Economic evaluation of computed tomography in a teaching hospital

Computed tomography is very important for accurate diagnosis of some health conditions. However, the procurement and maintenance of CT equipment is expensive and the operating cost per study is high. Against the backdrop, that financial resources are scarce, prudent management and appropriate price fixing of CT scanning procedures is necessary for continuity in business. Objectives: To evaluate the operations of a CT facility employing accounting, financial, and management principles to elucidate how to optimize economic gains in the operations of medical imaging facilities. Method: Record of CT scans done at the University of Port Harcourt Teaching Hospital (UPTH) from May, 2007 to December, 2008 and the revenues generated from the studies were obtained and used for economic performance evaluation of the CT facility. The evaluation was done by analyzing the average variable, fixed, and total costs, as well as the average revenue. Results: The operating cost per study for each of the studies was less than the billing per study thus, implying that profit was made per each study. Some studies contributed more to the profit per study than others e.g. sinuses, inner ear, and TMJ contributed 28,456.04 each to the profit/study while abdomen and chest contributed the least amounts of 17,792.01 and 17,818.24 respectively. Conclusion and recommendation: CT facility can generate enough profit to sustain itself if the products are adequately priced. It was therefore, recommended that part of the profit generated should be used to raise capital via a sinking fund for equipment replacement as demonstrated in the study

A Consideration of the Influences that Predict Middle School Principal Attitudes

Today’s successful school systems have certainly evolved into “heroic learning organizations” (Brown & Moffett, 1999). Competing for such prestigious titles as National Blue Ribbon Schools and Carolina First Palmetto’s Finest Award Schools, additional pressures are placed on everyone involved. The person held most accountable for problem solving is the principal. Two of the most prominent pressures are the challenges of No Child Left Behind (NCLB) and schools meeting Annual Yearly Progress (AYP) requirements for all students. As the instructional leader, the principal influences every aspect of the school and each of its participants. In the process he or she becomes a cheerleader, team captain, nurse, psychologist, visionary, disciplinarian, diplomat, utilitarian, chaplain, judge, prosecutor, negotiator, and clairvoyant. The principal creates, drives, inspires, establishes the culture, engenders the school’s spirit, dreams the vision, and serves as a role model to ensure everyone is integrated into the all-inclusive learning environment

High energy asymptotics for eigenvalues of the Schrödinger operator with a matrix potential

We consider a Schr"{o}dinger operator with a matrix potential defined in $L_{2}^{m}(Q)$ by the differential expression $Lu= - Delta u + Vu$ and the Neumann boundary condition, where $Q$ is a $d$-dimensional parallelepiped and $V$ a matrix potential, $dgeq 2$, $mgeq 2$. We obtain the high energy asymptotics of arbitrary order for a rich set of eigenvalues

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamento de Cundinamarca.

El presente trabajo se desarrolla partiendo de un análisis de las subjetividades que se presentan en los diferentes contextos de violencia en nuestro país, donde la lectura central se ha enfatizado en un sin número de consecuencias relevantes a nivel social, cultural y político traducidas en crisis humanitarias como, por ejemplo, el desplazamiento forzoso, muerte de la población civil, aumento de la pobreza, abuso de poder entre otras, vulnerando en todo caso los derechos humanos. De acuerdo a la problemática evidenciada se inicia el estudio de los resultados obtenidos a través de la estrategia de la narración que permite evidenciar estas experiencias y que, además, facilita una aproximación a la situación demostrando el impacto psicosocial que este tipo de situaciones deja tanto a nivel individual como en la comunidad. De otro lado, se realiza un análisis a la incursión que se presenta en poblaciones en la cuenca del rio Cacarica región del parque nacional de los Katios lo que inmediatamente nos contextualiza en una región rica en diversidad y recursos naturales pero al mismo tiempo en poblaciones vulnerables y con una real exposición a los diferentes grupos armados que tienen intereses en la región, por recursos, por tránsito de drogas y secuestrados por la región del Darién límite con Panamá lo que facilita la ilegalidad. Las comunidades de Cacarica en un alto porcentaje indígena y campesina hacen parte de esa Colombia Olvidada y victimizada por los diferentes flagelos que son caldo de cultivo para el conflicto armado, es allí donde las narrativas y acontecimientos documentados por parte de cada población y sus habitantes se hacen valiosos y nos contextualizan frente a las necesidades en materia de Salud pública mental y como desde esas realidades se pueden valorar alternativas de intervención psicosocial, indiquen vías que conduzcan a la reparación a la restitución de derechos y al perdón frente a las injusticias cometidas a las violaciones a los derechos fundamentales inclusive a la misma reparación a la biodiversidad de lugar. Es importante resaltar las estrategias de intervención que se presentan en este documento con el fin de orientar los procesos psicológicos desde las diferentes perspectivas epistemológicas que rige la existencia del ser humano, desde el análisis a través de la observación, interpretación del contexto y comprensión de si mismo por consiguiente la identificación de factores determinantes en la reestructuración integral física y mental de las víctimas de la violencia de nuestro país , cabe señalar que las políticas de salud mental para regiones y localidades con características como las de Cacarica deberán ser diseñadas particularmente para atender las necesidades particulares de estas poblaciones lo que invita a que se tomen acciones en los que todos los actores manifiesten sus necesidades partiendo de la responsabilidad en la participación de los eventos violentos, donde el perdón sea un acto desde un enfoque psicosocial preponderante en las acciones a tomar.The present work is developed based on an analysis of the subjectivities that occur in the different contexts of violence in our country, where the central reading has been emphasized in a number of relevant consequences at a social, cultural and political level translated into crisis such as, for example, forced displacement, death of the civilian population, increased poverty, abuse of power among others, in any case violating human rights. According to the evidenced problem, the study of the results begins, through the strategy of the narrative that allows to demonstrate these experiences and, in addition, facilitates an approach to the situation demonstrating the psychosocial impact that this type of situations leaves both at the level individual as in the community. On the other hand, an analysis is made of the incursion that occurs in populations in the Cacarica river basin region of the Katios National Park which immediately contextualizes us in a region rich in diversity and natural resources but at the same time in vulnerable populations and with a real exposure to the different armed groups that have interests in the region, by resources, by transit of drugs and kidnapped by the region of the Darién border with Panama which facilitates the illegality. The communities of Cacarica in a high percentage of indigenous and peasant people are part of that Colombia Forgotten and victimized by the different scourges that are a breeding ground for armed conflict, it is there where the narratives and documented events by each population and its inhabitants are they make valuable and contextualize us in the face of mental public health needs, and since from these realities, psychosocial intervention alternatives can be assessed, indicate ways that lead to reparation for the restitution of rights and forgiveness in the face of injustices committed to violations of fundamental rights including the same reparation for local biodiversity. It is important to highlight the intervention strategies presented in this document in order to guide the psychological processes from the different epistemological perspectives that govern the existence of the human being, from the analysis through observation, interpretation of the context and understanding of whether therefore, the identification of determining factors in the integral physical and mental restructuring of the victims of violence in our country, it should be noted that mental health policies for regions and localities with characteristics such as those in Cacarica should be designed in particular to address particular needs of these populations which invites actions to be taken in which all the actors express their needs based on the responsibility in the participation of violent events, where forgiveness is an act from a predominant psychosocial approach in the actions to be taken

The Challenges facing midwifery educators in sustaining a future education workforce

Background national and international trends have identified concerns over the ability of health and social care workforces in meeting the needs of service users. Attention has increasingly been drawn to problems of recruiting and retaining professionals within higher education; however data in relation to the midwifery profession is scant. Aim to examine the perceptions and experiences of midwifery educators, in south-west England, about the challenges facing them sustaining the education workforce of the future. Design a mixed methodology approach was adopted involving heads of midwifery education and midwife educators. Methodology midwifery participants were recruited from three higher education institutions in south west England. Data collection comprised of self-administered questionnaires plus individual qualitative interviews with heads of midwifery education (n=3), and tape recorded focus groups with midwife academics (n=19). Numerical data were analysed using descriptive statistics. Textual data were analysed for themes that represented the experiences and perspectives of participants. Ethics approval was granted by one University Ethics committee. Findings demographic data suggests that within south-west England, there is a clear ageing population and few in possession of a doctorate within midwifery. The six identified sub-themes represented in the data describe challenges and tensions that midwifery academics experienced in their efforts to attract new recruits and retain those in post in a highly changing educational environment which demands more from a contracting workforce. Conclusion and implications for practice there remain some serious challenges facing midwifery educators in sustaining the future education workforce, which if unresolved may jeopardise standards of education and quality of care women receive. Active succession planning and more radical approaches that embrace flexible careers will enable educational workforce to be sustained and by a clinically credible and scholarly orientated midwifery workforce

The outlook of building information modeling for sustainable development

As human needs evolve, information technologies and natural environments require a wider perspective of sustainable development, especially when examining the built environment that impacts the central of social-ecological systems. The objectives of the paper are (a) to review the status and development of building information modeling (BIM) in regards to the sustainable development in the built environment, and (b) to develop a future outlook framework that promotes BIM in sustainable development. Seven areas of sustainability were classified to analyze forty-four BIM guidelines and standards. This review examines the use of BIM in sustainable development, focusing primarily on certain areas of sustainability, such as project development, design, and construction. The developed framework describes the need for collaboration with the multiple disciplines for the future adoption and use of BIM for the sustainable development. It also considers the integration between “BIM and green assessment criteria”; and “BIM and renewable energy” to address the shortcomings of the standards and guidelines

Breast cancer risk and drinking water contaminated by wastewater: a case control study

BACKGROUND: Drinking water contaminated by wastewater is a potential source of exposure to mammary carcinogens and endocrine disrupting compounds from commercial products and excreted natural and pharmaceutical hormones. These contaminants are hypothesized to increase breast cancer risk. Cape Cod, Massachusetts, has a history of wastewater contamination in many, but not all, of its public water supplies; and the region has a history of higher breast cancer incidence that is unexplained by the population's age, in-migration, mammography use, or established breast cancer risk factors. We conducted a case-control study to investigate whether exposure to drinking water contaminated by wastewater increases the risk of breast cancer. METHODS: Participants were 824 Cape Cod women diagnosed with breast cancer in 1988–1995 and 745 controls who lived in homes served by public drinking water supplies and never lived in a home served by a Cape Cod private well. We assessed each woman's exposure yearly since 1972 at each of her Cape Cod addresses, using nitrate nitrogen (nitrate-N) levels measured in public wells and pumping volumes for the wells. Nitrate-N is an established wastewater indicator in the region. As an alternative drinking water quality indicator, we calculated the fraction of recharge zones in residential, commercial, and pesticide land use areas. RESULTS: After controlling for established breast cancer risk factors, mammography, and length of residence on Cape Cod, results showed no consistent association between breast cancer and average annual nitrate-N (OR = 1.8; 95% CI 0.6 – 5.0 for ≥ 1.2 vs. < .3 mg/L), the sum of annual nitrate-N concentrations (OR = 0.9; 95% CI 0.6 – 1.5 for ≥ 10 vs. 1 to < 10 mg/L), or the number of years exposed to nitrate-N over 1 mg/L (OR = 0.9; 95% CI 0.5 – 1.5 for ≥ 8 vs. 0 years). Variation in exposure levels was limited, with 99% of women receiving some of their water from supplies with nitrate-N levels in excess of background. The total fraction of residential, commercial, and pesticide use land in recharge zones of public supply wells was associated with a small statistically unstable higher breast cancer incidence (OR = 1.4; 95% CI 0.8–2.4 for highest compared with lowest land use), but risk did not increase for increasing land use fractions. CONCLUSION: Results did not provide evidence of an association between breast cancer and drinking water contaminated by wastewater. The computer mapping methods used in this study to link routine measurements required by the Safe Drinking Water Act with interview data can enhance individual-level epidemiologic studies of multiple health outcomes, including diseases with substantial latency

Streamlining Digital Modeling and Building Information Modelling (BIM) Uses for the Oil and Gas Projects

The oil and gas industry is a technology-driven industry. Over the last two decades, it has heavily made use of digital modeling and associated technologies (DMAT) to enhance its commercial capability. Meanwhile, the Building Information Modelling (BIM) has grown at an exponential rate in the built environment sector. It is not only a digital representation of physical and functional characteristics of a facility, but it has also made an impact on the management processes of building project lifecycle. It is apparent that there are many similarities between BIM and DMAT usability in the aspect of physical modeling and functionality. The aim of this study is to streamline the usage of both DMAT and BIM whilst discovering valuable practices for performance improvement in the oil and gas projects. To achieve this, 28 BIM guidelines, 83 DMAT academic publications and 101 DMAT vendor case studies were selected for review. The findings uncover (a) 38 BIM uses; (b) 32 DMAT uses and; (c) 36 both DMAT and BIM uses. The synergy between DMAT and BIM uses would render insightful references into managing efficient oil and gas’s projects. It also helps project stakeholders to recognise future investment or potential development areas of BIM and DMAT uses in their projects

Do Fruit Nutrients Affect Subgrouping Patterns in Wild Spider Monkeys (Ateles geoffroyi)?

One of the main costs of group living is feeding competition. Fission–fusion dynamics are thought to be a strategy to avoid overt competition for food resources. We tested whether food abundance and quality affected such dynamics in a species characterized by a high degree of fission–fusion dynamics. We collected data on 22 adult and subadult spider monkeys (Ateles geoffroyi) living in a large community in the protected area of Otoch Ma’ax Yetel Kooh, Yucatan, Mexico. We recorded subgroup size and fission events as well as fruit abundance during 12 mo and conducted nutritional analyses on the fruit species that the study subjects consumed most. We found no effect of fruit abundance or nutritional quality of recently visited food patches on individual fission decisions, but the amount of protein in the food patches visited over the course of the day was a good predictor of subgroup size. While the absence of support for a relationship between fruit characteristics and fission decisions may be due to the short temporal scale of the analysis, our findings relating subgroup size to the amount of protein in the visited food patches over the course of the day may be explained by individual spider monkeys attempting to obtain sufficient protein intake from their fruit-based diet. © 2016 Springer Science+Business Media New Yor