Global Outsourcing of Healthcare: A Medical Tourism Decision Model

The demand for global healthcare services is experiencing tremendous growth. US patients are seeking to reduce their expenditures on healthcare through obtaining treatment on an internationally competitive basis. This trend, known as medical tourism, is on the rise, and US legislators and policy makes must be aware of the issues facing American patients. This paper seeks to model factors that influence a patient's decision to seek healthcare services abroad. we develop a two-stage model for medical tourism- the first stage being the evaluation of the foreign country and the second stage choosing the healthcare facility. We argue country-specific characteristics influence the country of choice-including economic condition, political climate, and regulatory policies. We also argue that certain factors- including costs, hospital accreditaion, quality of care, and physician trining- impact the choice of healthcare facility. The model suggests that no one factor is dominant in the decision, but all play a crucial role in choosing healthcare on an international basis. Policy makers must use these factors to evaluate the impact medical tourism will continuw to have on the US healtcare system in order to effectively compete in today's global, consumer-driven healthcare market.Medical tourism; global outsourcing; decision model; health care system; healthcare services; health policy; health costs

Post-test simulations for the NACIE-UP benchmark by STH codes

This paper illustrates the results obtained in the last phase of the NACIE-UP benchmark activity foreseen inside the EU SESAME Project. The purpose of this research activity, performed by system thermal–hydraulic (STH) codes, is finalized to the improvement, development and validation of existing STH codes for Heavy Liquid Metal (HLM) systems. All the participants improved their modelling of the NACIE-UP facility, respect to the initial blind simulation phase, adopting the actual experimental boundary conditions and reducing as much as possible sources of uncertainty in their numerical model. Four different STH codes were employed by the participants to the benchmark to model the NACIE-UP facility, namely: CATHARE for ENEA, ATHLET for GRS, RELAP5-3D© for the “Sapienza” University of Rome and RELAP5/Mod3.3(modified) for the University of Pisa. Three reference tests foreseen in the NACIE-UP benchmark and carried out at ENEA Brasimone Research Centre were analysed from four participants. The data from the post-test analyses, performed independently by the participant using different STH codes, were compared together and with the available experimental results and critically discussed

Academic Accounting Salaries in the Southwest: A Revisitation and Exploration

This study examines the faculty located in the Southwest Region of the American Accounting Association to ascertain salary determinants as well explore salary compression and inversion. This study finds there are differences among faculty salaries based on longevity, institutional type and size. Typically larger, public institutions pay higher salaries. Further this study finds that salary, perceived salary compared to others, institutional longevity, marital status, institutional type and size are significantly associated with faculty’s gender

The state of Texas vs the Methodist hospital system: An accounting case study: Working paper series--99-02

Pressures to contain costs have given private hospitals the economic incentive to reduce provision of charity care services, shifting the burden onto government hospitals. Budget pressures on governmental units have produced resistance to any further shift in charity care burden. We observe in a lawsuit (State of Texas vs. Methodist Hospital System [MHS]) what appears to be a classic moral hazard situation. The government expects a certain (unspecified) level of charity care to be performed in exchange for tax exemptions; hospital management allegedly consumes perquisites and overstates reported charity care figures. Both sides use accounting numbers to defend their positions. The Case makes five contributions. First, it is relevant and flexible enough for use in several different accounting or business courses, including financial, audit, tax, not-for-profit, or ethics courses. Second, it provides students an introduction to not-for-profit accounting placed in an interesting and relevant context. Third, students must employ forensic skills, much as did the state attorney general. Fourth, the Case requires students to make several audit-related determinations, including knowledge of a client's business, fraud, and related-party transactions. Finally, as students progress through the case, they are required to consider several ethical issues

Experimental and RELAP5-3D results on IELLLO (Integrated European Lead Lithium LOop) operation

The experimental facility IELLLO (Integrated European Lead Lithium LOop) was designed and installed at the ENEA Brasimone Research Centre to support the design of the HCLL TBM (Helium Cooled Lithium Lead Test Blanket Module).This work presents the results of the experimental campaign carried out within the framework of F4E-FPA-372 and which had three main objectives. First, to produce new experimental data for flowing LLE (Lead-Lithium Eutectic) for an analysis of the loop and the characterization of its main components. Then, to evaluate performances of commercial instrumentation as available instrumentation is not designed for use in LLE. Lastly, to use the data for validation of the model developed with the system code RELAP5-3D. The data collected could prove helpful to analyze the behavior of the LLE loop of ITER and DEMO in accidental conditions.The results show that the regenerative countercurrent heat exchanger has an efficiency ranging from 70 to 85%, mainly depending on the LLE mass flow rate. It was verified that the air cooler has the capability to keep the cold part of the loop at 623. K, even in the most demanding situation (700. rpm and maximum temperature of the hot part). The instrumentation tested showed good accuracy, with the exception of the turbine flow meter. Nevertheless, specific limitations in the upper operative temperatures were found for the LLE direct contact pressure transducer. RELAP5-3D simulations fit very well the associated experimental results achieved

Label-based Optimization of Dense Disparity Estimation for Robotic Single Incision Abdominal Surgery

Minimally invasive surgical techniques have led to novel approaches such as Single Incision Laparoscopic Surgery (SILS), which allows the reduction of post-operative infections and patient recovery time, improving surgical outcomes. However, the new techniques pose also new challenges to surgeons: during SILS, visualization of the surgical field is limited by the endoscope field of view, and the access to the target area is limited by the fact that instruments have to be inserted through a single port. In this context, intra-operative navigation and augmented reality based on pre-operative images have the potential to enhance SILS procedures by providing the information necessary to increase the intervention accuracy and safety. Problems arise when structures of interest change their pose or deform with respect to pre-operative planning, as usually happens in soft tissue abdominal surgery. This requires online estimation of the deformations to correct the pre-operative plan, which can be done, for example, through methods of depth estimation from stereo endoscopic images (3D reconstruction). The denser the reconstruction, the more accurate the deformation identification can be. This work presents an algorithm for 3D reconstruction of soft tissue, focusing on the refinement of the disparity map in order to obtain an accurate and dense point map. This algorithm is part of an assistive system for intra-operative guidance and safety supervision for robotic abdominal SILS . Results show that comparing our method with state-of-the-art CPU implementations, the percentage of valid pixel obtained with our method is 24% higher while providing comparable accuracy. Future research will focus on the development of a real-time implementation of the proposed algorithm, potentially based on a hybrid CPU-GPU processing framework

Virtual Assistive System for Robotic Single Incision Laparoscopic Surgery

Single Incision Laparoscopic Surgery (SILS) reduces the trauma of large wounds decreasing the post-operative infections, but introduces technical difficulties for the surgeon, who has to deal with at least three instruments in a single incision. These drawbacks can be overcome with the introduction of robotic arms inside the abdominal cavity, but still remain difficulties in the surgical field vision, limited by the endoscope field of view. This work is aimed at developing a system to improve the information required by the surgeon and enhance the vision during a robotic SILS. In the pre-operative phase, the segmentation and surface rendering of organs allow the surgeon to plan the surgery. During the intra-operative phase, the run-time information (tools and endoscope pose) and the pre-operative information (3D models of organs) are combined in a virtual environment. A point-based rigid registration of the virtual abdomen on the real patient creates a connection between reality and virtuality. The camera-image plane calibration allows to know at run-time the pose of the endoscopic view. The results show how using a small set of 4 points (the minimal number of points that would be used in a real procedure) for the camera-image plane calibration and for the registration between real and virtual model of the abdomen, is enough to provide a calibration/registration accuracy within the requirements

Experimental and Numerical Results of LIFUS5/Mod3 Series E Test on In-Box LOCA Transient for WCLL-BB

The in-box LOCA (Loss of Coolant Accident) represents a major safety concern to be addressed in the design of the WCLL-BB (water-cooled lead-lithium breeding blanket). Research activities are ongoing to master the phenomena and processes that occur during the postulated accident, to enhance the predictive capability and reliability of numerical tools, and to validate computer models, codes, and procedures for their applications. Following these objectives, ENEA designed and built the new separate effects test facility LIFUS5/Mod3. Two experimental campaigns (Series D and Series E) were executed by injecting water at high pressure into a pool of PbLi in WCLL-BB-relevant parameter ranges. The obtained experimental data were used to check the capabilities of the RELAP5 system code to reproduce the pressure transient of a water system, to validate the chemical model of PbLi/water reactions implemented in the modified version of SIMMER codes for fusion application, to investigate the dynamic effects of energy release on the structures, and to provide relevant feedback for the follow-up experimental campaigns. This work presents the experimental data and the numerical simulations of Test E4.1. The results of the test are presented and critically discussed. The code simulations highlight that SIMMER code is able to reproduce the phenomena connected to PbLi/water interaction, and the relevant test parameters are in agreement with the acquired experimental signals. Moreover, the results obtained by the first approach to SIMMER-RELAP5 code-coupling demonstrate its capability of and strength for predicting the transient scenario in complex geometries, considering multiple physical phenomena and minimizing the computational cost

Experimental characterization of leak detection systems in HLM pool using LIFUS5/Mod3 facility

In the framework of the European Union MAXSIMA project, the safety of the steam generator (SG) adopted in the primary loop of the Heavy Liquid Metal Fast Reactor has been studied investigating the consequences and damage propagation of a SG tube rupture event and characterizing leak rates from typical cracks. Instrumentation able to promptly detect the presence of a crack in the SG tubes may be used to prevent its further propagation, which would lead to a full rupture of the tube. Application of the leak-before-break concept is relevant for improving the safety of a reactor system and decreasing the probability of a pipe break event. In this framework, a new experimental campaign (Test Series C) has been carried out in the LIFUS5/Mod3 facility, installed at ENEA Centro Ricerche Brasimone, in order to characterize and to correlate the leak rate through typical cracks occurring in the pressurized tubes with signals detected by proper transducers. Test C1.3_60 was executed injecting water at about 20 bars and 200°C into lead-bismuth eutectic alloy. The injection was performed through a laser microholed plate 60 μm in diameter. Analysis of the thermohydraulic data permitted characterization of the leakage through typical cracks that can occur in the pressurized tubes of the SG. Analysis of the data acquired by microphones and accelerometers highlighted that it is possible to correlate the signals to the leakage and the rate of release

Building A Health Administration Program: Strategies For Success

Nearly 200 students have now graduated from the University of Baltimore’s (UB’s) six-year-old undergraduate Health Systems Management program (HSMG). With a total student enrollment of 113, the program is one of the larger health administration programs in the United States. The program, an affiliate member of the Association of University Programs in Health Administration, is a unique weekend program that allows working professionals with an Associate’s degree to complete a Bachelor of Science degree in 2½ years. The students have, on average, 10–15 years of experience in the heath industry either as nurses or radiology technicians, thus bringing extensive practical experience to the classroom. By any academic measure, the program has been a success. Recruitment is strong and steady, the retention rate and graduation rate (over 80 percent) is high compared to both the university and national averages, and over 90 percent of the graduating students finish in the 2½ years. The purpose of this paper is to discuss the issues and strategies involved in implementing the program, as well as some of the unique features of this program. We believe our success can be replicated in other university and program settings. The health care employment market in the greater Baltimore region provided a significant student population base from which we were able to draw for enrollment in our HSMG program. Other regional markets can be addressed in a similar fashion to meet the educational needs of students and enhance the achievement of university enrollment goals