889 resultados para Health management system


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Geographic information systems (GIS) and artificial intelligence (AI) techniques were used to develop an intelligent snow removal asset management system (SRAMS). The system has been evaluated through a case study examining snow removal from the roads in Black Hawk County, Iowa, for which the Iowa Department of Transportation (Iowa DOT) is responsible. The SRAMS is comprised of an expert system that contains the logical rules and expertise of the Iowa DOT’s snow removal experts in Black Hawk County, and a geographic information system to access and manage road data. The system is implemented on a mid-range PC by integrating MapObjects 2.1 (a GIS package), Visual Rule Studio 2.2 (an AI shell), and Visual Basic 6.0 (a programming tool). The system could efficiently be used to generate prioritized snowplowing routes in visual format, to optimize the allocation of assets for plowing, and to track materials (e.g., salt and sand). A test of the system reveals an improvement in snowplowing time by 1.9 percent for moderate snowfall and 9.7 percent for snowstorm conditions over the current manual system.

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Interest groups advocate centre-specific outcome data as a useful tool for patients in choosing a hospital for their treatment and for decision-making by politicians and the insurance industry. Haematopoietic stem cell transplantation (HSCT) requires significant infrastructure and represents a cost-intensive procedure. It therefore qualifies as a prime target for such a policy. We made use of the comprehensive database of the Swiss Blood Stem Cells Transplant Group (SBST) to evaluate potential use of mortality rates. Nine institutions reported a total of 4717 HSCT - 1427 allogeneic (30.3%), 3290 autologous (69.7%) - in 3808 patients between the years 1997 and 2008. Data were analysed for survival- and transplantation-related mortality (TRM) at day 100 and at 5 years. The data showed marked and significant differences between centres in unadjusted analyses. These differences were absent or marginal when the results were adjusted for disease, year of transplant and the EBMT risk score (a score incorporating patient age, disease stage, time interval between diagnosis and transplantation, and, for allogeneic transplants, donor type and donor-recipient gender combination) in a multivariable analysis. These data indicate comparable quality among centres in Switzerland. They show that comparison of crude centre-specific outcome data without adjustment for the patient mix may be misleading. Mandatory data collection and systematic review of all cases within a comprehensive quality management system might, in contrast, serve as a model to ascertain the quality of other cost-intensive therapies in Switzerland.

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Expanded abstract: Iowa Department of Transportation (IA DOT) is finalizing research to streamline field inventory/inspection of culverts by Maintenance and Construction staff while maximizing the use of tablet technologies. The project began in 2011 to develop some new best practices for field staff to assist in the inventory, inspection and maintenance of assets along the roadway. The team has spent the past year working through the complexities of identifying the most appropriate tablet hardware for field data collection. A small scale deployment of tablets occurred in spring of 2013 to collect several safety related assets (culverts, signs, guardrail, and incidents). Data can be collected in disconnected or connected modes and there is an associated desktop environment where data can be viewed and queried after being synced into the master database. The development of a deployment plan and related workflow processes are underway; which will eventually feed information into IA DOTs larger asset management system and make the information available for decision making. The team is also working with the IA DOT Design Office on Computer Aided Drafting (CAD) data processing and the IA DOT Construction office with a new digital As-Built plan process to leverage the complete data life-cycle so information can be developed once and leveraged by the Maintenance staff farther along in the process.

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BACKGROUND: Most societies elaborate ways to contain increasing health care expenditures. In Switzerland out of pocket payments and cuts in the catalogue of reimbursed services are used as cost-containment measures. The aims of the study were to estimate the extent of health care renunciation for economic reasons and to identify associated factors. METHODS: A population-based cross-sectional survey (2008-2009) of a representative sample in the Canton of Geneva, Switzerland. Health care underuse, income level categories (<CHF 3000/month, 3000-4999, 5000-6999, 7000-9499, 9500-13 000, >13 000), education, occupation, insurance status and cardiovascular comorbidities were collected using self-rated questionnaires. RESULTS: 765 men and 814 women aged 35-74 years participated. 14.5% (229/1579) (95%CI 12.7-16.2) renounced health care for economic reasons. Among those who renounced (N = 229), 74% renounced dental care, 37% physician consultation (22% specialist, 15% general practitioner), 26% health devices, 13% medication, and 5% surgery. Income was negatively correlated with renouncement (r = -0.18, p <.0001). Each decrease in income level category provided a 48% increased risk of renouncing health care for economic reasons (OR 1.48, 1.31-1.65). This association remained when dental care was excluded from the definition of health care renunciation. CONCLUSIONS: In a region of Switzerland with a high cost of living, such as Geneva, socioeconomic status may influence the use of the health care system, and renunciation for economic reasons was not uncommon. More than 30% of the lowest income group renounced health care for economical reasons in the previous year. Health care underuse and renunciation may worsen the health status of a substantial part of society.

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To evaluate the effect of soil management systems on population of white grubs, (Phyllophaga cuyabana Moser), and on its damage in soybean, experiments were set up under no-tillage and conventional tillage (one disk plow, and a leveling disk harrow) areas. Primary tillage equipment, used in other soil management systems, such as moldboard plow, disk plow, chisel plow and heavy duty disk harrow were also tested. Fluctuation of P. cuyabana population and the extent of its damage to soybean was similar under no-tillage and conventional tillage systems. Results comparing a range of primary tillage equipment showed that it affected soil insect populations differently, depending on the time during the season in which tillage was executed. Larval mortality could mostly be attributed to their exposure to adverse factors, soon after tillage, than to changes in soil conditions. Reduction of white grub population was more evident in plots managed by heavier equipment, such as the moldboard plow. Soil tillage could be one component within the soil pest management system in soybean, however, its use can not be generalized.

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The objective of this experiment was to study the effects of soil management systems on the bulk density, chemical soil properties, and on the soil microbial activity on a Latossolo Vermelho distrófico (Oxisol). Soil samples were collected from plots under the following management conditions: a) natural dense "cerrado" vegetation (savanna); b) degraded Brachiaria decumbens pasture, 20 years old; c) no-tillage treatment with annual crop sequence (bean, corn, soybean and dark-oat in continuous rotation), 8 years old; d) conventional tillage treatment with crop residues added to the soil, and annual crop sequence, 10 years old. The continuous use of no-tillage system resulted in an increase in microbial biomass and decrease in soil basal respiration, therefore displaying evident long-term effects on the increase of soil C content. The no-tillage system also provided an improvement in bulk density and chemical properties of the soil. Hence, the no-tillage management system could be an alternative for the conservation and maintenance of physical and chemical conditions and the productive potential of "cerrado" soils.

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This report is divided into two volumes. This volume (Volume I) summarizes a structural health monitoring (SHM) system that was developed for the Iowa DOT to remotely and continuously monitor fatigue critical bridges (FCB) to aid in the detection of crack formation. The developed FCB SHM system enables bridge owners to remotely monitor FCB for gradual or sudden damage formation. The SHM system utilizes fiber bragg grating (FBG) fiber optic sensors (FOSs) to measure strains at critical locations. The strain-based SHM system is trained with measured performance data to identify typical bridge response when subjected to ambient traffic loads, and that knowledge is used to evaluate newly collected data. At specified intervals, the SHM system autonomously generates evaluation reports that summarize the current behavior of the bridge. The evaluation reports are collected and distributed to the bridge owner for interpretation and decision making. Volume II summarizes the development and demonstration of an autonomous, continuous SHM system that can be used to monitor typical girder bridges. The developed SHM system can be grouped into two main categories: an office component and a field component. The office component is a structural analysis software program that can be used to generate thresholds which are used for identifying isolated events. The field component includes hardware and field monitoring software which performs data processing and evaluation. The hardware system consists of sensors, data acquisition equipment, and a communication system backbone. The field monitoring software has been developed such that, once started, it will operate autonomously with minimal user interaction. In general, the SHM system features two key uses. First, the system can be integrated into an active bridge management system that tracks usage and structural changes. Second, the system helps owners to identify damage and deterioration.

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This phase of the research project involved two major efforts: (1) Complete the implementation of AEC-Sync (formerly known as Attolist) on the Iowa Falls Arch Bridge project and (2) develop a web-based project management system (WPMS) for projects under $10 million. For the first major effort, AEC-Sync was provided for the Iowa Department of Transportation (DOT) in a software as a service agreement, allowing the Iowa DOT to rapidly implement the solution with modest effort. During the 2010 fiscal year, the research team was able to help with the implementation process for the solution. The research team also collected feedback from the Broadway Viaduct project team members before the start of the project and implementation of the solution. For the 2011 fiscal year, the research team collected the post-project surveys from the Broadway Viaduct project members and compared them to the pre-project survey results. The result of the AEC-Sync implementation in the Broadway Viaduct project was a positive one. The project members were satisfied with the performance of AEC-Sync and how it facilitated document management and transparency. In addition, the research team distributed, collected, and analyzed the pre-project surveys for the Iowa Falls Arch Bridge project. During the 2012 fiscal year, the research team analyzed the post-project surveys for the Iowa Falls Arch Bridge project AEC-Sync implementation and found a positive outcome when compared to the pre-project surveys. The second major effort for this project involved the identification and implementation of a WPMS solution for smaller bridge and highway projects. During the 2011 fiscal year, Microsoft SharePoint was selected to be implemented on these smaller highway projects. In this year, workflows for the shop/working drawings for the smaller highway projects specified in Section 1105 of the Iowa DOT Specifications were developed. These workflows will serve as the guide for the development of the SharePoint pages. In order to implement the Microsoft SharePoint pages, the effort of an integrated team proved to be vital because it brought together the expertise required from researchers, programmers, and webpage developers to develop the SharePoint pages.

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The work described in this report documents the activities performed for the evaluation, development, and enhancement of the Iowa Department of Transportation (DOT) pavement condition information as part of their pavement management system operation. The study covers all of the Iowa DOT’s interstate and primary National Highway System (NHS) and non-NHS system. A new pavement condition rating system that provides a consistent, unified approach in rating pavements in Iowa is being proposed. The proposed 100-scale system is based on five individual indices derived from specific distress data and pavement properties, and an overall pavement condition index, PCI-2, that combines individual indices using weighting factors. The different indices cover cracking, ride, rutting, faulting, and friction. The Cracking Index is formed by combining cracking data (transverse, longitudinal, wheel-path, and alligator cracking indices). Ride, rutting, and faulting indices utilize the International Roughness Index (IRI), rut depth, and fault height, respectively.

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Several studies clarified the role of different interventions such as vitamine D replacement, denosumab treatment, and vertebroplasty in the prevention and management of falls and fractures. A trial tested the effectiveness of pharmaceutical assistance at the time of discharge, emphasizing the potential benefits for the patients and the health care system. Syncopal episodes frequently lead to hospital admission. A retrospective study evaluated the diagnostic yield of different tests and emphasized the importance to actively seek orthostatic hypotension in older patients. Finally, advances remain modest in the field of dementias.

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This paper describes the result of a research about diverse areas of the information technology world applied to cartography. Its final result is a complete and custom geographic information web system, designed and implemented to manage archaeological information of the city of Tarragona. The goal of the platform is to show on a web-focused application geographical and alphanumerical data and to provide concrete queries to explorate this. Various tools, between others, have been used: the PostgreSQL database management system in conjunction with its geographical extension PostGIS, the geographic server GeoServer, the GeoWebCache tile caching, the maps viewer and maps and satellite imagery from Google Maps, locations imagery from Google Street View, and other open source libraries. The technology has been chosen from an investigation of the requirements of the project, and has taken great part of its development. Except from the Google Maps tools which are not open source but are free, all design has been implemented with open source and free tools.

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The Iowa Department of Transportation's Access Management Task Force was established as part of the Iowa Department of Transportation's overall Safety Management System (SMS) effort. The goal of the Access Management Task Force is to develop a program designed to educate and market the concept and benefits of access management to landowners and developers, professional planners and engineers, planning and zoning staff members, appointed and elected officials, and motorists. Access management is pursued through the design and control of driveways, curb cuts, turning movements, interior circulation of parking lots, and public street connections and intersections. Usually, state highways or major urban and suburban arterial streets are the targets of access management projects. Access management is also a concern on main county roads when there is a transition from a rural environment to a town or city.

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[spa]En este trabajo se describe la experiencia de innovación docente desarrollada en la ULD a lo largo de los 10 años de existencia. Se comentan algunos de los indicadores del sistema de gestión de la calidad así como su evolución y los resultados más representativos obtenidos en su alimentación. El objetivo de este proyecto es introducir aspectos de la gestión de la calidad, seguridad, salud y medio ambiente en la formación de los estudiantes para que los apliquen a lo largo del desarrollo de las prácticas. De esta forma, podrán adquirir una formación transversal adicional que difícilmente le será transmitida a través de las diferentes asignaturas de la licenciatura y que mejorará sus competencias y facilitará su acceso al ámbito laboral. También se pretende contribuir en la mejora del funcionamiento y las infraestructuras de los laboratorios de prácticas de la facultad. [eng] In the following work it is summarized the innovative experience carried out by the ULD besides showing the results obtained from the different indicators that allow to evaluate the efficiency of the quality management system. The aim is to improve the management of the practical teaching by introducing aspects of quality management, safety, health and environment in the formation of the students. In such a way, they would be able to acquire a transverse additional formation that difficultly would be transmitted across the different subjects of the degree and that would improve their competitions when acceding to the working world.

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The purpose of this bachelor's thesis was to chart scientific research articles to present contributing factors to medication errors done by nurses in a hospital setting, and introduce methods to prevent medication errors. Additionally, international and Finnish research was combined and findings were reflected in relation to the Finnish health care system. Literature review was conducted out of 23 scientific articles. Data was searched systematically from CINAHL, MEDIC and MEDLINE databases, and also manually. Literature was analysed and the findings combined using inductive content analysis. Findings revealed that both organisational and individual factors contributed to medication errors. High workload, communication breakdowns, unsuitable working environment, distractions and interruptions, and similar medication products were identified as organisational factors. Individual factors included nurses' inability to follow protocol, inadequate knowledge of medications and personal qualities of the nurse. Developing and improving the physical environment, error reporting, and medication management protocols were emphasised as methods to prevent medication errors. Investing to the staff's competence and well-being was also identified as a prevention method. The number of Finnish articles was small, and therefore the applicability of the findings to Finland is difficult to assess. However, the findings seem to fit to the Finnish health care system relatively well. Further research is needed to identify those factors that contribute to medication errors in Finland. This is a necessity for the development of methods to prevent medication errors that fit in to the Finnish health care system.

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Diplomityö muodostuu kahdesta kokonaisuudesta. Työn teoriaosa kertoo mitä ympäristöjohtaminen on, millaisia ovat multi-site -organisaatio ja multi-site -johtamisjärjestelmä sekä mitä vaatimuksia nämä asettavat yritykselle. Työssä esitetään malli, jota käyttämällä kansainvälisten johtamisjärjestelmästandardien mukaan rakennetut laatu-, ympäristö-, terveys- ja turvallisuusjärjestelmät voidaan yhdistää yhdeksi kokonaisuudeksi, multi-site - johtamisjärjestelmäksi. Malli rakentuu kolmesta tasosta, joita ovat paikallinen, maakohtainen ja konsernitaso. Esimerkkien avulla kerrotaan miteneri lähtökohdista voidaan näiden tasojen kautta edetä kohti yhtä johtamiskokonaisuutta. Esille tuodaan myös multi-site -johtamisjärjestelmän käyttöönottoa puoltavat ja vastustavat näkökohdat. Työn konkreettinen osa on johtamisjärjestelmämallin paikallisen tason toteuttaminen. Ympäristöjohtamisjärjestelmän rakentaminen standardin EN ISO 14001:2004 vaatimusten mukaiseksi Kvaerner Power Oy:n Suomen toimipaikoille sekä tämän järjestelmän yhdistäminen sertifioituun EN ISO 9001 -standardin mukaiseen laatujärjestelmään. Työssä kerrotaan miten ympäristöjohtamisjärjestelmä on rakennettu ja miten laatu- ja ympäristöjärjestelmät on liitetty yhdeksi kokonaisuudeksi. Työn tuloksena syntyi malli johtamisjärjestelmien yhdistämisestä sekä sertifioitu ympäristöjohtamisjärjestelmä, jonka yhdistäminen laatujärjestelmään toteutettiin tavoitteiden mukaisesti.