The relationship between hospital financial performance and information technology integration strategy selection

In light of the new healthcare regulations, hospitals are increasingly reevaluating their IT integration strategies to meet expanded healthcare information exchange requirements. Nevertheless, hospital executives do not have all the information they need to differentiate between the available strategies and recognize what may better fit their organizational needs. ^ In the interest of providing the desired information, this study explored the relationships between hospital financial performance, integration strategy selection, and strategy change. The integration strategies examined – applied as binary logistic regression dependent variables and in the order from most to least integrated – were Single-Vendor (SV), Best-of-Suite (BoS), and Best-of-Breed (BoB). In addition, the financial measurements adopted as independent variables for the models were two administrative labor efficiency and six industry standard financial ratios designed to provide a broad proxy of hospital financial performance. Furthermore, descriptive statistical analyses were carried out to evaluate recent trends in hospital integration strategy change. Overall six research questions were proposed for this study. ^ The first research question sought to answer if financial performance was related to the selection of integration strategies. The next questions, however, explored whether hospitals were more likely to change strategies or remain the same when there was no external stimulus to change, and if they did change, they would prefer strategies closer to the existing ones. These were followed by a question that inquired if financial performance was also related to strategy change. Nevertheless, rounding up the questions, the last two probed if the new Health Information Technology for Economic and Clinical Health (HITECH) Act had any impact on the frequency and direction of strategy change. ^ The results confirmed that financial performance is related to both IT integration strategy selection and strategy change, while concurred with prior studies that suggested hospital and environmental characteristics are associated factors as well. Specifically this study noted that the most integrated SV strategy is related to increased administrative labor efficiency and the hybrid BoS strategy is associated with improved financial health (based on operating margin and equity financing ratios). On the other hand, no financial indicators were found to be related to the least integrated BoB strategy, except for short-term liquidity (current ratio) when involving strategy change. ^ Ultimately, this study concluded that when making IT integration strategy decisions hospitals closely follow the resource dependence view of minimizing uncertainty. As each integration strategy may favor certain organizational characteristics, hospitals traditionally preferred not to make strategy changes and when they did, they selected strategies that were more closely related to the existing ones. However, as new regulations further heighten revenue uncertainty while require increased information integration, moving forward, as evidence already suggests a growing trend of organizations shifting towards more integrated strategies, hospitals may be more limited in their strategy selection choices.^

Efficiency from pharmacy inventory technology: A means to improving quality in non-profit hospitals

Hospitals, like all organizations, have both a mission and a finite supply of resources with which to accomplish that mission. Because the inventory of therapeutic drugs is among the more expensive resources needed by a hospital to achieve its mission, a conceptual model of structure plus process equals outcome posits that adequate emphasis should be placed on optimization of the organization's investment in this important structural resource to provide highest quality outcomes. Therefore emphasis should be placed on the optimization of pharmacy inventory because lowering the financial investment in drug inventory and associated costs increases productive efficiency, a key element of quality. ^ In this study, a post-intervention analysis of a hospital pharmacy inventory management technology implementation at The University of Texas M.D. Anderson Cancer Center was conducted to determine if an intervention which reduced a hospital's financial investment in pharmaceutical inventory provided an opportunity to incrementally optimize the organization's mix of structural resources thereby improving quality of care. The results suggest that hospital pharmacies currently lacking technology to support automated purchasing logistics and perpetual, real-time inventory management for drugs may achieve measurable benefits from the careful implementation of such technology, enabling the hospital to lower its investment in on-hand inventory and, potentially, to reduce overall purchasing expenditures. ^ The importance of these savings to the hospital and potentially to the patient should not be underestimated for their ability to generate funding for previously unfunded public health programs or in their ability to provide financial relief to patients in the form of lower drug costs given the current climate of escalating healthcare costs and tightening reimbursements.^

Low current performance of the Bern medical cyclotron down to the pA range

A medical cyclotron accelerating H- ions to 18 MeV is in operation at the Bern University Hospital (Inselspital). It is the commercial IBA 18/18 cyclotron equipped with a specifically conceived 6 m long external beam line ending in a separate bunker. This feature is unique for a hospital-based facility and makes it possible to conduct routine radioisotope production for PET diagnostics in parallel with multidisciplinary research activities, among which are novel particle detectors, radiation biophysics, radioprotection, radiochemistry and radiopharmacy developments. Several of these activities, such as radiobiology experiments for example, require low current beams down to the pA range, while medical cyclotrons are designed for high current operation above 10 μA. In this paper, we present the first results on the low current performance of a PET medical cyclotron obtained by ion source, radio-frequency and main coil tuning. With this method, stable beam currents down to (1.5+/- 0.5 ) pA were obtained and measured with a high-sensitivity Faraday cup located at the end of the beam transport line.

Student Reciprocal Peer Teaching as a Method for Active Learning: An Experience in an Electrotechnical Laboratory

Active learning is one of the most efficient mechanisms for learning, according to the psychology of learning. When students act as teachers for other students, the communication is more fluent and knowledge is transferred easier than in a traditional classroom. This teaching method is referred to in the literature as reciprocal peer teaching. In this study, the method is applied to laboratory sessions of a higher education institution course, and the students who act as teachers are referred to as ‘‘laboratory monitors.’’ A particular way to select the monitors and its impact in the final marks is proposed. A total of 181 students participated in the experiment, experiences with laboratory monitors are discussed, and methods for motivating and training laboratory monitors and regular students are proposed. The types of laboratory sessions that can be led by classmates are discussed. This work is related to the changes in teaching methods in the Spanish higher education system, prompted by the Bologna Process for the construction of the European Higher Education Area

Conceptual design of the liquid metal laboratory of the TECHNOFUSION facility

The application of liquid metal technology in fusion devices requires R&D related to many phenomena: interaction between liquid metals and structural material as corrosion, erosion and passivation techniques; magneto-hydrodynamics; free surface fluid-dynamics and any other physical aspect that will be needed for their safe reliable operation. In particular, there is a significant shortage of experimental facilities dedicated to the development of the lithium technology. In the framework of the TECHNOFUSION project, an experimental laboratory devoted to the lithium technology development is proposed, in order to shed some light in the path to IFMIF and the design of chamber's first wall and divertors. The conceptual design foresee a development in two stages, the first one consisting on a material testing loop. The second stage proposes the construction of a mock-up of the IFMIF target that will allow to assess the behaviour of a free-surface lithium target under vacuum conditions. In this paper, such conceptual design is addressed.

Design and control of multi-finger haptic devices for dexterous manipulation

En la interacción con el entorno que nos rodea durante nuestra vida diaria (utilizar un cepillo de dientes, abrir puertas, utilizar el teléfono móvil, etc.) y en situaciones profesionales (intervenciones médicas, procesos de producción, etc.), típicamente realizamos manipulaciones avanzadas que incluyen la utilización de los dedos de ambas manos. De esta forma el desarrollo de métodos de interacción háptica multi-dedo dan lugar a interfaces hombre-máquina más naturales y realistas. No obstante, la mayoría de interfaces hápticas disponibles en el mercado están basadas en interacciones con un solo punto de contacto; esto puede ser suficiente para la exploración o palpación del entorno pero no permite la realización de tareas más avanzadas como agarres. En esta tesis, se investiga el diseño mecánico, control y aplicaciones de dispositivos hápticos modulares con capacidad de reflexión de fuerzas en los dedos índice, corazón y pulgar del usuario. El diseño mecánico de la interfaz diseñada, ha sido optimizado con funciones multi-objetivo para conseguir una baja inercia, un amplio espacio de trabajo, alta manipulabilidad y reflexión de fuerzas superiores a 3 N en el espacio de trabajo. El ancho de banda y la rigidez del dispositivo se han evaluado mediante simulación y experimentación real. Una de las áreas más importantes en el diseño de estos dispositivos es el efector final, ya que es la parte que está en contacto con el usuario. Durante este trabajo se ha diseñado un dedal de bajo peso, adaptable a diferentes usuarios que, mediante la incorporación de sensores de contacto, permite estimar fuerzas normales y tangenciales durante la interacción con entornos reales y virtuales. Para el diseño de la arquitectura de control, se estudiaron los principales requisitos para estos dispositivos. Entre estos, cabe destacar la adquisición, procesado e intercambio a través de internet de numerosas señales de control e instrumentación; la computación de equaciones matemáticas incluyendo la cinemática directa e inversa, jacobiana, algoritmos de detección de agarres, etc. Todos estos componentes deben calcularse en tiempo real garantizando una frecuencia mínima de 1 KHz. Además, se describen sistemas para manipulación de precisión virtual y remota; así como el diseño de un método denominado "desacoplo cinemático iterativo" para computar la cinemática inversa de robots y la comparación con otros métodos actuales. Para entender la importancia de la interacción multimodal, se ha llevado a cabo un estudio para comprobar qué estímulos sensoriales se correlacionan con tiempos de respuesta más rápidos y de mayor precisión. Estos experimentos se desarrollaron en colaboración con neurocientíficos del instituto Technion Israel Institute of Technology. Comparando los tiempos de respuesta en la interacción unimodal (auditiva, visual y háptica) con combinaciones bimodales y trimodales de los mismos, se demuestra que el movimiento sincronizado de los dedos para generar respuestas de agarre se basa principalmente en la percepción háptica. La ventaja en el tiempo de procesamiento de los estímulos hápticos, sugiere que los entornos virtuales que incluyen esta componente sensorial generan mejores contingencias motoras y mejoran la credibilidad de los eventos. Se concluye que, los sistemas que incluyen percepción háptica dotan a los usuarios de más tiempo en las etapas cognitivas para rellenar información de forma creativa y formar una experiencia más rica. Una aplicación interesante de los dispositivos hápticos es el diseño de nuevos simuladores que permitan entrenar habilidades manuales en el sector médico. En colaboración con fisioterapeutas de Griffith University en Australia, se desarrolló un simulador que permite realizar ejercicios de rehabilitación de la mano. Las propiedades de rigidez no lineales de la articulación metacarpofalange del dedo índice se estimaron mediante la utilización del efector final diseñado. Estos parámetros, se han implementado en un escenario que simula el comportamiento de la mano humana y que permite la interacción háptica a través de esta interfaz. Las aplicaciones potenciales de este simulador están relacionadas con entrenamiento y educación de estudiantes de fisioterapia. En esta tesis, se han desarrollado nuevos métodos que permiten el control simultáneo de robots y manos robóticas en la interacción con entornos reales. El espacio de trabajo alcanzable por el dispositivo háptico, se extiende mediante el cambio de modo de control automático entre posición y velocidad. Además, estos métodos permiten reconocer el gesto del usuario durante las primeras etapas de aproximación al objeto para su agarre. Mediante experimentos de manipulación avanzada de objetos con un manipulador y diferentes manos robóticas, se muestra que el tiempo en realizar una tarea se reduce y que el sistema permite la realización de la tarea con precisión. Este trabajo, es el resultado de una colaboración con investigadores de Harvard BioRobotics Laboratory. ABSTRACT When we interact with the environment in our daily life (using a toothbrush, opening doors, using cell-phones, etc.), or in professional situations (medical interventions, manufacturing processes, etc.) we typically perform dexterous manipulations that involve multiple fingers and palm for both hands. Therefore, multi-Finger haptic methods can provide a realistic and natural human-machine interface to enhance immersion when interacting with simulated or remote environments. Most commercial devices allow haptic interaction with only one contact point, which may be sufficient for some exploration or palpation tasks but are not enough to perform advanced object manipulations such as grasping. In this thesis, I investigate the mechanical design, control and applications of a modular haptic device that can provide force feedback to the index, thumb and middle fingers of the user. The designed mechanical device is optimized with a multi-objective design function to achieve a low inertia, a large workspace, manipulability, and force-feedback of up to 3 N within the workspace; the bandwidth and rigidity for the device is assessed through simulation and real experimentation. One of the most important areas when designing haptic devices is the end-effector, since it is in contact with the user. In this thesis the design and evaluation of a thimble-like, lightweight, user-adaptable, and cost-effective device that incorporates four contact force sensors is described. This design allows estimation of the forces applied by a user during manipulation of virtual and real objects. The design of a real-time, modular control architecture for multi-finger haptic interaction is described. Requirements for control of multi-finger haptic devices are explored. Moreover, a large number of signals have to be acquired, processed, sent over the network and mathematical computations such as device direct and inverse kinematics, jacobian, grasp detection algorithms, etc. have to be calculated in Real Time to assure the required high fidelity for the haptic interaction. The Hardware control architecture has different modules and consists of an FPGA for the low-level controller and a RT controller for managing all the complex calculations (jacobian, kinematics, etc.); this provides a compact and scalable solution for the required high computation capabilities assuring a correct frequency rate for the control loop of 1 kHz. A set-up for dexterous virtual and real manipulation is described. Moreover, a new algorithm named the iterative kinematic decoupling method was implemented to solve the inverse kinematics of a robotic manipulator. In order to understand the importance of multi-modal interaction including haptics, a subject study was carried out to look for sensory stimuli that correlate with fast response time and enhanced accuracy. This experiment was carried out in collaboration with neuro-scientists from Technion Israel Institute of Technology. By comparing the grasping response times in unimodal (auditory, visual, and haptic) events with the response times in events with bimodal and trimodal combinations. It is concluded that in grasping tasks the synchronized motion of the fingers to generate the grasping response relies on haptic cues. This processing-speed advantage of haptic cues suggests that multimodalhaptic virtual environments are superior in generating motor contingencies, enhancing the plausibility of events. Applications that include haptics provide users with more time at the cognitive stages to fill in missing information creatively and form a richer experience. A major application of haptic devices is the design of new simulators to train manual skills for the medical sector. In collaboration with physical therapists from Griffith University in Australia, we developed a simulator to allow hand rehabilitation manipulations. First, the non-linear stiffness properties of the metacarpophalangeal joint of the index finger were estimated by using the designed end-effector; these parameters are implemented in a scenario that simulates the behavior of the human hand and that allows haptic interaction through the designed haptic device. The potential application of this work is related to educational and medical training purposes. In this thesis, new methods to simultaneously control the position and orientation of a robotic manipulator and the grasp of a robotic hand when interacting with large real environments are studied. The reachable workspace is extended by automatically switching between rate and position control modes. Moreover, the human hand gesture is recognized by reading the relative movements of the index, thumb and middle fingers of the user during the early stages of the approximation-to-the-object phase and then mapped to the robotic hand actuators. These methods are validated to perform dexterous manipulation of objects with a robotic manipulator, and different robotic hands. This work is the result of a research collaboration with researchers from the Harvard BioRobotics Laboratory. The developed experiments show that the overall task time is reduced and that the developed methods allow for full dexterity and correct completion of dexterous manipulations.

The ESA "Plasma Laboratory in Space" study

The European Space Agency has initiated, in the context of its General Studies Programme, a study of the possible use of space for studies in pure and applied plasma physics, in areas not traditionally covered by “space plasma physics”. A team of experts has been set-up to review a broad range of area including industrial plasma physics and pure plasma physics, astrophysical and solar-terrestrial areas. A set of experiments have been identified that can potentially provide access to new phenomena and to allow advances in several fields of plasma science. These experiments concern phenomena on spatial scale (102 to104 m) intermediate between what is achievable on ground experiment and usual solar system plasma observations.

AMELIE: Authoring Multimedia-Enhanced Learning Interactive Environment for medical contents

This paper presents the AMELIE Authoring Tool for medical e-learning applications. The tool allows for the creation of enhanced-video based didactic contents, and can be adjusted to any number of platforms and applications. Validation provides preliminary good results on its acceptance and usefulness.

AMELIE: Authoring Multimedia-Enhanced Learning Interactive Environment for medical contents

This paper presents the AMELIE Authoring Tool for medical e-learning applications. The tool allows for the creation of enhanced-video based didactic contents, and can be adjusted to any number of platforms and applications. Validation provides preliminary good results on its acceptance and usefulness.

Eliminación de nutrientes mediante tratamientos biopelícula : corrientes actuales y necesidades de investigación

Los tratamientos biopelícula fueron unos de los primeros tratamientos biológicos que se aplicaron en las aguas residuales. Los tratamientos biopelícula presentan importantes ventajas frente a los cultivos en suspensión, sin embargo, el control de los tratamientos biopelícula es complicado y su modelización también. Las bases teóricas del comportamiento de las biopelículas empezaron a desarrollarse fundamentalmente a partir de los años 80. Dado que el proceso es complejo con ecuaciones de difícil resolución, estas conceptualizaciones han sido consideradas durante años como ejercicios matemáticos más que como herramientas de diseño y simulación. Los diseños de los reactores estaban basados en experiencias de plantas piloto o en comportamientos empíricos de determinadas plantas. Las ecuaciones de diseño eran regresiones de los datos empíricos. La aplicabilidad de las ecuaciones se reducía a las condiciones particulares de la planta de la que provenían los datos empíricos. De tal forma que existía una gran variedad y diversidad de ecuaciones empíricas para cada tipo de reactor. La investigación médica durante los años 90 centró su atención en la formación y eliminación de las biopelículas. Gracias al desarrollo de nuevas prácticas de laboratorio que permitían estudiar el interior de las biopelículas y gracias también al aumento de la capacidad de los ordenadores, la simulación del comportamiento de las biopelículas tomó un nuevo impulso en esta década. El desarrollo de un tipo de biopelículas, fangos granulares, en condiciones aerobias realizando simultaneamente procesos de eliminación de nutrientes ha sido recientemente patentado. Esta patente ha recibido numerosos premios y reconocimientos internacionales tales como la Eurpean Invention Award (2012). En 1995 se descubrió que determinadas bacterias podían realizar un nuevo proceso de eliminación de nitrógeno denominado Anammox. Este nuevo tipo de proceso de eliminación de nitrógeno tiene el potencial de ofrecer importantes mejoras en el rendimiento de eliminación y en el consumo de energía. En los últimos 10 años, se han desarrollado una serie de tratamientos denominados “innovadores” de eliminación de nutrientes. Dado que no resulta posible el establecimiento de estas bacterias Anammox en fangos activos convencionales, normalmente se recurre al uso de cultivos biopelícula. La investigación se ha centrado en el desarrollo de estos procesos innovadores en cultivos biopelícula, en particular en los fangos granulares y MBBR e IFAs, con el objeto de establecer las condiciones bajo las cuales estos procesos se pueden desarrollar de forma estable. Muchas empresas y organizaciones buscan una segunda patente. Una cuestión principal en el desarrollo de estos procesos se encuentra la correcta selección de las condiciones ambientales y de operación para que unas bacterias desplacen a otras en el interior de las biopelículas. El diseño de plantas basado en cultivos biopelícula con procesos convencionales se ha realizado normalmente mediante el uso de métodos empíricos y semi-empíricos. Sin embargo, los criterios de selección avanzados aplicados en los Tratamientos Innovadores de Eliminación de Nitrógeno unido a la complejidad de los mecanismos de transporte de sustratos y crecimiento de la biomasa en las biopelículas, hace necesario el uso de herramientas de modelización para poder conclusiones no evidentes. Biofilms were one of the first biological treatments used in the wastewater treatment. Biofilms exhibit important advantages over suspended growth activated sludge. However, controlling biofilms growth is complicated and likewise its simulation. The theoretical underpinnings of biofilms performance began to be developed during 80s. As the equations that govern the growth of biofilms are complex and its resolution is challenging, these conceptualisations have been considered for years as mathematical exercises instead of practical design and simulation tools. The design of biofilm reactors has been based on performance information of pilot plants and specific plants. Most of the times, the designing equations were simple regressions of empirical data. The applicability of these equations were confined to the particular conditions of the plant from where the data came from. Consequently, there were a wide range of design equations for each type of reactor During 90s medical research focused its efforts on how biofilm´s growth with the ultimate goal of avoiding it. Thanks to the development of new laboratory techniques that allowed the study the interior of the biofilms and thanks as well to the development of the computers, simulation of biofilms’ performance had a considerable evolution during this decade. In 1995 it was discovered that certain bacteria can carry out a new sort of nutrient removal process named Anammox. This new type of nutrient removal process potentially can enhance considerably the removal performance and the energy consumption. In the last decade, it has been developed a range of treatments based on the Anammox generally named “Innovative Nutrient Removal Treatments”. As it is not possible to cultivate Anammox bacteria in activated sludge, normally scientists and designers resort to the use of biofilms. A critical issue in the development of these innovative processes is the correct selection of environment and operation conditions so as to certain bacterial population displace to others bacteria within the biofilm. The design of biofilm technology plants is normally based on the use of empirical and semi-empirical methods. However, the advanced control strategies used in the Innovative Nutrient Removal Processes together with the complexity of the mass transfer and biomass growth in biofilms, require the use of modeling tools to be able to set non evident conclusions.

Neutron field characteristics of Ciemat's Neutron Standards Laboratory Hector Rene Vega-Carrillo

Monte Carlo calculations were carried out to characterize the neutron field produced by the calibration neutron sources of the Neutron Standards Laboratory at the Research Center for Energy, Environment and Technology (CIEMAT) in Spain. For 241AmBe and 252Cf neutron sources, the neutron spectra, the ambient dose equivalent rates and the total neutron fluence rates were estimated. In the calibration hall, there are several items that modify the neutron field. To evaluate their effects different cases were used, from point-like source in vacuum up to the full model. Additionally, using the full model, the neutron spectra were estimated to different distances along the bench; with these spectra, the total neutron fluence and the ambient dose equivalent rates were calculated. The hall walls induce the largest changes in the neutron spectra and the respective integral quantities. The free-field neutron spectrum is modified due the room return effect.

Why do health economists promote technology adoption rather than the search for efficiency? A proposal for a change in our approach to economic evaluation in health care

Acknowledgments Financial Support: HERU and HSRU receive a core grant from the Chief Scientist’s Office of the Scottish Government Health and Social Care Directorates, and the Centre for Clinical epidemiology & Evaluation is funded by Vancouver Coastal Health Authority. The model used for the illustrative case study in this paper was developed as part of a NHS Technology Assessment Review, funded by the National Institute for Health Research (NIHR) Health Technology Assessment Program (project number 09/146/01). The views and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the Scottish Government, NHS, Vancouver Coastal Health, NIHR HTA Program or the Department of Health. The authors wish to thank Kathleen Boyd and members of the audience at the UK Health Economists Study Group, for comments received on an earlier version of this paper. We also wish to thank Cynthia Fraser (University of Aberdeen) for literature searches undertaken to inform the manuscript, and Mohsen Sadatsafavi (University of British Columbia) for comments on an earlier draft

Republican Scientific-Medical Library, The Republic of Armenia: progress and programs*

In 1990, the Republican Scientific-Medical Library (RSML) of the Ministry of Health of Armenia in collaboration with the Fund for Armenian Relief created a vision of a national library network supported by information technology. This vision incorporated four goals: (1) to develop a national resource collection of biomedical literature accessible to all health professionals, (2) to develop a national network for access to bibliographic information, (3) to develop a systematic mechanism for sharing resources, and (4) to develop a national network of health sciences libraries. During the last decade, the RSML has achieved significant progress toward all four goals and has realized its vision of becoming a fully functional national library. The RSML now provides access to the literature of the health sciences including access to the Armenian medical literature, provides education and training to health professionals and health sciences librarians, and manages a national network of libraries of the major health care institutions in Armenia. The RSML is now able to provide rapid access to the biomedical literature and train health professionals and health sciences librarians in Armenia in information system use. This paper describes the evolution of the RSML and how it was accomplished.