Are Hospital Pharmacies More Efficient if They Employ Nurses?

This paper assesses the efficiency of utilizing nurses in Washington State hospital pharmacies. We take the perspective of a pharmacy department manager and model an input oriented hospital pharmacy production process. Data envelopment analysis (DEA) is used to examine both scale efficiency and technical efficiency, and differences across hospital pharmacies that use and do not use nurse staffing are analyzed using cross-tabulations and nonparametric hypothesis tests. The results indicate that the use of nurse staffing does not significantly impact either scale or technical efficiency. Thus, permitting nurses to play a greater role in hospital pharmacies does not adversely affect efficiency. This paper has important policy implications for hospital administrators and pharmacists.

Self-Organized Criticality Effect on Stability: Magneto-Thermal Oscillations in a Granular YBCO Superconductor

We show that the self-organized criticality of the Bean's state in each of the grains of a granular superconductor results in magneto-thermal oscillations preceding a series of subsequent flux jumps. We find that the frequency of these oscillations is proportional to the external magnetic field sweep rate and is inversely proportional to the square root of the heat capacity. We demonstrate experimentally and theoretically the universality of this dependence that is mainly influenced by the granularity of the superconductor.Comment: submitted to Physical Review Letters, 4 pages, RevTeX, 4 figures available as uufile

Area-level incarceration and STI risk among a cohort of justice-involved adolescents and adults

Background: Living in areas of high incarceration is associated with increased risk of STI; however, STI risk with respect to both this area-level exposure and an individual’s involvement with the justice system is not known. Objective: Among individuals before and after arrest or incarceration, assess the association between area-level incarceration rates and risk of chlamydia, gonorrhea, or syphilis. Methods: Retrospective cohort study of individuals living in Marion County (Indianapolis), Indiana who were arrested or in jail, prison, juvenile detention, or juvenile prison between 2005-2008 (N=97,765). Area-level incarceration exposure was defined by the proportion of person-days incarcerated among the total population*365 within a census block group. A 1-year period was assessed before and after a randomly-selected arrest/incarceration per person. Multivariable logistic regression, controlling for age, race, STI history, and year, was performed to assess chlamydia, gonorrhea, or syphilis risk by quartile area-level incarceration exposure, adjusting for individual clustering and stratifying by gender. Results: Area-level incarceration was associated with increased odds of each STI, with a dose response relationship particularly among those with an arrest or jail stay. Women with a history of arrest or jail/prison stay and living in high incarceration areas had higher odds of STI, compared to men with comparable incarceration history and living in similar areas

Nanoscale piezoelectric response across a single antiparallel ferroelectric domain wall

Surprising asymmetry in the local electromechanical response across a single antiparallel ferroelectric domain wall is reported. Piezoelectric force microscopy is used to investigate both the in-plane and out-of- plane electromechanical signals around domain walls in congruent and near-stoichiometric lithium niobate. The observed asymmetry is shown to have a strong correlation to crystal stoichiometry, suggesting defect-domain wall interactions. A defect-dipole model is proposed. Finite element method is used to simulate the electromechanical processes at the wall and reconstruct the images. For the near-stoichiometric composition, good agreement is found in both form and magnitude. Some discrepancy remains between the experimental and modeling widths of the imaged effects across a wall. This is analyzed from the perspective of possible electrostatic contributions to the imaging process, as well as local changes in the material properties in the vicinity of the wall

Using Electronic Health Record Data to Improve Community Health Assessment

Background: Community health assessments assist health departments in identifying health needs as well as disparities, and they enable linking of needs with available interventions. Electronic health record (EHR) systems possess growing volumes of clinical and administrative data, making them a valuable source of data for ongoing community health assessment. Purpose: To produce population health indicators using data from EHR systems that could be combined and visually displayed alongside social determinants data, and to provide data sets at geographic levels smaller than a county. Methods: Data from multiple EHR systems used by major health systems covering \u3e90% of the population in a metropolitan urban area were extracted and linked using a health information exchange (HIE) network for individuals who had at least two clinical encounters within the HIE network over a 3-year period. Population health indicators of highest interest to public health stakeholders were calculated and visualized at varying levels of geographic granularity. Results: Ten population health indicators were calculated, visualized, and shared with public health partners. Indicators ranged from the prevalence of a disease to the proportion of individuals with poor maintenance of their chronic condition. Calculating rates at the census-tract level or larger (e.g., average population size \u3e 4000 people) is preferable to smaller geographic units of analysis. Implications: Extraction and linking of EHR system data are feasible for public health via an HIE network. While indicators can be derived, biases exist in the data that require more study. Further, HIE networks do not yet possess data for all conditions and measures desired by local public health stakeholders. The data that can be extracted, however, can be combined with public datasets on social determinant

Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana

BACKGROUND: Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. METHODS: We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics. RESULTS: We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. CONCLUSIONS: This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population

Database queries for hospitalizations for acute congestive heart failure: flexible methods and validation based on set theory

Background and objective Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical ‘phenotypes’ accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one ‘gold standard’ chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods We used retrospective queries of hospitalizations (2002–2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP >500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF (presence/absence) outcome was based on expert chart review using a priori criteria. Results Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8% (SE 1.5%) for acute CHF and sensitivity 94.3% (1.3%). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4% (SE 2.4%) and sensitivity 28.8% (1.1%). PPV was <10% when there was no echocardiogram, no BNP, and no primary diagnosis. ‘False positive’ hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF

Functional modelling in evolvable assembly systems

The design and reconfiguration of adaptive production systems is a key driver in modern advanced manufacturing. We summarise the use of an ap-proach from the field of functional modelling to capture the function, behaviour, and structure of a system. This model is an integral part of the Evolvable Assembly Systems architecture, allowing the system to adapt its behaviour in response to changing product requirements. The integrated approach is illustrated with an example taken from a real EAS instantiation

Mortality of Youth Offenders Along a Continuum of Justice System Involvement

Introduction Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts. Methods Criminal and death records of 49,479 youth offenders (ages 10–18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014. Results From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality. Conclusions Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention

Multidisciplinary design in virtual worlds

Large design projects, such as those in the AEC domain, involve collaboration among a number of design disciplines, often in separate locations. With the increase in CAD usage in design offices, there has been an increase in the interest in collaboration using the electronic medium, both synchronously and asynchronously. The use of a single shared database representing a single model of a building has been widely put forward but this paper argues that this does not take into account the different representations required by each discipline. This paper puts forward an environment which provides real-time multi-user collaboration in a 3D virtual world for designers in different locations. Agent technology is used to manage the different views, creation and modifications of objects in the 3D virtual world and the necessary relationships with the database(s) belonging to each discipline