Reporting Mistreatment of Older Adults: The Role of Physicians

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111194/1/j.1532-5415.1996.tb05640.x.pd

Measuring case severity: a novel tool for benchmarking and clinical documentation improvement

BACKGROUND: Severity of illness (SOI) is an All Patients Refined Diagnosis Related Groups (APR DRG) modifier based on comorbidity capture. Tracking SOI helps hospitals improve performance and resource distribution. Furthermore, benchmarking SOI plays a key role in Quality Improvement (QI) efforts such as Clinical Documentation Improvement (CDI) programs. The current SOI system highly relies on the 3 M APR DRG grouper that is updated annually, making it difficult to track severity longitudinally and benchmark against hospitals with different patient populations. Here, we describe an alternative SOI scoring system that is grouper-independent and that can be tracked longitudinally. METHODS: Admission data for 2019-2020 U.S. News and World Report Honor Roll facilities were downloaded from the Vizient Clinical Database and split into training and testing datasets. Elixhauser comorbidities, body systems developed from the Healthcare Cost and Utilization Project (HCUP), and ICD-10-CM complication and comorbidity (CC/MCC) indicators were selected as the predictors for orthogonal polynomial regression models to predict patients\u27 admission and discharge SOI. Receiver operating characteristic (ROC) and Precision-Recall (PR) analysis, and prediction accuracy were used to evaluate model performance. RESULTS: In the training dataset, the full model including both Elixhauser comorbidities and body system CC/MCC indicators had the highest ROC AUC, PR AUC and predication accuracy for both admission (ROC AUC: 92.9%; PR AUC: 91.0%; prediction accuracy: 85.4%) and discharge SOI (ROC AUC: 93.6%; PR AUC: 92.8%; prediction accuracy: 86.2%). The model including only body system CC/MCC indicators had similar performance for admission (ROC AUC: 92.4%; PR AUC: 90.4%; prediction accuracy: 84.8%) and discharge SOI (ROC AUC: 93.1%; PR AUC: 92.2%; prediction accuracy: 85.6%) as the full model. The model including only Elixhauser comorbidities exhibited the lowest performance. Similarly, in the validation dataset, the prediction accuracy was 86.2% for the full model, 85.6% for the body system model, and 79.3% for the comorbidity model. With fewer variables and less model complexity, the body system model was more efficient and was determined to be the optimal model. The probabilities generated from this model, named J_Score and J_Score_POA, successfully measured SOI and had practical applications in assessment of CDI performance. CONCLUSIONS: The J_Scores generated from the body system model have significant value in evaluating admission and discharge severity of illness. We believe that this new scoring system will provide a useful tool for healthcare institutions to benchmark patients\u27 illness severity and augment Quality Improvement (QI) efforts

Climate change and water in the UK: past changes and future prospects

Climate change is expected to modify rainfall, temperature and catchment hydrological responses across the world, and adapting to these water-related changes is a pressing challenge. This paper reviews the impact of anthropogenic climate change on water in the UK and looks at projections of future change. The natural variability of the UK climate makes change hard to detect; only historical increases in air temperature can be attributed to anthropogenic climate forcing, but over the last 50 years more winter rainfall has been falling in intense events. Future changes in rainfall and evapotranspiration could lead to changed flow regimes and impacts on water quality, aquatic ecosystems and water availability. Summer flows may decrease on average, but floods may become larger and more frequent. River and lake water quality may decline as a result of higher water temperatures, lower river flows and increased algal blooms in summer, and because of higher flows in the winter. In communicating this important work, researchers should pay particular attention to explaining confidence and uncertainty clearly. Much of the relevant research is either global or highly localized: decision-makers would benefit from more studies that address water and climate change at a spatial and temporal scale appropriate for the decisions they mak

Sediment geochemistry of streams draining abandoned lead / zinc mines in central Wales: the Afon Twymyn

Purpose Despite the decline of metal mining in the UK during the early 20th century, a substantial legacy of heavy metal contamination persists in river channel and floodplain sediments. Poor sediment quality is likely to impede the achievement of ’good’ chemical and ecological status for surface waters under the European Union Water Framework Directive. This paper examines the environmental legacy of the Dylife lead/zinc mine in the central Wales mining district. Leachable heavy metal concentrations in the bed sediments of the Afon Twymyn are established and the geochemical partitioning, potential mobility and bioavailability of sediment-associated heavy metals are established. Materials and methods Sediment samples were collected from the river bed and dry-sieved into two size fractions (<63 μm and 64–2,000 μm). The fractionated samples were then subjected to a sequential extraction procedure to isolate heavy metals (Pb, Zn, Cu, Cd, Fe, Mn) in three different geochemical phases. Sediment samples were then analysed for heavy metals using ICP-AES. Results and discussion The bed sediment of the Afon Twymyn is grossly polluted with heavy metals. Within the vicinity of the former mine, Pb concentrations are up to 100 times greater than levels reported to have deleterious impacts on aquatic ecology. Most heavy metals exist in the most mobile easily exchangeable and carbonate-bound geochemical phases, potentially posing serious threats to ecological integrity and constituting a significant, secondary, diffuse source of pollution. Metal concentrations decrease sharply downstream of the former mine, although there is a gradual increase in the proportion of readily extractable Zn and Cd. Conclusions Implementation of sediment quality guidelines is important in order to achieve the aims of the Water Framework Directive. Assessments of sediment quality should include measurements of background metal concentrations, river water physico-chemistry and, most importantly, metal mobility and potential bioavailability. Uniformity of sediment guidelines throughout Europe and flexibility of targets with regard to the most heavily contaminated mine sites are recommended

Possibilite d'utilisation aux fins des garanties de l'AIEA de l'appareillage equipant une installation. Cas du complexe de fabrication des combustibles au plutonium de Cadarache

SIGLEAvailable from CEN Saclay, Service de Documentation, 91191 - Gif-sur-Yvette Cedex (France) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Effects of cell asymmetry on the performance of a large heterogeneous critical assembly

SIGLEAvailable from CEN Saclay, Service de Documentation, 91191 Gif-sur-Yvette Cedex (France) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Investigation of the melt-down behaviour of massive radial core enclosures during LWR accidents

Am Institut fuer Reaktorsicherheit (IRS) des Forschungszentrums Karlsruhe (FZK) wurden bis 1999 Unfallanalysen fuer den projektierten Europaeischen Druckwasser Reaktor (EPR) mit dem ''best estimate'' Kernschmelzcode SCDAP/RELAP5 (S/R5) durchgefuehrt. Von den verschiedenen mit S/R5 untersuchten Szenarien wurden der ''Ausfall der Wechselspannungsnetze'' (LOOP) und das kleine Leck (46 cm&quot;2) im kalten Strang der Hauptkuehlmittelleitung (SBLOCA) fuer eine ausfuehrlichere Diskussion ausgewaehlt. Um das Verhalten des ''heavy reflectors'' (HR) und des Kernmantels (CB) auch jenseits der Moeglichkeiten von S/R5 untersuchen zu koennen, wurde ein analytisches Programm entwickelt (LOWCOR2) und angewendet um Informationen ueber den Zeitpunkt des Schmelzebeginns, der zugehoerigen axialen Position, der Abschmelzgeschwindigkeit und der dabei erzeugten Schmelzemasse zu erhalten. Neben den S/R5 Daten wurden auch noch Ergebnisse der MELCOR Rechnungen von Siemens/KWU zum SBLOCA herangezogen. Daneben wurde untersucht, in wieweit ICARE2 und das FEM Programm FIDAP zur Loesung der o.g. Probleme herangezogen werden koennen. Die axiale Position des Schmelzebeginns ist abhaengig vom Szenario und variiert zwischen 1.0 m und 2.5 m Kernhoehe. Der Zeitbereich fuer das Abschmelzen der inneren HR-Kanten erstreckt sich ueber maximal 17 min. Das Zeitintervall bis zum lokalen Durchschmelzen des HR und des CB liegt in der Groessenordnung von einer Stunde. Bis zum Durchschmelzen werden zwischen 10 und 32 Mg Stahl verfluessigt und mit max. 35 kg/s entlang der HR Innenseite in den Kernbereich verlagert. (orig.)At the Institute for Reactor Safety (IRS) of the Forschungszentrum Karlsruhe (FZK) accident analyses were performed for the projected European pressurised water reactor (EPR) up to 1999 using the best estimate severe core damage code SCDAP/RELAP5 (S/R5). From various scenarios investigated with S/R5 the loss-of-offsite power (LOOP) and the 46 cm&quot;2 small break loss of coolant accident (SBLOCA) were selected to be discussed here in some detail. To simulate the heavy reflector (HR) and core barrel (CB) behaviour beyond the capabilities of S/R5 mod 3.2 a detailed stand alone analytical tool (LOWCOR2) was developed and used to determine the time of HR melting, its axial position, the melting velocity and the melt mass. Furthermore, results of MELCOR calculations performed at Siemens/KWU were used for the SBLOCA scenario. The analyses were extended by a feasibility study to find out whether ICARE2 and the commercial FEM code FIDAP are applicable. The axial position of HR and CB melt through strongly depends on the scenario an ranges between 1.0 m and 2.5 m core elevation. The time period to melt down the HR inner edges lasts up to 17 min and a complete melt through of HR and CB is in the order of magnitude of one hour. At melt through time LOWCOR2 calculated a molten steel mass between 10 Mg and 32 Mg and a melt relocation rate of 35 kg/s along the HR inner surface into the core cavity. (orig.)SIGLEAvailable from TIB Hannover: ZA 5141(6315) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Thermodynamic consequences of sodium spray fires in closed containments. Pt. 1 Experiments

Also published by CEA/Cadarache under Rapport No. EF.22.11.R/84.547SIGLECopy held by FIZ Karlsruhe; available from UB/TIB Hannover / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Plasma decontamination during ergodic divertor experiments in tore supra

Available at INIST (FR), Document Supply Service, under shelf-number : RM 1161 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

Comparison between the electron cyclotron current drive experiments on DIII-D and predictions for T-10

Electron cyclotron current drive has been demonstrated on the DIII-D tokamak in an experiment in which {approximately}1 MW of microwave power generated {approximately}50 kA of non-inductive current. The rf-generated portion was about 15% of the total current. On the T-10 tokamak, more than 3 MW of microwave power will be available for current generation, providing the possibility that all the plasma current could be maintained by this method. Fokker-Planck calculations using the code CQL3D and ray tracing calculations using TORAY have been performed to model both experiments. For DIII-D the agreement between the calculations and measurements is good, producing confidence in the validity of the computational models. The same calculations using the T-10 geometry predict that for n{sub e}(0) {approximately} 1.8 {times} 10{sup 13} cm{sup {minus}3}, and T{sub e}(0) {approximately} 7 keV, 1.2 MW, that is, the power available from only three gyrotrons, could generate as much as 150 kA of non-inductive current. Parameter space scans in which temperature, density and resonance location were varied have been performed to indicate the current drive expected under different experimental conditions. The residual dc electric field was considered in the DIII-D analysis because of its nonlinear effect on the electron distribution, which complicates the interpretation of the results. A 110 GHz ECH system is being installed on DIII-D. Initial operations, planned for late 1991, will use four gyrotrons with 500 kW each and 10 second output pulses. Injection will be from the low field side from launchers which can be steered to heat at the desired location. These launchers, two of which are presently installed, are set at 20 degrees to the radial and rf current drive studies are planned for the initial operation. 8 refs., 10 figs