Improving Scheduling for Diagnostic Imaging and the Effect on Hospital Revenue: An Ex Post Facto Study

Background and Need: Outpatient diagnostic radiology can be a substantial driver for revenue growth in health systems but without proper processes in place, health systems may not be optimizing patient access within their radiology departments health systems who are having difficulty getting patients to obtain care at their departments/centers and retain loyalty (Lu et.al 2011). To evaluate radiology patient access, patient retention, and market analysis, in 2018, Berkeley Research Group, LLC (BRG) engaged with a six-hospital faith-based health system in New York State to evaluate, create, and implement a variety of different performance improvement (PI) initiatives with the goal of optimizing diagnostic radiology patient throughput/retention to better treat the patient population, improve volumes, while increasing revenue. A key initiative was to review one of the outpatient diagnostic imaging centers owned by the health system and identify opportunities to improve financial performance through a combination of technology updates, centralized scheduling, and volume enhancement/growth strategies. Problem Statement: Outpatient diagnostic imaging centers at this health system is operating capacity constraints. Improvements in scheduling may improve the timeliness of patient care, decrease wait times and improve the facility’s profitabilit

STUDIES OF ORGANIC COMPOUNDS SPREADING OVER HIGH ENERGY SURFACES

Spreading plays an important role in coating, lubrication, printing and etc. During the spreading process, a liquid thin film forms prior to the expansion of a liquid drop. This thin film is called a precursor film. It not only changes the spreading mechanism, but impacts the wettability of a liquid. Early studies on the precursor films showed the films were stacked in a terraced structure, and the radius of each layer of the films was proportional to the square root of time. Optical techniques such as ellipsometry, X-ray diffraction and X-ray reflectivity solved the conformations of liquid molecules at the interfaces. However, the conformations of the interfacial molecules have rarely been correlated with their positions at the interface. In addition, the properties of the precursor films have not been fully studied yet. In this dissertation, two kinds of organic compounds, hexatriacontane (C36) and 1-butyl-3-methylimidazolium ([Bmim][Cl]), are proposed to be spread over octadecyltrichlorosilane partially degraded (OTSpd) patterned surfaces. Once organic molecules flow over such OTSpd surfaces, the liquids are limited within the patterned area. Characterized by atomic force microscopy (AFM), the structures and chemical identities and the formation mechanism of the precursor films are resolved thereafter. The precursor films formed by both compounds, C36 and [Bmim][Cl], were observed in a bilayer structure in that the molecules close to the solid substrate had different orientation from the molecules close to the air. They were called parallel layers and standing-up layers, respectively. The parallel layers of C36 formed prior to the standing-up layers through the vapor phase transport. In addition, the parallel layers were found more stable thermodynamically and the standing-up layers were more stable mechanically. The frictional study of C36 showed the standing-up layers could hold 0.49GPa pressure. The orientation of [Bmim][Cl] molecules were impacted by the polarities of the solid substrates. The achievements in this dissertation not only resolve the properties of the precursor films of two organic compounds, but provide a general method for the further studies of the precursor films

COMPETITIVE FOOD POLICY IMPLEMENTATION IN KENTUCKY SCHOOLS

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of competitive food policy effectiveness is difficult due to variability in policy implementation. A theoretical framework is needed to guide research on CFPI. This research was a mixed methods study including a review of the literature, quantitative secondary analysis, and a qualitative content analysis of transcripts from semi-structured interviews with school personnel to understand their experience with CFPI. First, a systematic review of the research literature on CFPI was conducted. Demographic and school factors, policy features, and school and parent/community-level factors that impact CFPI were identified. Second, the association of multiple demographic and school factors with CFPI scores was examined. CFPI scale (overall) and sub-scales (“inside” and “outside” school) were developed and validated to evaluate CFPI effectiveness in Kentucky middle and high schools (N=640, grades 5-12). The scales were based on responses to 8 questions on competitive food practices from a 2011 School Tobacco and Wellness Policy biannual survey conducted by the University Of Kentucky College Of Nursing Tobacco Policy Research Program. Student BMI tracking and presence of a written wellness policy predicted higher scores on the overall CFPI scale (BMI OR=2.06, p=0.001; Wellness OR=1.74, p=0.02), inside subscale scores (BMI OR=2.46, p\u3c0.0001; Wellness OR=1.58, p=0.05), and outside subscale scores (BMI OR=2.27, p=0.03; Wellness OR=1.54, p=0.0005). Greater county-level adult obesity rates predicted lower overall CFPI scores (OR=0.93, p=0.02). Private school status predicted lower scores on inside CFPI subscale scores (OR=0.47, p=0.004). Third, semi-structured interviews were conducted with 23 school personnel to explore CFPI. Interviews were recorded, transcribed and content analysis was conducted. Kentucky schools were stratified into four groups based on school level (middle or high) and CFPI scores (high or low). Sixteen schools were randomly selected for each of the four groups. A total of eight schools, two from each group, agreed to participate. The interview guide was based on a proposed CFPI framework based on implementation science, educational and organizational theory research. Six key themes emerged: internal/external forces enabling CFPI; internal and external obstacles to CFPI; key organizational values; organization value of CFPI; methods that organizations use to communicate organizational values; and CFPI policies and procedures. Findings were discussed in the context of the proposed theoretical framework. Implications for policy, practice and future research are presented