Optimal productive size of hospital’s intensive care units

Hospital, Intensive Care Units, Returns to Scale, Optimal Size

How Does Payer Mix and Technical Inefficiency Affect Hospital Net Revenue?

As changes in the US health care system continue to evolve and change, maintaining the financial viability of hospitals is crucial to the system’s operation. Two lines of inquiry have been pursued in describing factors affecting financial viability. The first line of inquiry relates to the external payer mix of patients focusing on patients who are unable to compensate hospitals for the care received. The second line of inquiry focuses on internal management and because hospitals do not typically answer to shareholders, managers become lax and X-inefficiency may arise. In this paper, we assess both these lines of research in order to determine if payment source by patients and/or managerial efficiency contributes to higher total net revenue. By using a weighted DEA we measured the inefficiency of inputs to the production process on our sample of 144 hospitals operating in Florida during 2005. We used the derived inefficient use of inputs along with the number of days by payer group (Medicare, Medicaid, private insurance, other public insurance, and uncompensated care) in order to explain their effects on total net revenue. To preview our results, we found that the inefficient use of beds and the provision of care to patients who are considered as uncompensated care reduce significantly total net revenue while private pay patients and patients covered by other public insurance add to total net revenue. These findings add to the literature by showing that it is patient payer mix and managerial inefficiency together affect hospital financial viability. We also demonstrate how our findings contribute to current policy debates both on the federal US and the state of Florida level.Hospital, Net Revenue, Efficiency, Payer, Uncompensated Care

Context as Theory: Towards Unification of Computer Applications and Quantitative Methods in Archaeology

Context in archaeology is a theory of inclusion, differing from context in computer science and other fields where context is a theory of exclusion or only part of a whole. Context is multidimensional, each layer of which is embedded and overlapping in multiple scales, constituting the dimensionality of archaeological research. Context as theory defines relevancy and theorizes GIS as a method that organizes this multidimensionality – ontologically based in the site, subsite, feature(s), assemblage(s), artefact(s), and the detail(s) of the artefact – literally, inclusively, everything! GIS layering and sequencing enable modelling and analysis of the multidimensionality of context. Geodatabase hyperlinks and multimedia within a GIS provide synergistic opportunity for alternative curation strategies and (re) connect detached research. A multidimensional, multiscalar perspective of context as theory crosscuts themes and archaeological settings to unify the seemingly fractured character of computer applications and quantitative methods in archaeology

The Significance of Kenny Wheeler in the Evolution of Jazz Compozition from Diatonic Chromatic Background

It is the intention of this paper to look at some of Wheelers music from a very specific period in his career (late 1970s through to early 1980s), place it in an overall developmental process in jazz composition already underway, and to examine it using some techniques that have been devised by the author over a long period of time. It is not intended for this document to outline any sort of process that is Wheelers per se, however there is a process that will be examined here; it is that of this authors own development as an improviser. This process has had Wheeler looming over it since near the very beginning, and, as more was learned about his music along with (for lack of a better term) more mainstream music, this author found it interesting that they shared more than they differed. The differences were not so much of a kind but of a viewpoint, a viewpoint that seemed to look through the same window, but out onto a bigger landscape. This document endeavours to shed some light on the relationship of diatonicism and chromaticism, but not in a surface way. In the action of moving through this paper it is hoped that a more subtle background idea of chromaticism can be seen that is still within the realm of perceived tonality. It is an improvisers process, yet a compositional one. If one looks at each of these in terms of the manipulation of the stuff of music then they are the same. The lens through which this idea of chromaticism will be examined is what will be termed the voicing, and in defining this voicing in a very specific manner, it can be shown that it carries inside it all the structure, voice leading, functionality and coherence required for the negotiation of tonal systems, both closed (diatonic) and open (chromatic). This will be a fairly lengthy process, but one that is felt necessary in order to appreciate the local tonality vs. global chromaticism which Wheelers music exemplifies. After the process of familiarization with the voicing and some analytical techniques, two compositions of Wheelers from the late 1970s into the early 1980s will be examined using these techniques.It is the intention of this paper to look at some of Wheelers music from a very specific period in his career (late 1970s through to early 1980s), place it in an overall developmental process in jazz composition already underway, and to examine it using some techniques that have been devised by the author over a long period of time. It is not intended for this document to outline any sort of process that is Wheelers per se, however there is a process that will be examined here; it is that of this authors own development as an improviser. This process has had Wheeler looming over it since near the very beginning, and, as more was learned about his music along with (for lack of a better term) more mainstream music, this author found it interesting that they shared more than they differed. The differences were not so much of a kind but of a viewpoint, a viewpoint that seemed to look through the same window, but out onto a bigger landscape. This document endeavours to shed some light on the relationship of diatonicism and chromaticism, but not in a surface way. In the action of moving through this paper it is hoped that a more subtle background idea of chromaticism can be seen that is still within the realm of perceived tonality. It is an improvisers process, yet a compositional one. If one looks at each of these in terms of the manipulation of the stuff of music then they are the same. The lens through which this idea of chromaticism will be examined is what will be termed the voicing, and in defining this voicing in a very specific manner, it can be shown that it carries inside it all the structure, voice leading, functionality and coherence required for the negotiation of tonal systems, both closed (diatonic) and open (chromatic). This will be a fairly lengthy process, but one that is felt necessary in order to appreciate the local tonality vs. global chromaticism which Wheelers music exemplifies. After the process of familiarization with the voicing and some analytical techniques, two compositions of Wheelers from the late 1970s into the early 1980s will be examined using these techniques

The Size and Service Offering Efficiencies of U.S. Hospitals.

Hospital productivity has been a research topic for over two decades. We expand on this research to include measures of dis/economies of scope. By using the Free Coordination Hull (FCH) we are able to determine if hospitals in our sample can become more efficient if they provide more services (diseconomies of scope) or if two smaller hospitals with a reallocation of resources could become more efficient (economies of scope). Using data from the American Hospital Association for the years 2004-2007, we found variations among hospital markets (measured by the Core Based Statistical Area). We can determine whether dis/economies of scope exist by comparing the results from two linear programming problems. Focusing on four markets: Los Angeles, Philadelphia, Madison, WI, and New Orleans we found variations in how best these hospitals operating in these markets could change in order to increase both scale and scope efficiencies. This approach could be used by policy makers and managers in order to reduce costs by sharing, reducing, or expanding services in hospitals. Findings from a study such as this should aid reform programs by providing more information on the sources of hospital inefficiency.Hospital, Efficiency, Economies of Scope, Hospital Markets

Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory

Purpose: This study aimed at conducting a systematic review in health professions education of determinants, mediators and outcomes of students’ motivation to engage in academic activities based on the self-determination theory’s perspective. Methods: A search was conducted across databases (MEDLINE, CINHAL, EMBASE, PsycINFO, and ERIC databases), hand-search of relevant journals, grey literature, and published research profile of key authors. Quantitative and qualitative studies were included if they reported research in health professions education focused on determinants, mediators, and/or outcomes of motivation from the self-determination and if meeting the quality criteria. Results: A total of 17 studies met the inclusion and quality criteria. Articles retrieved came from diverse locations and mainly from medical education and to a lesser extent from psychology and dental education. Intrapersonal (gender and personality traits) and interpersonal determinants (academic conditions and lifestyle, qualitative method of selection, feedback, and an autonomy supportive learning climate) have been reported to have a positive influence on students’ motivation to engage in academic activities. No studies were found that tested mediation effects between determinants and students’ motivation. In turn, students’ self-determined motivation has been found to be positively associated with different cognitive, affective, and behavioural outcomes. Conclusion: This study has found that generally, motivation could be enhanced by changes in the educational environment and by an early detection of students’ characteristics. Doing so may support future health practitioners’ self-determined motivation and positively influence how they process information and their emotions and how they approach their learning activities

Sharing Profits with Employees. A Critical Study of Methods in the Light of Presetn Conditions.

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Strengthening regional capacity for climate services in Africa, Victoria Falls, Zimbabwe, 27 October 2015.

CCAFS (through the International Livestock Research Institute and the International Research Institute for Climate and Society) and the Africa Climate Policy Center sponsored a workshop on ‘Strengthening Regional Capacity for Climate Services in Africa’, held on 27th October 2015 at Victoria Falls, Zimbabwe. The workshop, which was associated with and reported to the fifth conference on Climate Change and Development in Africa (CCDA-V), aimed to initiate a collaborative effort to strengthen capacity, through African regional institutions, to support smallholder farmers with relevant climate services. The workshop brought together 17 participants including scientists and technical experts to learn from and build on examples of good practice in farmer-focused climate information and advisory services, and to share elements of good practice in food security contingency planning. Discussions highlighted two key constraints to achieving the potential benefits of climate services for smallholder farming and pastoralist communities across Africa. The first is limited capacity to produce relevant climate information that is tailored to the needs of farmers, at a scale that is relevant to farm decision-making. The second is limited capacity to communicate climate-related information effectively, in a manner that farmers can incorporate into their decision-making. Organizations present at the workshop offer several promising innovations that have potential to overcome some of the critical gaps in the production and communication of climate-related information for farmers. Gaps in capacity to produce farmer-relevant climate information are closely linked to gaps in capacity to work with farming communities to communicate the information effectively and support its use. Financial investments and capacity-development efforts should address these gaps in parallel. National meteorological and hydrological services (NMHS) have the mandate to produce weather and climate information; but institutions in the agriculture sector are generally better positioned to translate raw climate information into decision-relevant information and advisories, and to communicate that information with farmers. If climate services are to work for farmers, they must therefore be developed and implemented jointly by NMHS and agricultural technical institutions. This may require new institutional arrangements at the national level. Regional institutions, such as African Climate Policy Center (ACPC), IGAD Climate Prediction and Applications Center (ICPAC) and AGRHYMET Regional Center, are well positioned to assist national governments to strengthen climate services that can benefit smallholder farmers – at scale. The workshop provided an opportunity to advance discussions about collaboration toward strengthening climate services for agriculture in Africa, through regional organizations and processes

The Journal of Chester Fritz: Travels Through Western China in 1917

Chester Fritz embarked on a six month journey through China in 1917. He kept a detailed journal and took many photographs along the way. This journal was edited by UND History Professor Dr. James Vivian and published by the University of North Dakota Press in 1981. Dan Rylance, curator of the Orin G. Libby Manuscript Collection at the the Chester Fritz Library, wrote the introduction.https://commons.und.edu/und-books/1101/thumbnail.jp