A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission

INTRODUCTION The cost of medical care is spiraling out of control, and one of the many reasons is lack of preventative care, poor communication to the patient and primary caregiver(s) both in an inpatient and outpatient setting. There are potentially many reasons for this cost escalation, one of the drivers of this cost is 30 day readmission after a hospitalization and this is what was examined in this analysis. The purpose of this paper in particular is to share what has been learned using a systems thinking approach to hospital readmissions and the patient experience. It is critical to understand the problems that occurred in the past. In addition, we will explain the methodology utilized and bring awareness to the iterative process. We will also demonstrate a suggested redesigned model

Observations of acoustic emission activity during gear defect diagnosis.

It is widely recognised that acoustic emission (AE) is gaining ground as a non- destructive technique (NDT) for health diagnosis on rotating machinery. The source of AE is attributed to the release of stored elastic energy that manifests itself in the form of elastic waves that propagate in all directions on the surface of a material. These detectable AE waves can provide useful information about the health condition of a machine. This paper reports on part of an ongoing experimental investigation on the application of AE for gear defect diagnosis. Furthermore, the possibility of monitoring gear defects from the bearing casing is examined. It is concluded that AE offers a complimentary tool for health monitoring of gears

An initial investigation on the potential applicability of Acoustic Emission to rail track fault detection.

In light of recent accidents in the rail industry, the assessment of the mechanical integrity of rail-track is of vital importance. This encompasses the integrity of the track due to rolling contact fatigue and surface wear. Whilst numerous techniques are employed for crack detection, several defects have clearly been missed. In Europe, more than 100 rails are broken each year and rail maintenance costs within the European Union is estimated at 300-million Euros annually [Inst Mech Engrs 216 (2001) 249]. The derailment of a train at Hatfield in October 2000 is a tragic example of a fractured rail going undetected. This paper presents an experimental study on the applicability of Acoustic Emissions (AE) for rail-track defect diagnosis. An experimental test- rig was employed for this programme. This allowed for a surface defect to be seeded onto the test-rig. The investigation presented is part of an on-going attempt to develop the non-destructive technique of AE for assessing the surface integrity of rail-track. The AE technique is not new but the application in this particular instance is unique. It is concluded that the AE technique offers a complementary tool for rail track defect detection

Organic Food Subscription Schemes in Emerging Organic Markets: TEI-KEI, CSA and Box-Schemes

In this article the development of Organic Food Subscription Schemes beginning from the 70ies in Japan (TEI-KEI), the 80ies in North-America (CSA) and in 90ies in Europe (BOX- and BAG-SCHEMES) will be outlined. Furthmermore the Box-Scheme Development Modell will be discribed and important management issues will be discussed