this model the signature inversion is caused by the competition between the Coriolis and the proton-neutron residual interactions in low K space. Such calculations have been also successfully applied to the π g9/2 νh 11/2 bands in the odd-odd 98 Rh and 102 Rh nuclei. Recent observations of chiral band structures in the nearby Rh nuclei suggest a possibility of triaxiality in these nuclei, too. In the present work we examined the possible influence of triaxiality on the signature inversion using a triaxial rotor plus two-quasiparticle model and compared the results with the experimental data of 98 Rh and 102 Rh. The calculations provided a better agreement with the experiment than the axially symmetric calculations. Compared to the axially symmetric case, the triaxiality applied in the Hamiltonian enlarges the amplitudes of high-spin signature zigzags at small triaxial deformation and might push the

Examining Rural/Urban Differences in Prescription Opioid Misuse Among US Adolescents.

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Monnat, Shannon M; Rigg, Khary K

2016-01-01

This study examines differences in prescription opioid misuse (POM) among adolescents in rural, small urban, and large urban areas of the United States and identifies several individual, social, and community risk factors contributing to those differences. We used nationally representative data from the 2011 and 2012 National Survey on Drug Use and Health and estimated binary logistic regression and formal mediation models to assess past-year POM among 32,036 adolescents aged 12-17. Among adolescents, 6.8% of rural, 6.0% of small urban, and 5.3% of large urban engaged in past-year POM. Net of multiple risk and protective factors, rural adolescents have 35% greater odds and small urban adolescents have 21% greater odds of past-year POM compared to large urban adolescents. The difference between rural and small urban adolescents was not significant. Criminal activity, lower perceived substance use risk, and greater use of emergency medical treatment partially contribute to higher odds among rural adolescents, but they are also partially buffered by less peer substance use, less illicit drug access, and stronger religious beliefs. Researchers, policy makers, and treatment providers must consider the complex array of individual, social, and community risk and protective factors to understand rural/urban differences in adolescent POM. Potential points of intervention to prevent POM in general and reduce rural disparities include early education about addiction risks, use of family drug courts to link criminal offenders to treatment, and access to nonemergency medical services to reduce rural residents' reliance on emergency departments where opioid prescribing is more likely. © 2015 National Rural Health Association.

Prevalence of Alcohol Use and Associated Factors in Urban Hospital Outpatients in South Africa

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Hendry Van der Heever

2011-06-01

Full Text Available The aim of this study was to assess the prevalence of alcohol use and associated factors among outpatients in an urban hospital in South Africa. The sample included 1,532 (56.4% men and women 43.6% consecutively selected patients from different hospital outpatient departments. Results indicate that 41.2% of men and 18.3% of women were found to be hazardous drinkers, and 3.6% of men and 1.4% of women meet criteria for probable alcohol dependence or harmful drinking as defined by the Alcohol Use Disorder Identification Test (AUDIT. Two in five patients (40.5% were hazardous or harmful drinkers and/or had anxiety or depression. Logistic multiple regression found that for men tobacco use and not having been diagnosed with diabetes and for women tobacco use and having been diagnosed with migraine headache was associated with hazardous and harmful drinking. Although the study is cross-sectional, it does identify groups that may be at high risk of alcohol misuse and for whom intervention is urgent. Because prevalence of hazardous and harmful alcohol use is high in this population, routine screening should be introduced in hospital out-patient settings.

Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center.

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Mina, Michael J; Jhunjhunwala, Rashi; Gelbard, Rondi B; Dougherty, Stacy D; Carr, Jacquelyn S; Dente, Christopher J; Nicholas, Jeffrey M; Wyrzykowski, Amy D; Salomone, Jeffrey P; Vercruysse, Gary A; Feliciano, David V; Morse, Bryan C

2017-06-01

Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a "protective" effect for survivors to the hospital (OR = .08). Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination. Copyright © 2016 Elsevier Inc. All rights reserved.

Projected shell model study of odd-odd f-p-g shell proton-rich nuclei

International Nuclear Information System (INIS)

Palit, R.; Sheikh, J.A.; Sun, Y.; Jain, H.C.

2003-01-01

A systematic study of two-quasiparticle bands of the proton-rich odd-odd nuclei in the mass A∼70-80 region is performed using the projected shell model approach. The study includes Br, Rb, and Y isotopes with N=Z+2 and Z+4. We describe the energy spectra and electromagnetic transition strengths in terms of the configuration mixing of the angular-momentum projected multi-quasiparticle states. Signature splitting and signature inversion in the rotational bands are discussed and are shown to be well described. A preliminary study of the odd-odd N=Z nucleus 74 Rb, using the concept of spontaneous symmetry breaking is also presented

First observation of yrast band in odd-odd 162Lu

International Nuclear Information System (INIS)

Zhang, Y.H.; Yuan, G.J.; Liu, X.A.

1996-01-01

High spin states of the odd-odd 162 Lu nucleus have been studied via 147 Sm( 19 F, 4nγ) 162 Lu reaction at 95MeV beam energy. Level scheme for yrast band based on π[h 11/2 ] υ[i 13/2 ] quasiparticle configuration was established up to I π =(23 - ) for the first time. This band shows the signature inversion in energy before backbending generally appeared in this mass region. It is stressed that the signature splitting in 162 Lu is larger than that in the 160 Tm nucleus. (orig.)

Odd-frequency pairing in superconducting heterostructures

Energy Technology Data Exchange (ETDEWEB)

Golubov, A A [Faculty of Science and Technology and MESA Institute for Nanotechnology, University of Twente, 7500 AE Enschede (Netherlands); Tanaka, Y [Department of Applied Physics, Nagoya University, Nagoya, 464-8603 (Japan); Asano, Y [Department of Applied Physics, Hokkaido University, Sapporo 060-8628 (Japan); Tanuma, Y [Institute of Physics, Kanagawa University, 3-7-1, Rokkakubashi, Kanagawa-ku, Yokohama 221-8686 (Japan)], E-mail: a.golubov@utwente.nl

2009-04-22

We review the theory of odd-frequency pairing in superconducting heterostructures, where an odd-frequency pairing component is induced near interfaces. A general description of the superconducting proximity effect in a normal metal or a ferromagnet attached to an unconventional superconductor (S) is given within quasiclassical kinetic theory for various types of symmetry state in S. Various possible symmetry classes in a superconductor are considered which are consistent with the Pauli principle: even-frequency spin-singlet even-parity (ESE) state, even-frequency spin-triplet odd-parity (ETO) state, odd-frequency spin-triplet even-parity (OTE) state and odd-frequency spin-singlet odd-parity (OSO) state. As an example, we consider a junction between a diffusive normal metal (DN) and a p-wave superconductor (even-frequency spin-triplet odd-parity symmetry), where the pairing amplitude in DN belongs to an odd-frequency spin-triplet even-parity symmetry class. We also discuss the manifestation of odd-frequency pairing in conventional superconductor/normal (S/N) proximity systems and its relation to the classical McMillan-Rowell oscillations.

Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

Directory of Open Access Journals (Sweden)

La Thi Quynh Lien

2016-06-01

Full Text Available Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi and in an urban hospital (in the center of Hanoi in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L. Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L. A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01 and metronidazole (r = 0.99; p < 0.001.

Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

Science.gov (United States)

Lien, La Thi Quynh; Hoa, Nguyen Quynh; Chuc, Nguyen Thi Kim; Thoa, Nguyen Thi Minh; Phuc, Ho Dang; Diwan, Vishal; Dat, Nguyen Thanh; Tamhankar, Ashok J.; Lundborg, Cecilia Stålsby

2016-01-01

Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001). PMID:27314366

Physical activity and cardiovascular risk factors among rural and urban groups and rural-to-urban migrants in Peru: a cross-sectional study.

Science.gov (United States)

Masterson Creber, Ruth M; Smeeth, Liam; Gilman, Robert H; Miranda, J Jaime

2010-07-01

To compare physical activity and sedentary behavior patterns of rural-to-urban migrants in Peru versus lifetime rural and urban residents and to determine any associations between low physical activity and four cardiovascular risk factors: obesity (body mass index > 30 kg/m²), systolic and diastolic blood pressure, hypertension, and metabolic syndrome. The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) cross-sectional study was designed to measure physical activity among rural, urban, and rural-to-urban migrants with the International Physical Activity Questionnaire (IPAQ). The World Health Organization (WHO) age-standardized prevalence of low physical activity was 2.2% in lifetime rural residents, 32.2% in rural-to-urban migrants, and 39.2% in lifetime urban residents. The adjusted odds ratios for low physical activity were 21.43 and 32.98 for migrant and urban groups respectively compared to the rural group. The adjusted odds ratio for being obese was 1.94 for those with low physical activity. There was no evidence of an association between low physical activity and blood pressure levels, hypertension, or metabolic syndrome. People living in a rural area had much higher levels of physical activity and lower risk of being overweight and obese compared to those living in an urban area of Lima. Study participants from the same rural area who had migrated to Lima had levels of physical inactivity and obesity similar to those who had always lived in Lima. Interventions aimed at maintaining higher levels of physical activity among rural-to-urban migrants may help reduce the epidemic of obesity in urban cities.

High-Spin States in Odd-Odd N=Z {sup 46}V

Energy Technology Data Exchange (ETDEWEB)

O' Leary, C.D.; Bentley, M.A.; Appelbe, D.E.; Bark, R.A.; Cullen, D.M.; Erturk, S.; Maj. A.; Sheikh, J.A.; Warner, D.D.

1999-12-31

High-spin states up to the F{sub 7/2}-shell band termination at J{pi}=15+ have been observed for the first time in the odd-odd N=Z=23 nucleous {sup 46}V. The new level scheme has two separate structures corresponding to spherical and prolate shapes. A rotational band has very similar energies to the yrast sequence in {sup 46}Ti and is therefore assumed to be a T=1 configuration.

Separate treatment of hospital and urban wastewaters: A real scale comparison of effluents and their effect on microbial communities.

Science.gov (United States)

Chonova, Teofana; Keck, François; Labanowski, Jérôme; Montuelle, Bernard; Rimet, Frédéric; Bouchez, Agnès

2016-01-15

Hospital wastewaters (HWW) contain wider spectrum and higher quantity of pharmaceuticals than urban wastewaters (UWW), but they are generally discharged in sewers without pretreatment. Since traditional urban wastewater treatment plants (WWTP) are not designed to treat HWWs, treated effluents may still contain pollutants that could impair receiving aquatic environments. Hence, a better understanding of the effect of pharmaceuticals in the environment is required. Biofilms are effective "biological sensors" for assessing the environmental effects of pharmaceuticals due to their ability to respond rapidly to physical, chemical and biological fluctuations by changes in their structure and composition. This study evaluated the efficiency of biological treatment with conventional activated sludge system performed parallel on HWW and UWW. Furthermore, six successive monthly colonizations of biofilms were done on autoclaved stones, placed in grid-baskets in the hospital treated effluents (HTE) and urban treated effluents (UTE). The biomass of these biofilms as well as the structure and diversity of their bacterial communities were investigated. Results showed better treatment efficiency for phosphate and nitrite/nitrate during the treatment of UWW. Pharmaceuticals from all investigated therapeutic classes (beta-blockers, nonsteroidal anti-inflammatory drugs, antibiotics, analgesics and anticonvulsants) were efficiently removed, except for carbamazepine. The removal efficiency of the antibiotics, NSAIDs and beta-blockers was higher during the treatment of HWW. HTE and UTE shaped the bacterial communities in different ways. Higher concentrations of pharmaceuticals in the HTE caused adapted development of the microbial community, leading to less developed biomass and lower bacterial diversity. Seasonal changes in solar irradiance and temperature, caused changes in the community composition of biofilms in both effluents. According to the removal efficiency of pharmaceuticals

High-spin states in odd-odd 106,108,110,112Rh

International Nuclear Information System (INIS)

Fotiades, N.; Cizewski, J.A.; Kruecken, R.; McNabb, D.P.; Becker, J.A.; Bernstein, L.A.; Younes, W.; Clark, R.M.; Fallon, P.; Lee, I.Y.; Macchiavelli, A.O.

2003-01-01

The level structures of 106,108,110,112 Rh have been studied in the fission of the compound system formed in three different heavy-ion induced reactions. Sequences of five transitions, together with weak crossover transitions, have been assigned to each isotope based on coincidences with known transitions in the complementary fragments. Comparison with the lighter odd-odd Rh isotopes supports assignment of these sequences as the yrast bands built on the πg 9/2 xνh 11/2 configuration

Effective neutron-proton interaction in rare earth odd-odd nuclei

International Nuclear Information System (INIS)

Boisson, Jean-Paul.

1975-01-01

The effective neutron-proton interaction V(np) in the rare earth odd-odd deformed nuclei is studied. The parameters of the effective interaction are determined from least square fits of calculated matrix elements compared to the ones extracted from experiment. These fits show the existence of a long range repulsive component as well the importance of the even term of the tensor part of V(np). Some informations are obtained concerning the influence of the choice of the sample of experimental data, of the average field and finally, of the radial shape of the effective interaction. Some predictions are made concerning as yet unconfirmed V(np) matrix elements [fr

High-Spin Structure in Odd-Odd 160Lu Nucleus

International Nuclear Information System (INIS)

Wang Lie-Lin; Lu Jing-Bin; Yang Dong; Ma Ke-Yan; Yin Li-Chang; Zhou Yin-Hang; Wu Xiao-Guang; Wen Shu-Xian; Li Guang-Sheng; Yang Chun-Xiang

2012-01-01

The high-spin states of 160 Lu are populated by the fusion-evaporation reaction 144 Sm( 19 F,3n) 160 Lu at beam energies of 90 and 106 MeV. A new level scheme of 160 Lu is established. A possible isomeric state based on the πh 11/2 νh 9/2 configuration is observed. The new decoupled band with the configuration of πd 3/2 [411]1/2 + νi 13/2 [660]1/2 + is established, and the configurations of these similar decoupled bands in the neighboring odd-odd 162−166 Lu nuclei are suggested. A positive parity coupled band is assigned as the πd 5/2 [402]5/2 + νi 13/2 [660]1/2 + configuration. (nuclear physics)

The core-quasiparticle model for odd-odd nuclei and applications to candidates for gamma-ray lasers

International Nuclear Information System (INIS)

Strottman, D.D.

1988-01-01

A reliable estimate of the properties of isomers that may be viable candidates for a gamma-ray laser requires the use of the most accurate save functions possible. The majority of models that have been used to estimate the properties of isomers are applicable to only selected regions of the nuclear mass table. In particular, the Bohr-Mottelson model of odd-A and odd-odd nuclei will fail if the even-even core is not strongly deformed or if the deformations are changing strongly as a function of mass. This paper reports how the problem is overcome in a new core- quasiparticle model for odd-odd nuclei. The model introduces the pairing interaction ab initio; the odd-A states are mixtures of particle and hole states. The core may be soft towards deformation or axial asymmetry and may change rapidly as a function of mass. Thus, the model is ideally suited for application to the region of transitional nuclei such as the Te, La, and Os regions

Gamow-Teller decay of T = 1 nuclei to odd-odd N = Z nuclei

Energy Technology Data Exchange (ETDEWEB)

Lisetskiy, A F [National Superconducting Cyclotron Laboratory, MSU, East Lansing, MI 48824 (United States); Gelberg, A [Institute for Nuclear Physics, University of Cologne, 50937 Cologne (Germany); Institute of Physical and Chemical Reasearch (RIKEN), Wako, 351-0198 (Japan); Brentano, P von [Institute for Nuclear Physics, University of Cologne, 50937 Cologne (Germany)

2005-01-01

Transition strengths of Gamow-Teller decay of T{sub z} = {+-}1 nuclei to N = Z odd-odd nuclei have been calculated in a two-nucleon approximation for spherical and deformed nuclei. The results obtained for the latter are quite close to the values obtained by full-space shell-model calculations and to the experiment.

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya

Science.gov (United States)

Karuri, Stella W.; Murithi, Maureen K.; Irimu, Grace; English, Mike

2017-01-01

Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN) to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County). We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district) hospitals in the CIN, with admissions from February 1 st 2014 to February 28 th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences. PMID:29062911

Magnetic dipole moments of deformed odd-odd nuclei up to 2p-1f shells

Energy Technology Data Exchange (ETDEWEB)

Garg, V P; Verma, A K; Gandhi, R; Sharma, S D [Punjabi Univ., Patiala (India). Dept. of Physics

1981-02-01

The expression for magnetic moments for the states comprising ground state configurations of odd-odd nuclei has been simplified by excluding mixing of other nucleonic configurations. This is contrary to Sharma's and Davidson's results which had been obtained by diagonalizing state matrices for a set of parameters using Davidov and Filippov's non-axial rotor model. According to the relative directions of spins of unpaired odd nucleons, the nuclei have been classified under four categories-an exercise not attempted till now. The calculations have been done with various quenching factors depending upon the relative spin orientations of odd nucleons. For most of the nuclei, the results show considerable improvement over those of Gallagher and Moszkowski and of Sharma.

Association Between Hospitals Caring for a Disproportionately High Percentage of Minority Trauma Patients and Increased Mortality

Science.gov (United States)

Haider, Adil H.; Ong’uti, Sharon; Efron, David T.; Oyetunji, Tolulope A.; Crandall, Marie L.; Scott, Valerie K.; Haut, Elliott R.; Schneider, Eric B.; Powe, Neil R.; Cooper, Lisa A.; Cornwell, Edward E.

2012-01-01

Objective To determine whether there is an increased odds of mortality among trauma patients treated at hospitals with higher proportions of minority patients (ie, black and Hispanic patients combined). Design Hospitals were categorized on the basis of the percentage of minority patients admitted with trauma. The adjusted odds of in-hospital mortality were compared between hospitals with less than 25% of patients who were minorities (the reference group) and hospitals with 25% to 50% of patients who were minorities and hospitals with more than 50% of patients who were minorities. Multivariate logistic regression (with generalized linear modeling and a cluster-correlated robust estimate of variance) was used to control for multiple patient and injury severity characteristics. Setting A total of 434 hospitals in the National Trauma Data Bank. Participants Patients aged 18 to 64 years whose medical records were included in the National Trauma Data Bank for the years 2007 and 2008 with an Injury Severity Score of 9 or greater and who were white, black, or Hispanic. Main Outcome Measures Crude mortality and adjusted odds of in-hospital mortality. Results A total of 311 568 patients were examined. Hospitals in which the percentage of minority patients was more than 50% also had younger patients, fewer female patients, more patients with penetrating trauma, and the highest crude mortality. After adjustment for potential confounders, patients treated at hospitals in which the percentage of minority patients was 25% to 50% and at hospitals in which the percentage of minority patients was more than 50% demonstrated increased odds of death (adjusted odds ratio, 1.16 [95% confidence interval, 1.01–1.34] and adjusted odds ratio, 1.37 [95% confidence interval, 1.16–1.61], respectively), compared with the reference group. This disparity increased further on subset analysis of patients with a blunt injury. Uninsured patients had significantly increased odds of mortality within

The Trend Odds Model for Ordinal Data‡

Science.gov (United States)

Capuano, Ana W.; Dawson, Jeffrey D.

2013-01-01

Ordinal data appear in a wide variety of scientific fields. These data are often analyzed using ordinal logistic regression models that assume proportional odds. When this assumption is not met, it may be possible to capture the lack of proportionality using a constrained structural relationship between the odds and the cut-points of the ordinal values (Peterson and Harrell, 1990). We consider a trend odds version of this constrained model, where the odds parameter increases or decreases in a monotonic manner across the cut-points. We demonstrate algebraically and graphically how this model is related to latent logistic, normal, and exponential distributions. In particular, we find that scale changes in these potential latent distributions are consistent with the trend odds assumption, with the logistic and exponential distributions having odds that increase in a linear or nearly linear fashion. We show how to fit this model using SAS Proc Nlmixed, and perform simulations under proportional odds and trend odds processes. We find that the added complexity of the trend odds model gives improved power over the proportional odds model when there are moderate to severe departures from proportionality. A hypothetical dataset is used to illustrate the interpretation of the trend odds model, and we apply this model to a Swine Influenza example where the proportional odds assumption appears to be violated. PMID:23225520

The trend odds model for ordinal data.

Science.gov (United States)

Capuano, Ana W; Dawson, Jeffrey D

2013-06-15

Ordinal data appear in a wide variety of scientific fields. These data are often analyzed using ordinal logistic regression models that assume proportional odds. When this assumption is not met, it may be possible to capture the lack of proportionality using a constrained structural relationship between the odds and the cut-points of the ordinal values. We consider a trend odds version of this constrained model, wherein the odds parameter increases or decreases in a monotonic manner across the cut-points. We demonstrate algebraically and graphically how this model is related to latent logistic, normal, and exponential distributions. In particular, we find that scale changes in these potential latent distributions are consistent with the trend odds assumption, with the logistic and exponential distributions having odds that increase in a linear or nearly linear fashion. We show how to fit this model using SAS Proc NLMIXED and perform simulations under proportional odds and trend odds processes. We find that the added complexity of the trend odds model gives improved power over the proportional odds model when there are moderate to severe departures from proportionality. A hypothetical data set is used to illustrate the interpretation of the trend odds model, and we apply this model to a swine influenza example wherein the proportional odds assumption appears to be violated. Copyright © 2012 John Wiley & Sons, Ltd.

Migration, urbanization, and drug use and casual sex in China: a multilevel analysis

OpenAIRE

Xiushi Yang; Huasong Luo

2009-01-01

Using data from a survey conducted in 2003 and employing multilevel modeling, this paper examines the impact of migration and urbanization on drug abuse and casual sex in China. The results suggest that being a migrant predicts significantly higher odds of having casual sex but lower odds of drug abuse. Living in an urban place is a significant risk factor for both illicit drug use and casual sex. There are significant cross-community (primary sampling unit) variances in the random intercept ...

Hospitalization rates among economic immigrants to Canada.

Science.gov (United States)

Ng, Edward; Sanmartin, Claudia; Manuel, Douglas G

2017-07-19

Economic immigrants generally, and economic class principal applicants (ECPAs) specifically, tend to have better health than other immigrants. However, health outcomes vary among subcategories within this group, especially by sex. This study examines hospitalization rates among ECPAs aged 25 to 74 who arrived in Canada between 1980 and 2006 as skilled workers, business immigrants, or live-in caregivers. The analysis used two linked databases to estimate age-standardized hospitalization rates (ASHRs) overall and for leading causes by sex. ASHRs of ECPA subcategories were compared with each other and with those of the Canadian-born population. Logistic regression was used to derive odds ratios for hospitalization among ECPAs, by sex. Male and female ECPAs aged 25 to 74 had significantly lower all-cause ASHRs than did the Canadian-born population in the same age range. This pattern prevailed for each ECPA subcategory and for each disease examined. Compared with skilled workers, business immigrants had lower odds of hospitalization; live-in caregivers who arrived after 1992 had higher odds. Adjustment for education, official language proficiency, and world region reduced the strength of or eliminated these associations. Compared with the Canadian-born population, ECPAs generally had low hospitalization rates. Differences were apparent among ECPA subcategories.

Effectiveness of smoking-cessation interventions for urban hospital patients: study protocol for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Grossman Ellie

2012-08-01

Full Text Available Abstract Background Hospitalization may be a particularly important time to promote smoking cessation, especially in the immediate post-discharge period. However, there are few studies to date that shed light on the most effective or cost-effective methods to provide post-discharge cessation treatment, especially among low-income populations and those with a heavy burden of mental illness and substance use disorders. Methods/design This randomized trial will compare the effectiveness and cost-effectiveness of two approaches to smoking cessation treatment among patients discharged from two urban public hospitals in New York City. During hospitalization, staff will be prompted to ask about smoking and to offer nicotine replacement therapy (NRT on admission and at discharge. Subjects will be randomized on discharge to one of two arms: one arm will be proactive multi-session telephone counseling with motivational enhancement delivered by study staff, and the other will be a faxed or online referral to the New York State Quitline. The primary outcome is 30-day point-prevalence abstinence from smoking at 6-month follow-up post-discharge. We will also examine cost-effectiveness from a societal and a payer perspective, as well as explore subgroup analyses related to patient location of hospitalization, race/ethnicity, immigrant status, and inpatient diagnosis. Discussion This study will explore issues of implementation feasibility in a post-hospitalization patient population, as well as add information about the effectiveness and cost-effectiveness of different strategies for designing smoking cessation programs for hospitalized patients. Trial registration Clinicaltrials.gov ID# NCT01363245

Urban sprawl and its relationship with active transportation, physical activity and obesity in Canadian youth.

Science.gov (United States)

Seliske, Laura; Pickett, William; Janssen, Ian

2012-06-01

Urban sprawl is a potential environmental influence on youth overweight/obesity. However, little is known about the association between urban sprawl and behaviours that influence obesity such as active transportation and physical activity. The study population consisted of 7,017 respondents aged 12 to 19 to the 2007/2008 Canadian Community Health Survey, living in Canada's 33 census metropolitan areas (CMAs). Factor analysis was used to obtain an urban sprawl score for each CMA, incorporating dwelling density, percentage of single or detached dwelling units, and percentage of the population living in the urban core. Multi-level logistic regression examined whether urban sprawl was associated with frequent active transportation (30 or more minutes a day), moderate-to-vigorous physical activity (MVPA) (60 or more minutes a day), and overweight/obesity. Urban sprawl was associated with active transportation among 12- to 15-year-olds, with the relative odds of engaging in at least 30 minutes of active transportation per day increasing by 24% (95% CI: 10-39%) for each standard deviation (SD) increase in the urban sprawl score. For the entire sample aged 12 to 19, higher urban sprawl was associated with MVPA (odds ratio per SD increase = 1.10, 95% CI: 1.01-1.20), but not with overweight/obesity (odds ratio per SD increase = 1.06, 95% CI: 0.94-1.18). Urban sprawl was associated with active transportation and MVPA in Canadian youth, although in the opposite direction to what has been reported in the literature for adults.

The impact of urbanization on the community food environment in China.

Science.gov (United States)

Wu, Yang; Xue, Hong; Wang, Huijun; Su, Chang; Du, Shufa; Wang, Youfa

2017-05-01

Research on how urbanization has influenced the food environment in China is limited. The study aimed to examine the impact of urbanization on the food environment in China. Longitudinal data collected during 1989-2009 from the China Health and Nutrition Survey were used, which covered 9 provinces in China. Urbanicity index (0-10) was assessed using an urbanicity scale. Final analyses included 216 communities. Random-effect models were used in analyses. Urbanization (higher urbanicity index) increased the odds of having fast food restaurants (OR=2.78, 95% CI: 2.18-3.54) and other indoor restaurants (OR=2.93, 95% CI: 2.28-3.76) within the community, the odds of having supermarkets (OR=2.43, 95% CI: 2.04-2.89) and free markets (OR=2.56, 95% CI: 1.77-3.70) within 30 minutes' bus ride from the community. Food prices for apples (β=0.06, 95% CI: 0.04-0.08) and lean pork (β =0.02, 95% CI: 0.01-0.03) increased with urbanicity, while prices for other food did not. Urbanicity was positively associated with community norms for fast food consumption (RR=1.28, 95% CI: 1.22-1.33), fast food preferences (RR=1.09, 95% CI: 1.06-1.12) and nutrition knowledge (RR=1.02, 95% CI: 1.01-1.03). Urbanization is associated with food environment in China. The findings provide insight for future economic development and public health efforts related to urbanization.

Factors associated with induced abortion at selected hospitals in the Volta Region, Ghana

Directory of Open Access Journals (Sweden)

Klutsey EE

2014-08-01

Full Text Available Ellen Eyi Klutsey,1 Augustine Ankomah2 1School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, 2Department of Population, Family and Reproductive Health School of Public Health, University of Ghana, Legon, Accra, Ghana Background: Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods: A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results: Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22. Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65. It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively

Urban Rural Comparisons of Polycystic Ovary Syndrome Burden among Adolescent Girls in a Hospital Setting in India

Directory of Open Access Journals (Sweden)

Swetha Balaji

2015-01-01

Full Text Available Background. Polycystic ovarian syndrome (PCOS is a multifaceted disorder characterized by varying clinical presentations. Objective. The aim of this study was to determine urban and rural differences in the burden of polycystic ovarian syndrome among Indian adolescent females aged 12 to 19 years. Methods. A pilot cross-sectional study was conducted for a period of one month (August-September 2013 at Balaji Hospital, Vellore, Tamil Nadu, India. The final sample included 126 study participants located in various urban (50%, n=63 and rural (50%, n=63 settings. Information was gathered on sociodemographic and anthropometric characteristics, clinical history, occurrence of acne and hirsutism, serum testosterone levels, obstetric history, family history of chronic diseases, menstrual history, physical activity, and dietary intake. Results. Eighteen percent of the participants were confirmed of having PCOS by recent guidelines of Rotterdam Consensus for adolescent diagnosis of PCOS (presence of all three elements. Majority of the individuals with PCOS had an average age of 16 (SD = 2 (P=.02 years with an average age of menarche 12 years (SD = 1. Conclusion. The proportion of participants diagnosed with PCOS was higher among urban participants in comparison to rural participants.

Boson and fermion degrees of freedom in the orthosymplectic extension of the IVBM: Odd-odd nuclear spectra

International Nuclear Information System (INIS)

Ganev, H. G.; Georgieva, A. I.

2008-01-01

The dynamical symmetry group Sp(12, R) of the Interacting Vector Boson Model (IVBM) is extended to the orthosymplectic group OSp(2Ω/12, R) in order to incorporate fermion degrees of freedom. The structure of even-even nuclei is used as a core on which the collective excitations of the neighboring odd-mass and odd-odd nuclei are build on. Hence, the spectra of odd-mass and odd-odd nuclei arise as a result of the coupling of the fermion degrees of freedom, specified by the fermion sector SOF (2Ω) to the boson core, whose states belong to an Sp(12, R) irreducible representation. The orthosymplectic dynamical symmetry is applied for the simultaneous description of the spectra of some neighboring nuclei from rare earth region. The theoretical predictions for different low-lying collective bands with positive and negative parity are compared with the experiment. The obtained results reveal the applicability of the model and its boson-fermion extension.

Nursing magnet hospitals have better CMS hospital compare ratings

Directory of Open Access Journals (Sweden)

Robbins RA

2017-11-01

Full Text Available Background: There has been conflicting data on whether Nursing Magnet Hospitals (NMH provide better care. Methods: NMH in the Southwest USA (Arizona, California, Colorado, Hawaii, Nevada, and New Mexico were compared to hospitals not designated as NMH using the Centers for Medicare and Medicaid (CMS hospital compare star designation. Results: NMH had higher star ratings than non-NMH hospitals (3.34 + 0.78 vs. 2.86 + 0.83, p<0.001. The hospitals were mostly large, urban non-critical access hospitals. Academic medical centers made up a disproportionately large portion of the NMH. Conclusions: Although NMH had higher hospital ratings, the data may favor non-critical access academic medical centers which are known to have better outcomes.

Social and clinical predictors of drug-resistant tuberculosis in a public hospital, Monterrey, Mexico.

Science.gov (United States)

Young, Bonnie N; Burgos, Marcos; Handal, Alexis J; Baker, Jack; Rendón, Adrian; Rosas-Taraco, Adrian; Long, Jeffrey; Hunley, Keith

2014-10-01

Drug-resistant tuberculosis (DRTB) is steadily increasing in Mexico, but little is known of patient risk factors in the Mexico-United States border region. This preliminary case-control study included 95 patients with active pulmonary TB with drug susceptibility results attending the José E. González University Hospital in the urban hub of Nuevo León-the Monterrey Metropolitan Area. We report potential social and clinical risk factors of DRTB among this hospital-based sample. We collected data through face-to-face interviews and medical record reviews from 25 cases with DRTB and 70 drug-sensitive controls. DNA was collected to assess an effect of genetic ancestry on DRTB by using a panel of 291,917 genomic markers. We calculated crude and multivariate logistic regression. After adjusting for potential confounding factors, we found that prior TB treatment (odds ratio, 4.5; 95% confidence interval, 0.9-21.1) and use of crack cocaine (odds ratio, 4.6; 95% confidence interval, 1.1-18.7) were associated with DRTB. No other variables, including genetic ancestry and comorbidities, were predictive. Health care providers may benefit from recognizing predictors of DRTB in regions where routine drug susceptibility testing is limited. Prior TB treatment and illicit drug use, specifically crack cocaine, may be important risk factors for DRTB in this region. Copyright © 2014 Elsevier Inc. All rights reserved.

Quartetting in even-even and odd-odd N=Z nuclei

Science.gov (United States)

Sambataro, M.; Sandulescu, N.

2018-02-01

We report on a microscopic description of even-even N = Z nuclei in a formalism of quartets. Quartets are four-body correlated structures characterized by isospin T and angular momentum J. We show that the ground state correlations induced by a realistic shell model interaction can be well accounted for in terms of a restricted set of T = 0 low-J quartets, the J = 0 one playing by far a leading role among them. A conceptually similar description of odd-odd self-conjugate nuclei is given in terms of two distinct families of building blocks, one formed by the same T = 0 quartets employed for the even-even systems and the other by collective pairs with either T = 0 or T = 1. Some applications of this formalism are discussed for nuclei in the sd shell.

Gamow-Teller transitions and proton-neutron pair correlation in N =Z odd-odd p -shell nuclei

Science.gov (United States)

Morita, Hiroyuki; Kanada-En'yo, Yoshiko

2017-10-01

We have studied the Gamow-Teller (GT) transitions from N =Z +2 neighbors to N =Z odd-odd nuclei in the p -shell region by using isospin-projected and β γ -constraint antisymmetrized molecular dynamics combined with the generator coordinate method. The calculated GT transition strengths from 0+1 states to 1+0 states such as 6He(01+1 ) →6Li(11+0 ) , 10Be(01+1 ) →10B(11+0 ) , and 14C(01+1 ) →14N(12+0 ) exhaust more than 50% of the sum rule. These N =Z +2 initial states and N =Z odd-odd final states are found to dominantly have S =0 ,T =1 n n pairs and S =1 ,T =0 p n pairs, respectively. Based on the two-nucleon (N N ) pair picture, we can understand the concentration of the GT strengths as the spin-isospin-flip transition n n (S =0 ,T =1 )→p n (S =1 ,T =0 ) in L S coupling. The GT transition can be a good probe to identify the spin-isospin partner states with n n pairs and p n pairs of N =Z +2 and N =Z odd-odd nuclei, respectively.

Calculation of β-ray spectra. Odd-odd nuclei

International Nuclear Information System (INIS)

Tachibana, Takahiro

1996-01-01

In order to study β-ray of atomic nucleus, it is natural to consider β-ray data fundamental and important. In a recent experiment, Rudstam measured β-ray spectra from short term nuclear fission product species in 1990. It is an important check point in theoretical study on β-ray to investigate if these experimental data can be reproduced by any theoretical calculation. As there are several spectrum studies of β-ray through decay heat for its various properties due to the general theory of the β-decay, little descriptions can be found. In even such studies, spectra under high excitation state of daughter species difficult to measure and apt to short experimental results were treated with combination spectra composed of experimental and calculated values such as substitution of a part of the general theory with calculated value. In this paper, the β spectra supposed by only the general theory was reported without using such data combination in order to confirm effectiveness of the theory. In particular, this report was described mainly on the results using recent modification of odd-odd nucleus species. (G.K.)

Calculation of {beta}-ray spectra. Odd-odd nuclei

Energy Technology Data Exchange (ETDEWEB)

Tachibana, Takahiro [Waseda Univ., Tokyo (Japan). Advanced Research Center for Science and Engineering

1996-05-01

In order to study {beta}-ray of atomic nucleus, it is natural to consider {beta}-ray data fundamental and important. In a recent experiment, Rudstam measured {beta}-ray spectra from short term nuclear fission product species in 1990. It is an important check point in theoretical study on {beta}-ray to investigate if these experimental data can be reproduced by any theoretical calculation. As there are several spectrum studies of {beta}-ray through decay heat for its various properties due to the general theory of the {beta}-decay, little descriptions can be found. In even such studies, spectra under high excitation state of daughter species difficult to measure and apt to short experimental results were treated with combination spectra composed of experimental and calculated values such as substitution of a part of the general theory with calculated value. In this paper, the {beta} spectra supposed by only the general theory was reported without using such data combination in order to confirm effectiveness of the theory. In particular, this report was described mainly on the results using recent modification of odd-odd nucleus species. (G.K.)

Democracy against the odds

DEFF Research Database (Denmark)

Seeberg, Michael

Why have a number of poor countries sustained electoral democracy against the odds? The extant literature on democracy and democratization consistently points to the importance of socioeconomic development and democratic neighboring countries, in particular, as important prerequisites for a stable...... demonstrates the enormous potential of political parties and civil society in processes of democratization. ------------------------------------------------------------------- Hvorfor opretholder en række fattige lande en demokratisk styreform imod alle odds? Demokratiforskere forventer, at et land må have et...

Influence of triaxiality on the signature inversion in odd-odd nuclei

International Nuclear Information System (INIS)

Zheng Renrong; Zhu Shunquan; Luo Xiangdong; Gizon, A.; Gizon, J.; Paul, E.S.

2004-01-01

The nature of signature inversion in the πg 9/2 νh 11/2 bands of odd-odd 98,102 Rh nuclei is studied. Calculations are performed by using a triaxial rotor plus two-quasiparticle model and are compared with the experimentally observed signature inversions. The calculations reproduce well the observations and suggest that, in these bands, the signature inversion can be interpreted mainly as a competition between the Coriolis and the proton-neutron residual interactions in low K space. The triaxiality applied in the Hamiltonian enlarges the amplitudes of high spin signature zigzags at small triaxial deformation and might push the signature inversion point to higher spin at large triaxial deformation

Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008.

LENUS (Irish Health Repository)

McGowan, B

2013-03-13

INTRODUCTION: Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures. AIM: To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region. METHODOLOGY: We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James\\'s Hospital, Dublin. RESULTS: The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers. CONCLUSION: The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.

Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers.

Science.gov (United States)

Glover, McKinley; Khalilzadeh, Omid; Choy, Garry; Prabhakar, Anand M; Pandharipande, Pari V; Gazelle, G Scott

2015-10-01

An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook(®) correlate with a Hospital Compare(®) metric, specifically 30-day all cause unplanned hospital readmission rates. This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p Facebook-related variables. Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

Impact of urban sprawl on overweight, obesity, and physical activity in Sydney, Australia.

Science.gov (United States)

Garden, Frances L; Jalaludin, Bin B

2009-01-01

Obesity and inadequate physical activity are major risk factors for many diseases. The built environment plays an important role in influencing participation in physical activity. We aimed to determine whether urban sprawl in Sydney, Australia is associated with overweight/obesity and levels of physical activity. We used a cross-sectional multilevel study design to relate urban sprawl (based on population density) measured at an area level to overweight/obesity and levels of physical activity measured at an individual level whilst controlling for individual and area level covariates in metropolitan Sydney. Individual level data were obtained from the 2002 and 2003 New South Wales Population Health Survey. We had information on 7,290 respondents. The mean population density was 2,168 persons per square kilometer (standard deviation=1,741, range=218-7,045). After controlling for individual and area level covariates, for an inter-quartile increase in sprawl, the odds of being overweight was 1.26 (95% CI=1.10-1.44), the odds of being obese was 1.47 (95% CI=1.24-1.75), the odds of inadequate physical activity was 1.38 (95% CI=1.21-1.57), and the odds of not spending any time walking during the past week was 1.58 (95% CI=1.28-1.93). Living in more sprawling suburbs increases the risk of overweight/obesity and inadequate physical activity despite the relatively low levels of urban sprawl in metropolitan Sydney. Modifications to the urban environment to increase physical activity may be worthwhile.

Linear odd Poisson bracket on Grassmann variables

International Nuclear Information System (INIS)

Soroka, V.A.

1999-01-01

A linear odd Poisson bracket (antibracket) realized solely in terms of Grassmann variables is suggested. It is revealed that the bracket, which corresponds to a semi-simple Lie group, has at once three Grassmann-odd nilpotent Δ-like differential operators of the first, the second and the third orders with respect to Grassmann derivatives, in contrast with the canonical odd Poisson bracket having the only Grassmann-odd nilpotent differential Δ-operator of the second order. It is shown that these Δ-like operators together with a Grassmann-odd nilpotent Casimir function of this bracket form a finite-dimensional Lie superalgebra. (Copyright (c) 1999 Elsevier Science B.V., Amsterdam. All rights reserved.)

Population characteristics of markets of safety-net and non-safety-net hospitals.

Science.gov (United States)

Gaskin, D J; Hadley, J

1999-09-01

To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals. To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals. The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share payments and on state and local government subsidies to remain solvent. USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments. Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid and Medicare patient

Urban-rural differences in childhood and adolescent obesity in the United States: a systematic review and meta-analysis.

Science.gov (United States)

Johnson, James Allen; Johnson, Asal Mohamadi

2015-06-01

A systematic literature review and subsequent meta-analysis were performed to investigate differences in childhood obesity between urban and rural areas in the United States. A search of published studies comparing childhood obesity in urban and rural settings was undertaken by probing PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for articles that met predetermined inclusion criteria. A subsequent meta-analysis was conducted to determine the combined effect size and significance of differences in childhood obesity between urban and rural areas. Ten studies were identified for systematic review, five of which contributed to the meta-analysis. All but one study suggested that residence in rural areas was associated with higher prevalence or increased odds of childhood obesity, compared to children living in urban areas. A meta-analysis of 74,168 pooled participants ages 2-19 found that rural children have 26% greater odds of obesity, compared to urban children (odds ratio=1.26; 95% confidence interval, 1.21-1.32). Obesity rates are higher among rural children than urban children in the United States. To ensure successful targeted interventions and effective resource allocation, practitioners and policy makers alike should be cognizant of this disparity in childhood obesity.

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

Covariant Density Functionals: time-odd channel investigated

International Nuclear Information System (INIS)

Afanasjev, A. V.; Abusara, H.

2009-01-01

The description of exotic nuclear systems and phenomena requires a detailed understanding of all channels of density functional theories. The role of time-odd mean fields, their evidence in experiment, and an accurate description of these fields are subject of current interest. Recent studies advanced the understanding of these fields in energy density functional theories based on the Skyrme force [1,2]. Time-odd mean fields are related to nuclear magnetism in covariant density functional (CDF) theories [3]. They arise from space-like components of vector mesons and Lorentz invariance requires that their coupling strengths are identical to that of time-like components. There were only few limited efforts to understand the role of time-odd mean fields in covariant density functional theory [4,5]. For example, the microscopic role of nuclear magnetism and its impact on rotational properties of nuclei has been studied in Ref. [5]. It is known that time-odd mean fields modify the angular momentum content of the single-particle orbitals and thus the moments of inertia, effective alignments, alignment gains at the band crossings and other physical observables. We aim on more detailed and systematic understanding of the role of time-odd mean fields in covariant density functional theory. This investigation covers both rotating and non-rotating systems. It is shown that contrary to the Skyrme energy density functionals time-odd mean fields of CDF theory always provide additional binding in the systems with broken time-reversal symmetry (rotating nuclei, odd mass nuclei). This additional binding increases with spin and has its maximum exactly at the terminating state [6], where it can reach several MeV. The impact of time-odd mean fields on the properties of rotating systems has been studied in a systematic way (as a function of particle number and deformation) across the nuclear chart [7]. In addition, this contribution extends these studies to non-rotating systems such as

Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

Science.gov (United States)

Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

2010-06-01

We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

Descriptive Analysis on the Impacts of Universal Zero-Markup Drug Policy on a Chinese Urban Tertiary Hospital.

Directory of Open Access Journals (Sweden)

Wei Tian

Full Text Available Universal Zero-Markup Drug Policy (UZMDP mandates no price mark-ups on any drug dispensed by a healthcare institution, and covers the medicines not included in the China's National Essential Medicine System. Five tertiary hospitals in Beijing, China implemented UZMDP in 2012. Its impacts on these hospitals are unknown. We described the effects of UZMDP on a participating hospital, Jishuitan Hospital, Beijing, China (JST.This retrospective longitudinal study examined the hospital-level data of JST and city-level data of tertiary hospitals of Beijing, China (BJT 2009-2015. Rank-sum tests and join-point regression analyses were used to assess absolute changes and differences in trends, respectively.In absolute terms, after the UZDMP implementation, there were increased annual patient-visits and decreased ratios of medicine-to-healthcare-charges (RMOH in JST outpatient and inpatient services; however, in outpatient service, physician work-days decreased and physician-workload and inflation-adjusted per-visit healthcare charges increased, while the inpatient physician work-days increased and inpatient mortality-rate reduced. Interestingly, the decreasing trend in inpatient mortality-rate was neutralized after UZDMP implementation. Compared with BJT and under influence of UZDMP, JST outpatient and inpatient services both had increasing trends in annual patient-visits (annual percentage changes[APC] = 8.1% and 6.5%, respectively and decreasing trends in RMOH (APC = -4.3% and -5.4%, respectively, while JST outpatient services had increasing trend in inflation-adjusted per-visit healthcare charges (APC = 3.4% and JST inpatient service had decreasing trend in inflation-adjusted per-visit medicine-charges (APC = -5.2%.Implementation of UZMDP seems to increase annual patient-visits, reduce RMOH and have different impacts on outpatient and inpatient services in a Chinese urban tertiary hospital.

Descriptive Analysis on the Impacts of Universal Zero-Markup Drug Policy on a Chinese Urban Tertiary Hospital.

Science.gov (United States)

Tian, Wei; Yuan, Jiangfan; Yang, Dong; Zhang, Lanjing

2016-01-01

Universal Zero-Markup Drug Policy (UZMDP) mandates no price mark-ups on any drug dispensed by a healthcare institution, and covers the medicines not included in the China's National Essential Medicine System. Five tertiary hospitals in Beijing, China implemented UZMDP in 2012. Its impacts on these hospitals are unknown. We described the effects of UZMDP on a participating hospital, Jishuitan Hospital, Beijing, China (JST). This retrospective longitudinal study examined the hospital-level data of JST and city-level data of tertiary hospitals of Beijing, China (BJT) 2009-2015. Rank-sum tests and join-point regression analyses were used to assess absolute changes and differences in trends, respectively. In absolute terms, after the UZDMP implementation, there were increased annual patient-visits and decreased ratios of medicine-to-healthcare-charges (RMOH) in JST outpatient and inpatient services; however, in outpatient service, physician work-days decreased and physician-workload and inflation-adjusted per-visit healthcare charges increased, while the inpatient physician work-days increased and inpatient mortality-rate reduced. Interestingly, the decreasing trend in inpatient mortality-rate was neutralized after UZDMP implementation. Compared with BJT and under influence of UZDMP, JST outpatient and inpatient services both had increasing trends in annual patient-visits (annual percentage changes[APC] = 8.1% and 6.5%, respectively) and decreasing trends in RMOH (APC = -4.3% and -5.4%, respectively), while JST outpatient services had increasing trend in inflation-adjusted per-visit healthcare charges (APC = 3.4%) and JST inpatient service had decreasing trend in inflation-adjusted per-visit medicine-charges (APC = -5.2%). Implementation of UZMDP seems to increase annual patient-visits, reduce RMOH and have different impacts on outpatient and inpatient services in a Chinese urban tertiary hospital.

The nurse work environment, job satisfaction and turnover rates in rural and urban nursing units.

Science.gov (United States)

Baernholdt, Marianne; Mark, Barbara A

2009-12-01

The aim of the present study was to determine whether there are differences in hospital characteristics, nursing unit characteristics, the nurse work environment, job satisfaction and turnover rates in rural and urban nursing units. Research in urban hospitals has found an association between the nurse work environment and job satisfaction and turnover rates, but this association has not been examined in rural hospitals. Rural and urban nursing units were compared in a national random sample of 97 United States hospitals (194 nursing units) with between 99 and 450 beds. Significant differences were found between hospital and nursing unit characteristics and the nurse work environment in rural and urban nursing units. Both nursing unit characteristics and the work environment were found to have a significant influence on nurse job satisfaction and turnover rates. Job satisfaction and turnover rates in rural and urban nursing units are associated with both nursing unit characteristics and the work environment. Both rural and urban hospitals can improve nurse job satisfaction and turnover rates by changing unit characteristics, such as creating better support services and a work environment that supports autonomous nursing practice. Rural hospitals can also improve the work environment by providing nurses with more educational opportunities.

Charity care in nonprofit urban hospitals: analysis of the role of size and ownership type in Washington State for 2011.

Science.gov (United States)

Coyne, Joseph S; Ogle, Natalie M; McPherson, Sterling; Murphy, Sean; Smith, Gary J; Davidson, Gregg Agustín

2014-01-01

Nonprofit hospitals are expected to serve their communities as charitable organizations in exchange for the tax exemption benefits they receive. With the passage into law of the Affordable Care Act, additional guidelines were generated in 2010 to ensure nonprofit hospitals are compliant. Nonetheless, the debate continues on whether nonprofit hospitals provide adequate charity care to their patient population. In this study, charity care provided by 29 Washington State nonprofit urban hospitals was examined for 2011 using financial data from the Washington State Department of Health. Charity care levels were compared to both income tax savings and gross revenues to generate two financial ratios that were analyzed according to hospital bed size and nonprofit ownership type. For the first ratio, 97% of the hospitals (28 of 29) were providing charity care in greater amounts than the tax savings they accrued. The average ratio value using total charity care and total income tax savings of all the hospitals in the study was 6.10, and the median value was 3.46. The nonparametric Kruskal-Wallis test results by bed size and nonprofit ownership type indicate that ownership type has a significant effect on charity care to gross revenue ratios (p = .020). Our analysis indicates that church-owned hospitals had higher ratios of charity care to gross revenues than did the other two ownership types--government and voluntary--in this sample. Policy implications are offered and further studies are recommended to analyze appropriate levels of charity care in nonprofit hospitals given new requirements for maintaining a hospital's tax-exempt status.

Effects of Air Pollution on Hospital Emergency Room Visits for Respiratory Diseases: Urban-Suburban Differences in Eastern China

Directory of Open Access Journals (Sweden)

Peng Liu

2016-03-01

Full Text Available A study on the relationships between ambient air pollutants (PM2.5, SO2 and NO2 and hospital emergency room visits (ERVs for respiratory diseases from 2013 to 2014 was performed in both urban and suburban areas of Jinan, a heavily air-polluted city in Eastern China. This research was analyzed using generalized additive models (GAM with Poisson regression, which controls for long-time trends, the “day of the week” effect and meteorological parameters. An increase of 10 μg/m3 in PM2.5, SO2 and NO2 corresponded to a 1.4% (95% confidence interval (CI: 0.7%, 2.1%, 1.2% (95% CI: 0.5%, 1.9%, and 2.5% (95%: 0.8%, 4.2% growth in ERVs for the urban population, respectively, and a 1.5% (95%: 0.4%, 2.6%, 0.8% (95%: −0.7%, 2.3%, and 3.1% (95%: 0.5%, 5.7% rise in ERVs for the suburban population, respectively. It was found that females were more susceptible than males to air pollution in the urban area when the analysis was stratified by gender, and the reverse result was seen in the suburban area. Our results suggest that the increase in ERVs for respiratory illnesses is linked to the levels of air pollutants in Jinan, and there may be some urban-suburban discrepancies in health outcomes from air pollutant exposure.

Nuclear structure of the N = Z odd - odd nuclei around N=28 closed shell interpreted with IBFFM

International Nuclear Information System (INIS)

Dragulescu, E.; Serbanut, G. C.; Serbanut, I.

2001-01-01

In the very recent years the knowledge of the level structure at lower and higher energies in the fpg shell N=Z nuclei has renewed a growing interest due to major improvements in the theoretical techniques. Going away from closed shell, the shell model calculations rapidly exhaust computer capabilities and we must resort to the model observed on collective phenomena. The fpg odd-odd N = Z nuclei close to the doubly magic 56 Ni nucleus are good candidates to investigate the competition between collective and single-particle excitations. Here part of the results obtained from an exhaustive systematic study of the self conjugate doubly-odd nuclei with A > 62: 62 Ga and 66 As nuclei using the interacting - boson - fermion - fermion - model (IBFFM) is presented. The odd-odd nuclei are described in the framework of the IBFFM by coupling valence shell proton and neutron quasiparticles to even-even core described in the interacting - boson model. In the first step of the calculations the core parameters for 60 Zn and 64 Ge cores were fitted to the energies of their excited states. In the second step of calculations, we have adjusted the IBFM proton Hamiltonian to the low - lying levels of 63 Ga and 67 As nuclei and IBFM neutron Hamiltonian of low - lying levels of 61 Zn and 65 Ge nuclei involved in the cases of the structure of odd-odd 62 Ga and 66 As nuclei. We have finally calculated the level spectra and electromagnetic properties of above mentioned nuclei. The IBFFM positive - parity energy spectra are compared with experimental ones. The calculations show a reasonable agreement with experimental data and existing shell - model calculations. (authors)

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Stella W. Karuri

2017-08-01

Full Text Available Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County. We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district hospitals in the CIN, with admissions from February 1st 2014 to February 28th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences.

Using data from a multi-hospital clinical network to explore prevalence of pediatric rickets in Kenya [version 2; referees: 2 approved

Directory of Open Access Journals (Sweden)

Stella W. Karuri

2017-11-01

Full Text Available Background: Nutritional rickets is a public health concern in developing countries despite tropical climates and a re-emerging issue in developed countries. In this study, we reviewed pediatric admission data from the Clinical Information Network (CIN to help determine hospital and region based prevalence of rickets in three regions of Kenya (Central Kenya, Western Kenya and Nairobi County. We also examine the association of rickets with other diagnosis, such as malnutrition and pneumonia, and study the effect of rickets on regional hospital stays. Methods: We analyzed discharge records for children aged 1 month to 5 years from county (formerly district hospitals in the CIN, with admissions from February 1st 2014 to February 28th 2015. The strength of the association between rickets and key demographic factors, as well as with malnutrition and pneumonia, was assessed using odds ratios. The Fisher exact test was used to test the significance of the estimated odd ratios. Kaplan-Meier curves were used to analyze length of hospital stays. Results: There was a marked difference in prevalence across the three regions, with Nairobi having the highest number of cases of rickets at a proportion of 4.01%, followed by Central Region at 0.92%. Out of 9756 admissions in the Western Region, there was only one diagnosis of rickets. Malnutrition was associated with rickets; this association varied regionally. Pneumonia was found to be associated with rickets in Central Kenya. Children diagnosed with rickets had longer hospital stays, even when cases of malnutrition and pneumonia were excluded in the analysis. Conclusion: There was marked regional variation in hospital based prevalence of rickets, but in some regions it is a common clinical diagnosis suggesting the need for targeted public health interventions. Factors such as maternal and child nutrition, urbanization and cultural practices might explain these differences.

Odd-odd neutron-excess nuclei from the magicity region close to 132Sn

International Nuclear Information System (INIS)

Erokhina, K.I.; Isakov, V.I.

1994-01-01

This is the second publication in a series devoted to theoretical study of neutron-excess nuclei close to the doubly magic nuclide 132 Sn. Odd-odd nuclei from this region are considered by using the quasi-boson approximation. Energy level spectra, electromagnetic transition probabilities, and β-decay properties of nuclei are analyzed. Among other things, the renormalization of the axial-vector constant in the nucleus is determined. Numerical calculations are made for 134 Sb, 130 In, 132 Sb, and 132 In nuclides. Whenever possible, the results are compared with experimental data. 33 refs., 11 figs., 1 tab

Occurrence of antibiotics and antibiotic resistance genes in hospital and urban wastewaters and their impact on the receiving river.

Science.gov (United States)

Rodriguez-Mozaz, Sara; Chamorro, Sara; Marti, Elisabet; Huerta, Belinda; Gros, Meritxell; Sànchez-Melsió, Alexandre; Borrego, Carles M; Barceló, Damià; Balcázar, Jose Luis

2015-02-01

Antibiotic resistance has become a major health concern; thus, there is a growing interest in exploring the occurrence of antibiotic resistance genes (ARGs) in the environment as well as the factors that contribute to their emergence. Aquatic ecosystems provide an ideal setting for the acquisition and spread of ARGs due to the continuous pollution by antimicrobial compounds derived from anthropogenic activities. We investigated, therefore, the pollution level of a broad range of antibiotics and ARGs released from hospital and urban wastewaters, their removal through a wastewater treatment plant (WWTP) and their presence in the receiving river. Several antimicrobial compounds were detected in all water samples collected. Among antibiotic families, fluoroquinolones were detected at the highest concentration, especially in hospital effluent samples. Although good removal efficiency by treatment processes was observed for several antimicrobial compounds, most antibiotics were still present in WWTP effluents. The results also revealed that copy numbers of ARGs, such as blaTEM (resistance to β-lactams), qnrS (reduced susceptibility to fluoroquinolones), ermB (resistance to macrolides), sulI (resistance to sulfonamides) and tetW (resistance to tetracyclines), were detected at the highest concentrations in hospital effluent and WWTP influent samples. Although there was a significant reduction in copy numbers of these ARGs in WWTP effluent samples, this reduction was not uniform across analyzed ARGs. Relative concentration of ermB and tetW genes decreased as a result of wastewater treatment, whereas increased in the case of blaTEM, sulI and qnrS genes. The incomplete removal of antibiotics and ARGs in WWTP severely affected the receiving river, where both types of emerging pollutants were found at higher concentration in downstream waters than in samples collected upstream from the discharge point. Taken together, our findings demonstrate a widespread occurrence of

Hospital Clostridium difficile infection (CDI) incidence as a risk factor for hospital-associated CDI.

Science.gov (United States)

Miller, Aaron C; Polgreen, Linnea A; Cavanaugh, Joseph E; Polgreen, Philip M

2016-07-01

Environmental risk factors for Clostridium difficile infections (CDIs) have been described at the room or unit level but not the hospital level. To understand the environmental risk factors for CDI, we investigated the association between institutional- and individual-level CDI. We performed a retrospective cohort study using the Healthcare Cost and Utilization Project state inpatient databases for California (2005-2011). For each patient's hospital stay, we calculated the hospital CDI incidence rate corresponding to the patient's quarter of discharge, while excluding each patient's own CDI status. Adjusting for patient and hospital characteristics, we ran a pooled logistic regression to determine individual CDI risk attributable to the hospital's CDI rate. There were 10,329,988 patients (26,086 cases and 10,303,902 noncases) who were analyzed. We found that a percentage point increase in the CDI incidence rate a patient encountered increased the odds of CDI by a factor of 1.182. As a point of comparison, a 1-percentage point increase in the CDI incidence rate that the patient encountered had roughly the same impact on their odds of acquiring CDI as a 55.8-day increase in their length of stay or a 60-year increase in age. Patients treated in hospitals with a higher CDI rate are more likely to acquire CDI. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Differences in Hospital Readmission Risk across All Payer Groups in South Carolina.

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Chakraborty, Hrishikesh; Axon, Robert Neal; Brittingham, Jordan; Lyons, Genevieve Ray; Cole, Laura; Turley, Christine B

2017-06-01

To evaluate differences in hospital readmission risk across all payers in South Carolina (SC). South Carolina Revenue and Fiscal Affairs Office (SCRFA) statewide all payer claims database including 2,476,431 hospitalizations in SC acute care hospitals between 2008 and 2014. We compared the odds of unplanned all-cause 30-day readmission for private insurance, Medicare, Medicaid, uninsured, and other payers and examined interaction effects between payer and index admission characteristics using generalized estimating equations. SCRFA receives claims and administrative health care data from all SC health care facilities in accordance with SC state law. Odds of readmission were lower for females compared to males in private, Medicare, and Medicaid payers. African Americans had higher odds of readmission compared to whites across private insurance, Medicare, and Medicaid, but they had lower odds among the uninsured. Longer length of stay had the strongest association with readmission for private and other payers, whereas an increased number of comorbidities related to the highest readmission odds within Medicaid. Associations between index admission characteristics and readmission likelihood varied significantly with payer. Findings should guide the development of payer-specific quality improvement programs. © Health Research and Educational Trust.

Hospital care for mental health and substance abuse conditions in Parkinson's disease.

Science.gov (United States)

Willis, Allison W; Thibault, Dylan P; Schmidt, Peter N; Dorsey, E Ray; Weintraub, Daniel

2016-12-01

The objective of this study was to examine mental health conditions among hospitalized individuals with Parkinson's disease in the United States. This was a serial cross-sectional study of hospitalizations of individuals aged ≥60 identified in the Nationwide Inpatient Sample dataset from 2000 to 2010. We identified all hospitalizations with a diagnosis of PD, alcohol abuse, anxiety, bipolar disorder, depression, impulse control disorders, mania, psychosis, substance abuse, and attempted suicide/suicidal ideation. National estimates of each mental health condition were compared between hospitalized individuals with and without PD. Hierarchical logistic regression models determined which inpatient mental health diagnoses were associated with PD, adjusting for demographic, payer, geographic, and hospital characteristics. We identified 3,918,703 mental health and substance abuse hospitalizations. Of these, 2.8% (n = 104, 437) involved a person also diagnosed with PD. The majority of mental health and substance abuse patients were white (86.9% of PD vs 83.3% of non-PD). Women were more common than men in both groups (male:female prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34), psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse control disorders (adjusted odds ratio 1.51, 1.31-1.75), and mania (adjusted odds ratio 1.43, 1.18-1.74) were more likely among PD patients, alcohol abuse was less likely (adjusted odds ratio 0.26, 0.25-0.27). We found no PD-associated difference in suicide-related care. PD patients have unique patterns of acute care for mental health and substance abuse. Research is needed to guide PD treatment in individuals with pre-existing psychiatric illnesses, determine cross provider reliability of psychiatric diagnoses in PD patients, and inform efforts to improve psychiatric outcomes. © 2016 International Parkinson and

Level structures in odd-odd deformed nucleus {sup 184}Ta

Energy Technology Data Exchange (ETDEWEB)

Gowrishankar, R.; Sood, P.C. [Sri Sathya Sai Institute of Higher Learning, Department of Physics, Prasanthinilayam (India)

2016-02-15

A detailed low-energy level scheme of the odd-odd n-rich nucleus {sub 73}{sup 184}Ta{sub 111} is constructed using the well tested Two-Quasiparticle Rotor Model (TQRM) for calculating the bandhead energies of physically admissible 2qp configurations with the inclusion of residual n-p interaction contribution. The presently available data on this level scheme from {sup 184}Hf decay are shown to be in agreement with these calculations. Our analysis concludes that {sup 184}Hf (Q{sub β} = 1340(30) keV) decay admits of 7 additional (to the 3 presently reported) β -branches to {sup 184}Ta with J = 0 or 1 and 8 more physically admissible weak (1f{sup u}) β -branches populating J{sup π} = 2{sup -} levels in {sup 184}Ta. Further, a close examination of our level scheme clearly indicates the existence of a low-lying (E{sub x} = 260(40) keV) high-spin (J{sup π} = 10{sup -}) long-lived isomer in this nucleus. (orig.)

Coulomb excitation of the odd-odd isotopes $^{106, 108}$In

CERN Document Server

Ekstrom, A; Blazhev, A; Van de Walle, J; Weisshaar, D; Zielinska, M; Tveten, G M; Marsh, B A; Siem, S; Gorska, M; Engeland, T; Hurst, A M; Cederkall, J; Finke, F; Iwanicki, J; Hjorth-Jensen, M; Davinson, T; Eberth, J; Sletten, G; Mierzejewski, J; Reiter, P; Warr, N; Butler, P A; Fahlander, C; Stefanescu, I; Koester, U; Ivanov, O; Wenander, F; Voulot, D

2010-01-01

The low-lying states in the odd-odd and unstable isotopes In-106,In-108 have been Coulomb excited from the ground state and the first excited isomeric state at the REX-ISOLDE facility at CERN. With the additional data provided here the pi g(9/2)(-1) circle times nu d(5/2) and pi g(9/2)(-1) circle times nu g7/2 multiplets have been re-analyzed and are modified compared to previous results. The observed gamma-ray de-excitation patterns were interpreted within a shell model calculation based on a realistic effective interaction. The agreement between theory and experiment is satisfactory and the calculations reproduce the observed differences in the excitation pattern of the two isotopes. The calculations exclude a 6(+) ground state in In-106. This is in agreement with the conclusions drawn using other techniques. Furthermore, based on the experimental results, it is also concluded that the ordering of the isomeric and ground state in In-108 is inverted compared to the shell model prediction. Limits on B(E2) val...

Health literacy and English language comprehension among elderly inpatients at an urban safety-net hospital.

Science.gov (United States)

Cordasco, Kristina M; Asch, Steven M; Franco, Idalid; Mangione, Carol M

2009-01-01

To evaluate the relationship between health literacy and age in chronically-ill inpatients at a safety-net hospital. We recruited 399 English- and Spanish-speaking inpatients being evaluated or treated for Congestive Heart Failure or Coronary Artery Disease at a large, urban safety-net teaching hospital in Southern California. Participants were interviewed to ascertain education, English comprehension, and in-home language use. Health literacy was assessed using The Test of Functional Health Literacy in Adults (TOFHLA). We compared by age (aged 65 or more, 51 to 64 years of age, and less than age 50) levels of health literacy, educational attainment, English comprehension, and language use. Prevalence of inadequate health literacy significantly increased with increasing age (87.2% in > or = 65, 48.9% for 51-64, and 26.3% in immigration status. Additionally, older patients were more likely to have never learned to read (34.9% in > or = 65, 6.5% for 51-64, and 1.5% in or = 65, 9.0% for 51-64, and 0.8% in or = 65, 43.5% for 51-64, and 35.8% in language at home (82.3% in > or = 65, 70.2% for 51-64, and 62.2% in < or = 50, p=0.015). To prepare to meet the chronic disease needs of a growing older patient population, and ameliorate the negative health effects of associated low literacy, safety-net hospital leaders and providers need to prioritize the development and implementation of low-literacy educational materials, programs, and services.

Study on rotational bands in odd-odd nuclei 102,l04Nb by using PSM

International Nuclear Information System (INIS)

Dong Yongsheng; Hu Wentao; Feng Youliang; Wang Jinbao; Yu Shaoying; Shen Caiwan

2012-01-01

The Projected Shell Model (PSM) is used to study the low energy scheme of the neutron-rich normal-deformed isotopes of odd-odd nuclei 102,104 Nb. The quasiparticle configuration is assigned. The theoretical calculations of the energy band of 102,104 Nb could well reproduce the experimental data. It is shown that PSM is a valid method for studying the low energy scheme of heavy nuclei. (authors)

Odd-frequency pairing in superconducting heterostructures .

Science.gov (United States)

Golubov, A. A.; Tanaka, Y.; Yokoyama, T.; Asano, Y.

2007-03-01

We present a general theory of the proximity effect in junctions between unconventional superconductors and diffusive normal metals (DN) or ferromagnets (DF). We consider all possible symmetry classes in a superconductor allowed by the Pauli principle: even-frequency spin-singlet even-parity state, even-frequency spin-triplet odd-parity state, odd-frequency spin-triplet even-parity state and odd-frequency spin-singlet odd-parity state. For each of the above states, symmetry and spectral properties of the induced pair amplitude in the DN (DF) are determined. The cases of junctions with spin-singlet s- and d-wave superconductors and spin-triplet p-wave superconductors are adressed in detail. We discuss the interplay between the proximity effect and midgap Andreev bound states arising at interfaces in unconventional (d- or p-wave) junctions. The most striking property is the odd-frequency symmetry of the pairing amplitude induced in DN (DF) in contacts with p-wave superconductors. This leads to zero-energy singularity in the density of states and to anomalous screening of an external magnetic field. Peculiarities of Josephson effect in d- or p-wave junctions are discussed. Experiments are suggested to detect an order parameter symmetry using heterostructures with unconventional superconductors.

Hospitalization patterns associated with Appalachian coal mining.

Science.gov (United States)

Hendryx, Michael; Ahern, Melissa M; Nurkiewicz, Timothy R

2007-12-01

The goal of this study was to test whether the volume of coal mining was related to population hospitalization risk for diseases postulated to be sensitive or insensitive to coal mining by-products. The study was a retrospective analysis of 2001 adult hospitalization data (n = 93,952) for West Virginia, Kentucky, and Pennsylvania, merged with county-level coal production figures. Hospitalization data were obtained from the Health Care Utilization Project National Inpatient Sample. Diagnoses postulated to be sensitive to coal mining by-product exposure were contrasted with diagnoses postulated to be insensitive to exposure. Data were analyzed using hierarchical nonlinear models, controlling for patient age, gender, insurance, comorbidities, hospital teaching status, county poverty, and county social capital. Controlling for covariates, the volume of coal mining was significantly related to hospitalization risk for two conditions postulated to be sensitive to exposure: hypertension and chronic obstructive pulmonary disease (COPD). The odds for a COPD hospitalization increased 1% for each 1462 tons of coal, and the odds for a hypertension hospitalization increased 1% for each 1873 tons of coal. Other conditions were not related to mining volume. Exposure to particulates or other pollutants generated by coal mining activities may be linked to increased risk of COPD and hypertension hospitalizations. Limitations in the data likely result in an underestimate of associations.

Level Density In Interacting Boson-Fermion-Fermion Model (IBFFM) Of The Odd-Odd Nucleus 196Au

International Nuclear Information System (INIS)

Kabashi, Skender; Bekteshi, Sadik

2007-01-01

The level density of the odd-odd nucleus 196Au is investigated in the interacting boson-fermion-fermion model (IBFFM) which accounts for collectivity and complex interaction between quasiparticle and collective modes.The IBFFM total level density is fitted by Gaussian and its tail is also fitted by Bethe formula and constant temperature Fermi gas model

Tuberculosis in an urban area in China: differences between urban migrants and local residents.

Directory of Open Access Journals (Sweden)

Xin Shen

Full Text Available BACKGROUND: The increase in urban migrants is one of major challenges for tuberculosis control in China. The different characteristics of tuberculosis cases between urban migrants and local residents in China have not been investigated before. METHODOLOGY/PRINCIPAL FINDINGS: We performed a retrospective study of all pulmonary tuberculosis patients reported in Songjiang district, Shanghai, to determine the demographic, clinical and microbiological characteristics of tuberculosis cases between urban migrants and local residents. We calculated the odds ratios (OR and performed multivariate logistic regression to identify the characteristics that were independently associated with tuberculosis among urban migrants. A total of 1,348 pulmonary tuberculosis cases were reported during 2006-2008, among whom 440 (32.6% were local residents and 908 (67.4% were urban migrants. Urban migrant (38.9/100,000 population had higher tuberculosis rates than local residents (27.8/100,000 population, and the rates among persons younger than age 35 years were 3 times higher among urban migrants than among local residents. Younger age (adjusted OR per additional year at risk = 0.92, 95% CI: 0.91-0.94, p<0.001, poor treatment outcome (adjusted OR = 4.12, 95% CI: 2.65-5.72, p<0.001, and lower frequency of any comorbidity at diagnosis (adjusted OR = 0.20, 95% CI: 0.13-0.26, p = 0.013 were significantly associated with tuberculosis patients among urban migrants. There were poor treatment outcomes among urban migrants, mainly from transfers to another jurisdiction (19.3% of all tuberculosis patients among urban migrants. CONCLUSIONS/SIGNIFICANCE: A considerable proportion of tuberculosis cases in Songjiang district, China, during 2006-2008 occurred among urban migrants. Our findings highlight the need to develop and implement specific tuberculosis control strategies for urban migrants, such as more exhaustive case finding, improved case management and follow-up, and use of

The odd side of torsion geometry

DEFF Research Database (Denmark)

Conti, Diego; Madsen, Thomas Bruun

2014-01-01

We introduce and study a notion of `Sasaki with torsion structure' (ST) as an odd-dimensional analogue of Kähler with torsion geometry (KT). These are normal almost contact metric manifolds that admit a unique compatible connection with 3-form torsion. Any odd-dimensional compact Lie group is sho...

AKI in Children Hospitalized with Nephrotic Syndrome.

Science.gov (United States)

Rheault, Michelle N; Zhang, Lei; Selewski, David T; Kallash, Mahmoud; Tran, Cheryl L; Seamon, Meredith; Katsoufis, Chryso; Ashoor, Isa; Hernandez, Joel; Supe-Markovina, Katarina; D'Alessandri-Silva, Cynthia; DeJesus-Gonzalez, Nilka; Vasylyeva, Tetyana L; Formeck, Cassandra; Woll, Christopher; Gbadegesin, Rasheed; Geier, Pavel; Devarajan, Prasad; Carpenter, Shannon L; Kerlin, Bryce A; Smoyer, William E

2015-12-07

Children with nephrotic syndrome can develop life-threatening complications, including infection and thrombosis. While AKI is associated with adverse outcomes in hospitalized children, little is known about the epidemiology of AKI in children with nephrotic syndrome. The main objectives of this study were to determine the incidence, epidemiology, and hospital outcomes associated with AKI in a modern cohort of children hospitalized with nephrotic syndrome. Records of children with nephrotic syndrome admitted to 17 pediatric nephrology centers across North America from 2010 to 2012 were reviewed. AKI was classified using the pediatric RIFLE definition. AKI occurred in 58.6% of 336 children and 50.9% of 615 hospitalizations (27.3% in stage R, 17.2% in stage I, and 6.3% in stage F). After adjustment for race, sex, age at admission, and clinical diagnosis, infection (odds ratio, 2.24; 95% confidence interval, 1.37 to 3.65; P=0.001), nephrotoxic medication exposure (odds ratio, 1.35; 95% confidence interval, 1.11 to 1.64; P=0.002), days of nephrotoxic medication exposure (odds ratio, 1.10; 95% confidence interval, 1.05 to 1.15; Pchildren with nephrotic syndrome. Nephrotoxic medication exposure was common in this population, and each additional nephrotoxic medication received during a hospitalization was associated with 38% higher risk of AKI. AKI was associated with longer hospital stay after adjustment for race, sex, age at admission, clinical diagnosis, and infection (difference, 0.45 [log]days; 95% confidence interval, 0.36 to 0.53 [log]days; Pchildren hospitalized with nephrotic syndrome and should be deemed the third major complication of nephrotic syndrome in children in addition to infection and venous thromboembolism. Risk factors for AKI include steroid-resistant nephrotic syndrome, infection, and nephrotoxic medication exposure. Children with AKI have longer hospital lengths of stay and increased need for intensive care unit admission. Copyright © 2015 by the

Degenerate odd Poisson bracket on Grassmann variables

International Nuclear Information System (INIS)

Soroka, V.A.

2000-01-01

A linear degenerate odd Poisson bracket (antibracket) realized solely on Grassmann variables is proposed. It is revealed that this bracket has at once three Grassmann-odd nilpotent Δ-like differential operators of the first, second and third orders with respect to the Grassmann derivatives. It is shown that these Δ-like operators, together with the Grassmann-odd nilpotent Casimir function of this bracket, form a finite-dimensional Lie superalgebra

Delays in accessing electroconvulsive therapy: a comparison between two urban and two rural populations in Australia.

Science.gov (United States)

Johnston, Natalie E

2015-10-01

A comparison of the timing, rates and characteristics of electroconvulsive therapy use between urban and rural populations. The medical records of patients who received an acute course of electroconvulsive therapy at two rural and two urban psychiatric hospitals in New South Wales (NSW), Australia, in 2010 were reviewed retrospectively. Main outcome measures were the time from symptom onset, diagnosis and admission to commencing electroconvulsive therapy. Rates of use of electroconvulsive therapy were also compared between rural and urban hospitals using NSW statewide data. There was a significant delay in the time it took for rural patients to receive electroconvulsive therapy compared with urban patients when measured both from the time of symptom onset and from when they received a diagnosis. There were corresponding delays in the time taken for rural patients to be admitted to hospital compared with urban patients. There was no difference in the time it took to commence electroconvulsive therapy once a patient was admitted to hospital. NSW statewide urban-rural comparisons showed rates of electroconvulsive therapy treatment were significantly higher in urban hospitals. Patients in rural areas receive electroconvulsive therapy later in their acute illness due to delays in being admitted to hospital. The rate of use of electroconvulsive therapy also differs geographically. © The Royal Australian and New Zealand College of Psychiatrists 2015.

The Timing of Early Antibiotics and Hospital Mortality in Sepsis.

Science.gov (United States)

Liu, Vincent X; Fielding-Singh, Vikram; Greene, John D; Baker, Jennifer M; Iwashyna, Theodore J; Bhattacharya, Jay; Escobar, Gabriel J

2017-10-01

Prior sepsis studies evaluating antibiotic timing have shown mixed results. To evaluate the association between antibiotic timing and mortality among patients with sepsis receiving antibiotics within 6 hours of emergency department registration. Retrospective study of 35,000 randomly selected inpatients with sepsis treated at 21 emergency departments between 2010 and 2013 in Northern California. The primary exposure was antibiotics given within 6 hours of emergency department registration. The primary outcome was adjusted in-hospital mortality. We used detailed physiologic data to quantify severity of illness within 1 hour of registration and logistic regression to estimate the odds of hospital mortality based on antibiotic timing and patient factors. The median time to antibiotic administration was 2.1 hours (interquartile range, 1.4-3.1 h). The adjusted odds ratio for hospital mortality based on each hour of delay in antibiotics after registration was 1.09 (95% confidence interval [CI], 1.05-1.13) for each elapsed hour between registration and antibiotic administration. The increase in absolute mortality associated with an hour's delay in antibiotic administration was 0.3% (95% CI, 0.01-0.6%; P = 0.04) for sepsis, 0.4% (95% CI, 0.1-0.8%; P = 0.02) for severe sepsis, and 1.8% (95% CI, 0.8-3.0%; P = 0.001) for shock. In a large, contemporary, and multicenter sample of patients with sepsis in the emergency department, hourly delays in antibiotic administration were associated with increased odds of hospital mortality even among patients who received antibiotics within 6 hours. The odds increased within each sepsis severity strata, and the increased odds of mortality were greatest in septic shock.

Use of acute care hospital services by immigrant seniors in Ontario: A linkage study.

Science.gov (United States)

Ng, Edward; Sanmartin, Claudia; Tu, Jack; Manuel, Doug

2014-10-01

Seniors constitute the largest group of hospital users. The increasing share of immigrants in Canada's senior population can affect the demand for hospital care. This study used the linked 2006 Census-Hospital Discharge Abstract Database to examine hospitalization during the 2004-to-2006 period, by immigrant status, of Ontario seniors living in the community. Hospitalization was assessed with logistic regressions; cumulative length of stay, with zero-truncated negative binomial regressions. All-cause hospitalization and hospitalizations specific to circulatory and digestive diseases were examined. Immigrant seniors had significantly low age-/sex-adjusted odds of hospitalization, compared with Canadian-born seniors (OR = 0.81). The odds varied from 0.4 among East Asians to 0.89 among Europeans, and rose with length of time since arrival from 0.54 for recent (1994 to 2003) to 0.86 for long-term (before 1984) immigrants. Adjustment for demographic and socio-economic characteristics did not change the overall patterns. Immigrants' cumulated length of hospital stay tended to be shorter than or similar to that of Canadian-born seniors. Immigrant seniors, especially recent arrivals, had lower odds of hospitalization and similar time in hospital, compared with Canadian-born seniors. These patterns likely reflect differences in health status. Variations by world region and disease reflect the diverse health care needs of immigrant seniors.

Relationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality.

Science.gov (United States)

Sacks, Greg D; Lawson, Elise H; Dawes, Aaron J; Russell, Marcia M; Maggard-Gibbons, Melinda; Zingmond, David S; Ko, Clifford Y

2015-09-01

The Centers for Medicare and Medicaid Services include patient experience as a core component of its Value-Based Purchasing program, which ties financial incentives to hospital performance on a range of quality measures. However, it remains unclear whether patient satisfaction is an accurate marker of high-quality surgical care. To determine whether hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality. Retrospective observational study of participating American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) hospitals. We used data from a linked database of Medicare inpatient claims, ACS NSQIP, the American Hospital Association annual survey, and Hospital Compare from December 2, 2004, through December 31, 2008. A total of 103 866 patients older than 65 years undergoing inpatient surgery were included. Hospitals were grouped by quartile based on their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Controlling for preoperative risk factors, we created hierarchical logistic regression models to predict the occurrence of adverse postoperative outcomes based on a hospital's patient satisfaction scores. Thirty-day postoperative mortality, major and minor complications, failure to rescue, and hospital readmission. Of the 180 hospitals, the overall mean patient satisfaction score was 68.0% (first quartile mean, 58.7%; fourth quartile mean, 76.7%). Compared with patients treated at hospitals in the lowest quartile, those at the highest quartile had significantly lower risk-adjusted odds of death (odds ratio = 0.85; 95% CI, 0.73-0.99), failure to rescue (odds ratio = 0.82; 95% CI, 0.70-0.96), and minor complication (odds ratio = 0.87; 95% CI, 0.75-0.99). This translated to relative risk reductions of 11.1% (P = .04), 12.6% (P = .02), and 11.5% (P = .04), respectively. No significant relationship was noted between patient satisfaction

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound.

Science.gov (United States)

Yang, Nancy; Ornstein, Katherine A; Reckrey, Jennifer M

2016-07-01

Homebound adults experience significant symptom burden. To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and to examine associations between symptom burden and time to hospitalization, nursing home placement, and death. Three hundred eighteen patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death. Of the study sample, 45% had severe symptom burden (i.e., Edmonton Symptom Assessment Scale score >6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs. 85.5 years, P nursing home placement or death. The homebound with severe symptom burden represents a unique cohort of patients who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary health care utilization in this population. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

PARITY ODD BUBBLES IN HOT QCD.

Energy Technology Data Exchange (ETDEWEB)

KHARZEEV,D.; PISARSKI,R.D.; TYTGAT,M.H.G.

1998-04-16

We consider the topological susceptibility for an SU(N) gauge theory in the limit of a large number of colors, N {r_arrow} {infinity}. At nonzero temperature, the behavior of the topological susceptibility depends upon the order of the deconfining phase transition. The most interesting possibility is if the deconfining transition, at T = T{sub d}, is of second order. Then we argue that Witten's relation implies that the topological susceptibility vanishes in a calculable fashion at Td. As noted by Witten, this implies that for sufficiently light quark masses, metastable states which act like regions of nonzero {theta}--parity odd bubbles--can arise at temperatures just below T{sub d}. Experimentally, parity odd bubbles have dramatic signatures: the {eta}{prime} meson, and especially the {eta} meson, become light, and are copiously produced. Further, in parity odd bubbles, processes which are normally forbidden, such as {eta} {r_arrow} {pi}{sup 0}{pi}{sup 0}, are allowed. The most direct way to detect parity violation is by measuring a parity odd global asymmetry for charged pions, which we define.

PARITY ODD BUBBLES IN HOT QCD

International Nuclear Information System (INIS)

KHARZEEV, D.; PISARSKI, R.D.; TYTGAT, M.H.G.

1998-01-01

We consider the topological susceptibility for an SU(N) gauge theory in the limit of a large number of colors, N r a rrow ∞. At nonzero temperature, the behavior of the topological susceptibility depends upon the order of the deconfining phase transition. The most interesting possibility is if the deconfining transition, at T = T d , is of second order. Then we argue that Witten's relation implies that the topological susceptibility vanishes in a calculable fashion at Td. As noted by Witten, this implies that for sufficiently light quark masses, metastable states which act like regions of nonzero θ--parity odd bubbles--can arise at temperatures just below T d . Experimentally, parity odd bubbles have dramatic signatures: the ηprime meson, and especially the η meson, become light, and are copiously produced. Further, in parity odd bubbles, processes which are normally forbidden, such as η r a rrow π 0 π 0 , are allowed. The most direct way to detect parity violation is by measuring a parity odd global asymmetry for charged pions, which we define

Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

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Alcock, Glyn; Das, Sushmita; Shah More, Neena; Hate, Ketaki; More, Sharda; Pantvaidya, Shanti; Osrin, David; Houweling, Tanja A J

2015-09-28

Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities

Odd Shape Out

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Cady, Jo Ann; Wells, Pamela

2016-01-01

The Odd Shape Out task was an open-ended problem that engaged students in comparing shapes based on their properties. Four teachers submitted the work of 116 students from across the country. This article compares various student's responses to the task. The problem allowed for differentiation, as shown by the many different ways that students…

Total Breast-Feeding Duration and Dental Caries in Healthy Urban Children.

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Wong, Peter D; Birken, Catherine S; Parkin, Patricia C; Venu, Isvarya; Chen, Yang; Schroth, Robert J; Maguire, Jonathon L

2017-04-01

To determine if there is an association between longer breast-feeding duration and dental caries in healthy urban children. We conducted a cross-sectional study of urban children aged 1 to 6 years recruited through The Applied Research Group for Kids (TARGet Kids!) practice-based research network between September 2011 and August 2013. The main outcome measure was parental report of dental caries. The adjusted predicted probability of dental caries was 7%, 8%, 11%, and 16% with total duration of breast-feeding duration of 12, 18, 24, and 36 months, respectively. In the adjusted logistic regression analyses, relative to breast-feeding 0 to 5 months, the odds of dental caries with total breast-feeding duration >24 months was 2.75 (95% confidence interval 1.61-4.72). Among healthy urban children, longer breast-feeding duration was associated with higher odds of dental caries. These findings support heightened awareness and enhanced anticipatory guidance for preventive dental care, particularly among children who breast-feed beyond 2 years of age. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Highly-distorted and doubly-decoupled rotational bands in odd-odd nuclei

International Nuclear Information System (INIS)

McHarris, W.C.; Olivier, W.A.; Rios, A.; Hampton, C.; Chou, Wentsae; Aryaeinejad, R.

1991-01-01

Heavy-ion reactions induce large amounts of angular momentum; hence, they selectively populate rotationally-aligned particle states in compound nuclei. Such states tend to deexcite through similar states connected by large coriolis matrix elements, resulting in relatively few - but highly distorted - bands in the lower-energy portions of odd-odd spectra. The extreme cases of this are doubly-decoupled, K ∼ 1 (π 1/2 x ν 1/2) bands, whose γ transitions are the most intense in spectra from many light Re and Ir nuclei. The authors made a two-pronged assault on such bands, studying them via different HI reactions at different laboratories and using interacting-boson (IBFFA) calculations to aid in sorting them out. The authors are beginning to understand the types of (primarily coriolis) distortions involved and hope to grasp a handle on aspects of the p-n residual interaction, although the coriolis distortions are large enough to mask much of the latter. They also discuss similar but complementary effects in the light Pr region

The odd-proton effects on the potential energy surfaces of odd mass Tl, Au, Ir and Re isotopes

CERN Document Server

De Wieclawik, W; Larsson, S E; Leander, G; Vieu, C; Dionisio, J S

1976-01-01

The total potential energy surfaces of thallium, gold, iridium and rhenium odd mass isotopes are calculated microscopically as functions of the quadrupole deformation, epsilon /sub 2/, when the odd protons occupy definite orbitals. The nuclear shapes and the static equilibrium deformations of these nuclei are deduced from the results of these calculations for the proton orbitals nearest to the Fermi level. The influence of the hexadecapole deformation, epsilon /sub 4/, on these results is investigated too. Finally, a few experimental data available for these odd mass nuclei are correlated to the corresponding theoretical results. (16 refs).

Odd nitrogen production by meteoroids

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Park, C.; Menees, G. P.

1978-01-01

The process by which odd nitrogen species (atomic nitrogen and nitric oxide) are formed during atmospheric entry of meteoroids is analyzed theoretically. An ablating meteoroid is assumed to be a point source of mass with a continuum regime evolving in its wake. The amounts of odd nitrogen species, produced by high-temperature reactions of air in the continuum wake, are calculated by numerical integration of chemical rate equations. Flow properties are assumed to be uniform across the wake, and 29 reactions involving five neutral species and five singly ionized species are considered, as well as vibrational and electron temperature nonequilibrium phenomena. The results, when they are summed over the observed mass, velocity, and entry-angle distribution of meteoroids, provide odd-nitrogen-species annual global production rates as functions of altitude. The peak production of nitric oxide is found to occur at an altitude of about 85 km; atomic nitrogen production peaks at about 95 km. The total annual rate for nitric oxide is 40 million kg; for atomic nitrogen it is 170 million kg.

Characterization of children hospitalized with traumatic brain injuries after building falls.

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Loftus, Kirsten V; Rhine, Tara; Wade, Shari L; Pomerantz, Wendy J

2018-04-10

Unintentional falls cause a substantial proportion of pediatric traumatic brain injury (TBI), with building falls carrying particularly high risk for morbidity and mortality. The cohort of children sustaining building fall-related TBI has not been well-examined. We sought to characterize children hospitalized with building fall-related TBIs and evaluate if specific factors distinguished these children from children hospitalized with TBI due to other fall mechanisms. We secondarily assessed if TBI severity among children injured due to a building fall varied between children from urban versus non-urban areas. This was a secondary analysis of the Pediatric Health Information System (PHIS), an administrative database from pediatric hospitals. We identified children codes. Urban versus non-urban status was determined using PHIS-assigned Rural-Urban Commuting Area codes. Injury severity (i.e. Injury Severity Score (ISS) and head Abbreviated Injury Scale (AIS) score) were calculated. Head AIS scores were dichotomized into minor/moderate (1-2) and serious/severe (3-6) for analysis. Frequencies, descriptive statistics, Chi-square analysis, and Mann-Whitney U analysis characterized populations and determined group differences. The study cohort included 23,813 children, of whom 933 (3.9%) fell from buildings. Within the building fall cohort, 707 (75.8%) resided in urban areas, 619 (66.3%) were male, 513 (55.0%) were white, and 528 (56.6%) had government insurance; the mean age was 3.8 years (SD 2.9). There was a larger proportion of children with serious/severe TBI among those injured from building falls relative to other falls (63.4% vs 53.9%, p building falls, those from non-urban areas were more likely to sustain a serious/severe TBI relative to urban children (58.9% vs 53.6%, p buildings falls with TBI sustained more severe injuries relative to other fall types. Although a majority of children hospitalized with building fall related-TBIs were from urban areas, those

Spin-dependent level density in interacting Boson-Fermion-Fermion model of the Odd-Odd Nucleus 196Au

International Nuclear Information System (INIS)

Kabashi, S.; Bekteshi, S.; Ahmetaj, S.; Shaqiri, Z.

2009-01-01

The level density of the odd-odd nucleus 196 Au is investigated in the interacting boson-fermion-fermion model (IBFFM) which accounts for collectivity and complex interaction between quasiparticle and collective modes.The IBFFM spin-dependent level densities show high-spin reduction with respect to Bethe formula.This can be well accounted for by a modified spin-dependent level density formula. (authors)

Determinants of obesity in an urban township of South Africa

African Journals Online (AJOL)

to 54.3% among women, with a higher prevalence in the urban areas.2,6–10 .... Organization (WHO)31 categories of underweight (BMI < 18.5 kg/m2), normal weight (BMI ... logistic regression models gave adjusted odds ratios for each of the.

BKP and CKP revisited: the odd KP system

International Nuclear Information System (INIS)

Dimakis, Aristophanes; Müller-Hoissen, Folkert

2009-01-01

By restricting a linear system for the KP hierarchy to those independent variables t n with odd n, its compatibility (Zakharov-Shabat conditions) leads to the 'odd KP hierarchy'. The latter consists of pairs of equations for two dependent variables, taking values in an (typically noncommutative) associative algebra. If the algebra is commutative, the odd KP hierarchy is known to admit reductions to the BKP and the CKP hierarchy. We approach the odd KP hierarchy and its relation to BKP and CKP in different ways, and address the question of whether noncommutative versions of the BKP and the CKP equation (and some of their reductions) exist. In particular, we derive a functional representation of a linear system for the odd KP hierarchy, which in the commutative case produces functional representations of the BKP and CKP hierarchies in terms of a tau function. Furthermore, we consider a functional representation of the KP hierarchy that involves a second (auxiliary) dependent variable and features the odd KP hierarchy directly as a subhierarchy. A method to generate large classes of exact solutions to the KP hierarchy from solutions to a linear matrix ODE system, via a hierarchy of matrix Riccati equations, then also applies to the odd KP hierarchy, and this in turn can be exploited, in particular, to obtain solutions to the BKP and CKP hierarchies

Impact of sludge stabilization processes and sludge origin (urban or hospital) on the mobility of pharmaceutical compounds following sludge landspreading in laboratory soil-column experiments.

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Lachassagne, Delphine; Soubrand, Marilyne; Casellas, Magali; Gonzalez-Ospina, Adriana; Dagot, Christophe

2015-11-01

This study aimed to determine the effect of sludge stabilization treatments (liming and anaerobic digestion) on the mobility of different pharmaceutical compounds in soil amended by landspreading of treated sludge from different sources (urban and hospital). The sorption and desorption potential of the following pharmaceutical compounds: carbamazepine (CBZ), ciprofloxacin (CIP), sulfamethoxazole (SMX), salicylic acid (SAL), ibuprofen (IBU), paracetamol (PAR), diclofenac (DIC), ketoprofen (KTP), econazole (ECZ), atenolol (ATN), and their solid-liquid distribution during sludge treatment (from thickening to stabilization) were investigated in the course of batch testing. The different sludge samples were then landspread at laboratory scale and leached with an artificial rain simulating 1 year of precipitation adapted to the surface area of the soil column used. The quality of the resulting leachate was investigated. Results showed that ibuprofen had the highest desorption potential for limed and digested urban and hospital sludge. Ibuprofen, salicylic acid, diclofenac, and paracetamol were the only compounds found in amended soil leachates. Moreover, the leaching potential of these compounds and therefore the risk of groundwater contamination depend mainly on the origin of the sludge because ibuprofen and diclofenac were present in the leachates of soils amended with urban sludge, whereas paracetamol and salicylic acid were found only in the leachates of soils amended with hospital sludge. Although carbamazepine, ciprofloxacin, sulfamethoxazole, ketoprofen, econazole, and atenolol were detected in some sludge, they were not present in any leachate. This reflects either an accumulation and/or (bio)degradation of these compounds (CBZ, CIP, SMX, KTP, ECZ, and ATN ), thus resulting in very low mobility in soil. Ecotoxicological risk assessment, evaluated by calculating the risk quotients for each studied pharmaceutical compound, revealed no high risk due to the

Oppositional Defiant Disorder (ODD)

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... Antisocial behavior Impulse control problems Substance use disorder Suicide Many children and teens with ODD also have other mental health disorders, such as: Attention-deficit/hyperactivity disorder (ADHD) Conduct disorder Depression Anxiety Learning and communication disorders Treating these other ...

Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents.

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Khan, Aishah; Thapa, Janani R; Zhang, Donglan

2017-09-01

This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas. © 2017 National Rural Health Association.

Hospital and urban effluent waters as a source of accumulation of toxic metals in the sediment receiving system of the Cauvery River, Tiruchirappalli, Tamil Nadu, India.

Science.gov (United States)

Devarajan, Naresh; Laffite, Amandine; Ngelikoto, Patience; Elongo, Vicky; Prabakar, Kandasamy; Mubedi, Josué I; Piana, Pius T M; Wildi, Walter; Poté, John

2015-09-01

Hospital and urban effluents contain a variety of toxic and/or persistent substances in a wide range of concentrations, and most of these compounds belong to the group of emerging contaminants. The release of these substances into the aquatic ecosystem can lead to the pollution of water resources and may place aquatic organisms and human health at risk. Sediments receiving untreated and urban effluent waters from the city of Tiruchirappalli in the state of Tamil Nadu, India, are analyzed for potential environmental and human health risks. The sediment samples were collected from five hospital outlet pipes (HOP) and from the Cauvery River Basin (CRB) both of which receive untreated municipal effluent waters (Tiruchirappalli, Tamil Nadu, India). The samples were characterized for grain size, organic matter, toxic metals, and ecotoxicity. The results highlight the high concentration of toxic metals in HOP, reaching values (mg kg(-1)) of 1851 (Cr), 210 (Cu), 986 (Zn), 82 (Pb), and 17 (Hg). In contrast, the metal concentrations in sediments from CRB were lower than the values found in the HOP (except for Cu, Pb), with maximum values (mg kg(-1)) of 75 (Cr), 906 (Cu), 649 (Zn), 111 (Pb), and 0.99 (Hg). The metal concentrations in all sampling sites largely exceed the Sediment Quality Guidelines (SQGs) and the Probable Effect Concentration (PEC) for the Protection of Aquatic Life recommendation. The ecotoxicity test with ostracods exposed to the sediment samples presents a mortality rate ranging from 22 to 100 % (in sediments from HOP) and 18-87 % (in sediments from CRB). The results of this study show the variation of toxic metal levels as well as toxicity in sediment composition related to both the type of hospital and the sampling period. The method of elimination of hospital and urban effluents leads to the pollution of water resources and may place aquatic organisms and human health at risk.

Risk factors associated with malnutrition in hospitalized patients

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Roberta Flores Marquezini FRAGAS

2016-06-01

Full Text Available ABSTRACT Objective To identify factors associated with malnutrition in patients hospitalized in general public hospitals of the city of Manaus, Amazonas, Brazil. Methods This cross-sectional study included 397 patients of both sexes aged more than 18 years, staying at three public hospitals in Manaus, Amazonas. The patients were submitted to anthropometric and subjective global assessments, the latter being the main diagnostic method. For association analyses between malnutrition (dependent variable and other covariates, we used contingency table for variable selection and multiple logistic regression for independent effect test between exposure and outcome. The strength of association between the variables was expressed as odds ratio, with a 95% confidence interval. The analyses were performed by Epi Info 7.0. Results Among the risk factors associated with hospital malnutrition, hospital stays longer than 15 days, when analyzed alone, nearly tripled the odds of malnutrition. However, in the final model, the variables that remained associated were: persistent change in diet, presence of gastrointestinal symptoms, recent weight loss, weight loss in the last six months, cancer, and age higher than 60 years. Conclusion Malnutrition is recurrent in hospitals, and the factors associated with malnutrition can be identified on admission, allowing adequate monitoring during hospital stay. Therefore, a more effective performance of nutritional screening and monitoring programs is critical.

Urbanicity Gradients Are Associated with the Household- and Individual-Level Double Burden of Malnutrition in Sub-Saharan Africa.

Science.gov (United States)

Jones, Andrew D; Acharya, Yubraj; Galway, Lindsay P

2016-06-01

The nutrition transition is advancing throughout sub-Saharan Africa (SSA). However, the nutritional risk across urbanicity gradients associated with this transition is not clear. We aimed to determine 1) the extent to which overweight and anemia in women of childbearing age (WCBA) and stunting in preschool-age children (PSC) are spatially correlated within countries of SSA; and 2) the association of urbanicity with the individual-level nutritional double burden (i.e., concurrent overweight and anemia within an individual WCBA), the household-level double burden (i.e., overweight WCBA and stunted PSC in the same household), and the 3 components of these double burdens (i.e., overweight, anemia, and stunting). We used Demographic and Health Surveys (DHS) data for 30 countries in SSA from 2006-2012. We calculated overweight [body mass index (BMI; in kg/m(2)) ≥25] and anemia (hemoglobin concentration urbanicity. We used geolocated DHS data to calculate cluster-level mean population densities and the Moran's I statistic to assess spatial autocorrelation. Cluster-level BMI values and hemoglobin concentrations for WCBA were spatially correlated. The odds of overweight in WCBA were higher in periurban and urban areas than in rural areas (periurban, OR: 1.08; 95% CI: 1.01, 1.16; urban, OR: 1.26; 95% CI: 1.18, 1.36), as were the odds of stunting in PSC in periurban areas (OR: 1.13; 95% CI: 1.06, 1.22). The odds of both double burden conditions were higher in periurban and urban areas than in rural areas (individual-level-periurban, OR: 1.18; 95% CI: 1.05, 1.33; urban, OR: 1.43; 95% CI: 1.27, 1.61; household-level-periurban, OR: 1.24; 95% CI: 1.06, 1.44; urban, OR: 1.24; 95% CI: 1.06, 1.46). Urban and periurban areas in SSA may be particularly vulnerable to the nutritional double burden compared with rural areas. Clearly differentiating urban environments is important for assessing changing patterns of nutritional risk associated with the nutrition transition in SSA. �

Does marriage protect against hospitalization with pneumonia? A population-based case-control study

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Mor A

2013-10-01

Full Text Available Anil Mor, Sinna P Ulrichsen, Elisabeth Svensson, Klara Berencsi, Reimar W Thomsen Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark Background: To reduce the increasing burden of pneumonia hospitalizations, we need to understand their determinants. Being married may decrease the risk of severe infections, due to better social support and healthier lifestyle. Patients and methods: In this population-based case-control study, we identified all adult patients with a first-time pneumonia-related hospitalization between 1994 and 2008 in Northern Denmark. For each case, ten sex- and age-matched population controls were selected from Denmark's Civil Registration System. We performed conditional logistic regression analysis to estimate the odds ratios (ORs for pneumonia hospitalization among persons who were divorced, widowed, or never married, as compared with married persons, adjusting for age, sex, 19 different comorbidities, alcoholism-related conditions, immunosuppressant use, urbanization, and living with small children. Results: The study included 67,162 patients with a pneumonia-related hospitalization and 671,620 matched population controls. Compared with controls, the pneumonia patients were more likely to be divorced (10% versus 7% or never married (13% versus 11%. Divorced and never-married patients were much more likely to have previous diagnoses of alcoholism-related conditions (18% and 11%, respectively compared with married (3% and widowed (6% patients. The adjusted OR for pneumonia-related hospitalization was increased, at 1.29 (95% confidence interval [CI]: 1.25-1.33 among divorced; 1.15 (95% CI: 1.12-1.17 among widowed; and 1.33 (95% CI: 1.29-1.37 among never-married individuals as compared with those who were married. Conclusion: Married individuals have a decreased risk of being hospitalized with pneumonia compared with never-married, divorced, and widowed patients

Religious hospital policies on reproductive care: what do patients want to know?

Science.gov (United States)

Freedman, Lori R; Hebert, Luciana E; Battistelli, Molly F; Stulberg, Debra B

2018-02-01

Religious hospitals are a large and growing part of the American healthcare system. Patients who receive obstetric and other reproductive care in religious hospitals may face religiously-based restrictions on the treatment their doctor can provide. Little is known about patients' knowledge or preferences regarding religiously restricted reproductive healthcare. We aimed to assess women's preferences for knowing a hospital's religion and religiously based restrictions before deciding where to seek care and the acceptability of a hospital denying miscarriage treatment options for religious reasons, with and without informing the patient that other options may be available. We conducted a national survey of women aged 18-45 years. The sample was recruited from AmeriSpeak, a probability-based research panel of civilian noninstitutionalized adults. Of 2857 women invited to participate, 1430 completed surveys online or over the phone, for a survey response rate of 50.1%. All analyses adjusted for the complex sampling design and were weighted to generate estimates representative of the population of US adult reproductive-age women. We used χ 2 tests and multivariable logistic regression to evaluate associations. One third of women aged 18-45 years (34.5%) believe it is somewhat or very important to know a hospital's religion when deciding where to get care, but 80.7% feel it is somewhat or very important to know about a hospital's religious restrictions on care. Being Catholic or attending religious services more frequently does not make one more or less likely to want this information. Compared with Protestant women who do not identify as born-again, women of other religious backgrounds are more likely to consider it important to know a hospital's religious affiliation. These include religious minority women (adjusted odds ratio, 2.17; 95% confidence interval, 1.11-4.27), those who reported no religion/atheist/agnostic (adjusted odds ratio, 2.27; 95% confidence interval

Neighborhood-health links: Differences between rural-to-urban migrants and natives in Shanghai

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Danan Gu

2015-09-01

Full Text Available Background: It is well known that migrant workers tend to have different perceptions of neighborhood environments than urban natives. However, less is known about how these differences in perception may be linked to the health of members of these two groups. Objective: We investigated differences in links between perceived neighborhood social and physical environments and three health outcomes, self-rated health, social stress, and chronic conditions, between rural-to-urban migrants (migrant workers and Shanghai-born native urban residents in China. Methods: Data used in this study were based on a survey of 477 rural-to-urban migrants and 546 native urban residents aged 18-64, conducted in Shanghai in 2008. Logistic regression analyses were performed to model relationships for migrant workers and native residents. Results: We found that among migrant workers, more positive perceptions of neighborhood social environments (social cohesion and safety were linked to better self-rated health and lower levels of perceived stress but were not linked to chronic disease conditions; there were also no links between perceptions of physical environments and any of the three health outcomes of this study among migrant workers. By contrast, among urban natives, more positive perceptions of neighborhood social environments were linked to lower odds of chronic disease conditions but were not linked to self-rated health and perceived stress; more positive perceptions of physical environments (amenities and air quality were linked with lower odds of social stress and of chronic disease conditions. Conclusions: Neighborhood social and physical environments affected the health of migrant workers and urban natives differently.

Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients.

Science.gov (United States)

Tonelli, Marcello; Lloyd, Anita; Pannu, Neesh; Klarenbach, Scott; Ravani, Pietro; Jindal, Kailash; MacRae, Jennifer; Unsworth, Larry; Manns, Braden; Hemmelgarn, Brenda

2018-02-01

Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

Two-year survey of specific hospital wastewater treatment and its impact on pharmaceutical discharges.

Science.gov (United States)

Wiest, Laure; Chonova, Teofana; Bergé, Alexandre; Baudot, Robert; Bessueille-Barbier, Frédérique; Ayouni-Derouiche, Linda; Vulliet, Emmanuelle

2018-04-01

It is well known that pharmaceuticals are not completely removed by conventional activated sludge wastewater treatment plants. Hospital effluents are of major concern, as they present high concentrations of pharmaceutically active compounds. Despite this, these specific effluents are usually co-treated with domestic wastewaters. Separate treatment has been recommended. However, there is a lack of information concerning the efficiency of separate hospital wastewater treatment by activated sludge, especially on the removal of pharmaceuticals. In this context, this article presents the results of a 2-year monitoring of conventional parameters, surfactants, gadolinium, and 13 pharmaceuticals on the specific study site SIPIBEL. This site allows the characterization of urban and hospital wastewaters and their separate treatment using the same process. Flow proportional sampling, solid-phase extraction, and liquid chromatography coupled with tandem mass spectrometry were used in order to obtain accurate data and limits of quantification consistent with ultra-trace detection. Thanks to these consolidated data, an in-depth characterization of urban and hospital wastewaters was realized, as well as a comparison of treatment efficiency between both effluents. Higher concentrations of organic carbon, AOX, phosphates, gadolinium, paracetamol, ketoprofen, and antibiotics were observed in hospital wastewaters compared to urban wastewaters. Globally higher removals were observed in the hospital wastewater treatment plant, and some parameters were shown to be of high importance regarding removal efficiencies: hydraulic retention time, redox conditions, and ambient temperature. Eleven pharmaceuticals were still quantified at relevant concentrations in hospital and urban wastewaters after treatment (e.g., up to 1 μg/L for sulfamethoxazole). However, as the urban flow was about 37 times higher than the hospital flow, the hospital contribution appeared relatively low compared to

Searches for possible T-odd and P-odd short range interactions using polarized nuclei

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Chu P. H.

2014-03-01

Full Text Available Various theories predict the possible existence of T-odd and P-odd shortrange forces between spin ½ fermions, proportional to S・r where S is the fermion spin and r is the separation between particles. We use ensembles of polarized nuclei and an un-polarized mass to search for such a force over sub-mm ranges. We established an improved upper bound on the product gsgpn of the scalar coupling to particles in the un-polarized mass and the pseudo-scalar coupling of polarized neutrons for force ranges from 10−4 to 10−2 m, corresponding to a mass range of 2・10−3 to 2・10−5 eV for the exchange boson [1].

High-spin level scheme of odd-odd 142Pm

International Nuclear Information System (INIS)

Liu Minliang; Zhang Yuhu; Zhou Xiaohong; He Jianjun; Guo Yingxiang; Lei Xiangguo; Huang Wenxue; Liu Zhong; Luo Yixiao; Feng Xichen; Zhang Shuangquan; Xu Xiao; Zheng Yong; Luo Wanju

2002-01-01

The level structure of doubly odd nucleus 142 Pm has been studied via the 128 Te( 19 F, 5nγ) 142 Pm reaction in the energy region from 75 to 95 MeV. In-beam γ rays were measured including the excited function, γ-ray singles and γ-γ coincidences in experiment. The level scheme of 142 Pm has been extended up to excitation energy of 7030.0 keV including 25 new γ rays and 13 new levels. Based on the measured γ-ray anisotropies, the level spins in 142 Pm have been suggested

Rural model dedicated education unit: partnership between college and hospital.

Science.gov (United States)

Harmon, Lisa M

2013-02-01

This article describes the pilot project development of a rural model Dedicated Education Unit (DEU) by a rural college nursing program and a rural hospital to increase student nurses' confidence and proficiency and improve recruitment of prepared rural staff nurses. Traditionally, for economies of scale, most student clinical rotations occurred in urban settings with the number of students per clinical instructor allowed by the state board of nursing. College budget constraints negated the placement of fewer than this mandated maximum number of students in a rural hospital with a clinical instructor; moreover, rural hospitals could not accommodate 10 students at one time. Rural nursing students were anxious in the urban settings, and this anxiety precluded learning in many instances. Rural hospitals face higher registered nurse vacancies than urban centers. Of the nurses applying for open positions, many were not prepared for the demands of rural nursing, resulting in increased turnover and high orientation costs. The rural model DEU addressed issues of both the nursing program and the hospital. The design and development of the rural model DEU and the advantages of the partnership for the college nursing program and the hospital are discussed. Initial outcomes and serendipitous findings from the pilot project are also discussed. Copyright 2013, SLACK Incorporated.

On chiral-odd Generalized Parton Distributions

Energy Technology Data Exchange (ETDEWEB)

Wallon, Samuel [Laboratoire de Physique Theorique d' Orsay - LPT, Bat. 210, Univ. Paris-Sud 11, 91405 Orsay Cedex (France); UPMC Univ. Paris 6, Paris (France); Pire, Bernard [Centre de Physique Theorique - CPHT, UMR 7644, Ecole Polytechnique, Bat. 6, RDC, F91128 Palaiseau Cedex (France); Szymanowski, Lech [Soltan Institute for Nuclear Studies, Hoza 69, 00691, Warsaw (Poland)

2010-07-01

The chiral-odd transversity generalized parton distributions of the nucleon can be accessed experimentally through the exclusive photoproduction process {gamma} + N {yields} {pi} + {rho} + N', in the kinematics where the meson pair has a large invariant mass and the final nucleon has a small transverse momentum, provided the vector meson is produced in a transversally polarized state. Estimated counting rates show that the experiment is feasible with real or quasi real photon beams expected at JLab at 12 GeV and in the COMPASS experiment. (Phys Letters B688,154,2010) In addition, a consistent classification of the chiral-odd pion GPDs beyond the leading twist 2 is presented. Based on QCD equations of motion and on the invariance under rotation on the light-cone of any scattering amplitude involving such GPDs, we reduce the basis of these chiral-odd GPDs to a minimal set. (author)

Anomalous Josephson Effect between Even-and Odd-Frequency Superconductors

NARCIS (Netherlands)

Tanaka, Yukio; Golubov, Alexandre Avraamovitch; Kashiwaya, Satoshi; Ueda, Masahito

2007-01-01

We demonstrate that, contrary to standard wisdom, the lowest-order Josephson coupling is possible between odd- and even-frequency superconductors. The origin of this effect is the induced odd- (even-)frequency pairing component at the interface of bulk even- (odd-)frequency superconductors. The

Differences in cardiovascular risk factors in rural, urban and rural-to-urban migrants in Peru

Science.gov (United States)

Miranda, J. Jaime; Gilman, Robert H.; Smeeth, Liam

2011-01-01

Objectives To assess differences in cardiovascular risk profiles among rural-to-urban migrants and non-migrant groups. Design Cross-sectional study. Setting Ayacucho and Lima, Peru Participants rural (n=201); rural-urban migrants (n=589) and urban (n=199). Main outcome measures Cardiovascular risk factors were assessed according to migrant status (migrants vs. non-migrants), age at first migration, length of residency in an urban area and lifetime exposure to an urban area. Results For most risk factors, the migrant group had intermediate levels of risk between those observed for the rural and urban groups. Prevalences, for rural, migrant and urban groups, was 3%, 20% and 33% for obesity and 0.8%, 3% and 6% for type-2 diabetes. This gradient of risk was not observed uniformly across all risk factors. Blood pressure did not show a clear gradient of difference between groups. The migrant group had similar systolic blood pressure (SBP) but lower diastolic blood pressure (DBP) than the rural group. The urban group had higher SBP but similar DBP than rural group. Hypertension was more prevalent among the urban (29%) compared to both rural and migrant groups (11% and 16% respectively). For HbA1c, although the urban group had higher levels, the migrant and rural groups were similar to each other. No differences were observed in triglycerides between the three groups. Within migrants, those who migrated when aged older than 12 years had higher odds of diabetes, impaired fasting glucose and metabolic syndrome compared to people who migrated at younger ages. Adjustment for age, sex and socioeconomic indicators had little impact on the patterns observed. Conclusions The impact of rural to urban migration on cardiovascular risk profile is not uniform across different risk factors, and is further influenced by the age at which migration occurs. A gradient in levels was observed for some risk factors across study groups. This observation indicates that urbanization is indeed

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Science.gov (United States)

Aiken, Linda H; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

2017-01-01

Objectives To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Design Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Setting Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Participants Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Main outcome measures Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Results Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. Conclusions A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages. PMID:28626086

Health Services Utilization Among Fee-for-Service Medicare and Medicaid Patients Under Age 65 with Behavioral Health Illness at an Urban Safety Net Hospital.

Science.gov (United States)

Cancino, Ramon S; Jack, Brian W; Jarvis, John; Cummings, Alice Kate; Cooper, Ellie; Cremieux, Pierre-Yves; Burgess, James F

2017-07-01

In 2011, fee-for-service patients with both Medicare and Medicaid (dual eligible) sustained $319.5 billion in health care costs. To describe the emergency department (ED) use and hospital admissions of adult dual eligible patients aged under 65 years who used an urban safety net hospital. This was a retrospective database analysis of patients aged between 18 and 65 years with Medicare and Medicaid, who used an urban safety net academic health center between January 1, 2011, and December 31, 2011. We compared patients with and without behavioral health illness. The main outcome measures were hospital admission and ED use. Chi-square and Wilcoxon rank-sum tests were used for descriptive statistics on categorical and continuous variables, respectively. Greedy propensity score matching was used to control for confounding factors. Rate ratios (RR) and 95% confidence intervals (CI) were determined after matching and after adjusting for those variables that remained significantly different after matching. In 2011, 10% of all fee-for-service dual eligible patients aged less than 65 years in Massachusetts were seen at Boston Medical Center. Data before propensity score matching showed significant differences in age, sex, race/ethnicity, marital status, education, employment, physical comorbidities, and Charlson Comorbidity Index score between patients with and without behavioral health illness. Analysis after propensity score matching found significant differences in sex, Hispanic race, and other education and employment status. Compared with patients without behavioral health illness, patients with behavioral health illness had a higher RR for hospital admissions (RR = 2.07; 95% CI = 1.81-2.38; P fee-for-service plan had significantly higher rates of hospital admission and ED use compared with dual eligible patients without behavioral health illness at the largest urban safety net medical center in New England. Safety net hospitals care for a large proportion of dual

Does outsourcing affect hospital profitability?

Science.gov (United States)

Danvers, Kreag; Nikolov, Pavel

2010-01-01

Organizations outsource non-core service functions to achieve cost reductions and strategic benefits, both of which can impact profitability performance. This article examines relations between managerial outsourcing decisions and profitability for a multi-state sample of non-profit hospitals, across 16 states and four regions of the United States. Overall regression results indicate that outsourcing does not necessarily improve hospital profitability. In addition, we identify no profitability impact from outsourcing for urban hospitals, but somewhat positive effects for teaching hospitals. Our regional analysis suggests that hospitals located in the Midwest maintain positive profitability effects with outsourcing, but those located in the South realize negative effects. These findings have implications for cost reduction efforts and the financial viability of non-profit hospitals.

Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana

Directory of Open Access Journals (Sweden)

Kegels Guy

2010-12-01

Full Text Available Abstract Background There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. Methods A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. Results At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff. In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We

Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections

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Andrea L. Lorden

2017-08-01

Full Text Available Background: An estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs and accounted for $9.8 (USD billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events. Aims: To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population. Methods: Retrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line–associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics. Findings: We identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91 for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant. Conclusions: Clinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements.

Increased ultrafine particles and carbon monoxide concentrations are associated with asthma exacerbation among urban children

Science.gov (United States)

Evans, Kristin A.; Halterman, Jill S.; Hopke, Philip K.; Fagnano, Maria; Rich, David Q.

2014-01-01

Objectives Increased air pollutant concentrations have been linked to several asthma-related outcomes in children, including respiratory symptoms, medication use, and hospital visits. However, few studies have examined effects of ultrafine particles in a pediatric population. Our primary objective was to examine the effects of ambient concentrations of ultrafine particles on asthma exacerbation among urban children and determine whether consistent treatment with inhaled corticosteroids could attenuate these effects. We also explored the relationship between asthma exacerbation and ambient concentrations of accumulation mode particles, fine particles (≤ 2.5 micrograms [μm]; PM2.5), carbon monoxide, sulfur dioxide, and ozone. We hypothesized that increased 1 to 7 day concentrations of ultrafine particles and other pollutants would be associated with increases in the relative odds of an asthma exacerbation, but that this increase in risk would be attenuated among children receiving school-based corticosteroid therapy. Methods We conducted a pilot study using data from 3–10 year-old children participating in the School-Based Asthma Therapy trial. Using a time-stratified case-crossover design and conditional logistic regression, we estimated the relative odds of a pediatric asthma visit treated with prednisone (n=96 visits among 74 children) associated with increased pollutant concentrations in the previous 7 days. We re-ran these analyses separately for children receiving medications through the school-based intervention and children in a usual care control group. Results Interquartile range increases in ultrafine particles and carbon monoxide concentrations in the previous 7 days were associated with increases in the relative odds of a pediatric asthma visit, with the largest increases observed for 4-day mean ultrafine particles (interquartile range=2088 p/cm3; OR=1.27; 95% CI=0.90–1.79) and 7-day mean carbon monoxide (interquartile range=0.17 ppm; OR=1.63; 95

High-spin states in the transitional odd-odd nuclei 150Eu and 152Tb

International Nuclear Information System (INIS)

Barneoud, D.; Foin, C.; Pinston, J.A.; Monnand, E.

1983-06-01

The ( 7 Li, 5n) and ( 11 B, 5n) reactions have been used to study the high-spin states in the two odd-odd nuclei 150 Eu and 152 Tb. Three decoupled bands have been evidenced in each nucleus belonging to the same configurations [f 7/2]sub(n) [h 11/2]sub(p), [h 9/2]sub(n) [h 11/2 ]sub(p) and [i 13/2]sub(n) [h 11/2]sub(p). The latter one is well developped and improves our knowledge of this system between the spherical and deformed region. The analysis of the collective moment of inertia and transition ratios strongly suggests an increase of the deformation when the rotational frequency increases in these two transitional nuclei 150 Eu and 152 Tb

Outcomes of hospitalized patients undergoing emergency general surgery remote from admission.

Science.gov (United States)

Sharoky, Catherine E; Bailey, Elizabeth A; Sellers, Morgan M; Kaufman, Elinore J; Sinnamon, Andrew J; Wirtalla, Christopher J; Holena, Daniel N; Kelz, Rachel R

2017-09-01

Emergency general surgery during hospitalization has not been well characterized. We examined emergency operations remote from admission to identify predictors of postoperative 30-day mortality, postoperative duration of stay >30 days, and complications. Patients >18 years in The American College of Surgeons National Surgical Quality Improvement Program (2011-2014) who had 1 of 7 emergency operations between hospital day 3-18 were included. Patients with operations >95th percentile after admission (>18 days; n = 581) were excluded. Exploratory laparotomy only (with no secondary procedure) represented either nontherapeutic or decompressive laparotomy. Multivariable logistic regression was used to identify predictors of study outcomes. Of 10,093 patients with emergency operations, most were elderly (median 66 years old [interquartile ratio: 53-77 years]), white, and female. Postoperative 30-day mortality was 12.6% (n = 1,275). Almost half the cohort (40.1%) had a complication. A small subset (6.8%) had postoperative duration of stay >30 days. Postoperative mortality after exploratory laparotomy only was particularly high (>40%). In multivariable analysis, an operation on hospital day 11-18 compared with day 3-6 was associated with death (odds ratio 1.6 [1.3-2.0]), postoperative duration of stay >30 days (odds ratio 2.0 [1.6-2.6]), and complications (odds ratio 1.5 [1.3-1.8]). Exploratory laparotomy only also was associated with death (odds ratio 5.4 [2.8-10.4]). Emergency general surgery performed during a hospitalization is associated with high morbidity and mortality. A longer hospital course before an emergency operation is a predictor of poor outcomes, as is undergoing exploratory laparotomy only. Copyright © 2017 Elsevier Inc. All rights reserved.

Meaningful Use of Health Information Technology by Rural Hospitals

Science.gov (United States)

McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele

2011-01-01

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

Risk of malnutrition of hospitalized children in a university public hospital.

Science.gov (United States)

Muñoz-Esparza, Nelly Carolina; Vásquez-Garibay, Edgar Manuel; Romero-Velarde, Enrique; Troyo-Sanromán, Rogelio

2017-02-01

The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p malnutrition and require greater monitoring of nutritional status during hospitalization.

Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses

Science.gov (United States)

Gold, D. R.; Rogacz, S.; Bock, N.; Tosteson, T. D.; Baum, T. M.; Speizer, F. E.; Czeisler, C. A.

1992-01-01

A hospital-based survey on shift work, sleep, and accidents was carried out among 635 Massachusetts nurses. In comparison to nurses who worked only day/evening shifts, rotators had more sleep/wake cycle disruption and nodded off more at work. Rotators had twice the odds of nodding off while driving to or from work and twice the odds of a reported accident or error related to sleepiness. Application of circadian principles to the design of hospital work schedules may result in improved health and safety for nurses and patients.

Inverted spin sequences in the spectra of odd-odd nuclei in the 2S-1d and 2P-1f shells

International Nuclear Information System (INIS)

Sharma, Arvind; Sharma, S.D.

1990-01-01

In case of odd-odd nuclei, near magic numbers, there are found inverted sequences as well as few rotational members. In order to explain the unique feature of the spectra of odd-odd nuclei, we have applied modified form of rotational-vibrational model with two parameters A and B. It is found that level orders in inverted as well as in rotational sequences are very well reproduced on the basis of this model. In case of inverted spin sequences, the sign of B is found to be positive. The ratio of B/A is ≅ 10 -2 as compared to its value of the order of 10 -3 in case of even-even and odd-A nuclei. We infer that pair correlations are responsible for these invertions. The simple model applied here worked well to predict these inverted spectra. (author)

Coulomb excitation of the odd-odd isotopes {sup 106,108}In

Energy Technology Data Exchange (ETDEWEB)

Ekstroem, A.; Fahlander, C. [University of Lund, Physics Department, Box 118, Lund (Sweden); Cederkaell, J. [University of Lund, Physics Department, Box 118, Lund (Sweden); CERN, PH Department, Geneva 23 (Switzerland); Hjorth-Jensen, M.; Engeland, T. [University of Oslo, Physics Department and Center of Mathematics for Applications, Oslo (Norway); Blazhev, A.; Eberth, J.; Finke, F.; Reiter, P.; Warr, N.; Weisshaar, D. [University of Cologne, Institute of Nuclear Physics, Cologne (Germany); Butler, P.A.; Hurst, A.M. [University of Liverpool, Oliver Lodge Laboratory, Liverpool (United Kingdom); Davinson, T. [University of Edinburgh, Department of Physics and Astronomy, Edinburgh (United Kingdom); Goergen, A. [Service de Physique Nucleaire, CEA Saclay, Gif-sur-Yvette (France); Gorska, M. [Gesellschaft fuer Schwerionenforschung, Darmstadt (Germany); Ivanov, O.; Stefanescu, I. [Instituut voor Kern- en Stralingsfysica, K.U. Leuven (Belgium); Iwanicki, J. [University of Warsaw, Heavy Ion Laboratory, Warsaw (Poland); Koester, U. [CERN, PH Department, Geneva 23 (Switzerland); Institut Laue Langevin, Grenoble (France); Marsh, B.A. [University of Manchester, Department of Physics, Manchester (United Kingdom); CERN, AB Department, Geneva 23 (Switzerland); Mierzejewski, J. [University of Warsaw, Heavy Ion Laboratory, Warsaw (Poland); University of Warsaw, Institute of Experimental Physics, Warsaw (Poland); Siem, S. [University of Oslo, Department of Physics, Oslo (Norway); Sletten, G. [University of Copenhagen, Physics Department, Copenhagen (Denmark); Tveten, G.M. [CERN, PH Department, Geneva 23 (Switzerland); University of Oslo, Department of Physics, Oslo (Norway); Van de Walle, J. [CERN, PH Department, Geneva 23 (Switzerland); Instituut voor Kern- en Stralingsfysica, K.U. Leuven (Belgium); Voulot, D.; Wenander, F. [CERN, AB Department, Geneva 23 (Switzerland)

2010-06-15

The low-lying states in the odd-odd and unstable isotopes {sup 106,108}In have been Coulomb excited from the ground state and the first excited isomeric state at the REX-ISOLDE facility at CERN. With the additional data provided here the {pi}g{sub 9/2}{sup -1} x {nu}d{sub 5/2} and {pi}g{sub 9/2}{sup -1} x {nu} g{sub 7/2} multiplets have been re-analyzed and are modified compared to previous results. The observed {gamma} -ray de-excitation patterns were interpreted within a shell model calculation based on a realistic effective interaction. The agreement between theory and experiment is satisfactory and the calculations reproduce the observed differences in the excitation pattern of the two isotopes. The calculations exclude a 6{sup +} ground state in {sup 106}In. This is in agreement with the conclusions drawn using other techniques. Furthermore, based on the experimental results, it is also concluded that the ordering of the isomeric and ground state in {sup 108}In is inverted compared to the shell model prediction. Limits on B(E2) values have been extracted where possible. A previously unknown low-lying state at 367keV in {sup 106}In is also reported. (orig.)

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Science.gov (United States)

Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

The impact of hospital and urban wastewaters on the bacteriological contamination of the water resources in Kinshasa, Democratic Republic of Congo.

Science.gov (United States)

Kilunga, Pitchouna I; Kayembe, John M; Laffite, Amandine; Thevenon, Florian; Devarajan, Naresh; Mulaji, Crispin K; Mubedi, Josué I; Yav, Zéphirin G; Otamonga, Jean-Paul; Mpiana, Pius T; Poté, John

2016-10-14

hospital effluent waters can be a significant source of the deterioration of the bacteriological quality for urban rivers. The approach used in this investigation can be further used to decipher the pollution of water resources by human faecal contamination. The results of this research will help to better understand the microbiological pollution problems in river-receiving systems and will guide municipality decisions on improving the urban water quality.

Constraints on a parity-even/time-reversal-odd interaction

International Nuclear Information System (INIS)

Oers, Willem T.H. van

2000-01-01

Time-Reversal-Invariance non-conservation has for the first time been unequivocally demonstrated in a direct measurement, one of the results of the CPLEAR experiment. What is the situation then with regard to time-reversal-invariance non-conservation in systems other than the neutral kaon system? Two classes of tests of time-reversal-invariance need to be distinguished: the first one deals with parity violating (P-odd)/time-reversal-invariance non-conserving (T-odd) interactions, while the second one deals with P-even/T-odd interactions (assuming CPT conservation this implies C-conjugation non-conservation). Limits on a P-odd/T-odd interaction follow from measurements of the electric dipole moment of the neutron. This in turn provides a limit on a P-odd/T-odd pion-nucleon coupling constant which is 10 -4 times the weak interaction strength. Limits on a P-even/T-odd interaction are much less stringent. The better constraint stems also from the measurement of the electric dipole moment of the neutron. Of all the other tests, measurements of charge-symmetry breaking in neutron-proton elastic scattering provide the next better constraint. The latter experiments were performed at TRIUMF (at 477 and 347 MeV) and at IUCF (at 183 MeV). Weak decay experiments (the transverse polarization of the muon in K + →π 0 μ + ν μ and the transverse polarization of the positrons in polarized muon decay) have the potential to provide comparable or possibly better constraints

Relationships between pediatric asthma and socioeconomic/urban variables in Baltimore, Maryland

Science.gov (United States)

Kimes, Daniel; Ullah, Asad; Levine, Elissa; Nelson, Ross; Timmins, Sidey; Weiss, Sheila; Bollinger, Mary E.; Blaisdell, Carol

2004-01-01

Spatial relationships between clinical data for pediatric asthmatics (hospital and emergency department utilization rates), and socioeconomic and urban characteristics in Baltimore City were analyzed with the aim of identifying factors that contribute to increased asthma rates. Socioeconomic variables and urban characteristics derived from satellite data explained 95% of the spatial variation in hospital rates. The proportion of families headed by a single female was the most important variable accounting for 89% of the spatial variation. Evidence suggests that the high rates of hospital admissions and emergency department (ED) visits may partially be due to the difficulty of single parents with limited resources managing their child's asthma condition properly. This knowledge can be used for education towards mitigating ED and hospital events in Baltimore City.

Early hospital discharge and early puerperal complications.

Science.gov (United States)

Ramírez-Villalobos, Dolores; Hernández-Garduño, Adolfo; Salinas, Aarón; González, Dolores; Walker, Dilys; Rojo-Herrera, Guadalupe; Hernández-Prado, Bernardo

2009-01-01

To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

Analysis of reactor-neutrino spectra fully based on gross theory of beta-decay emphasizing the special role of odd-odd FP nuclides

Science.gov (United States)

Yoshida, Tadashi; Tachibana, Takahiro; Chiba, Satoshi

2017-09-01

We applied the gross theory of β-decay to calculate the reactor antineutrino (νe) spectra emitted from 235,238U and 239,241Pu samples under neutron irradiation by summing up all the contributions from a large number of decaying fission-products (FPs). Considering the special role of the odd(Z)-odd(N) FPs in spectrum-shaping, we utilized the experimentally-known spin-parity of each odd-odd FP through the treatment proposed by Nakata, Tachibana and Yamada. Owing to this treatment, the consistency between calculated and experimental spectra was remarkably improved in a way expected from the nature of the gross theory of β-decay.

Study of knowledge, attitude and practices regarding dengue in the urban and rural field practice area of a tertiary care teaching hospital in Pune, India

Directory of Open Access Journals (Sweden)

Samir Singru

2013-01-01

Full Text Available Context: Dengue is the most common disease among all the arthropod-borne viral diseases. There is no specific treatment or vaccine available for dengue. The sole method of prevention and control is the knowledge attitude and practices (KAP for the same. Although, dengue is considered an urban- and semi-urban disease, in recent years, due to water storage practices and large-scale development activities in rural areas, dengue has become endemic in rural areas of India as well. Aims: To assess the KAP regarding dengue. Settings and Design: Urban and rural field practice area of a Tertiary Care Teaching Hospital in Pune, India. Materials and Methods: A pre-tested, semi-structured questionnaire was used to study the knowledge, attitude, and practices regarding dengue. Stratified random sampling technique was used. A modified B. G. Prasad criterion was used for socio-economic classification. Statistical Analysis Used: KAP represented as proportion (%. Chi-square test was used as a test of significance. P value < 0.05 was considered as statistically significant. Results: 68.4% in urban areas and 40.4% in rural area knew that dengue is transmitted by mosquito. 62.6% in urban areas and 48% in rural areas respectively stated fever as a symptom of dengue. The use of anti-adult mosquito measures was 48.05% and 51.42% in urban and rural area respectively Conclusions: There is a definite need to increase the information education communication activities for dengue in the study area.

Household food security and HIV status in rural and urban communities in the Free State province, South Africa.

Science.gov (United States)

Pienaar, Michélle; van Rooyen, Francois C; Walsh, Corinna M

2017-12-01

participants reported feeling sad, blue or depressed for two weeks or more in a row. HIV infection was negatively associated with being married (odds ratio 0.20 in rural areas and 0.54 in urban areas), while church membership decreased the likelihood of HIV (odds ratio 0.22 in rural areas and 0.46 in urban areas). Indicators of higher socioeconomic status (having a microwave oven and access to vegetables from local farmers or shops) decreased the likelihood of HIV in rural areas (odds ratios 0.15 and 0.43, respectively). Indicators of lower socioeconomic status such as spending less money on food in the rural sample (odds ratio 3.29) and experiencing periods of food shortages in the urban sample (odds ratio 2.14), increased the likelihood of being HIV-infected. Interventions aimed at poverty alleviation and strengthening values can contribute to addressing HIV infection in South Africa.

Energy of the 4(+) isomer and new bands in the odd-odd nucleus 74Br

International Nuclear Information System (INIS)

Doering, J.; Holcomb, J.W.; Johnson, T.D.; Riley, M.A.; Tabor, S.L.; Womble, P.C.; Winter, G.

1993-01-01

High-spin states of the odd-odd nucleus 74 Br were investigated via the reactions 58 Ni ( 19 F,2pn) 74 Br and 65 Cu( 12 C,3n) 74 Br at beam energies of 62 and 50 MeV, respectively. On the basis of coincidence data new levels have been introduced and partly grouped into rotational bands. Some of these new states decay to known levels of negative-parity bands built on both the ground state and the long-lived 4 (+) isomer. Thus, an excitation energy of 13.8 keV has been deduced for the long-lived isomer in 74 Br. The level sequences observed are interpreted in terms of Nilsson configurations in conjunction with collective excitations

Hospital effluents are one of several sources of metal, antibiotic resistance genes and bacterial markers disseminated in Sub-Saharan urban rivers

Directory of Open Access Journals (Sweden)

Amandine Laffite

2016-07-01

Full Text Available Data concerning the occurrence of emerging biological contaminants such as antibiotic resistance genes (ARGs and fecal indicator bacteria (FIB in aquatic environments in Sub-Saharan African countries is limited. On the other hand, antibiotic resistance remains a worldwide problem which may pose serious potential risks to human and animal health. Consequently, there is a growing number of reports concerning the prevalence and dissemination of these contaminants into various environmental compartments. Sediments provide the opportunity to reconstruct the pollution history and evaluate impacts so this study investigates the abundance and distribution of toxic metals, FIB, and ARGs released from hospital effluent wastewaters and their presence in river sediments receiving systems. ARGs (blaTEM, blaCTX-M, blaSHV, and aadA, total bacterial load, and selected bacterial species FIB (E. coli, Enterococcus (ENT and Pseudomonas species (Psd were quantified by targeting species specific genes using quantitative PCR (qPCR in total DNA extracted from the sediments recovered from 4 hospital outlet pipes (HOP and their river receiving systems in the City of Kinshasa in the Democratic Republic of the Congo. The results highlight the great concentration of toxic metals in HOP, reaching the values (in mg kg-1 of 47.9 (Cr, 213.6 (Cu, 1434.4 (Zn, 2.6 (Cd, 281.5 (Pb, and 13.6 (Hg. The results also highlight the highest (P˂0.05 values of 16S rRNA, FIB, and ARGs copy numbers in all sampling sites including upstream (control site, discharge point, and downstream of receiving rivers, indicating that the hospital effluent water is not an exclusive source of the biological contaminants entering the urban rivers. Significant correlation were observed between (i all analyzed ARGs and total bacterial load (16S rRNA 0.51 to 0.72 (p<0.001, n=65; (ii ARGs (except blaTEM and FIB and Psd 0.57 < r < 0.82 (p<0.001, n=65; and (iii ARGs (except blaTEM and toxic metals (Cd, Cr, Cu

Trends in hospitalizations of pregnant HIV-infected women in the United States: 2004 through 2011.

Science.gov (United States)

Ewing, Alexander C; Datwani, Hema M; Flowers, Lisa M; Ellington, Sascha R; Jamieson, Denise J; Kourtis, Athena P

2016-10-01

With the development and widespread use of combination antiretroviral therapy, HIV-infected women live longer, healthier lives. Previous research has shown that, since the adoption of combination antiretroviral therapy in the United States, rates of morbidity and adverse obstetric outcomes remained higher for HIV-infected pregnant women compared with HIV-uninfected pregnant women. Monitoring trends in the outcomes these women experience is essential, as recommendations for this special population continue to evolve with the progress of HIV treatment and prevention options. We conducted an analysis comparing rates of hospitalizations and associated outcomes among HIV-infected and HIV-uninfected pregnant women in the United States from 2004 through 2011. We used cross-sectional hospital discharge data for girls and women age 15-49 from the 2004, 2007, and 2011 Nationwide Inpatient Sample, a nationally representative sample of US hospital discharges. Demographic characteristics, morbidity outcomes, and time trends were compared using χ(2) tests and multivariate logistic regression. Analyses were weighted to produce national estimates. In 2011, there were 4751 estimated pregnancy hospitalizations and 3855 delivery hospitalizations for HIV-infected pregnant women; neither increased since 2004. Compared with those of HIV-uninfected women, pregnancy hospitalizations of HIV-infected women were more likely to be longer, be in the South and Northeast, be covered by public insurance, and incur higher charges (all P pregnant women with HIV infection had higher rates for many adverse outcomes. Compared to 2004, hospitalizations of HIV-infected pregnant women in 2011 had higher odds of gestational diabetes (adjusted odds ratio, 1.81; 95% confidence interval, 1.16-2.84), preeclampsia/hypertensive disorders of pregnancy (adjusted odds ratio, 1.58; 95% confidence interval, 1.12-2.24), viral/mycotic/parasitic infections (adjusted odds ratio, 1.90; 95% confidence interval, 1

Antiviral treatment among older adults hospitalized with influenza, 2006-2012.

Directory of Open Access Journals (Sweden)

Mary Louise Lindegren

Full Text Available To describe antiviral use among older, hospitalized adults during six influenza seasons (2006-2012 in Davidson County, Tennessee, USA.Among adults ≥50 years old hospitalized with symptoms of respiratory illness or non-localizing fever, we collected information on provider-initiated influenza testing and nasal/throat swabs for influenza by RT-PCR in a research laboratory, and calculated the proportion treated with antivirals.We enrolled 1753 adults hospitalized with acute respiratory illness. Only 26% (457/1753 of enrolled patients had provider-initiated influenza testing. Thirty-eight patients had a positive clinical laboratory test, representing 2.2% of total patients and 8.3% of tested patients. Among the 38 subjects with clinical laboratory-confirmed influenza, 26.3% received antivirals compared to only 4.5% of those with negative clinical influenza tests and 0.7% of those not tested (p<0.001. There were 125 (7.1% patients who tested positive for influenza in the research laboratory. Of those with research laboratory-confirmed influenza, 0.9%, 2.7%, and 2.8% received antivirals (p=.046 during pre-pandemic, pandemic, and post-pandemic influenza seasons, respectively. Both research laboratory-confirmed influenza (adjusted odds ratio [AOR] 3.04 95%CI 1.26-7.35 and clinical laboratory-confirmed influenza (AOR 3.05, 95%CI 1.07-8.71 were independently associated with antiviral treatment. Severity of disease, presence of a high-risk condition, and symptom duration were not associated with antiviral use.In urban Tennessee, antiviral use was low in patients recognized to have influenza by the provider as well as those unrecognized to have influenza. The use of antivirals remained low despite recommendations to treat all hospitalized patients with confirmed or suspected influenza.

Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications.

Science.gov (United States)

Mehta, Ambar; Xu, Tim; Hutfless, Susan; Makary, Martin A; Sinno, Abdulrahman K; Tanner, Edward J; Stone, Rebecca L; Wang, Karen; Fader, Amanda N

2017-05-01

invasive surgery included older patient age (reference 45-64 years; 20-44 years: adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28), black race (reference white; adjusted odds ratio, 0.70; 95% confidence interval, 0.63-0.78), Hispanic ethnicity (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80), smaller hospital (reference large; small: adjusted odds ratio, 0.26; 95% confidence interval, 0.15-0.45; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.79-0.96), medium hospital hysterectomy volume (reference ≥200 hysterectomies; 100-200: adjusted odds ratio, 0.78; 95% confidence interval, 0.71-0.87), and medium vs high surgeon volume (reference high; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.78-0.97). Complications occurred in 25.8% of open and 8.2% of minimally invasive hysterectomies (P pay status (adjusted odds ratio, 2.41; 95% confidence interval, 1.40-4.12), and very-low and low surgeon hysterectomy volume (reference ≥21 cases; 1-5 cases: adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.47; 6-10 cases: adjusted odds ratio, 1.60; 95% confidence interval, 1.11-2.23) were associated with perioperative complications. Use of minimally invasive hysterectomy for benign indications remains variable, with most patients undergoing open, more morbid procedures. Older and black patients and smaller hospitals are associated with open hysterectomy. Patient race and payer status, hysterectomy approach, and surgeon volume were associated with perioperative complications. Hysterectomies performed for benign indications by high-volume surgeons or by minimally invasive techniques may represent an opportunity to reduce preventable harm. Copyright © 2017 Elsevier Inc. All rights reserved.

Risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation.

Science.gov (United States)

Atchison, Christie M; Amankwah, Ernest; Wilhelm, Jean; Arlikar, Shilpa; Branchford, Brian R; Stock, Arabela; Streiff, Michael; Takemoto, Clifford; Ayala, Irmel; Everett, Allen; Stapleton, Gary; Jacobs, Marshall L; Jacobs, Jeffrey P; Goldenberg, Neil A

2018-02-01

Paediatric hospital-associated venous thromboembolism is a leading quality and safety concern at children's hospitals. The aim of this study was to determine risk factors for hospital-associated venous thromboembolism in critically ill children following cardiothoracic surgery or therapeutic cardiac catheterisation. We conducted a retrospective, case-control study of children admitted to the cardiovascular intensive care unit at Johns Hopkins All Children's Hospital (St. Petersburg, Florida, United States of America) from 2006 to 2013. Hospital-associated venous thromboembolism cases were identified based on ICD-9 discharge codes and validated using radiological record review. We randomly selected two contemporaneous cardiovascular intensive care unit controls without hospital-associated venous thromboembolism for each hospital-associated venous thromboembolism case, and limited the study population to patients who had undergone cardiothoracic surgery or therapeutic cardiac catheterisation. Odds ratios and 95% confidence intervals for associations between putative risk factors and hospital-associated venous thromboembolism were determined using univariate and multivariate logistic regression. Among 2718 admissions to the cardiovascular intensive care unit during the study period, 65 met the criteria for hospital-associated venous thromboembolism (occurrence rate, 2%). Restriction to cases and controls having undergone the procedures of interest yielded a final study population of 57 hospital-associated venous thromboembolism cases and 76 controls. In a multiple logistic regression model, major infection (odds ratio=5.77, 95% confidence interval=1.06-31.4), age ⩽1 year (odds ratio=6.75, 95% confidence interval=1.13-160), and central venous catheterisation (odds ratio=7.36, 95% confidence interval=1.13-47.8) were found to be statistically significant independent risk factors for hospital-associated venous thromboembolism in these children. Patients with all three

High spin states in odd-odd {sup 132}Cs

Energy Technology Data Exchange (ETDEWEB)

Hayakawa, Takehito [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment; Lu, J; Furuno, K [and others

1998-03-01

Excited states with spin larger than 5 {Dirac_h} were newly established in the {sup 132}Cs nucleus via the {sup 124}Sn({sup 11}B,3n) reaction. Rotational bands built on the {nu}h{sub 11/2} x {pi}d{sub 5/2}, {nu}h{sub 11/2} x {pi}g{sub 7/2} and {nu}h{sub 11/2} x {pi}h{sub 11/2} configurations were observed up to spin I {approx} 16 {Dirac_h}. The {nu}h{sub 11/2} x {pi}h{sub 11/2} band shows inverted signature splitting below I < 14 {Dirac_h}. A dipole band was firstly observed in doubly odd Cs nuclei. (author)

The rising burden of chronic conditions among urban poor: a three-year follow-up survey in Bengaluru, India.

Science.gov (United States)

Gowda, Mrunalini J; Bhojani, Upendra; Devadasan, Narayanan; Beerenahally, Thriveni S

2015-08-15

Chronic conditions are on rise globally and in India. Prevailing intra-urban inequities in access to healthcare services compounds the problems faced by urban poor. This paper reports the trends in self-reported prevalence of chronic conditions and health-seeking pattern among residents of a poor urban neighborhood in south India. A cross sectional survey of 1099 households (5340 individuals) was conducted using a structured questionnaire. The prevalence and health-seeking pattern for chronic conditions in general and for hypertension and diabetes in particular were assessed and compared with a survey conducted in the same community three years ago. The predictors of prevalence and health-seeking pattern were analyzed through a multivariable logistic regression analysis. The overall self-reported prevalence of chronic conditions was 12%, with hypertension (7%) and diabetes (5.8%) being the common conditions. The self-reported prevalence of chronic conditions increased by 3.8 percentage point over a period of three years (OR: 1.5). Older people, women and people living below the poverty line had greater odds of having chronic conditions across the two studies compared. Majority of patients (89.3%) sought care from private health facilities indicating a decrease by 8.7 percentage points in use of government health facility compared to the earlier study (OR: 0.5). Patients seeking care from super specialty hospitals and those living below the poverty line were more likely to seek care from government health facilities. There is need to strengthen health services with a preferential focus on government services to assure affordable care for chronic conditions to urban poor.

Impact of congenital anomalies and treatment location on the outcomes of infants hospitalized with herpes simplex virus (HSV).

Science.gov (United States)

Lorch, Scott A; Millman, Andrea M; Shah, Samir S

2010-03-01

Herpes simplex virus (HSV) is a rare but costly reason for hospitalization in infants under 60 days of age. The impact of coexisting comorbid conditions and treatment location on hospital outcome is poorly understood. Determine patient and hospital factors associated with poor outcomes or death in infants hospitalized with HSV. : Retrospective cohort study using the 2003 Kids' Inpatient Database (KID). U.S. hospitals. Infants under 60 days of age with a diagnosis of HSV. Treatment at different types of hospitals, younger age at admission, and presence of congenital anomalies. Serious complications, in-hospital death. A total of 10% of the 1587 identified HSV hospitalizations had a concurrent congenital anomaly. A total of 267 infants had a serious complication and 50 died. After controlling for clinical and hospital characteristics, concurrent congenital anomalies were associated with higher odds of a serious complication (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI], 2.00-5.56) and higher odds of death (adjusted OR, 4.17; 95% CI, 1.74-10.0). Similar results were found for infants admitted under 7 days of age. Although different hospital types had statistically similar clinical outcomes after controlling for case-mix differences, treatment at a children's hospital was associated with an 18% reduction in length of stay (LOS). Infants with concurrent congenital anomalies infected with HSV were at increased risk for serious complications or death. Health resource use may be improved through identification and adoption of care practiced at children's hospitals.

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka.

Science.gov (United States)

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S; Tozan, Yeşim

2016-02-01

Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health's perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216-609 for pediatric cases and between US$196-866 for adult cases according to disease severity and treatment setting. This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka.

Costs of Dengue Control Activities and Hospitalizations in the Public Health Sector during an Epidemic Year in Urban Sri Lanka

Science.gov (United States)

Thalagala, Neil; Tissera, Hasitha; Palihawadana, Paba; Amarasinghe, Ananda; Ambagahawita, Anuradha; Wilder-Smith, Annelies; Shepard, Donald S.; Tozan, Yeşim

2016-01-01

Background Reported as a public health problem since the 1960s in Sri Lanka, dengue has become a high priority disease for public health authorities. The Ministry of Health is responsible for controlling dengue and other disease outbreaks and associated health care. The involvement of large numbers of public health staff in dengue control activities year-round and the provision of free medical care to dengue patients at secondary care hospitals place a formidable financial burden on the public health sector. Methods We estimated the public sector costs of dengue control activities and the direct costs of hospitalizations in Colombo, the most heavily urbanized district in Sri Lanka, during the epidemic year of 2012 from the Ministry of Health’s perspective. The financial costs borne by public health agencies and hospitals are collected using cost extraction tools designed specifically for the study and analysed retrospectively using a combination of activity-based and gross costing approaches. Results The total cost of dengue control and reported hospitalizations was estimated at US$3.45 million (US$1.50 per capita) in Colombo district in 2012. Personnel costs accounted for the largest shares of the total costs of dengue control activities (79%) and hospitalizations (46%). The results indicated a per capita cost of US$0.42 for dengue control activities. The average costs per hospitalization ranged between US$216–609 for pediatric cases and between US$196–866 for adult cases according to disease severity and treatment setting. Conclusions This analysis is a first attempt to assess the economic burden of dengue response in the public health sector in Sri Lanka. Country-specific evidence is needed for setting public health priorities and deciding about the deployment of existing or new technologies. Our results suggest that dengue poses a major economic burden on the public health sector in Sri Lanka. PMID:26910907

The Role of Mental Health Disease in Potentially Preventable Hospitalizations: Findings From a Large State.

Science.gov (United States)

Medford-Davis, Laura N; Shah, Rohan; Kennedy, Danielle; Becker, Emilie

2018-01-01

Preventable hospitalizations are markers of potentially low-value care. Addressing the problem requires understanding their contributing factors. The objective of this study is to determine the correlation between specific mental health diseases and each potentially preventable hospitalization as defined by the Agency for Healthcare Research and Quality. The Texas Inpatient Public Use Data File, an administrative database of all Texas hospital admissions, identified 7,351,476 adult acute care hospitalizations between 2005 and 2008. A hierarchical multivariable logistic regression model clustered by admitting hospital adjusted for patient and hospital factors and admission date. A total of 945,280 (12.9%) hospitalizations were potentially preventable, generating $6.3 billion in charges and 1.2 million hospital days per year. Mental health diseases [odds ratio (OR), 1.25; 95% confidence interval (CI), 1.22-1.27] and substance use disorders (OR, 1.13; 95% CI, 1.12-1.13) both increased odds that a hospitalization was potentially preventable. However, each mental health disease varied from increasing or decreasing the odds of potentially preventable hospitalization depending on which of the 12 preventable hospitalization diagnoses were examined. Older age (OR, 3.69; 95% CI, 3.66-3.72 for age above 75 years compared with 18-44 y), black race (OR 1.44; 95% CI, 1.43-1.45 compared to white), being uninsured (OR 1.52; 95% CI, 1.51-1.54) or dual-eligible for both Medicare and Medicaid (OR, 1.23; 95% CI, 1.22-1.24) compared with privately insured, and living in a low-income area (OR, 1.20; 95% CI, 1.17-1.23 for lowest income quartile compared with highest) were other patient factors associated with potentially preventable hospitalizations. Better coordination of preventative care for mental health disease may decrease potentially preventable hospitalizations.

The Lowest Spin and Parity Levels on Two Particle System for Odd-oddNuclei 60Co and 46K

International Nuclear Information System (INIS)

Wardhani, VIS; Siagian, Toga

2000-01-01

For obtaining the lowest spin and parity levels of odd-odd nuclei, theanalyzing of the nuclei 60 Co and 46 K has been done using delta forcemodel. The calculation is done by theoretically and compared with experiment.To get a result optimally, the data analyzed using least square method. It isshown that the lowest spin and parity level from calculation result and theexperiment result are similar. (author)

Risk of Parkinson's disease after hospital contact for head injury

DEFF Research Database (Denmark)

Rugbjerg, Kathrine; Ritz, Beate; Korbo, Lise

2008-01-01

OBJECTIVE: To determine whether a hospital contact for a head injury increases the risk of subsequently developing Parkinson's disease. DESIGN: Population based case-control study. SETTING: Denmark. PARTICIPANTS: 13 695 patients with a primary diagnosis of Parkinson's disease in the Danish national...... of history of head injury. RESULTS: An overall 50% increase in prevalence of hospital contacts for head injury was seen before the first registration of Parkinson's disease in this population (odds ratio 1.5, 95% confidence interval 1.4 to 1.7). The observed association was, however, due almost entirely...... to injuries that occurred during the three months before the first record of Parkinson's disease (odds ratio 8.0, 5.6 to 11.6), and no association was found between the two events when they occurred 10 or more years apart (1.1, 0.9 to 1.3). CONCLUSIONS: The steeply increased frequency of hospital contacts...

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care.

Science.gov (United States)

Aiken, Linda H; Sloane, Douglas; Griffiths, Peter; Rafferty, Anne Marie; Bruyneel, Luk; McHugh, Matthew; Maier, Claudia B; Moreno-Casbas, Teresa; Ball, Jane E; Ausserhofer, Dietmar; Sermeus, Walter

2017-07-01

To determine the association of hospital nursing skill mix with patient mortality, patient ratings of their care and indicators of quality of care. Cross-sectional patient discharge data, hospital characteristics and nurse and patient survey data were merged and analysed using generalised estimating equations (GEE) and logistic regression models. Adult acute care hospitals in Belgium, England, Finland, Ireland, Spain and Switzerland. Survey data were collected from 13 077 nurses in 243 hospitals, and 18 828 patients in 182 of the same hospitals in the six countries. Discharge data were obtained for 275 519 surgical patients in 188 of these hospitals. Patient mortality, patient ratings of care, care quality, patient safety, adverse events and nurse burnout and job dissatisfaction. Richer nurse skill mix (eg, every 10-point increase in the percentage of professional nurses among all nursing personnel) was associated with lower odds of mortality (OR=0.89), lower odds of low hospital ratings from patients (OR=0.90) and lower odds of reports of poor quality (OR=0.89), poor safety grades (OR=0.85) and other poor outcomes (0.80nurses is associated with an 11% increase in the odds of death. In our hospital sample, there were an average of six caregivers for every 25 patients, four of whom were professional nurses. Substituting one nurse assistant for a professional nurse for every 25 patients is associated with a 21% increase in the odds of dying. A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding nursing associates and other categories of assistive nursing personnel without professional nurse qualifications may contribute to preventable deaths, erode quality and safety of hospital care and contribute to hospital nurse shortages. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please

Single Particle energy levels in ODD-A Nuclei

International Nuclear Information System (INIS)

Lasijo, R.S.

1997-01-01

Singe particle energies for atomic nuclei with odd-A number of nucleons, i.e. nuclei possessing odd number of protons or odd number of neutrons, were calculated based on Nilsson's theory, and then the diagrams were made. the energy diagram is in the from of plot of energies as function of deformations, entities identifying the deviations from the spherical shape. The energy calculations were done using FORTRAN 77 language of PC (Personal Computer) version with Microsoft Fortran Power Station compiler, which was then combined with WORD version 6.0 and EXCEL version 5.0 of WINDOWS WORKGROUP to make the plot

Pseudo-spin band in the odd-odd nucleus sup 1 sup 7 sup 2 Lu

CERN Document Server

Venkova, T; Gast, W; Podsvirova, E O; Jäger, H M; Mihailescu, L; Bazzacco, D; Menegazzo, R; Lunardi, S; Alvarez, C R; Ur, C; Martínez, T; Angelis, G D; Axiotis, M; Napoli, D; Urban, W; Rzaca-Urban, T; Frauendorf, S

2003-01-01

High-spin states in the odd-odd nucleus sup 1 sup 7 sup 2 Lu have been populated in a sup 1 sup 7 sup 0 Er( sup 7 Li,5n) reaction and the emitted gamma-radiation was detected with the GASP array. Two sequences of a new identical band have been observed with the transition energies in the favoured and unfavoured sequences being identical within approx 3 keV at low spins and approx 1 keV at high spins over the whole observed spin range. An interpretation as a pseudo-spin singlet band of pi 1/2 sup - [541] x nu 1/2 sup - [420] configuration is proposed. It represents the best example of a pseudo-spin singlet band in normal deformed nuclei known until now.

Readmissions to Different Hospitals After Common Surgical Procedures and Consequences for Implementation of Perioperative Surgical Home Programs.

Science.gov (United States)

Dexter, Franklin; Epstein, Richard H; Sun, Eric C; Lubarsky, David A; Dexter, Elisabeth U

2017-09-01

We consider whether there should be greater priority of information sharing about postacute surgical resources used: (1) at skilled nursing facilities or inpatient rehabilitation hospitals to which patients are transferred upon discharge (when applicable) versus (2) at different hospitals where readmissions occur. Obtaining and storing data electronically from these 2 sources for Perioperative Surgical Home initiatives are dissimilar; both can be challenging depending on the country and health system. Using the 2013 US Nationwide Readmissions Database, we studied discharges of surgical diagnosis-related group (DRG) with US national median length of stay (LOS) ≥ 3 days and ≥ 10 hospitals each with ≥ 100 discharges for the Medicare Severity DRG. Nationwide, 16.15% (95% confidence interval [CI], 15.14%-17.22%) of discharges were with a disposition of "not to home" (ie, transfer to a skilled nursing facility or an inpatient rehabilitation hospital). Within 30 days, 0.88% of discharges (0.82%-0.95%) were followed by readmission and to a different hospital than the original hospital where the surgery was performed. Among all discharges, disposition "not to home" versus "to home" was associated with greater odds that the patient would have readmission within 30 days and to a different hospital than where the surgery was performed (2.11, 95% CI, 1.96-2.27; P < .0001). In part, this was because disposition "not to home" was associated with greater odds of readmission to any hospital (1.90, 95% CI, 1.82-1.98; P < .0001). In addition, among the subset of discharges with readmission within 30 days, disposition "not to home" versus "to home" was associated with greater odds that the readmission was to a different hospital than where the surgery was performed (1.20, 95% CI, 1.11-1.31; P < .0001). There was no association between the hospitals' median LOS for the DRG and the odds that readmission was to a different hospital (P = .82). The odds ratio per each 1 day decrease

CP-odd Phase Correlations and Electric Dipole Moments

CERN Document Server

Olive, Keith A; Ritz, A; Santoso, Y; Olive, Keith A.; Pospelov, Maxim; Ritz, Adam; Santoso, Yudi

2005-01-01

We revisit the constraints imposed by electric dipole moments (EDMs) of nucleons and heavy atoms on new CP-violating sources within supersymmetric theories. We point out that certain two-loop renormalization group corrections induce significant mixing between the basis-invariant CP-odd phases. In the framework of the constrained minimal supersymmetric standard model (CMSSM), the CP-odd invariant related to the soft trilinear A-phase at the GUT scale, theta_A, induces non-trivial and distinct CP-odd phases for the three gaugino masses at the weak scale. The latter give one-loop contributions to EDMs enhanced by tan beta, and can provide the dominant contribution to the electron EDM induced by theta_A. We perform a detailed analysis of the EDM constraints within the CMSSM, exhibiting the reach, in terms of sparticle spectra, which may be obtained assuming generic phases, as well as the limits on the CP-odd phases for some specific parameter points where detailed phenomenological studies are available. We also i...

Defining a Hospital Volume Threshold for Minimally Invasive Pancreaticoduodenectomy in the United States

Science.gov (United States)

Adam, Mohamed Abdelgadir; Thomas, Samantha; Youngwirth, Linda; Pappas, Theodore; Roman, Sanziana A.

2016-01-01

Importance There is increasing interest in expanding use of minimally invasive pancreaticoduodenectomy (MIPD). This procedure is complex, with data suggesting a significant association between hospital volume and outcomes. Objective To determine whether there is an MIPD hospital volume threshold for which patient outcomes could be optimized. Design, Setting, and Participants Adult patients undergoing MIPD were identified from the Healthcare Cost and Utilization Project National Inpatient Sample from 2000 to 2012. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting annual hospital volume against the adjusted odds of postoperative complications. The current analysis was conducted on August 16, 2016. Main Outcomes and Measures Incidence of any complication. Results Of the 865 patients who underwent MIPD, 474 (55%) were male and the median patient age was 67 years (interquartile range, 59-74 years). Among the patients, 747 (86%) had cancer and 91 (11%) had benign conditions/pancreatitis. Overall, 410 patients (47%) had postoperative complications and 31 (4%) died in-hospital. After adjustment for demographic and clinical characteristics, increasing hospital volume was associated with reduced complications (overall association P < .001); the likelihood of experiencing a complication declined as hospital volume increased up to 22 cases per year (95% CI, 21-23). Median hospital volume was 6 cases per year (range, 1-60). Most patients (n = 717; 83%) underwent the procedure at low-volume (≤22 cases per year) hospitals. After adjustment for patient mix, undergoing MIPD at low- vs high-volume hospitals was significantly associated with increased odds for postoperative complications (odds ratio, 1.74; 95% CI, 1.03-2.94; P = .04). Conclusions and Relevance Hospital volume is significantly associated with improved outcomes from MIPD, with a threshold of 22 cases per year. Most patients undergo MIPD at low

Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients.

Science.gov (United States)

Thongprayoon, Charat; Cheungpasitporn, Wisit; Kittanamongkolchai, Wonngarm; Harrison, Andrew M; Kashani, Kianoush

2017-05-01

The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients. This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality. Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients. Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Magnetic dipole moments of deformed odd-odd nuclei in 2s-1d and 2p-1f shells

Energy Technology Data Exchange (ETDEWEB)

Verma, A K; Garg, V P; Sharma, S D [Punjabi Univ., Patiala (India). Dept. of Physics

1979-01-01

A simple expression is derived for the computation of the magnetic moments of odd-odd nuclei. The computation of magnetic dipole moments is done with and without quenching factors for the last proton and neutron. The results are found to improve for /sup 22/Na, /sup 24/Na, sup(82m)Rb, /sup 14/N, /sup 68/Gd, /sup 54/Mn and /sup 86/Rb with extreme coupling of angular moments.

Maternal morbidity and risk of death at delivery hospitalization.

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Campbell, Katherine H; Savitz, David; Werner, Erika F; Pettker, Christian M; Goffman, Dena; Chazotte, Cynthia; Lipkind, Heather S

2013-09-01

To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization. We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995-2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression. During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5-12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7-12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1-8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3-8.1), HIV (adjusted OR, 7.7; 95% CI 3.4-17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8-269.3) were associated with an increased risk of death during the delivery hospitalization. The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization. II.

Which Executive Functioning Deficits Are Associated with AD/HD, ODD/CD and Comorbid AD/HD+ODD/CD? (Attention Deficit/hyperactivity Disorder)(Oppositional Defiant Disorder)

Science.gov (United States)

Oosterlaan, Jaap; Scheres, Anouk; Sergeant, Joseph A.

2005-01-01

This study investigated (1) whether attention deficit/hyperactivity disorder (AD/HD) is associated with executive functioning (EF) deficits while controlling for oppositional defiant disorder/conduct disorder (ODD/CD), (2) whether ODD/CD is associated with EF deficits while controlling for AD/HD, and (3) whether a combination of AD/HD and ODD/CD…

Risk factors of workplace violence at hospitals in Japan.

Science.gov (United States)

Fujita, Shigeru; Ito, Shinya; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika; Hasegawa, Tomonori

2012-02-01

Patients and their relatives exposed to mental stress caused by hospitalization or illness might use violence against healthcare staff and interfere with quality healthcare. The aim of this study was to investigate incidences of workplace violence and the attributes of healthcare staff who are at high risk. A questionnaire-based, anonymous, and self-administered cross-sectional survey. Healthcare staff (n = 11,095) of 19 hospitals in Japan. Incidence rates and adjusted odd ratios of workplace violence were calculated to examine the effect of attributes of healthcare staff to workplace violence by using logistic regression analysis. The response rate for survey completion was 79.1% (8711/11,095). Among the respondents, 36.4% experienced workplace violence by patients or their relatives in the past year; 15.9% experienced physical aggression, 29.8% experienced verbal abuse, and 9.9% experienced sexual harassment. Adjusted odds ratios of physical aggression were significantly high in psychiatric wards, critical care centers/intensive care units (ICU)/cardiac care units (CCU), long-term care wards, for nurses, nursing aides/care workers, and for longer working hours. Adjusted odds ratios of verbal abuse were significantly high in psychiatric wards, long-term care wards, outpatient departments, dialysis departments, and for longer years of work experience, and for longer working hours. Adjusted odds ratios of sexual harassment were significantly high in dialysis departments, for nurses, nursing aides/care workers, technicians, therapists and females. The general ward and direct interaction with patients were common risk factors for each type of workplace violence. The mechanisms and the countermeasures for each type of workplace violence at those high-risk areas should be investigated. Copyright © 2011 Society of Hospital Medicine.

Rural Hospital Wages and the Area Wage Index

Science.gov (United States)

Dalton, Kathleen; Slifkin, Rebecca T.; Howard, Hilda A.

2002-01-01

We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey. Patterns of within-market wage variation across rural-urban continuum codes identify three separate sub-markets within the State-level aggregates defining rural labor markets. Geographic reclassification decisions appear to eliminate one of the three. Remaining systematic within-market rural wage differences work to the reimbursement advantage of hospitals in the smaller and more isolated communities. PMID:12545604

Rural hospitals: an asset in the continuum of care.

Science.gov (United States)

Arduino, Kelly

2015-11-01

When embarking on a partnership or acquisition, a rural hospital and a larger health system can accomplish a smooth transition, as long as they both keep in mind: > The fundamental (and financial) differences between urban and rural hospitals > The areas where the rural hospital in the partnership or acquisition is profitable > The importance of a clinic strategy in a partnership.

Determinants of self-rated health in elderly populations in urban areas in Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey.

Science.gov (United States)

Stanojevic Jerkovic, Olivera; Sauliune, Skirmante; Šumskas, Linas; Birt, Christopher A; Kersnik, Janko

2017-05-01

Ageing imposes extra financial burdens on social and health services in developed countries. Self-rated health (SRH) is considered to be both a reliable measurement of overall health status including morbidity and mortality and an important predictor of hospitalization, functional impairment and greater demand for health-care services in the elderly. Our aim was to identify factors associated with poor SRH in elderly populations and investigate possible differences between urban areas in Slovenia, Lithuania and UK. Data were obtained from population-based surveys from the European Urban Health Indicator System Part 2 project. The stratified representative sample (41% men and 59% women) consisted of a total of 2547 respondents aged ≥65 from the urban areas in the three countries. The prevalence of poor SRH was highest in Lithuanian urban areas. The strongest factors associated with poor SRH were low education [OR (odds ratio) 4.3, 95% CI (confidence interval) 2.5-7.3, P Slovenia) (OR 2.0, 95% CI 1.1-3.7, P = 0,023), female sex (Lithuania) (OR 2.0, 95% CI 1.0-4.2, P = 0.058) and inadequate physical activity (UK) (OR 2.2, 95% CI 1.3-3.6, P = 0,003). Despite different levels of poor SRH, the factors associated with poor SRH were similar for the urban areas of the three countries. Factors associated with poor SRH in the urban areas could also reflect either cultural differences or specific situations for elderly in that country, which need further research. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Resonance spin memory in low-energy gamma-ray spectra from Sb, Tb, Ho and Ta odd-odd compound nuclei

International Nuclear Information System (INIS)

Olejniczak, U.; Gundorin, N.A.; Pikelner, L.B.; Serov, D.G.; Przytula, M.

2002-01-01

The low-energy gamma-ray spectra from neutron resonance capture with natural samples of Sb, Tb, Ho and Ta were measured using a HPGe detector at the IBR-30 pulsed reactor (JINR, Dubna). The resonance spin memory effect in the spectra from the odd-odd compound nuclei of 122 Sb, 160 Tb and 166 Ho was found to be quite distinct. For the 182 Ta compound nucleus it proved to be rather weak

T-odd polarization observables in deuteron electrodisintegration

International Nuclear Information System (INIS)

Rekalo, M.P.; Gakh, G.I.; Rekalo, A.P.

1996-01-01

It is considered such simplest T-odd polarization observables of the deuteron disintegration as proton polarization in d(e, e' p-bar)n and the asymmetry in the scattering of unpolarized electrons by a vector-polarized target, d-bar (e, e' p)n. The θ dependence of theses observables has been studied. The procedure of making the conserved electromagnetic current has an essential influence on the final θ dependence of the T-odd polarization observables [ru

Iron-Based Superconductors as Odd-Parity Superconductors

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Jiangping Hu

2013-07-01

Full Text Available Parity is a fundamental quantum number used to classify a state of matter. Materials rarely possess ground states with odd parity. We show that the superconducting state in iron-based superconductors is classified as an odd-parity s-wave spin-singlet pairing state in a single trilayer FeAs/Se, the building block of the materials. In a low-energy effective model constructed on the Fe square bipartite lattice, the superconducting order parameter in this state is a combination of an s-wave normal pairing between two sublattices and an s-wave η pairing within the sublattices. The state has a fingerprint with a real-space sign inversion between the top and bottom As/Se layers. The results suggest that iron-based superconductors are a new quantum state of matter, and the measurement of the odd parity can help to establish high-temperature superconducting mechanisms.

Against all odds?

DEFF Research Database (Denmark)

Triantafillou, Peter

2014-01-01

, in the face of these obstacles, DDKM was ultimately implemented. It is argued that DDKM is the result of the emergence of hospital quality management assemblage in 1980s and 1990s made up by new methods of categorizing disease treatments, computerization of such treatments, concerns over cost......-effectiveness, complaint registration, the availability of international hospital quality assessment systems, the mobilization of organized medical interest groups, and a tradition of consultative policymaking procedures. This assemblage was crucial for identifying quality as a problem in need of administrative...

Population-based assessment of heartburn in urban Black Americans.

Science.gov (United States)

Friedenberg, F K; Makipour, K; Palit, A; Shah, S; Vanar, V; Richter, J E

2013-08-01

Prevalence data for heartburn in the urban Black American community is lacking. In order to estimate prevalence for this community, we analyzed data from an ongoing cohort study in progress at our hospital. Comprehensive interviews allowed for exploration of factors associated with heartburn. Complex, stratified sampling design was the method used. Survey invitations are hand-delivered to random blocks in a single zip code tabulation area. One member per eligible household is invited to complete a computer-based survey. Heartburn was defined as ≥ 3 days/week of symptoms as defined by the Montreal Definition and Classification of gastroesophageal reflux disease. Scaling and weighting factors were utilized to estimate population level prevalence. Multivariate logistic regression was used to identify independent predictor variables for heartburn. Enrolled 379 participants corresponding to a weighted sample size of 22,409 (20,888-23,930) citizens. Demographic characteristics of the sample closely matched those of the entire targeted population. Overall, the weighted prevalence of heartburn ≥ 3 times per week was 17.6% (16.4-18.8%). Variables independently associated with heartburn were body mass index, daily caloric and fat intake, diabetes mellitus (odds ratio = 2.95; 2.59-3.36), cigarette smoking, and alcohol consumption (odds ratio = 2.55; 2.25-2.89). Factors inversely associated included illicit drug use and increased physical activity. Waist : hip ratio showed no relationship. The prevalence of heartburn ≥ 3 times per week is high in the Black American community. Adverse lifestyle behaviors showed particularly important associations. Our study needs to be replicated in other communities with similar demographics. © 2012 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

A Decomposition of Hospital Profitability

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Jason Turner

2015-06-01

Full Text Available Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover, and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552. The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of

A Decomposition of Hospital Profitability

Science.gov (United States)

Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO

The relationship between new media exposure and fast food consumption among Chinese children and adolescents in school: a rural-urban comparison.

Science.gov (United States)

Hansstein, Francesca Valeria; Hong, Yu; Di, Chen

2017-09-01

In recent decades, China has experienced an exponential growth in the number of internet users, especially among the youngest population, as well as a rapid proliferation of Western-type fast food restaurants. The health consequences of internet availability and fast food consumption among youth have been largely studied in Western countries, but few studies have focused on China. This paper has two goals. The first is to evaluate the differences in new media exposure and preferences for fast foods between rural and urban areas. The second goal is to test the association between new media exposure and fast food consumption. The targets of this analysis are Chinese children and adolescents aged 6-18 attending school at the time of the interview. Research hypotheses were tested using mean-groups comparisons for differences between rural urban sub-samples, and logistic regressions with odds ratios to estimate the relationship between media exposure and preferences towards fast foods. Cross-sectional data from the 2009 China Health and Nutrition Survey were employed. Watching online videos and playing computer games are behaviors associated with higher probabilities of eating at fast food restaurants in both rural and urban young residents, with higher odds in rural areas. Surfing the internet is associated with higher odds of being overweight in both rural and urban settings. Results also show that children living in rural areas spend significantly more time playing computer games, watching TV and videotapes, but less time doing homework than their urban peers. This paper suggests that monitoring the nutritional effects of new media exposure in China is of key importance in order to develop adequate health promotion policies, in both rural and urban areas.

Identifying types of domestic violence and its associated risk factors in a pregnant population in Kerman hospitals, Iran Republic.

Science.gov (United States)

Salari, Zohreh; Nakhaee, Nouzar

2008-01-01

The objective of this study was to estimate the prevalence of different kinds of physical and emotional violence in an Iranian pregnant population and to examine its associated risk factors. This cross-sectional study was done from March through July 2005 in the 4 main hospitals of Kerman, Iran, which had maternity units. In total, 416 out of 460 women who were asked to participate agreed to be interviewed, a 90.4% response rate. All respondents were interviewed privately during the first 48 hours after delivery. The mean age (+/- SD) was 28.0 +/- 5.6, and all were married. Most of the women were urban residents (89.2%), and the majority of them were multiparous (78.8%). Nearly 16% of mothers said the pregnancies were unintended. In total, 35% (95% confidence interval: 30%-40%) of women had experienced 1 or more episodes of emotional violence during the pregnancy inflicted by their husbands, and 106 women (25%; 95% confidence interval: 21%-30%) had experienced at least 1 episode of physical violence. The highest odds of domestic violence during pregnancy was associated with unintended pregnancies (odds ratio: 7.66; 95% confidence interval: 3.45-16.99) and multiparous pregnancies (odds ratio: 6.88; 95% confidence interval: 3.46-13.68). Considering the high prevalence of different types of domestic violence during pregnancy, it should be regarded as a priority for health policy experts in Kerman and possibly Iran.

Urban Heat Wave Hazard Assessment

Science.gov (United States)

Quattrochi, Dale A.; Jedlovec, Gary; Meyer, Paul J.; LaFontaine, Frank J.; Crane, Dakota L.

2016-01-01

Heat waves are the largest cause of environment-related deaths globally. On average, over 6,000 people in the United States alone are hospitalized each summer due to excessive heat. Key elements leading to these disasters are elevated humidity and the urban heat island effect, which act together to increase apparent temperature and amplify the effects of a heat wave. Urban demographics and socioeconomic factors also play a role in determining individual risk. Currently, advisories of impending heat waves are often too generalized, with limited or no spatial variability over urban regions. This frequently contributes to a lack of specific response on behalf of the population. A goal of this project is to develop a product that has the potential to provide more specific heat wave guidance invoking greater awareness and action.

Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study

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Zhang Yanshen

2010-10-01

Full Text Available Abstract Background A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension. Methods Daily data on emergency hospital visits (EHVs for hypertension were collected from the Peking University Third Hospital. Daily data on gaseous air pollutants (sulfur dioxide (SO2 and nitrogen dioxide (NO2 and particulate matter less than 10 μm in aerodynamic diameter (PM10 were collected from the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was conducted to evaluate the relationship between urban gaseous air pollution and EHVs for hypertension. Temperature and relative humidity were controlled for. Results In the single air pollutant models, a 10 μg/m3 increase in SO2 and NO2 were significantly associated with EHVs for hypertension. The odds ratios (ORs were 1.037 (95% confidence interval (CI: 1.004-1.071 for SO2 at lag 0 day, and 1.101 (95% CI: 1.038-1.168 for NO2 at lag 3 day. After controlling for PM10, the ORs associated with SO2 and NO2 were 1.025 (95% CI: 0.987-1.065 and 1.114 (95% CI: 1.037-1.195, respectively. Conclusion Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing, China.

Psychosocial and nonclinical factors predicting hospital utilization in patients of a chronic disease management program: a prospective observational study.

Science.gov (United States)

Tran, Mark W; Weiland, Tracey J; Phillips, Georgina A

2015-01-01

Psychosocial factors such as marital status (odds ratio, 3.52; 95% confidence interval, 1.43-8.69; P = .006) and nonclinical factors such as outpatient nonattendances (odds ratio, 2.52; 95% confidence interval, 1.22-5.23; P = .013) and referrals made (odds ratio, 1.20; 95% confidence interval, 1.06-1.35; P = .003) predict hospital utilization for patients in a chronic disease management program. Along with optimizing patients' clinical condition by prescribed medical guidelines and supporting patient self-management, addressing psychosocial and nonclinical issues are important in attempting to avoid hospital utilization for people with chronic illnesses.

Factors Associated with Physical Inactivity among Adult Urban Population of Puducherry, India: A Population Based Cross-sectional Study.

Science.gov (United States)

Newtonraj, Ariarathinam; Murugan, Natesan; Singh, Zile; Chauhan, Ramesh Chand; Velavan, Anandan; Mani, Manikandan

2017-05-01

Physical inactivity is the fourth leading cause of death worldwide. Increase in physical activity decreases the incidence of cardiovascular diseases, Type 2 diabetes, stroke, and improves psychological wellbeing. To study the level of physical inactivity among the adult population in an urban area of Puducherry in India and its associated risk factors. This cross-sectional study was conducted among 569 adult participants from an urban area of Pondicherry. The level of physical inactivity was measured by using WHO standard Global Physical Activity Questionnaire (GPAQ). Overall prevalence of physical inactivity in our study was 49.7% (CI: 45.6-53.8). Among the physically active people, contribution of physical activity by work was 77.4%, leisure time activities were 11.6% and transport time was 11%. Both men and women were equally inactive {Physically inactive among women was 50% (CI:44.1-55.9)} and {Physically inactive among men was 49.5% (CI:43.8-55.2)}. Prevalence of physical inactivity was increasing with increasing age. Non tobacco users were two times more active than tobacco users {Adjusted Odds Ratio: 2.183 (1.175- 4.057)}. Employed were more active as compared to retired {Adjusted Odds Ratio: 0.412 (0.171-0.991)}, students {Adjusted Odds Ratio: 0.456 (0.196-1.060)}, house wives {Adjusted Odds Ratio: 0.757 (0.509-1.127)} and unemployed {Adjusted Odds Ratio: 0.538 (0.271-1.068)}. Non alcoholics were only 0.34 times as active as alcoholics. Level of physical activity was found to be insufficient among adult urban population of Puducherry. Working adult population found to be active, that too due to their work pattern. There is a need to promote leisure time and travelling time physical activity.

In a niche of time: do specialty hospitals outperform general services hospitals?

Science.gov (United States)

Poole, LeJon; Davis, Jullet A; Gunby, Norris W

2013-01-01

Niche hospitals represent a growing segment in the health care industry. Niche facilities are primarily engaged in the treatment of cardiac or orthopedic conditions. The effectiveness of this strategy is of interest because niche hospitals focus on only the most profitable services. The purpose of this research was to assess the financial effectiveness of the niche strategy. We theorize that firm and market-level factors concomitantly with the strategy of the hospital-niche versus traditional-are associated with financial performance. This research used 2 data sources, the 2003 Medicare Cost Report and the 2003 Area Resource File. The sample was limited to only for-profit, urban, nongovernmental hospitals (n = 995). The data were analyzed using hierarchical least squares regression. Financial performance was operationalized using the hospital's return on assets. The principal finding of this project is that niche hospitals had significantly higher performance than traditional facilities. From the organizational perspective, the niche strategy leads to better financial performance. From a societal perspective, the niche strategy provides increased focus and efficiencies through repetition. Despite the limited focus of this strategy, patients who can access these providers may experience better outcomes than patients in more traditional hospitals.

Cardiovascular comorbidities of pediatric psoriasis among hospitalized children in the United States.

Science.gov (United States)

Kwa, Lauren; Kwa, Michael C; Silverberg, Jonathan I

2017-12-01

Psoriasis has been shown to be associated with cardiovascular disease in adults. Little is known about cardiovascular risk in pediatric psoriasis. To determine if there is an association between pediatric psoriasis and cardiovascular comorbidities. Data were analyzed from the 2002-2012 Nationwide Inpatient Sample, which included 4,884,448 hospitalized children aged 0-17 years. Bivariate and multivariate survey logistic regression models were created to calculate the odds of psoriasis on cardiovascular comorbidities. In multivariate survey logistic regression models adjusting for age, sex, and race/ethnicity, pediatric psoriasis was significantly associated with 5 of 10 cardiovascular comorbidities (adjusted odds ratio [95% confidence interval]), including obesity (3.15 [2.46-4.05]), hypertension (2.63 [1.93-3.59]), diabetes (2.90 [1.90-4.42]), arrhythmia (1.39 [1.02-1.88]), and valvular heart disease (1.90 [1.07-3.37]). The highest odds of cardiovascular risk factors occurred in blacks and Hispanics and children ages 0-9 years, but there were no sex differences. The study was limited to hospitalized children. We were unable to assess the impact of psoriasis treatment or family history on cardiovascular risk. Pediatric psoriasis is associated with higher odds of multiple cardiovascular comorbidities among hospitalized patients. Strategies for mitigating excess cardiovascular risk in pediatric psoriasis need to be determined. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Unintentional childhood injury patterns, odds, and outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit.

Science.gov (United States)

Mutto, Milton; Lawoko, Stephen; Nansamba, Catherine; Ovuga, Emilio; Svanstrom, Leif

2011-01-01

Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years). A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention priorities could include home, road and school safety; especially

Unintentional Childhood Injury Patterns, Odds, and Outcomes in Kampala City: an analysis of surveillance data from the National Pediatric Emergency Unit

Directory of Open Access Journals (Sweden)

Emilio Ovuga

2011-01-01

Full Text Available BACKGROUND: Unintentional Childhood Injuries pose a major public health challenge in Africa and Uganda. Previous estimates of the problem may have underestimated the childhood problem. We set to determine unintentional childhood injury pattern, odds, and outcomes at the National Paediatric Emergency unit in Kampala city using surveillance data. METHODS: Incident proportions, odds and proportional rates were calculated and used to determine unintentional injury patterns across childhood (1-12 years. RESULTS: A total of 556 cases recorded between January and May 2008 were analyzed: majority had been transported to hospital by mothers using mini-buses, private cars, and motorcycles. Median distance from injury location to hospital was 5 km. Homes, roads, and schools were leading injury locations. Males constituted 60% of the cases. Play and daily living activities were commonest injury time activities. Falls, burns and traffic accounted for 70.5% of unintentional childhood injuries. Burns, open wounds, fractures were commonest injury types. Motorcycles, buses and passenger-cars caused most crashes. Play grounds, furniture, stairs and trees were commonest source of falls. Most burn injuries were caused by liquids, fires and hot objects. 43.8% of cases were admitted. 30% were discharged without disability; 10%, were disabled; 1%, died. Injury odds and proportional incidence rates varied with age, place and cause. Poisoning and drowning were rare. Local pediatric injury priorities should include home, road and school safety. CONCLUSIONS: Unintentional injuries are common causes of hospital visit by children under 13 years especially boys. Homes, roads and educational facilities are commonest unintentional injury sites. Significant age and gender differences exist in intentional injury causation, characteristics and outcomes. In its current form, our surveillance system seems inefficient in capturing poisoning and drowning. The local prevention

A comparative study of cervical smears in an urban Hospital in India and a population-based screening program in Mauritius

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Mulay Kaustubh

2009-01-01

Full Text Available Objective: To study cervical smear abnormalities in urban women in India and women in Mauritius and to compare the results in the two groups. Study Design: An analysis of 6010 cervical smears taken as part of routine check-ups in an urban hospital was done and an analysis of 10,000 cervical smears taken from women participating in a National Cancer Screening Program in Mauritius was done. Emphasis was put on cervical epithelial cell abnormalities and the results in the two populations are compared with that of similar studies in other parts of the world. Results: Non specific inflammation formed 19.6% and 25.34% of the smears in the Indian and Mauritian groups, respectively (with specific infection forming 6.05% and 15.08%. The epithelial abnormalities constituted 1.392% of the Indian group and 0.47% of the Mauritian group. The difference was statistically significant in the atypical squamous cells of uncertain significance (ASCUS and atypical glandular cells of uncertain significance (AGUS group. Conclusions: The prevalence of low-grade squamous intraepithelial lesions (LSIL and high-grade squamous intraepithelial lesions (HSIL is similar to that in the developed world.

A Dietary Pattern Derived by Reduced Rank Regression is Associated with Type 2 Diabetes in An Urban Ghanaian Population

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Laura K. Frank

2015-07-01

Full Text Available Reduced rank regression (RRR is an innovative technique to establish dietary patterns related to biochemical risk factors for type 2 diabetes, but has not been applied in sub-Saharan Africa. In a hospital-based case-control study for type 2 diabetes in Kumasi (diabetes cases, 538; controls, 668 dietary intake was assessed by a specific food frequency questionnaire. After random split of our study population, we derived a dietary pattern in the training set using RRR with adiponectin, HDL-cholesterol and triglycerides as responses and 35 food items as predictors. This pattern score was applied to the validation set, and its association with type 2 diabetes was examined by logistic regression. The dietary pattern was characterized by a high consumption of plantain, cassava, and garden egg, and a low intake of rice, juice, vegetable oil, eggs, chocolate drink, sweets, and red meat; the score correlated positively with serum triglycerides and negatively with adiponectin. The multivariate-adjusted odds ratio of type 2 diabetes for the highest quintile compared to the lowest was 4.43 (95% confidence interval: 1.87–10.50, p for trend < 0.001. The identified dietary pattern increases the odds of type 2 diabetes in urban Ghanaians, which is mainly attributed to increased serum triglycerides.

Trends in in-hospital mortality among patients with stroke in China.

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Qian He

Full Text Available BACKGROUND: The incidence and burden of stroke in China is increasing rapidly. However, little is known about trends in mortality during stroke hospitalization. The objectives of this study were to assess trends of in-hospital mortality among patients with stroke and explore influence factors of in-hospital death after stroke in China. METHODS: 109 grade III class A hospitals were sampled by multistage stratified cluster sampling. All patients admitted to hospitals between 2007 and 2010 with a discharge diagnosis of stroke were included. Trends in in-hospital mortality among patients with stroke were assessed. Influence factors of in-hospital death after stroke were explored using multivariable logistic regression. RESULTS: Overall stroke hospitalizations increased from 79,894 in 2007 to 85,475 in 2010, and in-hospital mortality of stroke decreased from 3.16% to 2.30% (P<0.0001. The percentage of severe patients increased while odds of mortality (2010 versus 2007 decreased regardless of stroke type: subarachnoid hemorrhage (OR 0.792, 95% CI = 0.636 to 0.987, intracerebral hemorrhage (OR 0.647, 95% CI = 0.591 to 0.708, and ischemic stroke (OR 0.588, 95% CI = 0.532 to 0.649. In multivariable analyses, older age, male, basic health insurance, multiple comorbidities and severity of disease were linked to higher odds of in-hospital mortality. CONCLUSIONS: The mortality of stroke hospitalizations decreased likely reflecting advancements in stroke care and prevention. Decreasing of mortality with increasing of severe stroke patients indicated that we should pay more attention to rehabilitation and life quality of stroke patients. Specific individual and hospital-level characteristics may be targets for facilitating further declines.

Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

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Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W

2016-06-01

This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases. © The Author(s) 2014.

Linear Parks along Urban Rivers: Perceptions of Thermal Comfort and Climate Change Adaptation in Cyprus

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Elias Giannakis

2016-10-01

Full Text Available The development of green space along urban rivers could mitigate urban heat island effects, enhance the physical and mental well-being of city dwellers, and improve flood resilience. A linear park has been recently created along the ephemeral Pedieos River in the urban area of Nicosia, Cyprus. Questionnaire surveys and micrometeorological measurements were conducted to explore people’s perceptions and satisfaction regarding the services of the urban park. People’s main reasons to visit the park were physical activity and exercise (67%, nature (13%, and cooling (4%. The micrometeorological measurements in and near the park revealed a relatively low cooling effect (0.5 °C of the park. However, the majority of the visitors (84% were satisfied or very satisfied with the cooling effect of the park. Logistic regression analysis indicated that the odds of individuals feeling very comfortable under a projected 3 °C future increase in temperature would be 0.34 times lower than the odds of feeling less comfortable. The discrepancies between the observed thermal comfort index and people’s perceptions revealed that people in semi-arid environments are adapted to the hot climatic conditions; 63% of the park visitors did not feel uncomfortable at temperatures between 27 °C and 37 °C. Further research is needed to assess other key ecosystems services of this urban green river corridor, such as flood protection, air quality regulation, and biodiversity conservation, to contribute to integrated climate change adaptation planning.

Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

DEFF Research Database (Denmark)

Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde

2011-01-01

Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

24 CFR 242.57 - Maintenance of hospital facility.

Science.gov (United States)

2010-04-01

... HOUSING AND URBAN DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Regulatory Agreement, Accounting and Reporting, and Financial...

Revisiting the even-odd staggering in fission-fragment yields

International Nuclear Information System (INIS)

Caamano, M.; Rejmund, F.; Schmidt, K. H.

2010-01-01

The even-odd staggering observed in the experimental fission-fragment nuclear-charge yields is investigated over a wide systematics of fission fragments measured at Lohengrin in direct kinematics and at GSI in inverse kinematics. The general increase of the even-odd staggering in the fission-fragment charge yields towards asymmetric charge splits is explained by the absorption of the unpaired nucleons by the heavy fragment. As a consequence, the well established trend of even-odd staggering in the fission fragment charge yields to decrease with the fissility is attributed in part to the asymmetry evolution of the charge distribution. This interpretation is strongly supported by the data measured at GSI, which cover the complete charge distribution and include precise yields at symmetry. They reveal that the even-odd effect around symmetry remains constant over a large range of fissility. (authors)

Does difference matter? Diversity and human rights in a hospital workplace.

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Sulman, Joanne; Kanee, Marylin; Stewart, Paulette; Savage, Diane

2007-01-01

The urban hospital workplace is a dynamic environment that mirrors the cultural and social diversity of the modern city. This paper explores the literature relating to diversity in the workplace and then describes an urban Canadian teaching hospital's comprehensive approach to the promotion of an equitable and inclusive diverse environment. With this goal, four years ago the hospital established an office of Diversity and Human Rights staffed by a social worker. The office provides education, training, policy development and complaints management. The administration also convened a hospital-wide committee to advise on the outcomes, and to plan a process for diversity and human rights organizational change. The committee worked with a social work research consultant to design a qualitative focus group study, currently ongoing, to explore the perspectives of hospital staff. The lessons learned from the process have the potential to increase overall cultural competency of staff that can translate into more sensitive work with patients.

Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

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Edlynn, Emily S; Derrington, Sabrina; Morgan, Helene; Murray, Jennifer; Ornelas, Beatriz; Cucchiaro, Giovanni

2013-04-01

We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

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Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

2016-02-01

To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

The proportional odds cumulative incidence model for competing risks

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Eriksson, Frank; Li, Jianing; Scheike, Thomas

2015-01-01

We suggest an estimator for the proportional odds cumulative incidence model for competing risks data. The key advantage of this model is that the regression parameters have the simple and useful odds ratio interpretation. The model has been considered by many authors, but it is rarely used...... in practice due to the lack of reliable estimation procedures. We suggest such procedures and show that their performance improve considerably on existing methods. We also suggest a goodness-of-fit test for the proportional odds assumption. We derive the large sample properties and provide estimators...

Utilization of Workflow Process Maps to Analyze Gaps in Critical Event Notification at a Large, Urban Hospital.

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Bowen, Meredith; Prater, Adam; Safdar, Nabile M; Dehkharghani, Seena; Fountain, Jack A

2016-08-01

Stroke care is a time-sensitive workflow involving multiple specialties acting in unison, often relying on one-way paging systems to alert care providers. The goal of this study was to map and quantitatively evaluate such a system and address communication gaps with system improvements. A workflow process map of the stroke notification system at a large, urban hospital was created via observation and interviews with hospital staff. We recorded pager communication regarding 45 patients in the emergency department (ED), neuroradiology reading room (NRR), and a clinician residence (CR), categorizing transmissions as successful or unsuccessful (dropped or unintelligible). Data analysis and consultation with information technology staff and the vendor informed a quality intervention-replacing one paging antenna and adding another. Data from a 1-month post-intervention period was collected. Error rates before and after were compared using a chi-squared test. Seventy-five pages regarding 45 patients were recorded pre-intervention; 88 pages regarding 86 patients were recorded post-intervention. Initial transmission error rates in the ED, NRR, and CR were 40.0, 22.7, and 12.0 %. Post-intervention, error rates were 5.1, 18.8, and 1.1 %, a statistically significant improvement in the ED (p workflow process maps. The workflow process map effectively defined communication failure parameters, allowing for systematic testing and intervention to improve communication in essential clinical locations.

Occurrence of Antibiotic Resistance Genes and Bacterial Markers in a Tropical River Receiving Hospital and Urban Wastewaters.

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Naresh Devarajan

Full Text Available The occurrence of emerging biological contaminants including antibiotic resistance genes (ARGs and Faecal Indicator Bacteria (FIB is still little investigated in developing countries under tropical conditions. In this study, the total bacterial load, the abundance of FIB (E. coli and Enterococcus spp. (ENT, Pseudomonas spp. and ARGs (blaTEM, blaCTX-M, blaSHV, blaNDM and aadA were quantified using quantitative PCR in the total DNA extracted from the sediments recovered from hospital outlet pipes (HOP and the Cauvery River Basin (CRB, Tiruchirappalli, Tamil Nadu, India. The abundance of bacterial marker genes were 120, 104 and 89 fold higher for the E. coli, Enterococcus spp. and Pseudomonas spp., respectively at HOP when compared with CRB. The ARGs aadA and blaTEM were most frequently detected in higher concentration than other ARGs at all the sampling sites. The ARGs blaSHV and blaNDM were identified in CRB sediments contaminated by hospital and urban wastewaters. The ARGs abundance strongly correlated (r ≥ 0.36, p < 0.05, n = 45 with total bacterial load and E. coli in the sediments, indicating a common origin and extant source of contamination. Tropical aquatic ecosystems receiving wastewaters can act as reservoir of ARGs, which could potentially be transferred to susceptible bacterial pathogens at these sites.

Recent age- and gender-specific trends in mortality during stroke hospitalization in the United States.

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Ovbiagele, Bruce; Markovic, Daniela; Towfighi, Amytis

2011-10-01

Advancements in diagnosis and treatment have resulted in better clinical outcomes after stroke; however, the influence of age and gender on recent trends in death during stroke hospitalization has not been specifically investigated. We assessed the impact of age and gender on nationwide patterns of in-hospital mortality after stroke. Data were obtained from all US states that contributed to the Nationwide Inpatient Sample. All patients admitted to hospitals between 1997 and 1998 (n=1 351 293) and 2005 and 2006 (n=1 202 449), with a discharge diagnosis of stroke (identified by the International Classification of Diseases, Ninth Revision procedure codes), were included. Time trends for in-hospital mortality after stroke were evaluated by gender and age group based on 10-year age increments (84) using multivariable logistic regression. Between 1997 and 2006, in-hospital mortality rates decreased across time in all sub-groups (all P84 years. In unadjusted analysis, men aged >84 years in 1997-1998 had poorer mortality outcomes than similarly aged women (odds ratio 0·93, 95% confidence interval=0·88-0·98). This disparity worsened by 2005-2006 (odds ratio 0·88, 95% confidence interval=0·84-0·93). After adjusting for confounders, compared with similarly aged women, the mortality outcomes among men aged >84 years were poorer in 1997-1998 (odds ratio 0·97, 95% confidence interval=0·92-1·02) and were poorer in 2005-2006 (odds ratio 0·92, 95% confidence interval=0·87-0·96), P=0·04, for gender × time trend. Over the last decade, in-hospital mortality rates after stroke in the United States have declined for every age/gender group, except men aged >84 years. Given the rapidly ageing US population, avenues for boosting in-hospital survival among very elderly men with stroke need to be explored. © 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.

Juvenile paracoccidioidomycosis in urban area: report of two cases

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Rodrigo da Costa Carneiro

Full Text Available We present two cases of juvenile form of paracoccidioidomycosis (PCM, a systemic mycosis frequently found in rural areas, whose prognosis is poor in children and young adults. They are a 14-year-old boy and a 25-year-old woman, both residents in an urban area in São Paulo - Brazil, without any history of travelling to an endemic area. They have been admitted to the hospital due to fever, weight loss and lymphadenopathy. The diagnosis was confirmed by serologic and histopathologic study. Patients have recovered after therapy with oral itraconazole and were discharged from hospital, maintaining outpatient visits. In this article, the authors discuss the unusual presentation of PCM in an urban area.

CP-odd phase correlations and electric dipole moments

International Nuclear Information System (INIS)

Olive, Keith A.; Pospelov, Maxim; Ritz, Adam; Santoso, Yudi

2005-01-01

We revisit the constraints imposed by electric dipole moments (EDMs) of nucleons and heavy atoms on new CP-violating sources within supersymmetric theories. We point out that certain two-loop renormalization group corrections induce significant mixing between the basis-invariant CP-odd phases. In the framework of the constrained minimal supersymmetric standard model, the CP-odd invariant related to the soft trilinear A-phase at the grand unified theory (GUT) scale, θ A , induces nontrivial and distinct CP-odd phases for the three gaugino masses at the weak scale. The latter give one-loop contributions to EDMs enhanced by tanβ, and can provide the dominant contribution to the electron EDM induced by θ A . We perform a detailed analysis of the EDM constraints within the constrained minimal supersymmetric standard model, exhibiting the reach, in terms of sparticle spectra, which may be obtained assuming generic phases, as well as the limits on the CP-odd phases for some specific parameter points where detailed phenomenological studies are available. We also illustrate how this reach will expand with results from the next generation of experiments which are currently in development

[Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications].

Science.gov (United States)

Kim, Yunmi; You, Sunju; Kim, Jinhyun

2017-12-01

This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future. © 2017 Korean Society of Nursing Science

Characteristics and predictors of death among hospitalized HIV-infected patients in a low HIV prevalence country: Bangladesh.

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Lubaba Shahrin

Full Text Available Predictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh.The primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh.A study was conducted in the HIV in-patient unit (Jagori Ward of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death.Of 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67% were male and the median age was 35 (interquartile range: 2-65 years. Overall, 153 (52% patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs identified were tuberculosis (32%, oesophageal candidiasis (9%, Pneumocystis jirovecii pneumonia (PJP (8%, and histoplasmosis (7%. On multivariable analysis, independent predictors of mortality were CD4 count ≤200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.7-74.4, PJP (aOR: 18.5, 95% CI: 4.68-73.3, oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5-136.9, malignancy (aOR:15.2, 95% CI: 2.3-99.4, and bacteriuria (aOR:7.9, 95% CI: 1.2-50.5. Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.06-0.5 was associated with decreased mortality.This study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV.

Analyzing Rural Versus Urban Differences in Career Dissatisfaction and Plans to Leave Among Pennsylvanian Physicians.

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Vick, Brandon

2016-01-01

This study estimates whether physicians in rural Pennsylvania have higher odds of career dissatisfaction and plans to leave patient care in the next 6 years, compared to their urban counterparts. Rural-urban differences were estimated across specific subgroups of physicians (gender, race, and specialty) and with regard to specific sources of career dissatisfaction. The 2012 Pennsylvania Health Workforce Survey of Physicians allowed for analysis of 17,444 physicians younger than 55 years old actively practicing patient care. Multivariate, logistic regression was performed to estimate the associations with 2 outcome areas: career dissatisfaction and plans to leave patient care in the next 6 years. Controls included rural setting, age, sex, race, work hours, specialty, and practice characteristics. Over 12% of under-55 physicians are dissatisfied with their careers and over 18% report plans to leave patient care in the next 6 years. Rural physicians in Pennsylvania have 18.6% higher odds of reporting career dissatisfaction and 29.5% higher odds of leaving patient care in the next 6 years (P work (i.e., stress, practice demands, and lack of autonomy) and family situations and less related to income concerns. © 2015 National Rural Health Association.

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

Science.gov (United States)

Welton, John M

2015-10-01

The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital.

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Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

2016-10-01

ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground

Strategies for Improved Hospital Response to Mass Casualty Incidents.

Science.gov (United States)

TariVerdi, Mersedeh; Miller-Hooks, Elise; Kirsch, Thomas

2018-03-19

Mass casualty incidents are a concern in many urban areas. A community's ability to cope with such events depends on the capacities and capabilities of its hospitals for handling a sudden surge in demand of patients with resource-intensive and specialized medical needs. This paper uses a whole-hospital simulation model to replicate medical staff, resources, and space for the purpose of investigating hospital responsiveness to mass casualty incidents. It provides details of probable demand patterns of different mass casualty incident types in terms of patient categories and arrival patterns, and accounts for related transient system behavior over the response period. Using the layout of a typical urban hospital, it investigates a hospital's capacity and capability to handle mass casualty incidents of various sizes with various characteristics, and assesses the effectiveness of designed demand management and capacity-expansion strategies. Average performance improvements gained through capacity-expansion strategies are quantified and best response actions are identified. Capacity-expansion strategies were found to have superadditive benefits when combined. In fact, an acceptable service level could be achieved by implementing only 2 to 3 of the 9 studied enhancement strategies. (Disaster Med Public Health Preparedness. 2018;page 1 of 13).

Outcomes of patients hospitalized for acute decompensated heart failure: does nesiritide make a difference?

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Hauck Loran D

2007-11-01

Full Text Available Abstract Background Nesiritide is indicated in the treatment of acute decompensated heart failure. However, a recent meta-analysis reported that nesiritide may be associated with an increased risk of death. Our goal was to evaluate the impact of nesiritide treatment on four outcomes among adults hospitalized for congestive heart failure (CHF during a three-year period. Methods CHF patients discharged between 1/1/2002 and 12/31/2004 from the Adventist Health System, a national, not-for-profit hospital system, were identified. 25,330 records were included in this retrospective study. Nesiritide odds ratios (OR were adjusted for various factors including nine medications and/or an APR-DRG severity score. Results Initially, treatment with nesiritide was found to be associated with a 59% higher odds of hospital mortality (Unadjusted OR = 1.59, 95% confidence interval [CI]: 1.31–1.93. Adjusting for race, low economic status, APR-DRG severity of illness score, and the receipt of nine medications yielded a nonsignificant nesiritide OR of 1.07 for hospital death (95% CI: 0.85–1.35. Nesiritide was positively associated with the odds of prolonged length of stay (all adjusted ORs = 1.66 and elevated pharmacy cost (all adjusted ORs > 5. Conclusion In this observational study, nesiritide therapy was associated with increased length of stay and pharmacy cost, but not hospital mortality. Randomized trials are urgently needed to better define the efficacy, if any, of nesiritide in the treatment of decompensated heart failure.

Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital

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Hikone M

2015-07-01

Full Text Available Mayu Hikone,1 Yusuke Ainoda,1,2 Sayaka Tago,2 Takahiro Fujita,2 Yuji Hirai,2 Kaori Takeuchi,2 Kyoichi Totsuka31Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 2Department of Infectious Diseases, Tokyo Women's Medical University, 3Department of Internal Medicine, Kitatama Hospital, Tokyo, JapanBackground: Clostridium difficile infection (CDI is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%–30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors.Methods: We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI.Results: Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4% were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22–52.2; P=0.03 and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01–2,470; P=0.049.Conclusion: Intensive care unit hospitalization and malignancy are risk factors for recurrent

"Why Don't They Report?" Hospital Personnel Working with Children at Risk

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Svärd, Veronica

2017-01-01

Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children's hospitals had never made a report. However, nurses' and nurse assistants' odds of being low reporters were…

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

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Weiner, B J; Alexander, J A

1993-08-01

We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.

Variability in case-mix adjusted in-hospital cardiac arrest rates.

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Merchant, Raina M; Yang, Lin; Becker, Lance B; Berg, Robert A; Nadkarni, Vinay; Nichol, Graham; Carr, Brendan G; Mitra, Nandita; Bradley, Steven M; Abella, Benjamin S; Groeneveld, Peter W

2012-02-01

It is unknown how in-hospital cardiac arrest (IHCA) rates vary across hospitals and predictors of variability. Measure variability in IHCA across hospitals and determine if hospital-level factors predict differences in case-mix adjusted event rates. Get with the Guidelines Resuscitation (GWTG-R) (n=433 hospitals) was used to identify IHCA events between 2003 and 2007. The American Hospital Association survey, Medicare, and US Census were used to obtain detailed information about GWTG-R hospitals. Adult patients with IHCA. Case-mix-adjusted predicted IHCA rates were calculated for each hospital and variability across hospitals was compared. A regression model was used to predict case-mix adjusted event rates using hospital measures of volume, nurse-to-bed ratio, percent intensive care unit beds, palliative care services, urban designation, volume of black patients, income, trauma designation, academic designation, cardiac surgery capability, and a patient risk score. We evaluated 103,117 adult IHCAs at 433 US hospitals. The case-mix adjusted IHCA event rate was highly variable across hospitals, median 1/1000 bed days (interquartile range: 0.7 to 1.3 events/1000 bed days). In a multivariable regression model, case-mix adjusted IHCA event rates were highest in urban hospitals [rate ratio (RR), 1.1; 95% confidence interval (CI), 1.0-1.3; P=0.03] and hospitals with higher proportions of black patients (RR, 1.2; 95% CI, 1.0-1.3; P=0.01) and lower in larger hospitals (RR, 0.54; 95% CI, 0.45-0.66; PCase-mix adjusted IHCA event rates varied considerably across hospitals. Several hospital factors associated with higher IHCA event rates were consistent with factors often linked with lower hospital quality of care.

Improving the hospital 'soundscape': a framework to measure individual perceptual response to hospital sounds.

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Mackrill, J B; Jennings, P A; Cain, R

2013-01-01

Work on the perception of urban soundscapes has generated a number of perceptual models which are proposed as tools to test and evaluate soundscape interventions. However, despite the excessive sound levels and noise within hospital environments, perceptual models have not been developed for these spaces. To address this, a two-stage approach was developed by the authors to create such a model. First, semantics were obtained from listening evaluations which captured the feelings of individuals from hearing hospital sounds. Then, 30 participants rated a range of sound clips representative of a ward soundscape based on these semantics. Principal component analysis extracted a two-dimensional space representing an emotional-cognitive response. The framework enables soundscape interventions to be tested which may improve the perception of these hospital environments.

LOFT advanced control room operator diagnostic and display system (ODDS)

International Nuclear Information System (INIS)

Larsen, D.G.; Robb, T.C.

1980-01-01

The Loss-of-Fluid Test (LOFT) Reactor Facility in Idaho includes a highly instrumented nuclear reactor operated by the Department of Energy for the purpose of establishing nuclear safety requirements. The results of the development and installation into LOFT of an Operator Diagnostic and Display System (ODDS) are presented. The ODDS is a computer-based graphics display system centered around a PRIME 550 computer with several RAMTEK color graphic display units located within the control room and available to the reactor operators. Use of computer-based color graphics to aid the reactor operator is discussed. A detailed hardware description of the LOFT data system and the ODDS is presented. Methods and problems of backfitting the ODDS equipment into the LOFT plant are discussed

The Use of Pediatric Ventricular Assist Devices in Children's Hospitals From 2000 to 2010: Morbidity, Mortality, and Hospital Charges.

Science.gov (United States)

Mansfield, Robert T; Lin, Kimberly Y; Zaoutis, Theoklis; Mott, Antonio R; Mohamad, Zeinab; Luan, Xianqun; Kaufman, Beth D; Ravishankar, Chitra; Gaynor, J William; Shaddy, Robert E; Rossano, Joseph W

2015-07-01

The use of ventricular assist devices has increased dramatically in adult heart failure patients. However, the overall use, outcome, comorbidities, and resource utilization of ventricular assist devices in pediatric patients have not been well described. We sought to demonstrate that the use of ventricular assist devices in pediatric patients has increased over time and that mortality has decreased. A retrospective study of the Pediatric Health Information System database was performed for patients 20 years old or younger undergoing ventricular assist device placement from 2000 to 2010. None. Four hundred seventy-five pediatric patients were implanted with ventricular assist devices during the study period: 69 in 2000-2003 (era 1), 135 in 2004-2006 (era 2), and 271 in 2007-2010 (era 3). Median age at ventricular assist device implantation was 6.0 years (interquartile range, 0.5-13.8), and the proportion of children who were 1-12 years old increased from 29% in era 1 to 47% in era 3 (p = 0.002). The majority of patients had a diagnosis of cardiomyopathy; this increased from 52% in era 1 to 72% in era 3 (p = 0.003). Comorbidities included arrhythmias (48%), pulmonary hypertension (16%), acute renal failure (34%), cerebrovascular disease (28%), and sepsis/systemic inflammatory response syndrome (34%). Two hundred forty-seven patients (52%) underwent heart transplantation and 327 (69%) survived to hospital discharge. Hospital mortality decreased from 42% in era 1 to 25% in era 3 (p = 0.004). Median hospital length of stay increased (37 d [interquartile range, 12-64 d] in era 1 vs 69 d [interquartile range, 35-130] in era 3; p interquartile range, $227,052-$853,318] in era 1 vs $1,577,983 [interquartile range, $874,463-$2,280,435] in era 3; p < 0.001). Factors associated with increased mortality include age less than 1 year (odds ratio, 2.04; 95% CI, 1.01-3.83), acute renal failure (odds ratio, 2.1; 95% CI, 1.26-3.65), cerebrovascular disease (odds ratio, 2.1; 95% CI, 1

Quantifying urbanization as a risk factor for noncommunicable disease.

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Allender, Steven; Wickramasinghe, Kremlin; Goldacre, Michael; Matthews, David; Katulanda, Prasad

2011-10-01

The aim of this study was to investigate the poorly understood relationship between the process of urbanization and noncommunicable diseases (NCDs) in Sri Lanka using a multicomponent, quantitative measure of urbanicity. NCD prevalence data were taken from the Sri Lankan Diabetes and Cardiovascular Study, comprising a representative sample of people from seven of the nine provinces in Sri Lanka (n = 4,485/5,000; response rate = 89.7%). We constructed a measure of the urban environment for seven areas using a 7-item scale based on data from study clusters to develop an "urbanicity" scale. The items were population size, population density, and access to markets, transportation, communications/media, economic factors, environment/sanitation, health, education, and housing quality. Linear and logistic regression models were constructed to examine the relationship between urbanicity and chronic disease risk factors. Among men, urbanicity was positively associated with physical inactivity (odds ratio [OR] = 3.22; 2.27-4.57), high body mass index (OR = 2.45; 95% CI, 1.88-3.20) and diabetes mellitus (OR = 2.44; 95% CI, 1.66-3.57). Among women, too, urbanicity was positively associated with physical inactivity (OR = 2.29; 95% CI, 1.64-3.21), high body mass index (OR = 2.92; 95% CI, 2.41-3.55), and diabetes mellitus (OR = 2.10; 95% CI, 1.58 - 2.80). There is a clear relationship between urbanicity and common modifiable risk factors for chronic disease in a representative sample of Sri Lankan adults.

Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

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Choo, Esther K.; Spiro, David M.; Lowe, Robert A.; Newgard, Craig D.; Hall, Michael Kennedy; McConnell, Kenneth John

2010-01-01

Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs.…

The Betting Odds Rating System: Using soccer forecasts to forecast soccer.

Science.gov (United States)

Wunderlich, Fabian; Memmert, Daniel

2018-01-01

Betting odds are frequently found to outperform mathematical models in sports related forecasting tasks, however the factors contributing to betting odds are not fully traceable and in contrast to rating-based forecasts no straightforward measure of team-specific quality is deducible from the betting odds. The present study investigates the approach of combining the methods of mathematical models and the information included in betting odds. A soccer forecasting model based on the well-known ELO rating system and taking advantage of betting odds as a source of information is presented. Data from almost 15.000 soccer matches (seasons 2007/2008 until 2016/2017) are used, including both domestic matches (English Premier League, German Bundesliga, Spanish Primera Division and Italian Serie A) and international matches (UEFA Champions League, UEFA Europe League). The novel betting odds based ELO model is shown to outperform classic ELO models, thus demonstrating that betting odds prior to a match contain more relevant information than the result of the match itself. It is shown how the novel model can help to gain valuable insights into the quality of soccer teams and its development over time, thus having a practical benefit in performance analysis. Moreover, it is argued that network based approaches might help in further improving rating and forecasting methods.

Rural-urban variation in injury-related hospitalisation, health outcomes and treatment cost in New South Wales.

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Mitchell, Rebecca J; Lower, Tony

2018-04-19

To compare differences in injury characteristics, health outcomes and treatment costs between urban and rural residents who were hospitalised following an injury. A retrospective examination of injury-linked hospitalisation and mortality data in New South Wales from 1 January 2010 to 30 June 2014. Urban (496 325) and rural (213 139) residents who were hospitalised following an injury. Demographic and injury characteristics, injury severity, hospital length of stay, 28-day hospital readmission, 90-day mortality and treatment cost. Rural residents had an increased likelihood of being hospitalised for injuries from motorcycles, vehicles, animate causes, venomous animals or plants and assault compared to urban residents. Rural residents were less likely to be readmitted to hospital within 28 days and had a lower length of stay and age-adjusted length of stay than urban residents. Injury-related hospitalisations for urban and rural residents cost $4.4 billion and $1.7 billion, respectively. Annually, acute injury treatment ($1.1 billion), rehabilitation ($130 million) and subacute non-acute patient care ($57 million) cost $1.3 billion ($990 million for urban and $384 million for rural residents) in New South Wales. Fall-related injuries and transport incidents were the costliest injury mechanisms for both urban and rural residents. Injuries contribute substantially to hospitalised morbidity and its cost. The development and implementation of injury prevention strategies targeting the most common injuries for urban and rural residents will go some way towards reducing hospitalised injury and its cost. © 2018 National Rural Health Alliance Ltd.

Clinical response and hospital costs associated with the empirical use of vancomycin and linezolid for hospital-acquired pneumonia in a Chinese tertiary care hospital: a retrospective cohort study

Directory of Open Access Journals (Sweden)

Song Y

2014-10-01

Full Text Available Yuanlin Song,1,* Yicheng Yang,2,* Wendong Chen,3,4 Wei Liu,2 Kai Wang,2 Xuehai Li,5 Ke Wang,2 Manny Papadimitropoulos,3,6 William Montgomery7 1Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, 2Lilly Suzhou Pharmaceutical Co, Ltd, Shanghai Branch, Shanghai, People's Republic of China; 3Division of Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, 4Normin Health, Toronto, ON, Canada; 5VitalStrategic Research Institute, Shanghai, People's Republic of China; 6Global Health Outcomes Research, Eli Lilly, Indianapolis, IN, USA; 7Eli Lilly Australia Pty Ltd, West Ryde, NSW, Australia *These authors contributed equally to this work Aims: To evaluate clinical outcomes and allocation of hospital costs associated with empirical use of vancomycin or linezolid for hospital-acquired pneumonia (HAP in the People's Republic of China. Methods: Hospital episodes including HAP treated by vancomycin or linezolid between 2008 and 2012 in a Chinese tertiary care hospital were retrospectively identified from hospital administrative databases. Propensity score methods created best-matched pairs for the antibiotics. The matched pairs were used for adjusted comparisons on clinical response and allocation of hospital costs. Multiple regression analyses adjusting residual imbalance after matching were performed to confirm adjusted comparisons. Results: Sixty matched pairs were created. Adjusted comparisons between vancomycin and linezolid showed similar clinical response rates (clinical cure: 30.0% versus 31.7%, respectively; P=0.847; treatment failure: 55.0% versus 45.0%, respectively; P=0.289 but a significantly lower in-hospital mortality rate for vancomycin (3.3% versus 18.3%, respectively; P=0.013. After further adjusting for the imbalanced variables between matched treatment groups, the risks of treatment failure associated with the two antibiotics were comparable (odds ratio: 1.139; P=0.308 and there was

Fission barriers of two odd-neutron heavy nuclei

International Nuclear Information System (INIS)

Koh, Meng-Hock; Bonneau, L.; Nhan Hao, T. V.; Duc, Dao Duy; Quentin, P.

2015-01-01

The fission barriers of two odd-neutron heavy odd nuclei,namely the 235 U and 239 Pu isotopes have been calculated within a self-consistent Hartree-Fock-plus-BCS approach with blocking. A Skyrme nucleon-nucleon effective interaction has been used together with a seniority force to describe pairing correlations. A full account of the genuine time-reversal symmetry breaking due to the presence of an unpaired nucleon has been incorporated at the mean field level. The SIII and SkM* parametrizations of the Skyrme interaction have been retained as well as for a part a newer parametrization, SLy5*. The seniority force parameters have been fitted to reproduce experimental odd-even mass differences in the actinide region. To assess the relevance of our calculated fission barrier distribution (as a function of the quantum numbers), we have studied the quality of our results with respect to the spectroscopy of band heads (for configurations deemed to be a pure single particle character) in the ground and fission isomeric states. Fission barriers of the considered odd nuclei have been compared with what is obtained for their even-even neighbouring isotopes (namely 234 U and 236 U, 238 Pu and 240 Pu respectively) to determine the so-called specialization energies. Various corrections and associated uncertainties have been discussed in order to compare our results with available data

Healthcare Providers' Formative Experiences with Race and Black Male Patients in Urban Hospital Environments.

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Plaisime, Marie V; Malebranche, David J; Davis, Andrea L; Taylor, Jennifer A

2017-12-01

We explored health providers' formative personal and professional experiences with race and Black men as a way to assess their potential influence on interactions with Black male patients. Utilizing convenience sampling with snowballing techniques, we identified healthcare providers in two urban university hospitals. We compared Black and White providers' experiences based on race and level of training. We used the Gardener's Tale to conceptualize how racism may lead to racial health disparities. A semi-structured interview guide was used to conduct in-person interviews (n = 16). Using the grounded theory approach, we conducted three types of coding to examine data patterns. We found two themes reflective of personally mediated racism: (1) perception of Black males accompanied by two subthemes (a) biased care and (b) fear and discomfort and (2) cognitive dissonance. While this latter theme is more reflective of Jones's internalized racism level, we present its results because its novelty is compelling. Perception of Black males and cognitive dissonance appear to influence providers' approaches with Black male patients. This study suggests the need to develop initiatives and curricula in health professional schools that address provider racial bias. Understanding the dynamics operating in the patient-provider encounter enhances the ability to address and reduce health disparities.

Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction.

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Ängerud, Karin H; Sederholm Lawesson, Sofia; Isaksson, Rose-Marie; Thylén, Ingela; Swahn, Eva

2017-11-01

In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction. This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001). Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and

Climate shocks and rural-urban migration in Mexico: Exploring nonlinearities and thresholds

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Nawrotzki, Raphael J.; DeWaard, Jack; Bakhtsiyarava, Maryia; Ha, Jasmine Trang

2016-01-01

Adverse climatic conditions may differentially drive human migration patterns between rural and urban areas, with implications for changes in population composition and density, access to infrastructure and resources, and the delivery of essential goods and services. However, there is little empirical evidence to support this notion. In this study, we investigate the relationship between climate shocks and migration between rural and urban areas within Mexico. We combine individual records from the 2000 and 2010 Mexican censuses (n=683,518) with high-resolution climate data from Terra Populus that are linked to census data at the municipality level (n=2,321). We measure climate shocks as monthly deviation from a 30-year (1961-1990) long-term climate normal period, and uncover important nonlinearities using quadratic and cubic specifications. Satellite-based measures of urban extents allow us to classify migrant-sending and migrant-receiving municipalities as rural or urban to examine four internal migration patterns: rural-urban, rural-rural, urban-urban, and urban-rural. Among our key findings, results from multilevel models reveal that each additional drought month increases the odds of rural-urban migration by 3.6%. In contrast, the relationship between heat months and rural-urban migration is nonlinear. After a threshold of ~34 heat months is surpassed, the relationship between heat months and rural-urban migration becomes positive and progressively increases in strength. Policy and programmatic interventions may therefore reduce climate induced rural-urban migration in Mexico through rural climate change adaptation initiatives, while also assisting rural migrants in finding employment and housing in urban areas to offset population impacts. PMID:28435176

Organizational and market factors associated with leadership development programs in hospitals: a national study.

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Kim, Tae Hyun; Thompson, Jon M

2012-01-01

Effective leadership in hospitals is widely recognized as the key to organizational performance. Clinical, financial, and operational performance is increasingly being linked to the leadership practices of hospital managers. Moreover, effective leadership has been described as a means to achieve competitive advantage. Recent environmental forces, including reimbursement changes and increased competition, have prompted many hospitals to focus on building leadership competencies to successfully address these challenges. Using the resource dependence theory as our conceptual framework, we present results from a national study of hospitals examining the association of organizational and market factors with the provision of leadership development program activities, including the presence of a leadership development program, a diversity plan, a program for succession planning, and career development resources. The data are taken from the American Hospital Association's (AHA) 2008 Survey of Hospitals, the Area Resource File, and the Centers for Medicare & Medicaid Services. The results of multilevel logistic regressions of each leadership development program activity on organizational and market factors indicate that hospital size, system and network affiliation, and accreditation are significantly and positively associated with all leadership development program activities. The market factors significantly associated with all leadership development activities include a positive odds ratio for metropolitan statistical area location and a negative odds ratio for the percentage of the hospital's service area population that is female and minority. For-profit hospitals are less likely to provide leadership development program activities. Additional findings are presented, and the implications for hospital management are discussed.

Diffuse malignant pleural mesothelioma in an urban hospital: Clinical spectrum and trend in incidence over time

International Nuclear Information System (INIS)

Shepherd, K.E.; Oliver, L.C.; Kazemi, H.

1989-01-01

This retrospective analysis reviews the clinical experience of a major urban referral hospital with diffuse malignant pleural mesothelioma during the 14-year period from 1973 through 1986. Seventy-five cases of definite or equivocal mesothelioma were identified. There were four cases of primary malignant peritoneal mesothelioma, seven cases of benign fibrous mesothelioma, and 64 cases of diffuse malignant pleural mesothelioma. In 43 cases (67%) of diffuse malignant pleural mesothelioma, there was historic evidence of asbestos exposure. In 21 cases (33%), there was no known history of asbestos exposure. An increase in annual incidence of diffuse malignant pleural mesothelioma was observed over the study period, from three cases in 1973 to ten cases in 1986. Despite greater awareness of this disease, the diagnosis remains a difficult one to establish given the nonspecific symptoms, signs and radiographic appearance, variable histologic appearance, and poor diagnostic sensitivity and specificity of thoracentesis and closed pleural biopsy. Thoracotomy, thoracoscopy, and CT-guided needle biopsies gave higher yields and are the diagnostic measures of choice when diffuse malignant pleural mesothelioma is suspected

The Antarctic ozone minimum - Relationship to odd nitrogen, odd chlorine, the final warming, and the 11-year solar cycle

Science.gov (United States)

Callis, L. B.; Natarajan, M.

1986-01-01

Photochemical calculations along 'diabatic trajectories' in the meridional phase are used to search for the cause of the dramatic springtime minimum in Antarctic column ozone. The results indicate that the minimum is principally due to catalytic destruction of ozone by high levels of total odd nitrogen. Calculations suggest that these levels of odd nitrogen are transported within the polar vortex and during the polar night from the middle to upper stratosphere and lower mesosphere to the lower stratosphere. The possibility that these levels are related to the 11-year solar cycle and are increased by enhanced formation in the thermosphere and mesosphere during solar maximum conditions is discussed.

Medication and Dietary Supplement Interactions among a Low-Income, Hospitalized Patient Population Who Take Cardiac Medications

Directory of Open Access Journals (Sweden)

Paula Gardiner

2015-01-01

Full Text Available Purpose. To identify characteristics associated with the use of potentially harmful combinations of dietary supplements (DS and cardiac prescription medications in an urban, underserved, inpatient population. Methods. Cardiac prescription medication users were identified to assess the prevalence and risk factors of potentially harmful dietary supplement-prescription medication interactions (PHDS-PMI. We examined sociodemographic and clinical characteristics for crude (χ2 or t-tests and adjusted multivariable logistic regression associations with the outcome. Results. Among 558 patients, there were 121 who also used a DS. Of the 110 participants having a PHDS-PMI, 25% were asked about their DS use at admission, 75% had documentation of DS in their chart, and 21% reported the intention to continue DS use after discharge. A multivariable logistic regression model noted that for every additional medication or DS taken the odds of having a PHDS-PMI increase and that those with a high school education are significantly less likely to have a PHDS-PMI than those with a college education. Conclusion. Inpatients at an urban safety net hospital taking a combination of cardiac prescription medications and DS are at a high risk of harmful supplement-drug interactions. Providers must ask about DS use and should consider the potential for interactions when having patient discussions about cardiac medications and DS.

Epidemiology of Hospital Admissions with Influenza during the 2013/2014 Northern Hemisphere Influenza Season: Results from the Global Influenza Hospital Surveillance Network

Science.gov (United States)

Puig-Barberà, Joan; Natividad-Sancho, Angels; Trushakova, Svetlana; Sominina, Anna; Pisareva, Maria; Ciblak, Meral A.; Badur, Selim; Yu, Hongjie; Cowling, Benjamin J.; El Guerche-Séblain, Clotilde; Mira-Iglesias, Ainara; Kisteneva, Lidiya; Stolyarov, Kirill; Yurtcu, Kubra; Feng, Luzhao; López-Labrador, Xavier; Burtseva, Elena

2016-01-01

Background The Global Influenza Hospital Surveillance Network was established in 2012 to obtain valid epidemiologic data on hospital admissions with influenza-like illness. Here we describe the epidemiology of admissions with influenza within the Northern Hemisphere sites during the 2013/2014 influenza season, identify risk factors for severe outcomes and complications, and assess the impact of different influenza viruses on clinically relevant outcomes in at-risk populations. Methods Eligible consecutive admissions were screened for inclusion at 19 hospitals in Russia, Turkey, China, and Spain using a prospective, active surveillance approach. Patients that fulfilled a common case definition were enrolled and epidemiological data were collected. Risk factors for hospitalization with laboratory-confirmed influenza were identified by multivariable logistic regression. Findings 5303 of 9507 consecutive admissions were included in the analysis. Of these, 1086 were influenza positive (534 A(H3N2), 362 A(H1N1), 130 B/Yamagata lineage, 3 B/Victoria lineage, 40 untyped A, and 18 untyped B). The risk of hospitalization with influenza (adjusted odds ratio [95% confidence interval]) was elevated for patients with cardiovascular disease (1.63 [1.33–2.02]), asthma (2.25 [1.67–3.03]), immunosuppression (2.25 [1.23–4.11]), renal disease (2.11 [1.48–3.01]), liver disease (1.94 [1.18–3.19], autoimmune disease (2.97 [1.58–5.59]), and pregnancy (3.84 [2.48–5.94]). Patients without comorbidities accounted for 60% of admissions with influenza. The need for intensive care or in-hospital death was not significantly different between patients with or without influenza. Influenza vaccination was associated with a lower risk of confirmed influenza (adjusted odds ratio = 0.61 [0.48–0.77]). Conclusions Influenza infection was detected among hospital admissions with and without known risk factors. Pregnancy and underlying comorbidity increased the risk of detecting influenza

Pairing correlations. I. Description of odd nuclei in mean-field theories

International Nuclear Information System (INIS)

Duguet, T.; Bonche, P.; Heenen, P.-H.; Meyer, J.

2002-01-01

In order to extract informations on pairing correlations in nuclei from experimental masses, the different contributions to odd-even mass differences are investigated within the Skyrme Hartree-Fock-Bogoliubov (HFB) method. In this part of the paper, the description of odd nuclei within HFB is discussed since it is the key point for the understanding of the above mentioned contributions. To go from an even nucleus to an odd one, the advantage of a two steps process is demonstrated and its physical content is discussed. New results concerning time-reversal symmetry breaking in odd nuclei are also reported

Unexplained Variation for Hospitals' Use of Inpatient Rehabilitation and Skilled Nursing Facilities After an Acute Ischemic Stroke.

Science.gov (United States)

Xian, Ying; Thomas, Laine; Liang, Li; Federspiel, Jerome J; Webb, Laura E; Bushnell, Cheryl D; Duncan, Pamela W; Schwamm, Lee H; Stein, Joel; Fonarow, Gregg C; Hoenig, Helen; Montalvo, Cris; George, Mary G; Lutz, Barbara J; Peterson, Eric D; Bettger, Janet Prvu

2017-10-01

Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. URL: https://clinicaltrials.gov. Unique identifier: NCT02284165. © 2017 American Heart Association, Inc.

Magnetic dipole moments of deformed odd-A nuclei

Energy Technology Data Exchange (ETDEWEB)

Garg, V P; Sharma, S D; Mahesh, P S [Punjabi Univ., Patiala (India). Dept. of Physics

1976-12-01

Using an extended version of A S Davydov and G F Filippov's model (1958), B E Chi and J P Davidson have calculated magnetic moments of odd-A nuclei in 2s-ld shell, diagonalizing the state matrices for a set of parameters giving the best fit for nuclear spectra (1966). To study the failure of this model in case of nuclear moments, instead of diagonalizing an attempt has been made to simplify the expression for magnetic dipole moment for single nucleonic states without configuration mixing. The model takes care of the proper sign of spin projections. On replacing the total angular momentum j of odd particle (proton or neutron) by its projection ..cap omega.., the expression reduces to that of Mottelson and Nilsson for spin-up nuclei. The Coriolis coupling calculations also have been performed for those odd-A nuclei with K = 1/2. The results are found in better agreement with experimental report in comparison with those of other models.

Suicide among urban South African adolescents.

Science.gov (United States)

Burrows, Stephanie; Laflamme, Lucie

2008-01-01

Knowledge of suicide epidemiology in low- and middle-income settings is important for both well-tailored policies and an increased global understanding of suicide macro-determinants. Adolescents are an important target group in that respect, and those from South Africa are a particular concern, given the additional challenges associated with dramatic political, economic, and health transition. This study presents a profile of adolescent suicide occurrence and sex, race, and city differences. Adolescents aged 10-19 years in post-apartheid urban South Africa. Sex-, race- and city-specific suicide rates were calculated for two age groups (10-14, 15-19 years). Using logistic regression, odds ratios were compiled, first adjusting for age, then additionally for sex, race, and city. Female subjects, those classified as 'coloured' (denoting mixed racial origin), and those living in Tshwane were used as reference groups. Proportions (with 95% confidence intervals) of leading suicide methods were compared. Suicide rates were considerably higher among older adolescents and varied by sex, race, and city. Males had more than twice the odds of committing suicide compared with females. In the fully adjusted model, differences between races were not significant, but city-level differences remained. The leading suicide method was hanging for males and both hanging and poisoning for females. In contemporary urban South Africa, male sex, and city of residence, but not race, were associated with the commission of adolescent suicide, which tends to occur by quite specific methods. The findings warrant research into the possible underlying contextual, demographic, and individual mechanisms.

The scale of hospital production in different settings

DEFF Research Database (Denmark)

Asmild, Mette; Hollingsworth, Bruce; Birch, Stephen

2013-01-01

This paper analyses the productive efficiency of 141 public hospitals from 1998-2004 in two Canadian provinces; one a small province with a few small cities and a generally more rural population and the other a large province that is more urban in nature, with a population who mainly live in large...... - different hospitals may have different optimal sizes, or different efficient modes of operation, depending on location, the population they serve, and the policies their respective provincial governments wish to implement. In addition, there are lessons to be learned by comparing the hospitals across...

Urbanization of scrub typhus disease in South Korea.

Science.gov (United States)

Park, Sang-Won; Ha, Na-Young; Ryu, Boyeong; Bang, Ji Hwan; Song, Hoyeon; Kim, Yuri; Kim, Gwanghun; Oh, Myoung-don; Cho, Nam-Hyuk; Lee, Jong-koo

2015-05-01

Scrub typhus is an endemic disease in Asia. It has been a rural disease, but indigenous urban cases have been observed in Seoul, South Korea. Urban scrub typhus may have a significant impact because of the large population. Indigenous urban scrub typhus was epidemiologically identified in Seoul, the largest metropolitan city in South Korea, using national notifiable disease data from 2010 to 2013. For detailed analysis of clinical features, patients from one hospital that reported the majority of cases were selected and compared to a historic control group. Chigger mites were prospectively collected in the city using a direct chigger mite-collecting trap, and identified using both phenotypic and 18S rDNA sequencing analyses. Their infection with Orientia tsutsugamushi was confirmed by sequencing the 56-kDa antigen gene. Eighty-eight cases of urban scrub typhus were determined in Seoul. The possible sites of infection were mountainous areas (56.8%), city parks (20.5%), the vicinity of one's own residence (17.0%), and riversides (5.7%). Eighty-seven chigger mites were collected in Gwanak mountain, one of the suspected infection sites in southern Seoul, and seventy-six (87.4%) of them were identified as Helenicula miyagawai and eight (9.2%) as Leptotrombidium scutellare. Pooled DNA extracted from H. miyagawai mites yielded O. tsutsugamushi Boryong strain. Twenty-six patients from one hospital showed low APACHE II score (3.4 ± 2.7), low complication rate (3.8%), and no hypokalemia. We identified the presence of indigenous urban scrub typhus in Seoul, and a subgroup of them had mild clinical features. The chigger mite H. miyagawai infected with O. tsutsugamushi within the city was found. In endemic area, urban scrub typhus needs to be considered as one of the differential febrile diseases and a target for prevention.

ALGORITMA PARALEL ODD EVEN TRANSPOSITION PADA MODEL JARINGAN NON-LINIER

Directory of Open Access Journals (Sweden)

Ernastuti .

2012-05-01

Full Text Available Odd-even-transposition adalah suatu algoritma paralel yang merupakan pengembangan dari algoritma sekuensial “bubble sort”. Algoritma odd-even-transposition ini didesain khusus untuk model jaringan array linier (homogen. Untuk n elemen data, kompleksitas waktu dari algoritma bubble sort adalah O(n2, sedangkan pada odd-even-transposition yang bekerja di atas n prosesor adalah (n. Ada peningkatan kecepatan waktu pada kinerja algoritma paralel ini sebesar n kali dibanding algoritma sekuensialnya. Hypercube dimensi k adalah model jaringan non-linier (non-homogen terdiri dari n = 2k prosesor, di mana setiap prosesor berderajat k. Model jaringan Fibonacci cube dan extended Lucas cube masing-masing merupakan model subjaringan hypercube dengan jumlah prosesor < 2k prosesor dan maksimum derajat prosesornya adalah k. Pada paper ini, diperlihatkan bagaimana algoritma odd-even-transposition dapat dijalankan juga pada model jaringan komputer cluster non-linier hypercube, Fibonacci cube, dan extended Lucas cube dengan kompleksitas waktu O(n. Odd-even-transposition is a parallel algorithm which is the development of sequential algorithm “bubble sort”. Odd-even transposition algorithm is specially designed for linear array network model (homogeneous. For n data elements, the time complexity of bubble sort algorithm is O(n2, while the odd-even-transposition that works with n processor is (n. There in an increase in the speed of time on the performance of this parallel algorithms for n times than its sequential algorithm. K-dimensional hypercube is a non-linear network model (non-homogeneous consists of n = 2k processors, where each processor has k degree . Network model of Fibonacci cube and extended Lucas cube are the hypercube sub-network model with the number of processors

Developing marketing strategies for university teaching hospitals.

Science.gov (United States)

Fink, D J

1980-07-01

University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, a rising tide of consumerism, and in many cases a declining urban population base. These problems, which may threaten the teaching hospital's ability to continue tertiary care, teaching, and research functions, may be solved with the aid of new marketing strategies. In developing its marketing strategy, a hospital must assess its strengths and weaknesses, specify its goals in measurable terms, implement tactics to achieve these goals, and evaluate its marketing program. The strategies should be directed toward achieving better relationships with institutions, practitioners, and surrounding communities and increasing patient, visitor, and employee satisfaction. A wide variety of programs can be used to reach these goals and to help teaching hospitals meet the competitive challenges of this decade.

Memory effect for particle scattering in odd spacetime dimensions

Science.gov (United States)

Satishchandran, Gautam; Wald, Robert M.

2018-01-01

We investigate the gravitational memory effect for linearized perturbations off of Minkowski space in odd spacetime dimensions d by examining the effects of gravitational radiation from classical point particle scattering. We also investigate analogous memory effects for electromagnetic and scalar radiation. We find that there is no gravitational memory effect in all odd dimensions. For scalar and electromagnetic fields, there is no memory effect for d ≥7 ; for d =3 there is an infinite momentum memory effect, whereas for d =5 there is no momentum memory effect but the displacement of a test particle will grow unboundedly with time. Our results are further elucidated by analyzing the memory effect for any slowly moving source of compact spatial support in odd dimensions.

Association of neighborhood-level factors with hospitalization for community-associated methicillin-resistant Staphylococcus aureus, New York City, 2006: a multilevel observational study.

Science.gov (United States)

Farr, Amanda M; Marx, Melissa A; Weiss, Don; Nash, Denis

2013-02-13

Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression. The CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR](Q5 vs. Q1) 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AOR(Q4 vs. Q1) 1.7, 95% CI: 1.1, 2.7; females: AOR(Q4 vs. Q1) 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AOR(Q5 vs. Q1) 1.2, 95% CI: 0.76, 1.8; females: AOR(Q5 vs. Q1) 1.5, 95% CI: 0.82, 2.7). Neighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.

Superdeformation studies in the odd-odd nucleus {sup 192}Tl

Energy Technology Data Exchange (ETDEWEB)

Fischer, S.; Carpenter, M.P.; Janssens, R.V.F. [and others

1995-08-01

The study of yrast and near-yrast structures of odd-odd nuclei to high spins is somewhat limited due to the complexity of the spectra resulting from the many proton-neutron couplings near the Fermi surface. In superdeformed nuclei, the number of available protons and neutrons near the Fermi surface is somewhat limited due to the presence of large-shell gaps which stabilize the nuclear shape. A relatively small number of available neutron and proton configurations can lead to fragmentation of the SD intensity into a number of different bands. Two good examples of this phenomenon were found in {sup 192}Tl and {sup 194}Tl where the presence of six superdeformed bands were reported in both nuclei. We reexamined {sup 192}Tl at Gammasphere using the {sup 160}Gd({sup 37}Cl,5n) reaction at 178 MeV to populate states in the superdeformed well of this nucleus. While our previous study on {sup 192}Tl at ATLAS was very successful, a number of questions remained which formed the basis of our objectives in this experiment: obtain better {gamma}-ray energies for the known transitions and identify higher spin members in each band; determine how the bands feed the known yrast states in {sup 192}Tl as well as determine the complete spectrum in coincidence with the SD bands; look for M1 transitions connecting proposed signature partners; and attempt to identify other excitations in the superdeformed well. Analysis is underway and four of the six bands were confirmed. The reasons that two of the reported bands were not observed in this latest work is still under investigation. As of this time, no other superdeformed bands were identified in the data. Two of the confirmed SD bands have a constant moment of inertia and show indications of cross-talk between each other. This observation is not unexpected since the calculated M1 rates for the proposed configuration of the band, {pi}{sub 13/2} x {upsilon}j{sub 15/2}, indicate that M1 transitions linking the two SD bands should be observed.

Even and odd symplectic and Kaehlerian structures on projective superspaces

International Nuclear Information System (INIS)

Khudaverdyan, O.M.; Nersessyan, A.P.

1992-01-01

Supergeneralization of CP(N) provided by even and odd Kaehlerian structures from Hamiltonian reduction are construct. Operator Δ which used in Batalin - Vilkovsky quantization formalism and mechanics which are bi-Hamiltonian under corresponding even and odd Poisson brackets are considered. 21 refs

Description of low-lying states in odd-odd deformed nuclei taking account of the coupling with core rotations and vibrations. 1

International Nuclear Information System (INIS)

Kvasil, J.; Hrivnacova, I.; Nesterenko, V.O.

1990-01-01

The microscopic approach for description of low-lyinig states in deformed odd-odd nuclei is formulated as a generalization of the quasiparticle-phonon model (QPM) with including the rotational degrees of freedom and n-p interaction between external nucleons into the QPM. In comparison with other models, the approach proposed includes all three the most important effects coupling with rotational and vibrational degrees of freedom of doubly-even core and p-n interaction mentioned above even treates them on the microscopic base. 36 refs

Similar long-term survival of consecutive in-hospital and out-of-hospital cardiac arrest patients treated with targeted temperature management

DEFF Research Database (Denmark)

Engsig, Magaly; Søholm, Helle; Folke, Fredrik

2016-01-01

OBJECTIVE: The long-term survival of in-hospital cardiac arrest (IHCA) patients treated with targeted temperature management (TTM) is poorly described. The aim of this study was to compare the outcomes of consecutive IHCA with out-of-hospital cardiac arrest (OHCA) patients treated with TTM. DESIGN...... SETTING AND PATIENTS: Retrospectively collected data on all consecutive adult patients treated with TTM at a university tertiary heart center between 2005 and 2011 were analyzed. MEASUREMENTS: Primary endpoints were survival to hospital discharge and long-term survival. Secondary endpoint was neurological...... time to return of spontaneous circulation (ROSC). Survival to hospital discharge was 54% for OHCA and 53% for IHCA (adjusted odds ratio 0.98 [95% confidence interval {CI}; 0.43-2.24]). Age ≤60 years, bystander CPR, time to ROSC ≤10 min, and shockable rhythm at presentation were associated with survival...

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study

Science.gov (United States)

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Sharma, Saket; Allen, Elizabeth; Shankar, Anuraj H; Zodpey, Sanjay

2016-01-01

Objectives Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. Setting Urban poor community in the Southeast district of Delhi, India. Participants We randomly sampled 1849 children aged 1–3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria–pertussis–tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers’ recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. Results Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. Conclusions Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in

Functional outcomes of child and adolescent ODD symptoms in young adult men

Science.gov (United States)

Burke, Jeffrey D.; Rowe, Richard; Boylan, Khrista

2013-01-01

Background ODD is considered to be a disorder of childhood, yet evidence suggests that prevalence rates of the disorder are stable into late adolescence and trajectories of symptoms persist into young adulthood. Functional outcomes associated with ODD through childhood and adolescence include conflict within families, poor peer relationships, peer rejection and academic difficulties. Little examination of functional outcomes in adulthood associated with ODD has been undertaken. Method Data for the present analyses come from a clinic referred sample of 177 boys aged 7 to 12 followed up annually to age 18 and again at age 24. Annual parental report of psychopathology through adolescence was used to predict self-reported functional outcomes at 24. Results Controlling for parent reported symptoms of ADHD, CD, depression and anxiety, ODD symptoms from childhood through adolescence predicted poorer age 24 functioning with peers, poorer romantic relationships, a poorer paternal relationship, and having nobody who would provide a recommendation for a job. CD symptoms predicted workplace problems, poor maternal relationship, lower academic attainment and violent injuries. Only parent reported ODD symptoms and child reported CD symptoms predicted a composite of poor adult outcomes. Conclusion ODD is a disorder that significantly interferes with functioning, particularly in social or interpersonal relationships. The persistence of impairment associated with ODD into young adulthood calls for a reconsideration of ODD as a disorder limited to childhood. PMID:24117754

Plastic and the nest entanglement of urban and agricultural crows.

Directory of Open Access Journals (Sweden)

Andrea K Townsend

Full Text Available Much attention has been paid to the impacts of plastics and other debris on marine organisms, but the effects of plastic on terrestrial organisms have been largely ignored. Detrimental effects of terrestrial plastic could be most pronounced in intensively human-modified landscapes (e.g., urban and agricultural areas, which are a source of much anthropogenic debris. Here, we examine the occurrence, types, landscape associations, and consequences of anthropogenic nest material in the American crow (Corvus brachyrhynchos, a North American species that breeds in both urban and agricultural landscapes. We monitored 195 nestlings in 106 nests across an urban and agricultural gradient in the Sacramento Valley, California, USA. We found that 85.2% of crow nests contained anthropogenic material, and 11 of 195 nestlings (5.6% were entangled in their nests. The length of the material was greater in nests in agricultural territories than in urban territories, and the odds of entanglement increased 7.55 times for each meter of anthropogenic material in the nest. Fledging success was significantly lower for entangled than for unentangled nestlings. In all environments, particularly urban, agricultural, and marine, careful disposal of potential hazards (string, packing and hay bale twine, balloon ribbon, wire, fishing line could reduce the occurrence of entanglement of nestling birds.

Plastic and the nest entanglement of urban and agricultural crows.

Science.gov (United States)

Townsend, Andrea K; Barker, Christopher M

2014-01-01

Much attention has been paid to the impacts of plastics and other debris on marine organisms, but the effects of plastic on terrestrial organisms have been largely ignored. Detrimental effects of terrestrial plastic could be most pronounced in intensively human-modified landscapes (e.g., urban and agricultural areas), which are a source of much anthropogenic debris. Here, we examine the occurrence, types, landscape associations, and consequences of anthropogenic nest material in the American crow (Corvus brachyrhynchos), a North American species that breeds in both urban and agricultural landscapes. We monitored 195 nestlings in 106 nests across an urban and agricultural gradient in the Sacramento Valley, California, USA. We found that 85.2% of crow nests contained anthropogenic material, and 11 of 195 nestlings (5.6%) were entangled in their nests. The length of the material was greater in nests in agricultural territories than in urban territories, and the odds of entanglement increased 7.55 times for each meter of anthropogenic material in the nest. Fledging success was significantly lower for entangled than for unentangled nestlings. In all environments, particularly urban, agricultural, and marine, careful disposal of potential hazards (string, packing and hay bale twine, balloon ribbon, wire, fishing line) could reduce the occurrence of entanglement of nestling birds.

Formulation of Hamiltonian mechanics with even and odd Poisson brackets

International Nuclear Information System (INIS)

Khudaverdyan, O.M.; Nersesyan, A.P.

1987-01-01

A possibility is studied as to constrict the odd Poisson bracket and odd Hamiltonian by the given dynamics in phase superspace - the even Poisson bracket and even Hamiltonian so the transition to the new structure does not change the equations of motion. 9 refs

Study of band structure of some odd proton Eu isotopes

International Nuclear Information System (INIS)

Pandit, Rakesh K.; Rani Devi; Khosa, S.K.

2016-01-01

Much work has been done on the odd-Z, odd-A nuclei in the rare earth region because of occurrence of fascinating variety of structures of nuclei in this mass region. The Eu nuclei are in the transitional deformation region and it provides an opportunity to investigate theoretically the deformation changes with mass number and excitation energy besides to study the structure of their excited states. The 153 Eu nucleus has been well studied over the last two decades. The aim of the present work is to study in detail the band structure of some odd-Z nuclei

Route of administration for illicit prescription opioids: a comparison of rural and urban drug users

Directory of Open Access Journals (Sweden)

Havens Jennifer R

2010-10-01

Full Text Available Abstract Background Nonmedical prescription opioid use has emerged as a major public health concern in recent years, particularly in rural Appalachia. Little is known about the routes of administration (ROA involved in nonmedical prescription opioid use among rural and urban drug users. The purpose of this study was to describe rural-urban differences in ROA for nonmedical prescription opioid use. Methods A purposive sample of 212 prescription drug users was recruited from a rural Appalachian county (n = 101 and a major metropolitan area (n = 111 in Kentucky. Consenting participants were given an interviewer-administered questionnaire examining sociodemographics, psychiatric disorders, and self-reported nonmedical use and ROA (swallowing, snorting, injecting for the following prescription drugs: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, OxyContin® and other oxycodone. Results Among urban participants, swallowing was the most common ROA, contrasting sharply with substance-specific variation in ROA among rural participants. Among rural participants, snorting was the most frequent ROA for hydrocodone, methadone, OxyContin®, and oxycodone, while injection was most common for hydromorphone and morphine. In age-, gender-, and race-adjusted analyses, rural participants had significantly higher odds of snorting hydrocodone, OxyContin®, and oxycodone than urban participants. Urban participants had significantly higher odds of swallowing hydrocodone and oxycodone than did rural participants. Notably, among rural participants, 67% of hydromorphone users and 63% of morphine users had injected the drugs. Conclusions Alternative ROA are common among rural drug users. This finding has implications for rural substance abuse treatment and harm reduction, in which interventions should incorporate methods to prevent and reduce route-specific health complications of drug use.

Higher (odd dimensional quantum Hall effect and extended dimensional hierarchy

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Kazuki Hasebe

2017-07-01

Full Text Available We demonstrate dimensional ladder of higher dimensional quantum Hall effects by exploiting quantum Hall effects on arbitrary odd dimensional spheres. Non-relativistic and relativistic Landau models are analyzed on S2k−1 in the SO(2k−1 monopole background. The total sub-band degeneracy of the odd dimensional lowest Landau level is shown to be equal to the winding number from the base-manifold S2k−1 to the one-dimension higher SO(2k gauge group. Based on the chiral Hopf maps, we clarify the underlying quantum Nambu geometry for odd dimensional quantum Hall effect and the resulting quantum geometry is naturally embedded also in one-dimension higher quantum geometry. An origin of such dimensional ladder connecting even and odd dimensional quantum Hall effects is illuminated from a viewpoint of the spectral flow of Atiyah–Patodi–Singer index theorem in differential topology. We also present a BF topological field theory as an effective field theory in which membranes with different dimensions undergo non-trivial linking in odd dimensional space. Finally, an extended version of the dimensional hierarchy for higher dimensional quantum Hall liquids is proposed, and its relationship to quantum anomaly and D-brane physics is discussed.

Establishing benchmarks for the management of elevated liver enzymes and/or dilated biliary trees in an urban safety net hospital: analysis of 915 subjects.

Science.gov (United States)

Liu, Laindy; Cripps, Michael W; Riggle, Andrew J; Wolf, Steven E; Nakonezny, Paul A; Phelan, Herb A

2015-12-01

The push for public reporting of outcomes necessitates relevant benchmarks for disease states across different settings. This study establishes benchmarks for choledocholithiasis management in a safety net hospital setting. We reviewed all patients admitted to our acute care surgery service with biochemical evidence of choledocholithiasis who underwent same-admission cholecystectomy (CCY) between July 2012 and December 2013. During this 18-month period, 915 patients were admitted with biochemical evidence of choledocholithiasis. Descriptive statistics for the cohort are provided, which include a 51% rate of obesity and 95% rate of pathologic cholecystitis. Conversion rates of 4% and complication rates of 6% were found. The majority had a CCY without biliary imaging (n = 630, 68.9%). Relevant benchmarks are characterized, and results of a practice pattern of omitting pre- or intraoperative biliary tree imaging are described. These findings serve as a first benchmark of choledocholithiasis management for urban safety net hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

Time-odd mean fields in covariant density functional theory: Rotating systems

International Nuclear Information System (INIS)

Afanasjev, A. V.; Abusara, H.

2010-01-01

Time-odd mean fields (nuclear magnetism) and their impact on physical observables in rotating nuclei are studied in the framework of covariant density functional theory (CDFT). It is shown that they have profound effect on the dynamic and kinematic moments of inertia. Particle number, configuration, and rotational frequency dependencies of their impact on the moments of inertia have been analyzed in a systematic way. Nuclear magnetism can also considerably modify the band crossing features such as crossing frequencies and the properties of the kinematic and dynamic moments of inertia in the band crossing region. The impact of time-odd mean fields on the moments of inertia in the regions away from band crossing only weakly depends on the relativistic mean-field parametrization, reflecting good localization of the properties of time-odd mean fields in CDFT. The moments of inertia of normal-deformed nuclei considerably deviate from the rigid-body value. On the contrary, superdeformed and hyperdeformed nuclei have the moments of inertia which are close to rigid-body value. The structure of the currents in rotating frame, their microscopic origin, and the relations to the moments of inertia have been systematically analyzed. The phenomenon of signature separation in odd-odd nuclei, induced by time-odd mean fields, has been analyzed in detail.

Health problems and the health care provider choices: A comparative study of urban and rural households in Egypt

Directory of Open Access Journals (Sweden)

Salma B. Galal

2014-06-01

Conclusion: Urban families have less health complaints than rural; however, rural families recover sooner. Families bypass often public primary health care services. Urban families overuse outpatient clinics in public hospitals.

Regression Tests and the Efficiency of Fixed Odds Betting Markets

NARCIS (Netherlands)

Koning, Ruud H.

The informational content of odds posted in sports betting market has been an ongoing topic of research. In this paper, I test whether fixed odds betting markets in soccer are informationally efficient. The contributions of the paper are threefold: first, I propose a simple yet flexible statistical

Quantum information with even and odd states of orbital angular momentum of light

Energy Technology Data Exchange (ETDEWEB)

Perumangatt, Chithrabhanu, E-mail: chithrabhanu@prl.res.in [Physical Research laboratory, Navarangpura, Ahmedabad, 380009 (India); Lal, Nijil [Physical Research laboratory, Navarangpura, Ahmedabad, 380009 (India); IIT Gandhinagar, Palaj, Ahmedabad, 382355 (India); Anwar, Ali [Physical Research laboratory, Navarangpura, Ahmedabad, 380009 (India); Gangi Reddy, Salla [University of Electro-communications, Chofu, Tokyo, 1828585 (Japan); Singh, R.P. [Physical Research laboratory, Navarangpura, Ahmedabad, 380009 (India)

2017-06-15

We address the possibility of using even/odd states of orbital angular momentum (OAM) of photons for the quantum information tasks. Single photon qubit states and two photon entangled states in even/odd basis of OAM are considered. We present a method for the tomography and general projective measurement in even/odd basis. With the general projective measurement, we show the Bell violation and quantum cryptography with Bell's inequality. We also describe hyper and hybrid entanglement of even/odd OAM states along with polarization, which can be applied in the implementation of quantum protocols like super dense coding. - Highlights: • We propose to use even and odd states of orbital angular momentum (OAM) of light for quantum information tasks. • We describe the OAM qubits and entangled states in even/odd basis and the corresponding projective operators. • We present a method for the tomography and the Bell's inequality violation for photons entangled in even/odd OAM states. • We also describe hyper and hybrid entanglement of even/odd OAM states along with polarization and their applications.

The even and the odd spectral flows on the N=2 superconformal algebras

International Nuclear Information System (INIS)

Gato-Rivera, B.

1998-01-01

There are two different spectral flows on the N=2 superconformal algebras (four in the case of the topological algebra). The usual spectral flow, first considered by Schwimmer and Seiberg, is an even transformation, whereas the spectral flow previously considered by the author and Rosado is an odd transformation. We show that the even spectral flow is generated by the odd spectral flow, and therefore only the latter is fundamental. We also analyze thoroughly the four ''topological'' spectral flows, writing two of them here for the first time. Whereas the even and the odd spectral flows have quasi-mirrored properties acting on the antiperiodic or the periodic algebras, the topological even and odd spectral flows have drastically different properties acting on the topological algebra. The other two topological spectral flows have mixed even and odd properties. We show that the even and the even-odd topological spectral flows are generated by the odd and the odd-even topological spectral flows, and therefore only the latter are fundamental. (orig.)

Psychotherapy Utilization Among Rural and Urban Veterans From 2007 to 2010.

Science.gov (United States)

Mott, Juliette M; Grubbs, Kathleen M; Sansgiry, Shubhada; Fortney, John C; Cully, Jeffrey A

2015-01-01

This study evaluated change in rural and urban veterans' psychotherapy use during a period of widespread effort within the Veterans Health Administration (VHA) to engage rural veterans in mental health care. National VHA administrative databases were queried for patients receiving a new diagnosis of depression, anxiety, or posttraumatic stress disorder in fiscal years (FY) 2007 and 2010. Using the US Department of Agriculture Rural-Urban Continuum Codes, we identified urban (FY 2007: n = 192,347; FY 2010: n = 231,471) and rural (FY 2007: n = 72,923; FY 2010: n = 81,905) veterans. Veterans' psychotherapy use during the 12 months following diagnosis was assessed. From FY 2007 to 2010, the proportion of veterans receiving any psychotherapy increased from 17% to 22% for rural veterans and 24% to 28% for urban veterans. Rural veterans were less likely to receive psychotherapy across both fiscal years; however, the magnitude of this disparity decreased significantly from 2007 (odds ratio [OR] = 1.51) to 2010 (OR = 1.41). Similarly, although urban veterans received more psychotherapy sessions, urban-rural disparities in the receipt of 8 or more psychotherapy sessions decreased over the study period (2007: OR = 2.32; 2010: OR = 1.69). Rural and urban veterans are increasingly making use of psychotherapy, and rural-urban gaps in psychotherapy use are shrinking. These improvements suggest that recent VHA efforts to engage rural veterans in care have been successful at reducing differences between rural and urban veterans with respect to access and engagement in psychotherapy. © 2014 National Rural Health Association.

The effect of hospital volume on mortality in patients admitted with severe sepsis.

Directory of Open Access Journals (Sweden)

Sajid Shahul

Full Text Available IMPORTANCE: The association between hospital volume and inpatient mortality for severe sepsis is unclear. OBJECTIVE: To assess the effect of severe sepsis case volume and inpatient mortality. DESIGN SETTING AND PARTICIPANTS: Retrospective cohort study from 646,988 patient discharges with severe sepsis from 3,487 hospitals in the Nationwide Inpatient Sample from 2002 to 2011. EXPOSURES: The exposure of interest was the mean yearly sepsis case volume per hospital divided into tertiles. MAIN OUTCOMES AND MEASURES: Inpatient mortality. RESULTS: Compared with the highest tertile of severe sepsis volume (>60 cases per year, the odds ratio for inpatient mortality among persons admitted to hospitals in the lowest tertile (≤10 severe sepsis cases per year was 1.188 (95% CI: 1.074-1.315, while the odds ratio was 1.090 (95% CI: 1.031-1.152 for patients admitted to hospitals in the middle tertile. Similarly, improved survival was seen across the tertiles with an adjusted inpatient mortality incidence of 35.81 (95% CI: 33.64-38.03 for hospitals with the lowest volume of severe sepsis cases and a drop to 32.07 (95% CI: 31.51-32.64 for hospitals with the highest volume. CONCLUSIONS AND RELEVANCE: We demonstrate an association between a higher severe sepsis case volume and decreased mortality. The need for a systems-based approach for improved outcomes may require a high volume of severely septic patients.

Improving Rates of Post-Essure Hysterosalpingography in an Urban Population Using Electronic Tracking Reminders.

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Virginia Hu, Yu-Han; Arora, Kavita Shah

2017-02-01

To demonstrate the efficacy of electronic reminders for follow-up hysterosalpingography (HSG) after Essure hysteroscopic sterilization in an urban tertiary care hospital obstetrics and gynecology practice. Retrospective cohort study (Canadian Task Force classification II-3). Obstetrics and gynecology practice at a university-affiliated urban tertiary care teaching hospital. Two hundred and fifty patients who underwent Essure hysteroscopic sterilization between June 2011 and July 2014. Implementation of electronic reminders for the office staff. Two hundred and fifty of 259 patients (96.5%) underwent Essure hysteroscopic sterilization and successful placement of coils into bilateral Fallopian tubes. Among these 250 patients, 135 (54%) returned for HSG at 3 months post-Essure as advised at the time of procedure. The use of electronic reminders prompted another 45 patients (18%) to return for HSG, improving the total post-Essure follow-up rate to 72%. Electronic reminders for the office staff of an urban tertiary care hospital's obstetrics and gynecology practice is an effective method for improving the rate of post-Essure HSG. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

Comparison of domestic violence against women in urban versus rural areas of southeast Nigeria

Directory of Open Access Journals (Sweden)

Ajah LO

2014-10-01

Full Text Available Leonard Ogbonna Ajah,1,2 Chukwuemeka Anthony Iyoke,1 Peter Onubiwe Nkwo,1 Boniface Nwakoby,3 Paul Ezeonu2 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; 3Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria Background: The perception and prevalence of domestic violence (DV in rural areas is poorly understood; the result is that most efforts at eradicating this harmful practice are concentrated in urban areas. The objective of the study was to compare the burden and perception of DV among women living in rural and urban Igbo communities of southeast Nigeria. Methods: This was a comparative, cross-sectional study of women residing in rural and urban communities in Enugu, Nigeria, who had gathered for an annual religious meeting from August 1–7, 2011. Data analysis involved descriptive and inferential statistics and was conducted with the Statistical Package for Social Sciences, software version 17.0, at a 95% level of confidence. Results: A total of 836 women who met the eligibility criteria participated in the survey. Of these, 376 were from Okpanku, a rural community, while 460 were from Ogui Nike, an urban community. The prevalence of DV among rural women was significantly higher than that among urban women (97% versus 81%, P<0.001. In particular, the prevalence of physical violence was significantly higher among rural women than among urban women (37.2% versus 23.5%; P=0.05. In contrast, rural and urban women did not differ significantly in the proportions that had experienced psychological or sexual violence. The proportion of women who believed that DV was excusable was significantly higher among rural dwellers than among urban dwellers (58.5% versus 29.6%; P=0.03. Conclusion: The burden of DV against women may be higher in rural

Low-spin identical bands in odd-A nuclei

International Nuclear Information System (INIS)

Baktash, C.; Garrett, J.D.; Winchell, D.F.; Smith, A.

1992-01-01

A comprehensive study of odd-A rotational bands in normally-deformed rare-earth nuclei indicates that a large number of seniority-one configurations (30% for odd-Z nuclei) at low spin have moments of inertia nearly identical to that of the seniority-zero configuration of the neighboring even-even nucleus with one less nucleon. It is difficult to reconcile these results with conventional models, based on the traditional picture of nuclear pair correlation in vogue for more than three decades, which predict variations of about 15% in the moments of inertia of configurations differing by one unit in seniority

Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

Directory of Open Access Journals (Sweden)

Mamta Swaroop

2013-01-01

Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau

DEFF Research Database (Denmark)

Veirum, Jens Erik; Biai, Sidu; Jakobsen, Marianne

2007-01-01

AIM: To describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. METHODS: Hospital data on child admissions in a 6-year period were linked to information...... been hospitalized, and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1,000 person-years, respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12...... minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should...

"Dealing" with Incidence, Prevalence, and Odds Concepts in Undergraduate Epidemiology

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Senchina, David S.; Laurson, Kelly R.

2009-01-01

Concepts and associated statistical formulae of incidence, prevalence, and odds/odds ratios are core knowledge in epidemiology yet can be confusing for students. The purpose of this project was to develop, validate, and share one possible pedagogical technique using playing cards that could be employed to improve undergraduate understanding of…

Effects of Age and Sex on Hospital Readmission in Traumatic Brain Injury.

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Li, Chih-Ying; Karmarkar, Amol; Adhikari, Deepak; Ottenbacher, Kenneth; Kuo, Yong-Fang

2018-01-04

To investigate the effects of age and sex on 30-, 60-, and 90-day hospital readmission after acute hospital discharge for individuals with traumatic brain injury (TBI). Retrospective cohort study. Acute hospitals and postacute discharge settings. Individuals (N=52,877) with Diagnosis Related Group codes of TBI, who were divided into 4 age groups: 18 to 40, 41 to 65, 66 to 75, and ≥76 years. Not applicable. All-cause hospital readmission. Sex differences in 30-, 60-, and 90-day hospital readmission were found among all age groups (Preadmission were in the 2 oldest groups (66-75 and ≥76y). For both sexes, the oldest group (≥76y) had the highest adjusted 90-day readmission risk (eg, 90-d readmission: odds ratio, 2.32 [95% confidence interval, 2.01-2.69] for men; odds ratio, 1.96 [95% confidence interval, 1.59-2.43] for women). Among those readmitted within 90 days, the youngest group (18-40y) had the highest cumulative readmission percentage (35% for both sexes) within the first week of hospital discharge. Age and sex were significantly associated with hospital readmission during the first 90 days postdischarge in our TBI sample. Specifically, those aged 66 to 75 or ≥76 years had the highest readmission risk over 90 days for both sexes. The findings suggest that clinicians should consider age and sex in discharge planning and for the entire episode of care for the population with TBI. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Transmission of antibiotic-resistant Escherichia coli between cattle, humans and the environment in peri-urban livestock keeping communities in Morogoro, Tanzania

DEFF Research Database (Denmark)

Lupindu, Athumani M; Dalsgaard, Anders; Msoffe, Peter L. M.

2015-01-01

Urban and peri-urban livestock farming is expanding world-widely because of increased urbanization and demands for food of animal origin. Such farming practices pose a public health risk as livestock are reservoirs of several zoonotic pathogens. In an attempt to determine the fecal transmission...... infrastructures (Odd Ratio=11.2, 95% CI=1.1-119.3) were associated with E. coli showing identical PFGE types within and between clusters. There is a need to improve animal husbandry and manure management practices to reduce risks of transmission of enteropathogens between livestock and humans in urban and peri-urban...... between livestock and people, 100 household clusters keeping cattle in close proximity of humans were selected in urban and peri-urban areas of Morogoro in Tanzania. One hundred eighteen ampicillin and tetracycline resistant Escherichia coli (40 from human stool, 50 from cattle feces, 21 from soil...

The associations between interpersonal violence and psychological distress among rural and urban young women in South Africa.

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Manyema, M; Norris, S A; Said-Mohamed, R; Tollman, S T; Twine, R; Kahn, K; Richter, L M

2018-03-23

Approximately 25% of the world's population consists of young people. The experience of violence peaks during adolescence and the early adult years. A link between personal experience of violence and mental health among young people has been demonstrated but rural-urban differences in these associations are less well known in low to middle income countries. The aim of this study was to investigate the associations between interpersonal violence and psychological distress among rural and urban young women. Data on experiences of violence and psychological distress were collected from a total of 926 non-pregnant young women aged between 18 and 22 years of age in rural and urban sites in South Africa. The General Health Questionnaire-28 was used to assess psychological distress as an indicator of mental health. Generalised structural equation models were employed to assess potential pathways of association between interpersonal violence and psychological distress. Thirty-four percent of the urban young women (n = 161) reported psychological distress compared to 18% of rural young women (n = 81). In unadjusted analysis, exposure to interpersonal violence doubled the odds of psychological distress in the urban adolescents and increased the odds 1.6 times in the rural adolescents. In adjusted models, the relationship remained significant in the urban area only (OR 1.84, 95% CI 1.13-3.00). Rural residence seemed protective against psychological distress (OR 0.41, 95% CI 0.24-0.69). Structural equation modelling did not reveal any direct association between exposure to interpersonal violence and psychological distress among rural young women. Stressful household events were indirectly associated with psychological distress, mediated by violence among young women in the urban area. The relationship between violence and psychological distress differs between urban and rural-residing young women in South Africa, and is influenced by individual, household and community

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

Energy Technology Data Exchange (ETDEWEB)

Fischer, Leonardo Marques; Dutra, João Pedro Passos [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); Mantovani, Augusto [UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Lima, Gustavo Glotz de [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Leiria, Tiago Luiz Luz, E-mail: drleiria@cardiol.br [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil)

2013-12-15

Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

International Nuclear Information System (INIS)

Fischer, Leonardo Marques; Dutra, João Pedro Passos; Mantovani, Augusto; Lima, Gustavo Glotz de; Leiria, Tiago Luiz Luz

2013-01-01

Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature

Association between allergic rhinitis and hospital resource use among asthmatic children in Norway

DEFF Research Database (Denmark)

Sazonov Kocevar, V; Thomas, J; Jonsson, L

2005-01-01

of hospital admissions during a 2-year period, 1998-1999. Multivariate linear regression, adjusting for risk factors including age, gender, year of admission, urban/rural residence and severity of asthma episode, estimated the association between allergic rhinitis and total hospital days. A multivariate Cox...

Age trends in 30 day hospital readmissions: US national retrospective analysis

Science.gov (United States)

Berry, Jay G; Gay, James C; Joynt Maddox, Karen; Coleman, Eric A; Bucholz, Emily M; O’Neill, Margaret R; Blaine, Kevin; Hall, Matthew

2018-01-01

Abstract Objective To assess trends in and risk factors for readmission to hospital across the age continuum. Design Retrospective analysis. Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. Main outcome measure 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. Results The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). Conclusions The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the

The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals

Science.gov (United States)

Carthon, J Margo Brooks; Lasater, Karen B; Sloane, Douglas M; Kutney-Lee, Ann

2015-01-01

Introduction Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. Aim The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. Methods Cross-sectional examination, using three linked data sources—(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data— from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. Results The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2–8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). Conclusions Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes. PMID:25672342

The Alleged Oddness of Ethical Egoism

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Marietta, Don E., Jr.

1977-01-01

There are some critics of ethical egoism who treat it seriously as an ethical doctrine, but consider it an odd approach. Examines this doctrine and suggests that if we are to have the benefit of egoism as a sound ethical approach, or rightly assess its inadequacies, we must first see it fairly. (Author/RK)

Size matters: a meta-analysis on the impact of hospital size on patient mortality.

Science.gov (United States)

Fareed, Naleef

2012-06-01

This paper seeks to understand the relationship between hospital size and patient mortality. Patient mortality has been used by several studies in the health services research field as a proxy for measuring healthcare quality. A systematic review is conducted to identify studies that investigate the impact of hospital size on patient mortality. Using the findings of 21 effect sizes from 10 eligible studies, a meta-analysis is performed using a random effects model. Subgroup analyses using three factors--the measure used for hospital size, type of mortality measure used and whether mortality was adjusted or unadjusted--were utilised to investigate their moderating influence on the study's primary relationship. Results from this analysis indicate that big hospitals have lower odds of patient mortality versus small hospitals. Specifically, the probability of patient mortality in a big hospital, in reference to a small hospital, is 11% less. Subgroup analyses show that studies with unadjusted mortality rates have an even lower overall odds ratio of mortality versus studies with adjusted mortality rates. Aside from some limitations in data reporting, the findings of this paper support theoretical notions that big hospitals have lower mortality rates than small hospitals. Guidelines for better data reporting and future research are provided to further explore the phenomenon. Policy implications of this paper's findings are underscored and a sense of urgency is called for in an effort to help improve the state of a healthcare system that struggles with advancing healthcare quality. © 2012 The Author. International Journal of Evidence-Based Healthcare © 2012 The Joanna Briggs Institute.

Rural Bypass of Critical Access Hospitals in Iowa: Do Visiting Surgical Specialists Make a Difference?

Science.gov (United States)

Weigel, Paula A M; Ullrich, Fred; Ward, Marcia M

2018-02-01

Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass. © 2016 National Rural Health Association.

A Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia.

Science.gov (United States)

Paranji, Suchitra; Paranji, Neethi; Wright, Scott; Chandra, Shalini

2017-02-01

To assess the impact of dysphagia on clinical and operational outcomes in hospitalized patients with dementia. Retrospective cohort study. 2012 Nationwide Inpatient Sample. All patients discharged with a diagnosis of dementia (N = 234,006) from US hospitals in 2012. Univariate and multivariate regression models, adjusting for stroke and patient characteristics, to assess the impact of dysphagia on the prevalence of comorbidities, including pneumonia, sepsis, and malnutrition; complications, including mechanical ventilation and death; and operational outcomes, including length of stay (LOS) and total charges for patients with dementia. Patients having dementia with dysphagia (DWD) had significantly higher odds of having percutaneous endoscopic gastrostomy placement during the admission (odds ratio [OR]: 13.68, 95% confidence interval [CI]: 12.53-14.95, P dysphagia. Dysphagia is a significant predictor of worse clinical and operational outcomes including a 38% longer LOS and a 30% increase in charge per case among hospitalized patients with dementia. Although these findings may not be surprising, this new evidence might bring heightened awareness for the need to more thoughtfully support patients with dementia and dysphagia who are hospitalized.

Population versus hospital controls for case-control studies on cancers in Chinese hospitals.

Science.gov (United States)

Li, Lin; Zhang, Min; Holman, D'Arcy

2011-12-15

Correct control selection is crucial to the internal validity of case-control studies. Little information exists on differences between population and hospital controls in case-control studies on cancers in Chinese hospital setting. We conducted three parallel case-control studies on leukemia, breast and colorectal cancers in China between 2009 and 2010, using population and hospital controls to separately match 540 incident cases by age, gender and residency at a 1:1 ratio. Demographic and lifestyle factors were measured using a validated questionnaire in face-to-face interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using conditional logistic regression analyses. The two control groups had closely similar exposure distributions of 15 out of 16 factors, with the only exception being that hospital controls were less likely to have a BMI ≥ 25 (OR = 0.71, 95% CI: 0.54, 0.93). For exposure of green tea drinking, the adjusted ORs (95% CIs) comparing green tealeaves intake ≥ 1000 grams annually with non-drinkers were 0.51 (0.31, 0.83) and 0.21 (0.27, 0.74) for three cancers combined, 0.06 (0.01, 0.61) and 0.07 (0.01, 0.47) for breast cancer, 0.52 (0.29, 0.94) and 0.45 (0.25, 0.82) for colorectal cancer, 0.65 (0.08, 5.63) and 0.57 (0.07, 4.79) for leukemia using hospital and population controls respectively. The study found that hospital controls were comparable with population controls for most demographic characteristics and lifestyle factors measured, but there was a slight difference between the two control groups. Hospital outpatients provide a satisfactory control group in hospital-based case-control study in the Chinese hospital setting.

Population versus hospital controls for case-control studies on cancers in Chinese hospitals

Directory of Open Access Journals (Sweden)

Li Lin

2011-12-01

Full Text Available Abstract Background Correct control selection is crucial to the internal validity of case-control studies. Little information exists on differences between population and hospital controls in case-control studies on cancers in Chinese hospital setting. Methods We conducted three parallel case-control studies on leukemia, breast and colorectal cancers in China between 2009 and 2010, using population and hospital controls to separately match 540 incident cases by age, gender and residency at a 1:1 ratio. Demographic and lifestyle factors were measured using a validated questionnaire in face-to-face interview. Odds ratios (ORs and 95% confidence intervals (CIs were obtained using conditional logistic regression analyses. Results The two control groups had closely similar exposure distributions of 15 out of 16 factors, with the only exception being that hospital controls were less likely to have a BMI ≥ 25 (OR = 0.71, 95% CI: 0.54, 0.93. For exposure of green tea drinking, the adjusted ORs (95% CIs comparing green tealeaves intake ≥ 1000 grams annually with non-drinkers were 0.51 (0.31, 0.83 and 0.21 (0.27, 0.74 for three cancers combined, 0.06 (0.01, 0.61 and 0.07 (0.01, 0.47 for breast cancer, 0.52 (0.29, 0.94 and 0.45 (0.25, 0.82 for colorectal cancer, 0.65 (0.08, 5.63 and 0.57 (0.07, 4.79 for leukemia using hospital and population controls respectively. Conclusions The study found that hospital controls were comparable with population controls for most demographic characteristics and lifestyle factors measured, but there was a slight difference between the two control groups. Hospital outpatients provide a satisfactory control group in hospital-based case-control study in the Chinese hospital setting.

Commercial facilities in future cities and urban redevelopment

Energy Technology Data Exchange (ETDEWEB)

1988-07-01

The future trends of commercial facilities were clarified by interviewing the people concerned in the commercial facilities with large floor area and relatively large energy consumption per unit area such as office building, hospital, hotel, department store, restaurant, educational facilities, sports facilities and urban redevelopment. Since an intelligent building will basically employ the office automation, it is estimated that most of the commercial buildings constructed for the future redevelopment will be intelligent buildings. Hospitals will require the system maintaining the quality of life of individual patient. It is expected that high quality hotels focusing on a touch of high class will be constructed. Department stores will aim at the daily living industry. Future restaurants will need a definite concept. Universities will have to increase new sections according to new students and change in social conditions. It is expected that high quality businesses districts and living quarters in business-centered cities will be planned for urban redevelopment. (4 figs. 3 tabs.)

In-hospital pediatric cardiac arrest in Honduras.

Science.gov (United States)

Matamoros, Martha; Rodriguez, Roger; Callejas, Allison; Carranza, Douglas; Zeron, Hilda; Sánchez, Carlos; Del Castillo, Jimena; López-Herce, Jesús

2015-01-01

The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

Socio-economic status as an environmental factor - incidence of underweight, overweight and obesity in adolescents from less-urbanized regions of Poland.

Science.gov (United States)

Długosz, Anna; Niedźwiedzka, Ewa; Długosz, Tomasz; Wądołowska, Lidia

2015-01-01

Under-nutrition, over-nutrition and obesity incidence in relation to environmental diversity and socio-economic influences in adolescents from less urbanized regions of Poland has not been widely studied. To determine the correlation between socio-economic status and incidence of underweight, overweight and obesity in adolescents located in less-urbanized regions of Poland. The study involved 553 adolescents aged 13-18 living in 2 less-urbanized regions of Poland (small towns and villages in the central and north-eastern regions). The sample was randomly chosen. The distinguishing determinants of socio-economic status (SES) included 6 features. The SES index (SESI) was calculated. Low, average and high SESI adolescents were distinguished. Using logistic regression, the odds ratio (OR) of underweight (BMI0.05). The odds ratio of overweight incidence in the average SESI adolescent was 1.73 (95%CI: 0.93, 3.19; p>0.05) and in high SESI adolescents - 1.14 (95%CI: 0.83, 1.57; p>0.05). The odds ratio of obesity incidence in the average SESI adolescent was 0.70 (95%CI: 0.21, 2.34; p>0.05) and in high SESI adolescents - 0.76 (95%CI: 0.40, 1.44; p>0.05). Adjustments for gender, age or region of residence did not significantly change the ORs values or their interpretation. Underweight incidence in adolescents from less urbanized regions of Poland depended on socio-economic status. An adolescent with average socio-economic status was 3 times less likely to be underweight than an adolescent with low socio-economic status. The correlation between socio-economic status and overweight and obesity was not significant.

Hospital effluents as a source of emerging pollutants: An overview of micropollutants and sustainable treatment options

Science.gov (United States)

Verlicchi, P.; Galletti, A.; Petrovic, M.; Barceló, D.

2010-08-01

SummaryHospital wastewaters contain a variety of toxic or persistent substances such as pharmaceuticals, radionuclides, solvents and disinfectants for medical purposes in a wide range of concentrations due to laboratory and research activities or medicine excretion. Most of these compounds belong to the so called emerging contaminants; quite often unregulated pollutants which may be candidates for future regulation depending on research on their potential health effects and monitoring of their occurrence. Their main characteristic is that they do not need to persist in the environment to cause negative effects since their high transformation/removal rates can be compensated for by their continuous introduction into the environment. Some of these compounds, most of them pharmaceuticals and personal care products may also be present in urban wastewaters. Their concentrations in the effluents may vary from ng L -1 to μg L -1. In this paper, hospital effluents and urban wastewaters are compared in terms of quali-quantitative characteristics. On the basis of an in-depth survey: (i) hospital average specific daily water consumptions (L patient -1 day -1) are evaluated and compared to urban ones (L person -1 day -1), (ii) conventional parameters concentrations in hospital effluents are compared to urban ones and (iii) main pharmaceuticals and other emerging compounds contents are compared in the two wastewaters. Finally, an overview of the removal capacity of the different treatments is reported.

Melham's conjecture on odd power sums of fibonacci numbers | Sun ...

African Journals Online (AJOL)

Ozeki and Prodinger showed that the odd power sum of the first several consecutive Fibonacci numbers of even order is equal to a polynomial evaluated at a certain Fibonacci number of odd order. We prove that this polynomial and its derivative both vanish at 1, and will be an integer polynomial after multiplying it by a ...

Low-spin identical bands in odd-A nuclei

Energy Technology Data Exchange (ETDEWEB)

Baktash, C; Garrett, J D; Winchell, D F; Smith, A [Oak Ridge National Lab., TN (United States)

1992-08-01

A comprehensive study of odd-A rotational bands in normally-deformed rare-earth nuclei indicates that a large number of seniority-one configurations (30% for odd-Z nuclei) at low spin have moments of inertia nearly identical to that of the seniority-zero configuration of the neighboring even-even nucleus with one less nucleon. It is difficult to reconcile these results with conventional models, based on the traditional picture of nuclear pair correlation in vogue for more than three decades, which predict variations of about 15% in the moments of inertia of configurations differing by one unit in seniority. (author). 18 refs., 1 tab., 1 fig.

Low-spin identical bands in odd-A nuclei

International Nuclear Information System (INIS)

Baktash, C.; Garrett, J.D.; Winchell, D.F.; Smith, A.

1992-01-01

A comprehensive study of odd-A rotational bands in normally-deformed rare-earth nuclei indicates that a large number of seniority-one configurations (30% for odd-Z nuclei) at low spin have moments of inertia nearly identical to that of the seniority-zero configuration of the neighboring even-even nucleus with one less nucleon. It is difficult to reconcile these results with conventional models, based on the traditional picture of nuclear pair correlation in vogue for more than three decades, which predict variations of about 15% in the moments of inertia of configurations differing by one unit in seniority. (author). 18 refs., 1 tab., 1 fig

Odd-flavor Simulations by the Hybrid Monte Carlo

CERN Document Server

Takaishi, Tetsuya; Takaishi, Tetsuya; De Forcrand, Philippe

2001-01-01

The standard hybrid Monte Carlo algorithm is known to simulate even flavors QCD only. Simulations of odd flavors QCD, however, can be also performed in the framework of the hybrid Monte Carlo algorithm where the inverse of the fermion matrix is approximated by a polynomial. In this exploratory study we perform three flavors QCD simulations. We make a comparison of the hybrid Monte Carlo algorithm and the R-algorithm which also simulates odd flavors systems but has step-size errors. We find that results from our hybrid Monte Carlo algorithm are in agreement with those from the R-algorithm obtained at very small step-size.

The outcome and risk factors for recurrence and extended hospitalization of secondary spontaneous pneumothorax.

Science.gov (United States)

Saito, Yoshitaro; Suzuki, Yohei; Demura, Ryo; Kawai, Hideki

2018-03-01

Secondary spontaneous pneumothorax (SSP) is difficult to treat by itself and due to its association with serious underlying diseases. It has a high rate of recurrence and often requires extended hospitalization. Therefore, we evaluated the outcome and risk factors associated with recurrence and extended hospitalization. We retrospectively examined 61 patients with SSP, and evaluated the patients' characteristics, underlying diseases, introduction of home oxygen therapy, Brinkman index, and X-ray imaging findings to determine the risk factors for recurrence and extended hospitalization. There were 28 patients (46.0%) with chronic obstructive pulmonary disease, 8 (13.1%) with interstitial pneumonia, 16 (26.2%) with massive emphysema, and 9 (14.8%) with other diseases. Adhesion and mediastinal shift visualized by X-ray imaging were observed in 37 (37.9%) and 25 patients (40.1%), respectively. Recurrence occurred in 25 patients (40.9%) and the average hospitalization duration was 14.5 days (±11.2). A multivariate analysis showed that adhesion on X-ray imaging was a significant risk factor for recurrence (odds ratio 4.90, 95% confidence interval 1.38-21.44) and mediastinal shift on X-ray imaging was a significant risk factor for extended hospitalization (odds ratio 6.05, 95% confidence interval 1.44-31.06). Findings from X-ray imaging, and not underlying diseases, are risk factors for recurrence and extended hospitalization.

Some considerations of the energy spectrum of odd-odd deformed nuclei; Quelqes considerations sur le spectre d'energie des noyaux impair-impair deformes

Energy Technology Data Exchange (ETDEWEB)

Alceanu-G, Pinho de; Picard, J [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1965-07-01

The odd-odd deformed nuclei are described as a rotator plus two odd nucleons moving in orbitals {omega}{sub p} and {omega}{sub n} of the deformed potential. We investigate the energies and wave functions of the various states of the ({omega}{sub p}, {omega}{sub n}) configurations by calculating and numerically diagonalizing the Hamiltonian matrix (with R.P.C. and residual interactions). The Gallagher-Mosskowski coupling rules ana the abnormal K equals 0 rotational bands are discussed. (authors) [French] Les noyaux impair-impairs deformes sont decrits comme un rotateur plus deux nucleons non apparies dans les orbites {omega}{sub p} et {omega}{sub n} du potentiel deforme. Nous etudions le spectre d'energie et les fonctions d'onde des configurations ({omega}{sub p}, {omega}{sub n}) en tenant compte de l'interaction particule-rotation et de la force residuelle entre les deux nucleons celibataires.

Lifetimes and magnetic moments in odd-odd 70 As

International Nuclear Information System (INIS)

Pantelica, D.; Negoita, F.; Stanoiu, M.

1998-01-01

The extensive experimental and theoretical work on the structure of N∼Z, A = 60-80 nuclei revealed many interesting features: large prolate deformations (β = 0.4), strong shape variations as a function of particle number, excitation energy, spin and shape coexistence effects. They are related with drastic changes of properties observed in nuclei with Z≥33 when going from spherical nuclei with N = 50 to neutron deficient nuclei with N = 38 or 40. Both the rapid changes in structure and the shape coexistence appear to reflect the competition between the shell gaps which occur at large oblate and prolate deformations near nucleon numbers 36 and 38 for both protons and neutrons. For N∼Z nuclei the same shell gaps appear simultaneously for both protons and neutrons and reinforce each other. The microscopic structure of the nuclei in the mass region A = 60-80 is essentially determined by the 1g 9/2 , 2p 1/2 , 1f 5/2 and 2p 3/2 orbitals. Because no unique interpretation of the unusual features discovered in these nuclei exists, the systematic experimental study of structure of these nuclei is still an interesting subject. As part of a systematic experimental study undertaken to investigate the structure of neutron deficient, odd-odd As nuclei, 68,70,72 As, the level scheme of 70 As was investigated using heavy ion induced reactions and in-beam γ-ray spectroscopy techniques. At energies between 500 and 900 keV a multiplet of negative parity levels has been observed. At higher energies a high-spin positive parity sequence of levels starting with a E x = 1676 keV, J π 8 + level is strongly populated. Additional information is required in order to establish the structure of low and high-spin levels of both parities. The magnetic moments of the 8 + and 9 + levels have been measured using the time-integral perturbed angular distribution technique and the lifetimes of four levels have been determined using the recoil-distance method. From the measured lifetime for the 9

Topology Explains Why Automobile Sunshades Fold Oddly

Science.gov (United States)

Feist, Curtis; Naimi, Ramin

2009-01-01

Automobile sunshades always fold into an "odd" number of loops. The explanation why involves elementary topology (braid theory and linking number, both explained in detail here with definitions and examples), and an elementary fact from algebra about symmetric group.

Evaluation of pre-hospital administration of adrenaline (epinephrine) by emergency medical services for patients with out of hospital cardiac arrest in Japan: controlled propensity matched retrospective cohort study.

Science.gov (United States)

Nakahara, Shinji; Tomio, Jun; Takahashi, Hideto; Ichikawa, Masao; Nishida, Masamichi; Morimura, Naoto; Sakamoto, Tetsuya

2013-12-10

To evaluate the effectiveness of pre-hospital adrenaline (epinephrine) administered by emergency medical services to patients with out of hospital cardiac arrest. Controlled propensity matched retrospective cohort study, in which pairs of patients with or without (control) adrenaline were created with a sequential risk set matching based on time dependent propensity score. Japan's nationwide registry database of patients with out of hospital cardiac arrest registered between January 2007 and December 2010. Among patients aged 15-94 with out of hospital cardiac arrest witnessed by a bystander, we created 1990 pairs of patients with and without adrenaline with an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) and 9058 pairs among those with non-VF/VT. Overall and neurologically intact survival at one month or at discharge, whichever was earlier. After propensity matching, pre-hospital administration of adrenaline by emergency medical services was associated with a higher proportion of overall survival (17.0% v 13.4%; unadjusted odds ratio 1.34, 95% confidence interval 1.12 to 1.60) but not with neurologically intact survival (6.6% v 6.6%; 1.01, 0.78 to 1.30) among those with VF/VT; and higher proportions of overall survival (4.0% v 2.4%; odds ratio 1.72, 1.45 to 2.04) and neurologically intact survival (0.7% v 0.4%; 1.57, 1.04 to 2.37) among those with non-VF/VT. Pre-hospital administration of adrenaline by emergency medical services improves the long term outcome in patients with out of hospital cardiac arrest, although the absolute increase of neurologically intact survival was minimal.

Comparisons between shell-model calculations, seniority truncation, and quasiparticle approximations: Application to the odd Ni isotopes and odd N = 82 isotones

International Nuclear Information System (INIS)

Losano, L.; Dias, H.; Krmpotic, F.; Wildenthal, B.H.

1988-01-01

A detailed study of the results of correcting BCS approximation for the effects of particle-number projection and blocking has been carried out. A low-seniority shell-model approximation was used as the frame of reference for investigating the mixing of one- and three-quasiparticle states in odd-mass Ni isotopes and in odd-mass N = 82 isotones. We discuss the results obtained for the energy spectra and electromagnetic decay properties. Effects of seniority-five configurations on the low-lying states have also been studied through the comparison of the low-seniority shell-model results with those which arose from the corresponding full shell-model calculations

Locating Automated External Defibrillators in a Complicated Urban Environment Considering a Pedestrian-Accessible Network that Focuses on Out-of-Hospital Cardiac Arrests

Directory of Open Access Journals (Sweden)

Pil Kwon

2017-02-01

Full Text Available Automated external defibrillators (AEDs are portable devices that defibrillate and diagnose sudden-cardiac-arrest patients. Therefore, AEDs are widely installed in public places such as airports, schools, sport complexes, etc., and the installation of AEDs is required by law in these places. However, despite their usefulness, AEDs are mostly installed indoors with limited coverage outdoors. Hence, this study conducts research in the placement of AEDs in outdoor locations. This study considers a complicated urban environment using a pedestrian network dataset and network barriers. We draw on the Teitz and Bart’s (1968 heuristic method that was built in the location-allocation solver in ArcMap. The results of this study found that a total of 455 AEDs, including 227 pre-installed AEDs, could be placed in the study area, thus providing an additional 228 devices. Compared with 10 different installation methods that were set as experimental groups, our test results found that additional installations were able to cover 10% to 30% more actual out-of-hospital cardiac-arrest cases. The main contribution of this study is the proposal of a new method in locating AEDs in optimal areas while considering complicated urban environments. We predict that the cardiac-arrest-related mortality rate would be reduced through implementing the findings of this study.

Decay properties of certain odd-Z SHE

International Nuclear Information System (INIS)

Carmel Vigila Bai, G.M.; Santhosh Kumar, S.

2004-01-01

In this work the well known Cubic plus Yukawa plus Exponential model (CYEM) in two sphere approximation and incorporating deformation effects to parents and daughter was used to study the alpha decay properties of certain odd-Z super heavy elements

: Urban design, urban project, urban art, urban composition ... a question of vocabulary?

OpenAIRE

Pinson , Daniel

2014-01-01

Actes à paraître; International audience; The term "urbanism" of Pierre Clerget (1910) put the mess in the practice and the formations in France. Urban planning is thus, on the academic level, a coexistence of disciplinary approaches, which does not help to a multidisciplinary urban training. Thinking about "urban design", after beautifull city, urban composition, or alongside the urban project and other territorial approaches can help to see more clearly in town planning.; Le terme « urbanis...

Non-proportional odds multivariate logistic regression of ordinal family data.

Science.gov (United States)

Zaloumis, Sophie G; Scurrah, Katrina J; Harrap, Stephen B; Ellis, Justine A; Gurrin, Lyle C

2015-03-01

Methods to examine whether genetic and/or environmental sources can account for the residual variation in ordinal family data usually assume proportional odds. However, standard software to fit the non-proportional odds model to ordinal family data is limited because the correlation structure of family data is more complex than for other types of clustered data. To perform these analyses we propose the non-proportional odds multivariate logistic regression model and take a simulation-based approach to model fitting using Markov chain Monte Carlo methods, such as partially collapsed Gibbs sampling and the Metropolis algorithm. We applied the proposed methodology to male pattern baldness data from the Victorian Family Heart Study. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Teenage pregnancy in an urban hospital setting.

Science.gov (United States)

Davis, J K; Fink, R; Yesupria, A; Rajegowda, B; Lala, R

1986-01-01

Recent research suggests that adverse consequences of teenage pregnancy are largely a function of social background factors and adequacy of prenatal care. This study examines the situation of young mothers with new babies in a low income, urban environment. The study explores the relationship between age and ethnicity and various life circumstance and life style differences which might effect long term developmental outcome. 475 Hispanic and black mothers were interviewed using a structured questionnaire. The majority are poorly educated, single parents. Educational attainment is higher for blacks than for Hispanics and for older mothers than for younger. Older mothers are more likely to be living with the father, to be married, and to have received adequate prenatal care. Hispanic parents are more likely than Blacks to be planning to live together. Hispanic mothers are more likely than blacks to be planning to be the primary caretaker for their babies. Adequacy of prenatal care is related to both prematurity and low birth weight. The implications of these findings are discussed in relation to pregnancy prevention and parenting education programs.

Does a low-income urban population practise healthy dietary habits?

Science.gov (United States)

Azizan, Nurul Ain; Thangiah, Nithiah; Su, Tin Tin; Majid, Hazreen Abdul

2018-03-01

The purpose of this study was to identify the unhealthy dietary habits and practices in a low-income community in an urban area and determine the associated factors. A cross-sectional survey was conducted in a low-income housing area in Kuala Lumpur, Malaysia. Data were collected using a questionnaire via face-to-face interviews by trained enumerators in order to obtain details on sociodemographic characteristics and dietary practices. Descriptive statistics showed that 86.7% of the respondents in the low-income community consumed fruit and vegetables less than five times per day, 11.7% consumed carbonated and sweetened drinks more than twice per day and about 25% consumed fast food more than four times per month. In total, 65.2% (n=945) did not have healthy dietary practices. Binary logistic regression showed that age, education and ethnicity were significant predictors of unhealthy dietary practices among the low-income community. Those in the 30-59 years age group had higher odds (odds ratio 1.65, p=0.04) of practising an unhealthy diet as compared with those older than 60 years of age. Unhealthy dietary practices were found to be common among the low-income group living in an urban area. Healthy lifestyle intervention should be highlighted so that it can be adopted in the low-income group.

J/ψ dissociation in parity-odd bubbles

International Nuclear Information System (INIS)

Tuchin, Kirill

2011-01-01

We calculate the quarkonium dissociation rate in the P and CP-odd domains (bubbles) that were possibly created in heavy-ion collisions. In the presence of the magnetic field produced by the valence quarks of colliding ions, parity-odd domains generate electric field. Quarkonium dissociation is the result of quantum tunneling of quark or antiquark through the potential barrier in this electric field. The strength of the electric field in the quarkonium comoving frame depends on the quarkonium velocity with respect to the background magnetic field. We investigate momentum, electric field strength and azimuthal dependence of the dissociation rate. Azimuthal distribution of quarkonia surviving in the electromagnetic field is strongly anisotropic; the form of anisotropy depends on the relation between the electric and magnetic fields and quarkonium momentum P ⊥ . These features can be used to explore the properties of the electromagnetic field created in heavy ion collisions.

Limits on CP-odd four-fermion operators containing the strange quark field

International Nuclear Information System (INIS)

Hamzaoui, C.; Pospelov, M.

1999-01-01

The bounds on the neutron electric dipole moment and T-odd nucleon-nucleon interaction are used to extract the limits on the effective CP-odd four-fermion operators containing a strange quark field. This completes the study of the dim=5,6 CP-odd operators built from light-quark fields. The limits are very strong and comparable to those obtained previously for operators containing up and down flavors. We also analyze the shift of the axionic vacuum, θ eff , induced by four-fermion operators in the presence of the PQ mechanism and conclude that this gives subleading contributions to CP-odd observables as compared with the direct ones. copyright 1999 The American Physical Society

Association of ventricular arrhythmia and in-hospital mortality in stroke patients in Florida: A nonconcurrent prospective study.

Science.gov (United States)

Dahlin, Arielle A; Parsons, Chase C; Barengo, Noël C; Ruiz, Juan Gabriel; Ward-Peterson, Melissa; Zevallos, Juan Carlos

2017-07-01

Stroke remains one of the leading causes of death in the United States. Current evidence identified electrocardiographic abnormalities and cardiac arrhythmias in 50% of patients with an acute stroke. The purpose of this study was to assess whether the presence of ventricular arrhythmia (VA) in adult patients hospitalized in Florida with acute stroke increased the risk of in-hospital mortality.Secondary data analysis of 215,150 patients with ischemic and hemorrhagic stroke hospitalized in the state of Florida collected by the Florida Agency for Healthcare Administration from 2008 to 2012. The main outcome for this study was in-hospital mortality. The main exposure of this study was defined as the presence of VA. VA included the ICD-9 CM codes: paroxysmal ventricular tachycardia (427.1), ventricular fibrillation (427.41), ventricular flutter (427.42), ventricular fibrillation and flutter (427.4), and other - includes premature ventricular beats, contractions, or systoles (427.69). Differences in demographic and clinical characteristics and hospital outcomes were assessed between patients who developed versus did not develop VA during hospitalization (χ and t tests). Binary logistic regression was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals (CIs) between VA and in-hospital mortality.VA was associated with an increased risk of in-hospital mortality after adjusting for all covariates (odds ratio [OR]: 1.75; 95% CI: 1.6-1.2). There was an increased in-hospital mortality in women compared to men (OR: 1.1; 95% CI: 1.1-1.14), age greater than 85 years (OR: 3.9, 95% CI: 3.5-4.3), African Americans compared to Whites (OR: 1.1; 95% CI: 1.04-1.2), diagnosis of congestive heart failure (OR: 2.1; 95% CI: 2.0-2.3), and atrial arrhythmias (OR: 2.1, 95% CI: 2.0-2.2). Patients with hemorrhagic stroke had increased odds of in-hospital mortality (OR: 9.0; 95% CI: 8.6-9.4) compared to ischemic stroke.Identifying VAs in stroke patients may help in

Use of social media across US hospitals: descriptive analysis of adoption and utilization.

Science.gov (United States)

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin; Merchant, Raina M

2014-11-27

Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes, including links between social media use and the

Use of Social Media Across US Hospitals: Descriptive Analysis of Adoption and Utilization

Science.gov (United States)

Griffis, Heather M; Kilaru, Austin S; Werner, Rachel M; Asch, David A; Hershey, John C; Hill, Shawndra; Ha, Yoonhee P; Sellers, Allison; Mahoney, Kevin

2014-01-01

Background Use of social media has become widespread across the United States. Although businesses have invested in social media to engage consumers and promote products, less is known about the extent to which hospitals are using social media to interact with patients and promote health. Objective The aim was to investigate the relationship between hospital social media extent of adoption and utilization relative to hospital characteristics. Methods We conducted a cross-sectional review of hospital-related activity on 4 social media platforms: Facebook, Twitter, Yelp, and Foursquare. All US hospitals were included that reported complete data for the Centers for Medicare and Medicaid Services Hospital Consumer Assessment of Healthcare Providers and Systems survey and the American Hospital Association Annual Survey. We reviewed hospital social media webpages to determine the extent of adoption relative to hospital characteristics, including geographic region, urban designation, bed size, ownership type, and teaching status. Social media utilization was estimated from user activity specific to each social media platform, including number of Facebook likes, Twitter followers, Foursquare check-ins, and Yelp reviews. Results Adoption of social media varied across hospitals with 94.41% (3351/3371) having a Facebook page and 50.82% (1713/3371) having a Twitter account. A majority of hospitals had a Yelp page (99.14%, 3342/3371) and almost all hospitals had check-ins on Foursquare (99.41%, 3351/3371). Large, urban, private nonprofit, and teaching hospitals were more likely to have higher utilization of these accounts. Conclusions Although most hospitals adopted at least one social media platform, utilization of social media varied according to several hospital characteristics. This preliminary investigation of social media adoption and utilization among US hospitals provides the framework for future studies investigating the effect of social media on patient outcomes

Comparative evaluation of MRSA nasal colonization epidemiology in the urban and rural secondary school community of Kurdistan, Iraq.

Science.gov (United States)

Hussein, Nawfal R; Basharat, Zarrin; Muhammed, Ary H; Al-Dabbagh, Samim A

2015-01-01

To study the nasal carriage rate of Staphylococcus aureus (S. aureus) (including methicillin-resistant strains) in secondary school community of the urban and rural districts of the Kurdistan region of Iraq, a cross-sectional population based survey was carried out in the city Duhok and rural areas of Amedya, Akre and Zakho. Nasal swabs were obtained from nostrils of 509 students aged 14-23 years. Resistance to methicillin was assessed by Kirby-Bauer disk diffusion and agar dilution assay. Vancomycin sensitivity was also tested on Muller-Hinton agar. It was found that the frequency of overall S. aureus nasal carriage (SANC) was 17.75% (90/509, CI95, 14.58-21.42%). In urban areas, the carriage rate was 20.59% (49/239, CI95, 15.64-26.29%), whereas it was 15.24% (41/270, CI95, 11.17-20.10%) in rural districts. The frequency of methicillin-resistant S. aureus (MRSA) among the isolated strains was found to be 2.04% (1/49) and 21.95% (9/41) in urban and rural areas respectively. It was found that in urban residents, the odd ratio (OR) of acquiring SANC was 1.44 (CI95, 0.91-2.27%) and risk ratio (RR) was at least 1.35 (CI95, 0.92-1.96%) while OR decreased to 0.12 (CI95, 0.01-0.96%) for MRSA carriage. Hence, the S. aureus carriage rate was higher in urban districts compared to rural areas while more MRSA were found in rural areas compared to urban districts. All studied strains were sensitive to vancomycin. This study provided baseline information for S. aureus nasal colonization in the region. Also, it showed that living in rural areas increased the odds of MRSA colonization. More attention should be paid to control MRSA colonization in rural communities.

Determinants of childhood immunisation coverage in urban poor settlements of Delhi, India: a cross-sectional study.

Science.gov (United States)

Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Sharma, Saket; Allen, Elizabeth; Shankar, Anuraj H; Zodpey, Sanjay

2016-08-26

Aggregate data on childhood immunisation from urban settings may not reflect the coverage among the urban poor. This study provides information on complete childhood immunisation coverage among the urban poor, and explores its household and neighbourhood-level determinants. Urban poor community in the Southeast district of Delhi, India. We randomly sampled 1849 children aged 1-3.5 years from 13 451 households in 39 clusters (cluster defined as area covered by a community health worker) in 2 large urban poor settlements. Of these, 1343 completed the survey. We collected information regarding childhood immunisation (BCG, oral polio vaccine, diphtheria-pertussis-tetanus vaccine, hepatitis B and measles) from vaccination cards or mothers' recall. We used random intercept logistic regression to explore the sociodemographic determinants of complete immunisation. Complete immunisation coverage was 46.7% and 7.5% were not immunised. The odds of complete vaccination (OR, 95% CI) were lower in female children (0.70 (0.55 to 0.89)) and Muslim households (0.65 (0.45 to 0.94)). The odds of complete vaccination were higher if the mother was literate (1.6 (1.15 to 2.16)), if the child was born within the city (2.7 (1.97 to 3.65)), in a health facility ( 1.5 (1.19 to 2.02)), belonged to the highest wealth quintile (compared with the poorest; 2.46 (1.5 to 4.02)) or possessed a birth certificate (1.40 (1.03 to 1.91)). Cluster effect due to unmeasured neighbourhood factors expressed as median OR was 1.32. Immunisation coverage in this urban poor area was much lower than that of regional surveys reporting overall urban data. Socioeconomic status of the household, female illiteracy, health awareness and gender inequality were important determinants of coverage in this population. Hence, in addition to enhancing the infrastructure for providing mother and child services, efforts are also needed to address these issues in order to improve immunisation coverage in deprived urban

Sigma decomposition: the CP-odd Lagrangian

Energy Technology Data Exchange (ETDEWEB)

Hierro, I.M. [Dipartimento di Fisica “G. Galilei”, Università di Padova and INFN, Sezione di Padova,Via Marzolo 8, I-35131 Padua (Italy); Merlo, L. [Instituto de Física Teórica, IFT-UAM/CSIC, Universidad Autónoma de Madrid,Cantoblanco, 28049, Madrid (Spain); Rigolin, S. [Dipartimento di Fisica “G. Galilei”, Università di Padova and INFN, Sezione di Padova,Via Marzolo 8, I-35131 Padua (Italy)

2016-04-04

In Alonso et al., http://dx.doi.org/10.1007/JHEP12(2014)034, the CP-even sector of the effective chiral Lagrangian for a generic composite Higgs model with a symmetric coset has been constructed, up to four momenta. In this paper, the CP-odd couplings are studied within the same context. If only the Standard Model bosonic sources of custodial symmetry breaking are considered, then at most six independent operators form a basis. One of them is the weak-θ term linked to non-perturbative sources of CP violation, while the others describe CP-odd perturbative couplings between the Standard Model gauge bosons and an Higgs-like scalar belonging to the Goldstone boson sector. The procedure is then applied to three distinct exemplifying frameworks: the original SU(5)/SO(5) Georgi-Kaplan model, the minimal custodial-preserving SO(5)/SO(4) model and the minimal SU(3)/(SU(2)×U(1)) model, which intrinsically breaks custodial symmetry. Moreover, the projection of the high-energy electroweak effective theory to the low-energy chiral effective Lagrangian for a dynamical Higgs is performed, uncovering strong relations between the operator coefficients and pinpointing the differences with the elementary Higgs scenario.

Construct Validity of ADHD/ODD Rating Scales: Recommendations for the Evaluation of Forthcoming DSM-V ADHD/ODD Scales

Science.gov (United States)

Burns, G. Leonard; Walsh, James A.; Servera, Mateu; Lorenzo-Seva, Urbano; Cardo, Esther; Rodriguez-Fornells, Antoni

2013-01-01

Exploratory structural equation modeling (SEM) was applied to a multiple indicator (26 individual symptom ratings) by multitrait (ADHD-IN, ADHD-HI and ODD factors) by multiple source (mothers, fathers and teachers) model to test the invariance, convergent and discriminant validity of the Child and Adolescent Disruptive Behavior Inventory with 872…

Inattention and hyperactivity and the achievement gap among urban minority youth.

Science.gov (United States)

Basch, Charles E

2011-10-01

To outline the prevalence and disparities of inattention and hyperactivity among school-aged urban minority youth, causal pathways through which inattention and hyperactivity adversely affects academic achievement, and proven or promising approaches for schools to address these problems. Literature review. Approximately 4.6 million (8.4%) of American youth aged 6-17 have received a diagnosis of attention deficit/hyperactivity disorder (ADHD), and almost two thirds of these youth are reportedly under treatment with prescription medications. Urban minority youth are not only more likely to be affected but also less likely to receive accurate diagnosis and treatment. Causal pathways through which ADHD may affect academic achievement include sensory perceptions, cognition, school connectedness, absenteeism, and dropping out. In one study, youth with diagnosed ADHD were 2.7 times as likely to drop out (10.0% vs. 22.9%). A similar odds ratio for not graduating from high school was found in another prospective study, with an 8-year follow-up period (odds ratio = 2.4). There are many children who are below the clinical diagnostic threshold for ADHD but who exhibit signs and symptoms that interfere with learning. Evidence-based programs emphasizing functional academic and social outcomes are available. Inattention and hyperactivity are highly and disproportionately prevalent among school-aged urban minority youth, have a negative impact on academic achievement through their effects on sensory perceptions, cognition, school connectedness, absenteeism, and dropping out, and effective practices are available for schools to address these problems. This prevalent and complex syndrome has very powerful effects on academic achievement and educational attainment, and should be a high priority in efforts to help close the achievement gap. © 2011, American School Health Association.

Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013.

Directory of Open Access Journals (Sweden)

Qin Xu

Full Text Available Heavy fine particulate matter (PM2.5 air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM2.5 pollution and hospital emergency room visits (ERV for total and cause-specific respiratory diseases in urban areas in Beijing.Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender.A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM2.5 concentration was 102.1±73.6 μg/m3. Every 10 μg/m3 increase in PM2.5 concentration at lag0 was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%, 0.19% for upper respiratory tract infection (URTI (95%CI: 0.04%-0.35%, 0.34% for lower respiratory tract infection (LRTI (95%CI: 0.14%-0.53% and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD (95%CI: 0.13%-2.79%. The strongest association was identified between AECOPD and PM2.5 concentration at lag0-3 (3.15%, 95%CI: 1.39%-4.91%. The estimated effects were robust after adjusting for SO2, O3, CO and NO2. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM2.5 exposure.PM2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM2.5 pollution varied by gender and age.

Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013.

Science.gov (United States)

Xu, Qin; Li, Xia; Wang, Shuo; Wang, Chao; Huang, Fangfang; Gao, Qi; Wu, Lijuan; Tao, Lixin; Guo, Jin; Wang, Wei; Guo, Xiuhua

2016-01-01

Heavy fine particulate matter (PM2.5) air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM2.5 pollution and hospital emergency room visits (ERV) for total and cause-specific respiratory diseases in urban areas in Beijing. Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender. A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM2.5 concentration was 102.1±73.6 μg/m3. Every 10 μg/m3 increase in PM2.5 concentration at lag0 was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%), 0.19% for upper respiratory tract infection (URTI) (95%CI: 0.04%-0.35%), 0.34% for lower respiratory tract infection (LRTI) (95%CI: 0.14%-0.53%) and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (95%CI: 0.13%-2.79%). The strongest association was identified between AECOPD and PM2.5 concentration at lag0-3 (3.15%, 95%CI: 1.39%-4.91%). The estimated effects were robust after adjusting for SO2, O3, CO and NO2. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM2.5 exposure. PM2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM2.5 pollution varied by gender and age.

Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre.

Science.gov (United States)

Hannay, R Scott; Wyrzykowski, Amy D; Ball, Chad G; Laupland, Kevin; Feliciano, David V

2014-02-01

Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.

Factors associated with financial distress of nonprofit hospitals.

Science.gov (United States)

Kim, Tae Hyun

2010-01-01

Financial distress can have a detrimental influence on the performance of hospitals. Hospital management needs to monitor potential financial distress effectively and know how it will respond depending on the severity of the circumstances. This study examined the multiple factors that may explain the financial distress of nonprofit hospitals during 1998 to 2001 and discussed their importance. To obtain more robust results, financial distress was assessed in 2 ways: first, financial strength index was used to incorporate 4 financial dimensions including profitability, liquidity, leverage, and physical facilities; second, cash flow (CF) was used to address the issues of accrual-based accounting in hospitals. This study finds that decrease in occupancy rate and increase in Medicaid payer mix, health maintenance organization penetration, market competition, physician supply, and percentage of the elderly are associated with increased likelihood of financial distress of urban hospitals. Increases in both Medicare and Medicaid payer mix, however, are related to higher likelihood of financial distress of rural hospitals.

Migraine and risk of perioperative ischemic stroke and hospital readmission

DEFF Research Database (Denmark)

Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D

2017-01-01

OBJECTIVE: To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. DESIGN: Prospective hospital registry study. SETTING: Massachusetts General Hospital and two satellite campuses between...... was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. RESULTS: 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.......9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura. : Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). CONCLUSIONS: Surgical patients with a history of migraine are at increased...

Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

Science.gov (United States)

Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W

2016-04-06

To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation

Rural-urban disparities in the prevalence of diabetes and coronary heart disease.

Science.gov (United States)

O'Connor, A; Wellenius, G

2012-10-01

To examine the rural-urban differences in the prevalence of diabetes and coronary heart disease, and the extent to which they are explained by the presence of established risk factors including poverty. Cross-sectional study of more than 214,000 respondents using data from the US Centers for Disease Control and Prevention's (CDC's) 2008 Behavioral Risk Factor Surveillance System. Logistic regression models were utilized; prevalence odds ratios with corresponding confidence intervals and P-values are provided. The crude prevalence rates of diabetes and coronary heart disease were 8.6% (P = 0.001) and 38.8% (P rural areas compared with urban areas, respectively. The higher prevalence in rural areas of many of the common risk factors for these conditions, including poverty (P rural areas [prevalence odds ratio (POR) = 0.94, P = 0.032], but the prevalence of coronary heart disease was higher (POR = 1.09, P = 0.011). The higher prevalence of diabetes and coronary heart disease in rural populations in the USA presents a formidable public health challenge. It exacerbates many of the pre-existing rural health disparities, including a lack of access to financial resources and primary care providers. Copyright © 2012 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Mycoplasma Pneumoniae among Children Hospitalized with Community-acquired Pneumonia.

Science.gov (United States)

Kutty, Preeta K; Jain, Seema; Taylor, Thomas H; Bramley, Anna M; Diaz, Maureen H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Edwards, Kathryn M; McCullers, Jonathan A; Pavia, Andrew T; Winchell, Jonas M; Schrag, Stephanie J; Hicks, Lauri A

2018-05-17

The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had ≥1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics ≤5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children ≥5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

Physicians’ engagement in dual practices and the effects on labor supply in public hospitals: results from a register-based study

Science.gov (United States)

2014-01-01

Background Physician dual practice, a combination of public and private practice, has attracted attention due to fear of reduced work supply and a lack of key personnel in the public system, increase in low priority treatments, and conflicts of interest for physicians who may be competing for their own patients when working for private suppliers. In this article, we analyze both choice of dual practice among hospital physicians and the dual practices’ effect on work supply in public hospitals. Methods The sample consisted of 12,399 Norwegian hospital physicians working in public hospitals between 2001 and 2009. We linked hospital registry data on salaries and hospital working hours with data from national income and other registries covering non-hospital income, including income from dual work, cohabiting status, childbirths and socioeconomic characteristics. Our dataset also included hospital variables describing i.e. workload. We estimated odds ratio for choosing dual practice and the effects of dual practice on public working hours using different versions of mixed models. Results The percentage of physicians engaged in dual practice fell from 35.1% for men and 17.6% for women in 2001 to 25.0% and 14.2%, respectively, in 2009. For both genders, financial debt and interest payments were positively correlated and having a newborn baby was negatively correlated with engaging in dual practice. Larger family size and being cohabitating increased the odds ratio of dual practice among men but reduced it for women. The most significant internal hospital factor for choosing dual practice was high wages for extended working hours, which significantly reduced the odds ratio for dual practice. The total working hours in public hospitals were similar for both those who did and did not engage in dual practice; however, dual practice reduced public working hours in some specialties. Conclusion Economic factors followed by family variables are significant elements influencing

Some considerations of the energy spectrum of odd-odd deformed nuclei; Quelqes considerations sur le spectre d'energie des noyaux impair-impair deformes

Energy Technology Data Exchange (ETDEWEB)

Alceanu-G, Pinho de; Picard, J. [Commissariat a l' Energie Atomique, Saclay (France). Centre d' Etudes Nucleaires

1965-07-01

The odd-odd deformed nuclei are described as a rotator plus two odd nucleons moving in orbitals {omega}{sub p} and {omega}{sub n} of the deformed potential. We investigate the energies and wave functions of the various states of the ({omega}{sub p}, {omega}{sub n}) configurations by calculating and numerically diagonalizing the Hamiltonian matrix (with R.P.C. and residual interactions). The Gallagher-Mosskowski coupling rules ana the abnormal K equals 0 rotational bands are discussed. (authors) [French] Les noyaux impair-impairs deformes sont decrits comme un rotateur plus deux nucleons non apparies dans les orbites {omega}{sub p} et {omega}{sub n} du potentiel deforme. Nous etudions le spectre d'energie et les fonctions d'onde des configurations ({omega}{sub p}, {omega}{sub n}) en tenant compte de l'interaction particule-rotation et de la force residuelle entre les deux nucleons celibataires.

Signature inversion in doubly odd 124La

International Nuclear Information System (INIS)

Chantler, H.J.; Paul, E.S.; Boston, A.J.; Choy, P.T.W.; Nolan, P.J.; Carpenter, M.P.; Davids, C.N.; Seweryniak, D.; Charity, R.; Devlin, M.; Sarantites, D.G.; Chiara, C.J.; Fossan, D.B.; Koike, T.; LaFosse, D.R.; Starosta, K.; Fletcher, A.M.; Smith, J.F.; Jenkins, D.G.; Kelsall, N.S.

2002-01-01

High-spin states have been studied in neutron-deficient 57 124 La 67 , populated through the 64 Zn( 64 Zn,3pn) reaction at 260 MeV. The Gammasphere γ-ray spectrometer has been used in conjunction with the Microball charged-particle detector, the Neutron Shell, and the Argonne Fragment Mass Analyzer, in order to select evaporation residues of interest. The known band structures have been extended and new bands found. Most of the bands are linked together, allowing more consistent spin and parity assignments. Comparison of band properties to cranking calculations has allowed configuration assignments to be made and includes the first identification of the g 9/2 proton-hole in an odd-odd lanthanum isotope. Two bands have been assigned a πh 11/2 xνh 11/2 structure; the yrast one exhibits a signature inversion in its level energies below I=18.5(ℎ/2π), while the excited one exhibits a signature inversion above I=18.5(ℎ/2π)

Soil clay content underlies prion infection odds

Science.gov (United States)

David, Walter W.; Walsh, D.P.; Farnsworth, Matthew L.; Winkelman, D.L.; Miller, M.W.

2011-01-01

Environmental factors-especially soil properties-have been suggested as potentially important in the transmission of infectious prion diseases. Because binding to montmorillonite (an aluminosilicate clay mineral) or clay-enriched soils had been shown to enhance experimental prion transmissibility, we hypothesized that prion transmission among mule deer might also be enhanced in ranges with relatively high soil clay content. In this study, we report apparent influences of soil clay content on the odds of prion infection in free-ranging deer. Analysis of data from prion-infected deer herds in northern Colorado, USA, revealed that a 1% increase in the clay-sized particle content in soils within the approximate home range of an individual deer increased its odds of infection by up to 8.9%. Our findings suggest that soil clay content and related environmental properties deserve greater attention in assessing risks of prion disease outbreaks and prospects for their control in both natural and production settings. ?? 2011 Macmillan Publishers Limited. All rights reserved.

Research-active clinical nurses: against all odds.

Science.gov (United States)

Siedlecki, Sandra L; Albert, Nancy M

2017-03-01

To develop a theoretical understanding of factors that impact decisions of clinical nurses to conduct a research study. Only a small percentage of all nurses are research-active and even fewer clinical nurses are research-active. Several researchers have explored barriers to research activity by clinical nurses, but few have examined why, in spite of all odds, some clinical nurses are research-active. As the purpose of this study was to develop a theoretical understanding of the research-active nurse, a grounded theory approach was used. The sample interviewed for this study consisted of registered nurses (n = 26) who worked in a hospital or ambulatory setting, had daily direct patient contact and had participated as principal investigator on at least one completed clinical nursing research study that was not in fulfilment of an educational requirement. The interviews were digitally recorded and analysed by two researchers using the constant comparative method. The findings from this study suggest that the conduct of research by clinical nurses was the direct result of a clinical trigger, characteristics and beliefs of the nurse about research and their role in generating knowledge, and the presence of support conditions, such as a research mentor. Clinical nurses can and do conduct research, in spite of constraints due to a lack of time, money and/or knowledge, if they have access to research mentors and are practising in a research-supportive environment. Nurses at the bedside are in a unique position to identify problems most in need of solutions. Findings from this study provide a foundation upon which to develop and test various programmes that seek to increase the number of clinical nurses who are research-active. © 2016 John Wiley & Sons Ltd.

Oppositional defiant disorder (ODD), the forerunner of alcohol dependence: a controlled study.

Science.gov (United States)

Ghosh, Abhishek; Malhotra, Savita; Basu, Debasish

2014-10-01

There are common genetic, neurobiological and psycho-social substrates for oppositional defiant disorder (ODD) and substance dependence. ODD can be regarded as the mildest and earliest form of disruptive behavioral disorder and also represents the threshold of vulnerability for substance dependence. But it is a less researched area. The aim of this research was to study any possible association between childhood ODD and adult alcohol dependence. Data are presented from a non probability sample of 100 adult alcohol dependent subjects and equal number of biologically unrelated control subjects. Assessment was conducted by the instrument Semi-Structured Assessment for the Genetics of Alcoholism for both the assessment of ODD and alcohol dependence. The results of this study demonstrated significant association between childhood ODD and adult alcohol dependence. The association remained significant even after the exclusion of the possible confounding effects of the presence of conduct disorder and attention deficit hyperactivity disorder. Our study should encourage further research in this area and is expected to open up an opportunity for preventive research. Copyright © 2014 Elsevier B.V. All rights reserved.

Gravitational lens produces an odd number of images

International Nuclear Information System (INIS)

McKenzie, R.H.

1985-01-01

Rigorous results are given to the effect that a transparent gravitational lens produces an odd number of images. Suppose that p is an event and T the history of a light source in a globally hyperbolic space-time (M,g). Uhlenbeck's Morse theory of null geodesics is used to show under quite general conditions that if there are at most a finite number n of future-directed null geodesics from T to p, then M is contractible to a point. Moreover, n is odd and 1/2 (n-1) of the images of the source seen by an observer at p have the opposite orientation to the source. An analogous result is noted for Riemannian manifolds with positive definite metric

Evaluation of factors associated with the difficulty in finding receiving hospitals for traffic accident patients at the scene treated by emergency medical services: a population-based study in Osaka City, Japan.

Science.gov (United States)

Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Ogura, Hiroshi; Shimazu, Takeshi

2017-10-01

Although the prolongation of the time between injury and hospital arrival of traffic accident patients can influence their prognosis, factors associated with the difficulty in hospital acceptance of these patients have not been sufficiently evaluated in Japan. We retrospectively analyzed the population-based ambulance records of all traffic accident patients for whom the Osaka Municipal Fire Department (Osaka City, Japan) dispatched an ambulance in 2013. We defined "cases with difficulty in hospital acceptance" as cases that required ≥4 calls by emergency medical service personnel at the scene before receiving hospital acceptance. We included patient characteristics (age, sex, coma status, and trauma severity judged by emergency medical service personnel), time factors (day/night or weekday/holiday and weekends), and accident location for multivariable logistic regression analysis to assess factors associated with the difficulty in hospital acceptance. Among 13,427 traffic accident patients, 2,033 (15.1%) were cases with difficulty in hospital acceptance. Pediatric patients (adjusted odds ratio [OR], 1.265; 95% confidence interval [CI], 1.060-1.509), male sex (adjusted OR, 1.260; 95% CI, 1.135-1.398), moderate-grade trauma (adjusted OR, 2.241; 95% CI, 1.972-2.547), severe-grade trauma (adjusted OR, 2.057; 95% CI, 1.249-3.388), holidays and weekends (adjusted OR, 1.702; 95% CI, 1.539-1.882), and night-time (adjusted OR, 2.720; 95% CI, 2.443-3.027) were positively associated with difficulty in hospital acceptance. Using population-based ambulance records from a large urban community in Japan, we showed that the difficulty in hospital acceptance of patients at the scene of traffic accidents was positively associated with several prehospital factors.

Twin deliveries in Sacred Heart Catholic Hospital Obudu ...

African Journals Online (AJOL)

Background: Twin pregnancy is associated with increased risk of obstetric complications as well as increased perinatal mortality rate. The study aims to determine the incidence and outcome of twin pregnancy in a rural/semi urban hospital which provide secondary level obstetric services in South- south Nigeria. Method: ...

Urban residence, neighborhood poverty, race/ethnicity, and asthma morbidity among children on Medicaid.

Science.gov (United States)

Keet, Corinne A; Matsui, Elizabeth C; McCormack, Meredith C; Peng, Roger D

2017-09-01

Although poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the United States is not known. This study sought to examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma who are enrolled in Medicaid. Children aged 5 to 19 enrolled in Medicaid in 2009 to 2010 were included. Asthma was defined by at least 1 outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2-year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty, and race/ethnicity on rates of asthma outpatient visits, ED visits, and hospitalizations. This study included 16,860,716 children (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but it was associated with significantly more asthma-related ED visits and hospitalizations among those with asthma in crude analyses (risk ratio, 1.48; 95% CI, 1.24-1.36; and 1.97; 95% CI, 1.50-1.72, respectively) and when adjusted for race/ethnicity, age, and sex (adjusted risk ratio, 1.23; 95% CI, 1.08-1.15; and 1.62; 95% CI, 1.26-1.43). Residence in urban or poor areas and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma-related ED visits and hospitalizations. Residence in poor and urban areas is an important risk factor for asthma morbidity, but not for prevalence, among low-income US children. Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

The devil is in the details: trends in avoidable hospitalization rates by geography in British Columbia, 1990–2000

Directory of Open Access Journals (Sweden)

Penning Margaret J

2006-08-01

Full Text Available Abstract Background Researchers and policy makers have focussed on the development of indicators to help monitor the success of regionalization, primary care reform and other health sector restructuring initiatives. Certain indicators are useful in examining issues of equity in service provision, especially among older populations, regardless of where they live. AHRs are used as an indicator of primary care system efficiency and thus reveal information about access to general practitioners. The purpose of this paper is to examine trends in avoidable hospitalization rates (AHRs during a period of time characterized by several waves of health sector restructuring and regionalization in British Columbia. AHRs are examined in relation to non-avoidable and total hospitalization rates as well as by urban and rural geography across the province. Methods Analyses draw on linked administrative health data from the province of British Columbia for 1990 through 2000 for the population aged 50 and over. Joinpoint regression analyses and t-tests are used to detect and describe trends in the data. Results Generally speaking, non-avoidable hospitalizations constitute the vast majority of hospitalizations in a given year (i.e. around 95% with AHRs constituting the remaining 5% of hospitalizations. Comparing rural areas and urban areas reveals that standardized rates of avoidable, non-avoidable and total hospitalizations are consistently higher in rural areas. Joinpoint regression results show significantly decreasing trends overall; lines are parallel in the case of avoidable hospitalizations, and lines are diverging for non-avoidable and total hospitalizations, with the gap between rural and urban areas being wider at the end of the time interval than at the beginning. Conclusion These data suggest that access to effective primary care in rural communities remains problematic in BC given that rural areas did not make any gains in AHRs relative to urban areas

Is the Australian hospital system adequately prepared for terrorism?

Science.gov (United States)

Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

On supergroups with odd Clifford parameters and non-anticommutative supersymmetry

International Nuclear Information System (INIS)

Kuznetsova, Z.

2007-01-01

We investigate super groups with Grassmann parameters replaced by odd Clifford parameters. The connection with non-anti commutative supersymmetry is discussed. A Berezin-like calculus for odd Clifford variables is introduced. Fermionic covariant derivatives for super groups with odd Clifford variables are derived. Applications to supersymmetric quantum mechanics are made. Deformations of the original supersymmetric theories are encountered when the fermionic covariant derivatives do not obey the graded Leibniz property. The simplest non-trivial example is given by the N = 2 SQM with a real (1, 2, 1) multiplet and a cubic potential. The action is real. Depending on the overall sign ('Euclidean' or 'Lorentzian') of the deformation, a Bender-Boettcher pseudo-hermitian Hamiltonian is encountered when solving the equation of motion of the auxiliary field. A possible connection of our framework with the Drinfeld twist deformation of supersymmetry is pointed out. (author)

[Prediction model of health workforce and beds in county hospitals of Hunan by multiple linear regression].

Science.gov (United States)

Ling, Ru; Liu, Jiawang

2011-12-01

To construct prediction model for health workforce and hospital beds in county hospitals of Hunan by multiple linear regression. We surveyed 16 counties in Hunan with stratified random sampling according to uniform questionnaires,and multiple linear regression analysis with 20 quotas selected by literature view was done. Independent variables in the multiple linear regression model on medical personnels in county hospitals included the counties' urban residents' income, crude death rate, medical beds, business occupancy, professional equipment value, the number of devices valued above 10 000 yuan, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, and utilization rate of hospital beds. Independent variables in the multiple linear regression model on county hospital beds included the the population of aged 65 and above in the counties, disposable income of urban residents, medical personnel of medical institutions in county area, business occupancy, the total value of professional equipment, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, utilization rate of hospital beds, and length of hospitalization. The prediction model shows good explanatory and fitting, and may be used for short- and mid-term forecasting.

Confusion between Odds and Probability, a Pandemic?

Science.gov (United States)

Fulton, Lawrence V.; Mendez, Francis A.; Bastian, Nathaniel D.; Musal, R. Muzaffer

2012-01-01

This manuscript discusses the common confusion between the terms probability and odds. To emphasize the importance and responsibility of being meticulous in the dissemination of information and knowledge, this manuscript reveals five cases of sources of inaccurate statistical language imbedded in the dissemination of information to the general…

Odd-parity baryons: progress and problems

International Nuclear Information System (INIS)

Cutkosky, R.E.

1981-01-01

The odd-parity baryons have provided a graveyard for many cherished ideas about hadrons. The simple quark shell model, with QCD-inspired phenomenological perturbations, is the only model able to describe the states with even partial qualitative success. There are also important unexplained residual dynamical effects. Resonance decays can be accounted for, provided the usual spectator model is abandoned. Better experimental data could help to sort out the many remaining puzzles

Ten-Year Trends and Independent Risk Factors for Unplanned Readmission Following Elective Total Joint Arthroplasty at a Large Urban Academic Hospital.

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Varacallo, Matthew A; Herzog, Leah; Toossi, Nader; Johanson, Norman A

2017-06-01

Total joint arthroplasty procedures continue to provide consistent, long-term success and high patient satisfaction scores. However, early unplanned readmission to the hospital imparts significant financial risks to individual institutions as we shift away from the traditional fee-for-service payment model. Using a combination of our hospital's administrative database and retrospective chart reviews, we report the 30-day and 90-day readmission rates and all causes of readmission following all unilateral, primary elective total hip and knee arthroplasty procedures at a large, urban, academic hospital from 2004 to 2013. In total, 1165 primary total hip (511) and knee (654) arthroplasty procedures were identified, and the 30-day and 90-day unplanned readmission rates were 4.6% and 7.3%, respectively. A multivariate regression model controlled for a variety of potential clinical and surgical confounders. Increasing body mass index levels, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each independently correlated with risk of both 30-day and 90-day unplanned readmission to our institution. Additionally, use of general anesthesia during the procedure independently correlated with risk of readmission at 30 days only, while congestive heart failure independently correlated with risk of 90-day unplanned readmission. Readmissions related directly to the surgical site accounted for 47% of the cases, and collectively totaled more than any single medical or clinical complication leading to unplanned readmission within the 90-day period. Increasing body mass index values, general anesthesia, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each were independent risk factors for early unplanned readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

Colorectal Surgery Fellowship Improves In-hospital Mortality After Colectomy and Proctectomy Irrespective of Hospital and Surgeon Volume.

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Saraidaridis, Julia T; Hashimoto, Daniel A; Chang, David C; Bordeianou, Liliana G; Kunitake, Hiroko

2018-03-01

General surgery residents are increasingly pursuing sub-specialty training in colorectal (CR) surgery. However, the majority of operations performed by CR surgeons are also performed by general surgeons. This study aimed to assess in-hospital mortality stratified by CR training status after adjusting for surgeon and hospital volume. The Statewide Planning and Research Cooperative system database was used to identify all patients who underwent colectomy/proctectomy from January 1, 2000, to December 31, 2014, in the state of New York. Operations performed by board-certified CR surgeons were identified. The relationships between CR board certification and in-hospital mortality, in-hospital complications, length of stay, and ostomy were assessed using multivariate regression models. Two hundred seventy thousand six hundred eighty-four patients underwent colectomy/proctectomy over the study period. Seventy-two thousand two hundred seventy-nine (26.7%) of operations were performed by CR surgeons. Without adjusting for hospital and surgeon volume, in-hospital mortality was lower for those undergoing colectomy/proctectomy by a CR surgeon (OR 0.49, CI 0.44-0.54, p = 0.001). After controlling for hospital and surgeon volume, the odds of inpatient mortality after colectomy/proctectomy for those operated on by CR surgeons weakened to 0.76 (CI 0.68-0.86, p = 0.001). Hospital and surgeon volume accounted for 53% of the reduction in in-hospital mortality when CR surgeons performed colectomy/proctectomy. Patients who underwent surgery by a CR surgeon had a shorter inpatient stay (0.8 days, p = 0.001) and a decreased chance of colostomy (OR 0.86, CI 0.78-0.95, p accounting for hospital and surgeon volume.

Indirect costs of teaching in Canadian hospitals.

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MacKenzie, T A; Willan, A R; Cox, M A; Green, A

1991-01-01

We sought to determine whether there are indirect costs of teaching in Canadian hospitals. To examine cost differences between teaching and nonteaching hospitals we estimated two cost functions: cost per case and cost per patient-day (dependent variables). The independent variables were number of beds, occupancy rate, teaching ratio (number of residents and interns per 100 beds), province, urbanicity (the population density of the county in which the hospital was situated) and wage index. Within each hospital we categorized a random sample of patient discharges according to case mix and severity of illness using age and standard diagnosis and procedure codes. Teaching ratio and case severity were each highly correlated positively with the dependent variables. The other variables that led to higher costs in teaching hospitals were wage rates and number of beds. Our regression model could serve as the basis of a reimbursement system, adjusted for severity and teaching status, particularly in provinces moving toward introducing case-weighting mechanisms into their payment model. Even if teaching hospitals were paid more than nonteaching hospitals because of the difference in the severity of illness there should be an additional allowance to cover the indirect costs of teaching. PMID:1898870

[Use of emergency departments in rural and urban areas in Spain].

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Sarría-Santamera, A; Prado-Galbarro, J; Ramallo-Farina, Y; Quintana-Díaz, M; Martínez-Virto, A; Serrano-Aguilar, P

2015-03-01

Describe the use of emergency departments (ED), and analyse the differences in use between residents in rural and urban areas. Using data from the National Health Survey of 2006 and 2011, the profiles of patients with ED visits by population size of place of residence were obtained. The variables associated with making one visit to the ED were also evaluated, in order to determine the effect of the population size of place of residence. A higher use of ED is observed in persons with a higher frequency of use of Primary Care and hospital admissions, and increases with worse self-perceived health and functional status, with more chronic diseases, in people from lower social classes, and younger ages. Adjusting for the other variables, residents in larger cities have a higher use of ED than residents in rural areas, who show a higher use of public and non-hospital based ED, than residents in urban areas. There is a higher use of ED by inhabitants of urban areas that cannot be justified by a worst health status of that population. This tends to indicate that the use of ED is not under-used in rural areas, but overused in urban areas. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Surgical resource utilization in urban terrorist bombing: a computer simulation.

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Hirshberg, A; Stein, M; Walden, R

1999-09-01

The objective of this study was to analyze the utilization of surgical staff and facilities during an urban terrorist bombing incident. A discrete-event computer model of the emergency room and related hospital facilities was constructed and implemented, based on cumulated data from 12 urban terrorist bombing incidents in Israel. The simulation predicts that the admitting capacity of the hospital depends primarily on the number of available surgeons and defines an optimal staff profile for surgeons, residents, and trauma nurses. The major bottlenecks in the flow of critical casualties are the shock rooms and the computed tomographic scanner but not the operating rooms. The simulation also defines the number of reinforcement staff needed to treat noncritical casualties and shows that radiology is the major obstacle to the flow of these patients. Computer simulation is an important new tool for the optimization of surgical service elements for a multiple-casualty situation.

Hospital Variation in Early Tracheostomy in the United States: A Population-Based Study.

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Mehta, Anuj B; Cooke, Colin R; Wiener, Renda Soylemez; Walkey, Allan J

2016-08-01

Controversy exists regarding perceived benefits of early tracheostomy to facilitate weaning among mechanically ventilated patients, potentially leading to significant practice-pattern variation with implications for outcomes and resource utilization. We sought to determine practice-pattern variation and outcomes associated with tracheostomy timing in the United States. In a retrospective cohort study, we identified mechanically ventilated patients with the most common causes of respiratory failure leading to tracheostomy: pneumonia/sepsis and trauma. "Early tracheostomy" was performed within the first week of mechanical ventilation. We determined between-hospital variation in early tracheostomy utilization and the association of early tracheostomy with patient outcomes using hierarchical regression. 2012 National Inpatient Sample. A total of 6,075 pneumonia/sepsis patients and 12,030 trauma patients with tracheostomy. None. Trauma patients were twice as likely as pneumonia/sepsis patients to receive early tracheostomy (44.5% vs 21.7%; p tracheostomy-to-total-tracheostomy ratios was associated with increased risk for tracheostomy among mechanically ventilated trauma patients (adjusted odds ratio = 1.04; 95% CI, 1.01-1.07) but not pneumonia/sepsis (adjusted odds ratio =1.00; 95% CI, 0.98-1.02). We observed greater between-hospital variation in early tracheostomy rates among trauma patients (21.9-81.9%) compared with pneumonia/sepsis (14.9-38.3%; p tracheostomy had fewer feeding tube procedures and higher odds of discharge home. Early tracheostomy is potentially overused among mechanically ventilated trauma patients, with nearly half of tracheostomies performed within the first week of mechanical ventilation and large unexplained hospital variation, without clear benefits. Future studies are needed to characterize potentially differential benefits for early tracheostomy between disease subgroups and to investigate factors driving hospital variation in tracheostomy

Neurological Disease Burden in two Semi-urban Communities in ...

African Journals Online (AJOL)

BACKGROUND: Neurological disorders are a significant cause of morbidity and mortality worldwide. Urban hospital -based studies give some perspectives on the burden of neurological disease but there are no community- based studies from South East Nigeria. AIM: This study sought to screen for the scope and pattern of ...

The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus.

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Song, Fei; Bao, Cuiping; Deng, Meiyu; Xu, Hui; Fan, Meijuan; Paillard-Borg, Stéphanie; Xu, Weili; Qi, Xiuying

2017-01-01

The purpose of this study was to investigate the prevalence of hypothyroidism among hospitalized patients with type 2 diabetes mellitus and its related factors, and to assess the prevalence of macrovascular and microvascular diseases among type 2 diabetes mellitus inpatients with hypothyroidism and euthyroidism. A total of 1662 type 2 diabetes mellitus inpatients hospitalized at the Metabolic Diseases Hospital, Tianjin Medical University from 1 January 2008 to 1 March 2013 were included in this study. Information on demographic and anthropometric factors and additional variables related to hypothyroidism were collected from medical records. Prevalence rates were calculated and standardized using direct method based on the age-specific and sex-specific structure of all participants. Data were analyzed using binary logistic regression with adjustment for potential confounders. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and 77.0 % of the patients with hypothyroidism had subclinical hypothyroidism. The prevalence of hypothyroidism increased with age, and was higher in women (10.8 %) than in men (3.4 %). Older age (odds ratio, 1.74; 95 % confidence interval, 1. 05 to 2.89), female gender (odds ratio, 2.02; 95 % confidence interval, 1.05 to 3.87), and positive thyroid peroxidase antibody (odds ratio, 4.99; 95 % confidence interval, 2.83 to 8.79) were associated with higher odds of hypothyroidism among type 2 diabetes mellitus inpatients. The type 2 diabetes mellitus inpatients with hypothyroidism had higher prevalence of cerebrovascular diseases than those with euthyroidism after adjustment for age and gender. The prevalence of hypothyroidism among type 2 diabetes mellitus inpatients was 6.8 %, and most patients had subclinical hypothyroidism. Older age, female gender, and positive thyroid peroxidase antibody could be indicators for detecting hypothyroidism in type 2 diabetes mellitus inpatients.

The Hidden Face of Hospital Economy. The Hospital of Sant’Andrea of Vercelli in 14th and 15th century

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Antonio Olivieri

2016-05-01

Full Text Available The study of four fourteenth- and fifteenth-century registers of hospital of San Andrea of Vercelli allows to shine a light on some aspects of property management and hospital economy. On one hand, it is possible to see a technical evolution of the recordings of rents payment; on the other hand one can understand the nature of economic connection between the hospital and his tenants. It changed depending on the location of property together with the origin of the tenants, urban (above all craftsmen or rural. The careful accounting of the actual payment of rents ‒ with accounts of delays, of debts accumulation charging on tenants, of replacements of kind or money rents with manufactured goods or (in the case of peasants labour services ‒ enlightens the specific features of the hospital economy, aimed to product wealth in view of the nurture of the hospital life in its whole.

Assessing knowledge, performance, and efficiency for hospital waste management-a comparison of government and private hospitals in Pakistan.

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Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma

2017-04-01

Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.

Area-level risk factors for adverse birth outcomes: trends in urban and rural settings.

Science.gov (United States)

Kent, Shia T; McClure, Leslie A; Zaitchik, Ben F; Gohlke, Julia M

2013-06-10

Significant and persistent racial and income disparities in birth outcomes exist in the US. The analyses in this manuscript examine whether adverse birth outcome time trends and associations between area-level variables and adverse birth outcomes differ by urban-rural status. Alabama births records were merged with ZIP code-level census measures of race, poverty, and rurality. B-splines were used to determine long-term preterm birth (PTB) and low birth weight (LBW) trends by rurality. Logistic regression models were used to examine differences in the relationships between ZIP code-level percent poverty or percent African-American with either PTB or LBW. Interactions with rurality were examined. Population dense areas had higher adverse birth outcome rates compared to other regions. For LBW, the disparity between population dense and other regions increased during the 1991-2005 time period, and the magnitude of the disparity was maintained through 2010. Overall PTB and LBW rates have decreased since 2006, except within isolated rural regions. The addition of individual-level socioeconomic or race risk factors greatly attenuated these geographical disparities, but isolated rural regions maintained increased odds of adverse birth outcomes. ZIP code-level percent poverty and percent African American both had significant relationships with adverse birth outcomes. Poverty associations remained significant in the most population-dense regions when models were adjusted for individual-level risk factors. Population dense urban areas have heightened rates of adverse birth outcomes. High-poverty African American areas have higher odds of adverse birth outcomes in urban versus rural regions. These results suggest there are urban-specific social or environmental factors increasing risk for adverse birth outcomes in underserved communities. On the other hand, trends in PTBs and LBWs suggest interventions that have decreased adverse birth outcomes elsewhere may not be reaching

Overweight and obesity in urban Africa: A problem of the rich or the poor?

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Ziraba Abdhalah K

2009-12-01

Full Text Available Abstract Background Obesity is a well recognized risk factor for various chronic diseases such as cardiovascular diseases, hypertension, and type 2 diabetes mellitus. The aim of this study was to shed light on the patterns of overweight and obesity in sub-Saharan Africa, with special interest in differences between the urban poor and the urban non-poor. The specific goals were to describe trends in overweight and obesity among urban women; and examine how these trends vary by education and household wealth. Methods The paper used Demographic and Health Surveys data from seven African countries where two surveys had been carried out with an interval of at least 10 years between them. Among the countries studied, the earliest survey took place in 1992 and the latest in 2005. The dependent variable was body mass index coded as: Not overweight/obese; Overweight; Obese. The key covariates were time lapse between the two surveys; woman's education; and household wealth. Control variables included working status, age, marital status, parity, and country. Multivariate ordered logistic regression in the context of the partial proportional odds model was used. Results Descriptive results showed that the prevalence of urban overweight/obesity increased by nearly 35% during the period covered. The increase was higher among the poorest (+50% than among the richest (+7%. Importantly, there was an increase of 45-50% among the non-educated and primary-educated women, compared to a drop of 10% among women with secondary education or higher. In the multivariate analysis, the odds ratio of the variable time lapse was 1.05 (p Conclusion Overweight and obesity are on the rise in Africa and might take epidemic proportions in the near future. Like several other public health challenges, overweight and obesity should be tackled and prevented early as envisioned in the WHO Global strategy on diet, physical activity and health.

Dynamical interplay between pairing and quadrupole correlations in odd-mass nuclei

International Nuclear Information System (INIS)

Kaneko, Kazunari; Takada, Kenjiro; Sakata, Fumihiko; Tazaki, Shigeru.

1982-01-01

Study of the dynamical interplay between pairing and quadrupole correlations in odd-mass nuclei has been developed. One of the purposes of this paper is to predict that the new collective excited states may exist system-atically in odd-mass nuclei. Other purpose is to discuss a new collective band structure on the top of a unique-parity one-quasiparticle state. Through the numerical calculations, it has been clarified that the dynamical mutual interplay between the pairing and the quadrupole degrees of freedom played an important role in the odd-mass transitional nuclei to bring about the new type of collective states. The results of calculation were compared with the experimental data. (Kato, T.)

Socio-economic status as an environmental factor – incidence of underweight, overweight and obesity in adolescents from less-urbanized regions of Poland

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Anna Długosz

2015-09-01

Full Text Available [b][/b]Introduction. Under-nutrition, over-nutrition and obesity incidence in relation to environmental diversity and socio-economic influences in adolescents from less urbanized regions of Poland has not been widely studied. Objective. To determine the correlation between socio-economic status and incidence of underweight, overweight and obesity in adolescents located in less-urbanized regions of Poland. Material and methods. The study involved 553 adolescents aged 13–18 living in 2 less-urbanized regions of Poland (small towns and villages in the central and north-eastern regions. The sample was randomly chosen. The distinguishing determinants of socio-economic status (SES included 6 features. The SES index (SESI was calculated. Low, average and high SESI adolescents were distinguished. Using logistic regression, the odds ratio (OR of underweight (BMI0.05. The odds ratio of overweight incidence in the average SESI adolescent was 1.73 (95%CI: 0.93, 3.19; p>0.05 and in high SESI adolescents – 1.14 (95%CI: 0.83, 1.57; p>0.05. The odds ratio of obesity incidence in the average SESI adolescent was 0.70 (95%CI: 0.21, 2.34; p>0.05 and in high SESI adolescents – 0.76 (95%CI: 0.40, 1.44; p>0.05. Adjustments for gender, age or region of residence did not significantly change the ORs values or their interpretation. Conclusions. Underweight incidence in adolescents from less urbanized regions of Poland depended on socio-economic status. An adolescent with average socio-economic status was 3 times less likely to be underweight than an adolescent with low socio-economic status. The correlation between socio-economic status and overweight and obesity was not significant.

Urban lifestyle and urban biodiversity