Estimates of hospital and physician costs of epilepsy in the United States for 1995 comparing the provider -based survey method and a patient -based medical charts and billing method

This investigation compares two different methodologies for calculating the national cost of epilepsy: provider-based survey method (PBSM) and the patient-based medical charts and billing method (PBMC&BM). The PBSM uses the National Hospital Discharge Survey (NHDS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS) as the sources of utilization. The PBMC&BM uses patient data, charts and billings, to determine utilization rates for specific components of hospital, physician and drug prescriptions. ^ The 1995 hospital and physician cost of epilepsy is estimated to be $722 million using the PBSM and $1,058 million using the PBMC&BM. The difference of $336 million results from $136 million difference in utilization and $200 million difference in unit cost. ^ Utilization. The utilization difference of $136 million is composed of an inpatient variation of $129 million, $100 million hospital and $29 million physician, and an ambulatory variation of $7 million. The $100 million hospital variance is attributed to inclusion of febrile seizures in the PBSM, $−79 million, and the exclusion of admissions attributed to epilepsy, $179 million. The former suggests that the diagnostic codes used in the NHDS may not properly match the current definition of epilepsy as used in the PBMC&BM. The latter suggests NHDS errors in the attribution of an admission to the principal diagnosis. ^ The $29 million variance in inpatient physician utilization is the result of different per-day-of-care physician visit rates, 1.3 for the PBMC&BM versus 1.0 for the PBSM. The absence of visit frequency measures in the NHDS affects the internal validity of the PBSM estimate and requires the investigator to make conservative assumptions. ^ The remaining ambulatory resource utilization variance is $7 million. Of this amount, $22 million is the result of an underestimate of ancillaries in the NHAMCS and NAMCS extrapolations using the patient visit weight. ^ Unit cost. The resource cost variation is $200 million, inpatient is $22 million and ambulatory is $178 million. The inpatient variation of $22 million is composed of $19 million in hospital per day rates, due to a higher cost per day in the PBMC&BM, and $3 million in physician visit rates, due to a higher cost per visit in the PBMC&BM. ^ The ambulatory cost variance is $178 million, composed of higher per-physician-visit costs of $97 million and higher per-ancillary costs of $81 million. Both are attributed to the PBMC&BM's precise identification of resource utilization that permits accurate valuation. ^ Conclusion. Both methods have specific limitations. The PBSM strengths are its sample designs that lead to nationally representative estimates and permit statistical point and confidence interval estimation for the nation for certain variables under investigation. However, the findings of this investigation suggest the internal validity of the estimates derived is questionable and important additional information required to precisely estimate the cost of an illness is absent. ^ The PBMC&BM is a superior method in identifying resources utilized in the physician encounter with the patient permitting more accurate valuation. However, the PBMC&BM does not have the statistical reliability of the PBSM; it relies on synthesized national prevalence estimates to extrapolate a national cost estimate. While precision is important, the ability to generalize to the nation may be limited due to the small number of patients that are followed. ^

Client-Provider Communication in Postabortion Care

Muchos trabajadores de la salud que tratan a las mujeres que sufren complicaciones de aborto inducido o espontáneo están dispuestos a admitir que estas mujeres necesitan asesoría, pero a menudo ven la consejería como una función no médica que requiere una formación específica, un tiempo especialmente designado, aparte de la prestación de servicios postaborto y otras instalaciones separadas y privadas. De este modo, los proveedores de servicios de atención postaborto a menudo creen que el asesoramiento no es una de sus responsabilidades de trabajo y que carecen de la formación y las instalaciones para hacerlo

The shift of paradigm in the organizations like foundation of the style of ethical leadership

La presente investigación tiene por objeto analizar el cambio de paradigma en las organizaciones como fundamento del liderazgo ético desde una realidad postmoderna a fin de detectar la necesidad de un liderazgo ético en las organizaciones donde los líderes sean formadores de valores a través del modelaje directivo; es un estilo de liderazgo en el que la visión ética, sistémica e integradora son unas de las principales aptitudes que el líder ético ha de poner en la práctica. Se han desarrollado teorías de liderazgo centradas no tanto en los rasgos o comportamientos de los líderes, sino en la relación entre líder y sus seguidores

The organizations transcomplejas from the perspective of the nursing

El propósito del artículo es el análisis de las organizaciones transcomplejas desde la perspectiva de la Enfermería, en el contexto del paradigma de la complejidad. Todos los cuestionamientos realizados a las ciencias de la modernidad fueron necesarios para dar al mundo desarrollos de enorme significación, como es el paradigma de la complejidad donde se rescata la idea de la totalidad universal y con ella el holismo dentro de las organizaciones, si se consideran estas como organismos vivo; y este aplicado al campo de la salud donde los profesionales del cuidado de la salud entre ellos la enfermería ha aceptado la perspectiva de salud holística como, más que la ausencia de enfermedad, como la realización individual. La humanidad vive una crisis de fragmentación que conduce a sentimientos y emociones destructivas de la armonía y del arte de vivir en equilibrio. La perspectiva holistica se preocupa de promover la salud mediante la prevención y se aplica a las personas que se recuperan de una enfermedad y desean aprender a prevenir su repetición y mejorar su estatus de salud futura. Así, la enfermería estudia la totalidad o la salud de los humanos, reconociendo que los humanos están en continua interacción con su medio ambiente

Organizational Capability of Local Societies in Rural Development: A Comparative Study of Microfinance Organizations in Thailand and the Philippines

The importance of organizing local people for development work is widely recognized. Both governmental and non-governmental agencies have implemented various projects that have needed and encouraged collective action by people. Often, however, such projects malfunction after the outside agencies retreat from the project site, suggesting that making organizations is not the same as making a system of making organizations. The latter is essential to make rural organizations self-reliant and sustainable. This paper assumes that such a system exists in local societies and focuses on the capacity of local societies for creating and managing organizations for development. It reveals that (1) such capability differs according to the locality, (2) the difference depends on the structure of the organizations that coordinate people's social relations, and (3) the local administrative bodies define, at least partly, the organizational capability of local societies. We compare two rural societies, one in Thailand and the other in the Philippines, which show clear contrasts in both the form of microfinance organizations and the way of making these organizations.

Low workforce participation of educated female and the role of work organizations in post-war Sri Lanka

Sri Lanka as a developing economy that achieved gender equity in education and a higher literacy rate (both adult and youth) in the South Asian region still records a low labor force participation and high unemployment rate of females when compared to their male counterparts. With the suggestion of existing literature on the non-conventional models of careers those adopted by young and female populations at the working age, this paper discusses the role of work organizations in absorbing more females (and even minority groups) into the workforce. It mainly focuses on the need of designing appropriate human resource strategies and reforming the existing organizational structures in order for contributing to the national development in the post-war Sri Lanka economy.

Testing a Cloud Provider Network for Hybrid P2P and Cloud Streaming Architectures

The number of online real-time streaming services deployed over network topologies like P2P or centralized ones has remarkably increased in the recent years. This has revealed the lack of networks that are well prepared to respond to this kind of traffic. A hybrid distribution network can be an efficient solution for real-time streaming services. This paper contains the experimental results of streaming distribution in a hybrid architecture that consist of mixed connections among P2P and Cloud nodes that can interoperate together. We have chosen to represent the P2P nodes as Planet Lab machines over the world and the cloud nodes using a Cloud provider's network. First we present an experimental validation of the Cloud infrastructure's ability to distribute streaming sessions with respect to some key streaming QoS parameters: jitter, throughput and packet losses. Next we show the results obtained from different test scenarios, when a hybrid distribution network is used. The scenarios measure the improvement of the multimedia QoS parameters, when nodes in the streaming distribution network (located in different continents) are gradually moved into the Cloud provider infrastructure. The overall conclusion is that the QoS of a streaming service can be efficiently improved, unlike in traditional P2P systems and CDN, by deploying a hybrid streaming architecture. This enhancement can be obtained by strategic placing of certain distribution network nodes into the Cloud provider infrastructure, taking advantage of the reduced packet loss and low latency that exists among its datacenters.

Multilingual manager: a new strategic role in organizations

Today?s knowledge management (KM) systems seldom account for language management and, especially, multilingual information processing. Document management is one of the strongest components of KM systems. If these systems do not include a multilingual knowledge management policy, intranet searches, excessive document space occupancy and redundant information slow down what are the most effective processes in a single language environment. In this paper, we model information flow from the sources of knowledge to the persons/systems searching for specific information. Within this framework, we focus on the importance of multilingual information processing, which is a hugely complex component of modern organizations.

Resilience in Cloud Computing for Critical Systems. Resilience, Dependability, Reliability in the use of Cloud Computing in Critical Systems in Public Organizations.

La informática se está convirtiendo en la quinta utilidad (gas, agua, luz, teléfono) en parte debido al impacto de Cloud Computing en las mayorías de las organizaciones. Este uso de informática es usada por cada vez más tipos de sistemas, incluidos Sistemas Críticos. Esto tiene un impacto en la complejidad internad y la fiabilidad de los sistemas de la organización y los que se ofrecen a los clientes. Este trabajo investiga el uso de Cloud Computing por sistemas críticos, centrándose en las dependencias y especialmente en la fiabilidad de estos sistemas. Se han presentado algunos ejemplos de su uso, y aunque su utilización en sistemas críticos no está extendido, se presenta cual puede llegar a ser su impacto. El objetivo de este trabajo es primero definir un modelo que pueda representar de una forma cuantitativa las interdependencias en fiabilidad y interdependencia para las organizaciones que utilicen estos sistemas, y aplicar este modelo en un sistema crítico del campo de sanidad y mostrar sus resultados. Los conceptos de “macro-dependability” y “micro-dependability” son introducidos en el modelo para la definición de interdependencia y para analizar la fiabilidad de sistemas que dependen de otros sistemas. ABSTRACT With the increasing utilization of Internet services and cloud computing by most organizations (both private and public), it is clear that computing is becoming the 5th utility (along with water, electricity, telephony and gas). These technologies are used for almost all types of systems, and the number is increasing, including Critical Infrastructure systems. Even if Critical Infrastructure systems appear not to rely directly on cloud services, there may be hidden inter-dependencies. This is true even for private cloud computing, which seems more secure and reliable. The critical systems can began in some cases with a clear and simple design, but evolved as described by Egan to "rafted" networks. Because they are usually controlled by one or few organizations, even when they are complex systems, their dependencies can be understood. The organization oversees and manages changes. These CI systems have been affected by the introduction of new ICT models like global communications, PCs and the Internet. Even virtualization took more time to be adopted by Critical systems, due to their strategic nature, but once that these technologies have been proven in other areas, at the end they are adopted as well, for different reasons such as costs. A new technology model is happening now based on some previous technologies (virtualization, distributing and utility computing, web and software services) that are offered in new ways and is called cloud computing. The organizations are migrating more services to the cloud; this will have impact in their internal complexity and in the reliability of the systems they are offering to the organization itself and their clients. Not always this added complexity and associated risks to their reliability are seen. As well, when two or more CI systems are interacting, the risks of one can affect the rest, sharing the risks. This work investigates the use of cloud computing by critical systems, and is focused in the dependencies and reliability of these systems. Some examples are presented together with the associated risks. A framework is introduced for analysing the dependability and resilience of a system that relies on cloud services and how to improve them. As part of the framework, the concepts of micro and macro dependability are introduced to explain the internal and external dependability on services supplied by an external cloud. A pharmacovigilance model system has been used for framework validation.

Social capacity building in rural Aymara women organizations in Puno, Peru.

Social capacity building has been considered in the last decades an important element of rural development projects, as it helps organizations and communities to better use their resources, design and manage projects locally and improve their living standards. Social capacity building has been related to the development of certain skills and to the concept of leadership development. Social capacity building and leadership development under a social learning approach have guided a rural development project with an Aymara women organization in Puno, Peru, where around 400 women artisans are trying to develop a business organization to improve their lives and their communities. Qualitative and quantitative methodologies have been applied to assess improvements in capacities and leadership. Results show that the technical aspects are the first to be developed but that group process skills and contextual skills take longer and are crucial to the success of the projects.

Evaluating alternative industrial network organizations and information systems

Purpose – The purpose of this paper is to present a simulation‐based evaluation method for the comparison of different organizational forms and software support levels in the field of supply chain management (SCM). Design/methodology/approach – Apart from widely known logistic performance indicators, the discrete event simulation model considers explicitly coordination cost as stemming from iterative administration procedures. Findings - The method is applied to an exemplary supply chain configuration considering various parameter settings. Curiously, additional coordination cost does not always result in improved logistic performance. Influence factor variations lead to different organizational recommendations. The results confirm the high importance of (up to now) disregarded dimensions when evaluating SCM concepts and IT tools. Research limitations/implications – The model is based on simplified product and network structures. Future research shall include more complex, real world configurations. Practical implications – The developed method is designed for the identification of improvement potential when SCM software is employed. Coordination schemes based only on ERP systems are valid alternatives in industrial practice because significant investment IT can be avoided. Therefore, the evaluation of these coordination procedures, in particular the cost due to iterations, is of high managerial interest and the method provides a comprehensive tool for strategic IT decision making. Originality/value – Reviewed literature is mostly focused on the benefits of SCM software implementations. However, ERP system based supply chain coordination is still widespread industrial practice but associated coordination cost has not been addressed by researchers.

Analysis of type of leadership within post of management in sport organizations in Madrid Community, since gender perspective

The aim of this study is to determine whether there are different types of leadership for men and women and within different job roles (Manager, Technical Director and Coordinator).

GovCloud: the usage of cloud computing in public organizations

It has been shown that cloud computing brings cost benefits and promotes efficiency in the operations of the organizations, no matter what their type or size. However, few public organizations are benefiting from this new paradigm shift in the way the organizations consume and manage computational resources. The objective of this thesis is to analyze both internal and external factors that may influence the adoption of cloud computing by public organizations and propose possible strategies that can assist these organizations in their path to cloud usage. In order to achieve this objective, a SWOT analysis has been conducted, detecting internal factors (strengths and weaknesses) and external factors (opportunities and threats) that can influence the adoption of a governmental cloud. With the application of a TOWS matrix, by combining the internal and external factors, a list of possible strategies have been formulated to be used as a guide to decision-making related to the transition to a cloud environment.