Corporate decision-making: A case study of decision support systems and financial performance in health care organizations

The purpose of this study was twofold: (1) To describe the relation of the intensity of DSS implementation to financial performance as an empirical exploration of improved performance at the organizational level. (2) To describe the relation of the intensity of DSS implementation to the type of organizational decision culture. A multiple case study design was utilized to compare three groups of paired cases. A pattern matching strategy was applied in this study. Four predictions were specified and compared to the empirical data. A progressively upward trend in the scores was predicted for the following theoretical relationships. (1) The greater the number of DSSs, the higher the sophistication index. (2) The greater the number of DSSs, the higher the financial ratios. (3) The greater the number of DSSs, the higher the culture score. (4) The higher the culture score, the higher the financial ratios. The data did not support any of the predicted trends except the relation between the number of DSSs and the financial ratios. The Income/Revenue ratio indicates the efficiency of a company's operations. One would expect that this ratio would be most affected by the operational and financial decision support systems. The majority of the systems measured in the study supported decisions tangential to the patient service areas. The evidence suggested that the type and number of decision support systems affects the bottom line. ^

Measurement of isotopic uranium in water for compliance monitoring by liquid scintillation counting with alpha/beta discrimination

A simple and inexpensive method is described for analysis of uranium (U) activity and mass in water by liquid scintillation counting using $\alpha$/$\beta$ discrimination. This method appears to offer a solution to the need for an inexpensive protocol for monitoring U activity and mass simultaneously and an alternative to the potential inaccuracy involved when depending on the mass-to-activity conversion factor or activity screen.^ U is extracted virtually quantitatively into 20 ml extractive scintillator from a 1-$\ell$ aliquot of water acidified to less than pH 2. After phase separation, the sample is counted for a 20-minute screening count with a minimum detection level of 0.27 pCi $\ell\sp{-1}$. $\alpha$-particle emissions from the extracted U are counted with close to 100% efficiency with a Beckman LS6000 LL liquid scintillation counter equipped with pulse-shape discrimination electronics. Samples with activities higher than 10 pCi $\ell\sp-1$ are recounted for 500-1000 minutes for isotopic analysis. Isotopic analysis uses events that are automatically stored in spectral files and transferred to a computer during assay. The data can be transferred to a commercially available spreadsheet and retrieved for examination or data manipulation. Values for three readily observable spectral features can be rapidly identified by data examination and substituted into a simple formula to obtain $\sp{234}$U/$\sp{238}$U ratio for most samples. U mass is calculated by substituting the isotopic ratio value into a simple equation.^ The utility of this method for the proposed compliance monitoring of U in public drinking water supplies was field tested with a survey of drinking water from Texas supplies that had previously been known to contain elevated levels of gross $\alpha$ activity. U concentrations in 32 samples from 27 drinking water supplies ranged from 0.26 to 65.5 pCi $\ell\sp{-1}$, with seven samples exceeding the proposed Maximum Contaminant Level of 20 $\mu$g $\ell\sp{-1}$. Four exceeded the proposed activity screening level of 30 pCi $\ell\sp{-1}$. Isotopic ratios ranged from 0.87 to 41.8, while one sample contained $\sp{234}$U activity of 34.6 pCi $\ell\sp{-1}$ in the complete absence of its parent, $\sp{238}$U. U mass in the samples with elevated activity ranged from 0.0 to 103 $\mu$g $\ell\sp{-1}$. A limited test of screening surface and groundwaters for contamination by U from waste sites and natural processes was also successful. ^

Errors in the administration of medication in inpatient hospitals: A systematic review of the research literature on commercial computerized physician order entry systems

Errors in the administration of medication represent a significant loss of medical resources and pose life altering or life threatening risks to patients. This paper considered the question, what impact do Computerized Physician Order Entry (CPOE) systems have on medication errors in the hospital inpatient environment? Previous reviews have examined evidence of the impact of CPOE on medication errors, but have come to ambiguous conclusions as to the impact of CPOE and decision support systems (DSS). Forty-three papers were identified. Thirty-one demonstrated a significant reduction in prescribing error rates for all or some drug types; decreases in minor errors were most often reported. Several studies reported increases in the rate of duplicate orders and failures to remove contraindicated drugs, often attributed to inappropriate design or to an inability to operate the system properly. The evidence on the effectiveness of CPOE to reduce errors in medication administration is compelling though it is limited by modest study sample sizes and designs. ^

Spatial distribution of orofacial cleft birth defects and uranium-radium concentrations in tap water in Atascosa, Bee, Brooks, Calhoun, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kleberg, Live Oak, McMullen, Nueces, San Patricio, Refugio, Starr, Victoria, Webb, and Zavala Counties, Texas

Background Past and recent evidence shows that radionuclides in drinking water may be a public health concern. Developmental thresholds for birth defects with respect to chronic low level domestic radiation exposures, such as through drinking water, have not been definitely recognized, and there is a strong need to address this deficiency in information. In this study we examined the geographic distribution of orofacial cleft birth defects in and around uranium mining district Counties in South Texas (Atascosa, Bee, Brooks, Calhoun, Duval, Goliad, Hidalgo, Jim Hogg, Jim Wells, Karnes, Kleberg, Live Oak, McMullen, Nueces, San Patricio, Refugio, Starr, Victoria, Webb, and Zavala), from 1999 to 2007. The probable association of cleft birth defect rates by ZIP codes classified according to uranium and radium concentrations in drinking water supplies was evaluated. Similar associations between orofacial cleft birth defects and radium/radon in drinking water were reported earlier by Cech and co-investigators in another of the Gulf Coast region (Harris County, Texas).50, 55 Since substantial uranium mining activity existed and still exists in South Texas, contamination of drinking water sources with radiation and its relation to birth defects is a ground for concern. ^ Methods Residential addresses of orofacial cleft birth defect cases, as well as live births within the twenty Counties during 1999-2007 were geocoded and mapped. Prevalence rates were calculated by ZIP codes and were mapped accordingly. Locations of drinking water supplies were also geocoded and mapped. ZIP codes were stratified as having high combined uranium (≥30μg/L) vs. low combined uranium (<30μg/L). Likewise, ZIP codes having the uranium isotope, Ra-226 in drinking water, were also stratified as having elevated radium (≥3 pCi/L) vs. low radium (<3 pCi/L). A linear regression was performed using STATA® generalized linear model (GLM) program to evaluate the probable association between cleft birth defect rates by ZIP codes and concentration of uranium and radium via domestic water supply. These rates were further adjusted for potentially confounding variables such as maternal age, education, occupation, and ethnicity. ^ Results This study showed higher rates of cleft births in ZIP codes classified as having high combined uranium versus ZIP codes having low combined uranium. The model was further improved by adding radium stratified as explained above. Adjustment for maternal age and ethnicity did not substantially affect the statistical significance of uranium or radium concentrations in household water supplies. ^ Conclusion Although this study lacks individual exposure levels, the findings suggest a significant association between elevated uranium and radium concentrations in tap water and high orofacial birth defect rates by ZIP codes. Future case-control studies that can measure individual exposure levels and adjust for contending risk factors could result in a better understanding of the exposure-disease association.^

Comparison of two strategies for the treatment of acute myocardial infarction: In-hospital outcomes analysis

A strategy of pre-hospital reduced dose fibrinolytic administration coupled with urgent coronary intervention (PCI) for patients with STEMI (FAST-PCI) has been found to be superior to primary PCI (PPCI) alone. A coordinated STEMI system-of-care that includes FAST-PCI might offer better outcomes than pre-hospital diagnosis and STEMI team activation followed by PPCI alone. We compared the in-hospital outcomes for patients treated with the FAST-PCI approach with outcomes for patients treated with the PPCI approach during a pause in the FAST-PCI protocol. In-hospital data for 253 STEMI patients (03/2003–12/2009), treated with FAST-PCI protocol were compared to 124 patients (12/2009–08/2011), treated with PPCI strategy alone. In-hospital mortality was the primary endpoint. Stroke, major bleeding, and reinfarction during index hospitalization were secondary endpoints. Comparing the strategies used during the two time intervals, in-hospital mortality was significantly lower with FAST-PCI than with PPCI (2.77% vs. 10.48%, p = 0.0017). Rates of stroke, reinfarction and major bleeding were similar between the two groups. There was a lower frequency of pre- PCI TIMI 0 flow (no patency) seen in patients treated with FAST-PCI compared to the PPCI patients (26.7% vs. 62.7%, p<0.0001). Earlier infarct related artery patency in the FAST-PCI group had a favorable impact on the incidence of cardiogenic shock at hospital admission (FAST-PCI- 3.1% vs. PPCI- 20.9%, p<0.0001). The FAST-PCI strategy was associated with earlier infarct related artery patency and the lower incidence of cardiogenic shock on hospital arrival, as well as with reduced in-hospital mortality among STEMI patients.^

Isotopic signature of specific biomarkers derived from anaerobic methanotrophic archaea (ANME groups) and sulphate-reducing bacteria (SRB) at different cold seep provinces

Anaerobic methane-oxidizing microbial communities in sediments at cold methane seeps are important factors in controlling methane emission to the ocean and atmosphere. Here, we investigated the distribution and carbon isotopic signature of specific biomarkers derived from anaerobic methanotrophic archaea (ANME groups) and sulphate-reducing bacteria (SRB) responsible for the anaerobic oxidation of methane (AOM) at different cold seep provinces of Hydrate Ridge, Cascadia margin. The special focus was on their relation to in situ cell abundances and methane turnover. In general, maxima in biomarker abundances and minima in carbon isotope signatures correlated with maxima in AOM and sulphate reduction as well as with consortium biomass. We found ANME-2a/DSS aggregates associated with high abundances of sn-2,3-di-O-isoprenoidal glycerol ethers (archaeol, sn-2-hydroxyarchaeol) and specific bacterial fatty acids (C16:1omega5c, cyC17:0omega5,6) as well as with high methane fluxes (Beggiatoa site). The low to medium flux site (Calyptogena field) was dominated by ANME-2c/DSS aggregates and contained less of both compound classes but more of AOM-related glycerol dialkyl glycerol tetraethers (GDGTs). ANME-1 archaea dominated deeper sediment horizons at the Calyptogena field where sn-1,2-di-O-alkyl glycerol ethers (DAGEs), archaeol, methyl-branched fatty acids (ai-C15:0, i-C16:0, ai-C17:0), and diagnostic GDGTs were prevailing. AOM-specific bacterial and archaeal biomarkers in these sediment strata generally revealed very similar d13C-values of around -100 per mill. In ANME-2-dominated sediment sections, archaeal biomarkers were even more 13C-depleted (down to -120 per mill), whereas bacterial biomarkers were found to be likewise 13C-depleted as in ANME-1-dominated sediment layers (d13C: -100 per mill). The zero flux site (Acharax field), containing only a few numbers of ANME-2/DSS aggregates, however, provided no specific biomarker pattern. Deeper sediment sections (below 20 cm sediment depth) from Beggiatoa covered areas which included solid layers of methane gas hydrates contained ANME-2/DSS typical biomarkers showing subsurface peaks combined with negative shifts in carbon isotopic compositions. The maxima were detected just above the hydrate layers, indicating that methane stored in the hydrates may be available for the microbial community. The observed variations in biomarker abundances and 13C-depletions are indicative of multiple environmental and physiological factors selecting for different AOM consortia (ANME-2a/DSS, ANME-2c/DSS, ANME-1) along horizontal and vertical gradients of cold seep settings.

Habilitaciones, ubicuidad y apropiaciones de los nuevos medios digitales en el espacio escolar a partir del Plan Conectar Igualdad

El objetivo de esta ponencia es describir los usos y apropiaciones de los nuevos medios digitales que realizan jóvenes de sectores populares beneficiarios del plan estatal Conectar Igualdad (PCI) de la ciudad de La Plata y Berisso. En base a primeras interpretaciones de una investigación en desarrollo, se intenta comprender la productividad de ciertos cursos de acción a los que la incorporación masiva de las netbooks en el escenario escolar habilita. Centralmente, la posibilidad y disponibilidad de acceso a las redes sociales como Facebook. Lo que a su vez contribuye a explicar la ubicuidad que estas plataformas muestran en las tramas cotidianas de estos jóvenes

Estar o no estar actualizado, esa es la cuestión : La apropiación de la computadora e Internet por jóvenes de sectores populares en el marco de la implementación del Programa Conectar Igualdad

La presente investigación tiene como objetivo comprender de qué manera se vinculan la desigualdad social y la apropiación de computadoras e Internet. Para ello, a través de una estrategia metodológica cualitativa, se indaga en los procesos de apropiación de computadoras e Internet por parte de jóvenes estudiantes de sectores populares, en el contexto de implementación de una política universal como el Programa Conectar Igualdad (PCI). El trabajo de campo se llevó a cabo en una escuela secundaria pública de Berisso y consistió en la realización de entrevistas semiestructuradas en profundidad con jóvenes que encontraban cursando entre 3ro a 5to año. A partir del análisis del material empírico pudimos reconstruir momentos y características, así como distinguir actores y lugares principales del proceso de apropiación de la computadora e Internet, entre los que se destacan el grupo de amigos, la familia y los cibers barriales. A su vez, identificamos transformaciones en las condiciones de acceso a las tecnologías a partir de la compra de una computadora o de la llegada del PCI. Asimismo, logramos aproximarnos a las representaciones que los jóvenes han construido en torno a la computadora e Internet, entre la que se destaca la idea de ?estar siempre actualizado?; y a los usos para ellos más significativos, en donde sobresalen los ligados a la comunicación con amigos y el entretenimiento. Teniendo en cuenta nuestros hallazgos, consideramos que para los jóvenes entrevistados, a partir de la apropiación de la computadora e Internet, se han abierto nuevas posibilidades de elección y gestión de amplias dimensiones de la vida cotidiana, las cuales contribuyen a aliviar las desigualdades materiales y simbólicas

Estar o no estar actualizado, esa es la cuestión : La apropiación de la computadora e Internet por jóvenes de sectores populares en el marco de la implementación del Programa Conectar Igualdad

La presente investigación tiene como objetivo comprender de qué manera se vinculan la desigualdad social y la apropiación de computadoras e Internet. Para ello, a través de una estrategia metodológica cualitativa, se indaga en los procesos de apropiación de computadoras e Internet por parte de jóvenes estudiantes de sectores populares, en el contexto de implementación de una política universal como el Programa Conectar Igualdad (PCI). El trabajo de campo se llevó a cabo en una escuela secundaria pública de Berisso y consistió en la realización de entrevistas semiestructuradas en profundidad con jóvenes que encontraban cursando entre 3ro a 5to año. A partir del análisis del material empírico pudimos reconstruir momentos y características, así como distinguir actores y lugares principales del proceso de apropiación de la computadora e Internet, entre los que se destacan el grupo de amigos, la familia y los cibers barriales. A su vez, identificamos transformaciones en las condiciones de acceso a las tecnologías a partir de la compra de una computadora o de la llegada del PCI. Asimismo, logramos aproximarnos a las representaciones que los jóvenes han construido en torno a la computadora e Internet, entre la que se destaca la idea de ?estar siempre actualizado?; y a los usos para ellos más significativos, en donde sobresalen los ligados a la comunicación con amigos y el entretenimiento. Teniendo en cuenta nuestros hallazgos, consideramos que para los jóvenes entrevistados, a partir de la apropiación de la computadora e Internet, se han abierto nuevas posibilidades de elección y gestión de amplias dimensiones de la vida cotidiana, las cuales contribuyen a aliviar las desigualdades materiales y simbólicas

Habilitaciones, ubicuidad y apropiaciones de los nuevos medios digitales en el espacio escolar a partir del Plan Conectar Igualdad

El objetivo de esta ponencia es describir los usos y apropiaciones de los nuevos medios digitales que realizan jóvenes de sectores populares beneficiarios del plan estatal Conectar Igualdad (PCI) de la ciudad de La Plata y Berisso. En base a primeras interpretaciones de una investigación en desarrollo, se intenta comprender la productividad de ciertos cursos de acción a los que la incorporación masiva de las netbooks en el escenario escolar habilita. Centralmente, la posibilidad y disponibilidad de acceso a las redes sociales como Facebook. Lo que a su vez contribuye a explicar la ubicuidad que estas plataformas muestran en las tramas cotidianas de estos jóvenes

Estar o no estar actualizado, esa es la cuestión : La apropiación de la computadora e Internet por jóvenes de sectores populares en el marco de la implementación del Programa Conectar Igualdad

La presente investigación tiene como objetivo comprender de qué manera se vinculan la desigualdad social y la apropiación de computadoras e Internet. Para ello, a través de una estrategia metodológica cualitativa, se indaga en los procesos de apropiación de computadoras e Internet por parte de jóvenes estudiantes de sectores populares, en el contexto de implementación de una política universal como el Programa Conectar Igualdad (PCI). El trabajo de campo se llevó a cabo en una escuela secundaria pública de Berisso y consistió en la realización de entrevistas semiestructuradas en profundidad con jóvenes que encontraban cursando entre 3ro a 5to año. A partir del análisis del material empírico pudimos reconstruir momentos y características, así como distinguir actores y lugares principales del proceso de apropiación de la computadora e Internet, entre los que se destacan el grupo de amigos, la familia y los cibers barriales. A su vez, identificamos transformaciones en las condiciones de acceso a las tecnologías a partir de la compra de una computadora o de la llegada del PCI. Asimismo, logramos aproximarnos a las representaciones que los jóvenes han construido en torno a la computadora e Internet, entre la que se destaca la idea de ?estar siempre actualizado?; y a los usos para ellos más significativos, en donde sobresalen los ligados a la comunicación con amigos y el entretenimiento. Teniendo en cuenta nuestros hallazgos, consideramos que para los jóvenes entrevistados, a partir de la apropiación de la computadora e Internet, se han abierto nuevas posibilidades de elección y gestión de amplias dimensiones de la vida cotidiana, las cuales contribuyen a aliviar las desigualdades materiales y simbólicas

Evaluación de bibliotecas universitarias : Una propuesta desde las perspectivas objetiva y subjetiva

Tabla de contenidos: Consideraciones generales / Marcela Fushimi, Sandra Miguel. Evaluación objetiva / Marcela Fushimi. Evaluación subjetiva / Mónica G. Pené, Cecilia Rozemblum. La medición del impacto en bibliotecas universitarias / Claudia González, Sandra Miguel. Las críticas a la metodología y los problemas de contexto / Mariana Pichinini.

Habilitaciones, ubicuidad y apropiaciones de los nuevos medios digitales en el espacio escolar a partir del Plan Conectar Igualdad

El objetivo de esta ponencia es describir los usos y apropiaciones de los nuevos medios digitales que realizan jóvenes de sectores populares beneficiarios del plan estatal Conectar Igualdad (PCI) de la ciudad de La Plata y Berisso. En base a primeras interpretaciones de una investigación en desarrollo, se intenta comprender la productividad de ciertos cursos de acción a los que la incorporación masiva de las netbooks en el escenario escolar habilita. Centralmente, la posibilidad y disponibilidad de acceso a las redes sociales como Facebook. Lo que a su vez contribuye a explicar la ubicuidad que estas plataformas muestran en las tramas cotidianas de estos jóvenes

Anaerobic methanotrophic archaea-2 and Desulfosarcina/Desulfococcus group in sediments at different stations

The anaerobic oxidation of methane (AOM) with sulfate as terminal electron acceptor is mediated by consortia of methanotrophic archaea (ANME) and sulfate-reducing bacteria (SRB). In sediment samples from Hydrate Ridge, the Isis Mud Volcano and the Gulf of Mexico, DSS cells accounted for 3-6% of all DAPI-stained single cells. Out of these, 8-17% were labelled with probe SEEP1a-1441. This translated into relative abundances of single SEEP-SRB1a cells of 0.3% to 0.7%. Contrastingly, in a sediment sample from the Gullfaks oil field, DSS cells accounted for 18% and SEEP-SRB1a for 9% of all single cells. This sediment sample also featured an unusually high abundance of single ANME-2 cells and only very few ANME-2/DSS aggregates in comparison with other AOM habitats. Considering also the nature of the sample, it is likely that the high number of single ANME-2 and SEEP-SRB1a cells were an artifact of sample preparation. Here, harsher sonication was required to remove the microorganisms from coarse sand prior to CARD-FISH analysis.

NetCDF based data archiving system applied to ITER Fast Plant System Control prototype

EURATOM/CIEMAT and Technical University of Madrid (UPM) have been involved in the development of a FPSC [1] (Fast Plant System Control) prototype for ITER, based on PXIe (PCI eXtensions for Instrumentation). One of the main focuses of this project has been data acquisition and all the related issues, including scientific data archiving. Additionally, a new data archiving solution has been developed to demonstrate the obtainable performances and possible bottlenecks of scientific data archiving in Fast Plant System Control. The presented system implements a fault tolerant architecture over a GEthernet network where FPSC data are reliably archived on remote, while remaining accessible to be redistributed, within the duration of a pulse. The storing service is supported by a clustering solution to guaranty scalability, so that FPSC management and configuration may be simplified, and a unique view of all archived data provided. All the involved components have been integrated under EPICS [2] (Experimental Physics and Industrial Control System), implementing in each case the necessary extensions, state machines and configuration process variables. The prototyped solution is based on the NetCDF-4 [3] and [4] (Network Common Data Format) file format in order to incorporate important features, such as scientific data models support, huge size files management, platform independent codification, or single-writer/multiple-readers concurrency. In this contribution, a complete description of the above mentioned solution is presented, together with the most relevant results of the tests performed, while focusing in the benefits and limitations of the applied technologies.