Procedimenti di ottimizzazione di sistemi smorzati

La presente tesi riguarda lo studio di procedimenti di ottimizzazione di sistemi smorzati. In particolare, i sistemi studiati sono strutture shear-type soggette ad azioni di tipo sismico impresse alla base. Per effettuare l’ottimizzazione dei sistemi in oggetto si agisce sulle rigidezze di piano e sui coefficienti di smorzamento effettuando una ridistribuzione delle quantità suddette nei piani della struttura. È interessante effettuare l’ottimizzazione di sistemi smorzati nell’ottica della progettazione antisismica, in modo da ridurre la deformata della struttura e, conseguentemente, anche le sollecitazioni che agiscono su di essa. Il lavoro consta di sei capitoli nei quali vengono affrontate tre procedure numerico-analitiche per effettuare l’ottimizzazione di sistemi shear-type. Nel primo capitolo si studia l’ottimizzazione di sistemi shear-type agendo su funzioni di trasferimento opportunamente vincolate. In particolare, le variabili di progetto sono le rigidezze di piano, mentre i coefficienti di smorzamento e le masse di piano risultano quantità note e costanti durante tutto il procedimento di calcolo iterativo; per effettuare il controllo dinamico della struttura si cerca di ottenere una deformata pressoché rettilinea. Tale condizione viene raggiunta ponendo le ampiezze delle funzioni di trasferimento degli spostamenti di interpiano pari all’ampiezza della funzione di trasferimento del primo piano. Al termine della procedura si ottiene una ridistribuzione della rigidezza complessiva nei vari piani della struttura. In particolare, si evince un aumento della rigidezza nei piani più bassi che risultano essere quelli più sollecitati da una azione impressa alla base e, conseguentemente, si assiste ad una progressiva riduzione della variabile di progetto nei piani più alti. L’applicazione numerica di tale procedura viene effettuata nel secondo capitolo mediante l’ausilio di un programma di calcolo in linguaggio Matlab. In particolare, si effettua lo studio di sistemi a tre e a cinque gradi di libertà. La seconda procedura numerico-analitica viene presentata nel terzo capitolo. Essa riguarda l’ottimizzazione di sistemi smorzati agendo simultaneamente sulla rigidezza e sullo smorzamento e consta di due fasi. La prima fase ricerca il progetto ottimale della struttura per uno specifico valore della rigidezza complessiva e dello smorzamento totale, mentre la seconda fase esamina una serie di progetti ottimali in funzione di diversi valori della rigidezza e dello smorzamento totale. Nella prima fase, per ottenere il controllo dinamico della struttura, viene minimizzata la somma degli scarti quadratici medi degli spostamenti di interpiano. Le variabili di progetto, aggiornate dopo ogni iterazione, sono le rigidezze di piano ed i coefficienti di smorzamento. Si pone, inoltre, un vincolo sulla quantità totale di rigidezza e di smorzamento, e i valori delle rigidezze e dei coefficienti di smorzamento di ogni piano non devono superare un limite superiore posto all’inizio della procedura. Anche in questo caso viene effettuata una ridistribuzione delle rigidezze e dei coefficienti di smorzamento nei vari piani della struttura fino ad ottenere la minimizzazione della funzione obiettivo. La prima fase riduce la deformata della struttura minimizzando la somma degli scarti quadrarici medi degli spostamenti di interpiano, ma comporta un aumento dello scarto quadratico medio dell’accelerazione assoluta dell’ultimo piano. Per mantenere quest’ultima quantità entro limiti accettabili, si passa alla seconda fase in cui si effettua una riduzione dell’accelerazione attraverso l’aumento della quantità totale di smorzamento. La procedura di ottimizzazione di sistemi smorzati agendo simultaneamente sulla rigidezza e sullo smorzamento viene applicata numericamente, mediante l’utilizzo di un programma di calcolo in linguaggio Matlab, nel capitolo quattro. La procedura viene applicata a sistemi a due e a cinque gradi di libertà. L’ultima parte della tesi ha come oggetto la generalizzazione della procedura che viene applicata per un sistema dotato di isolatori alla base. Tale parte della tesi è riportata nel quinto capitolo. Per isolamento sismico di un edificio (sistema di controllo passivo) si intende l’inserimento tra la struttura e le sue fondazioni di opportuni dispositivi molto flessibili orizzontalmente, anche se rigidi in direzione verticale. Tali dispositivi consentono di ridurre la trasmissione del moto del suolo alla struttura in elevazione disaccoppiando il moto della sovrastruttura da quello del terreno. L’inserimento degli isolatori consente di ottenere un aumento del periodo proprio di vibrare della struttura per allontanarlo dalla zona dello spettro di risposta con maggiori accelerazioni. La principale peculiarità dell’isolamento alla base è la possibilità di eliminare completamente, o quantomeno ridurre sensibilmente, i danni a tutte le parti strutturali e non strutturali degli edifici. Quest’ultimo aspetto è importantissimo per gli edifici che devono rimanere operativi dopo un violento terremoto, quali ospedali e i centri operativi per la gestione delle emergenze. Nelle strutture isolate si osserva una sostanziale riduzione degli spostamenti di interpiano e delle accelerazioni relative. La procedura di ottimizzazione viene modificata considerando l’introduzione di isolatori alla base di tipo LRB. Essi sono costituiti da strati in elastomero (aventi la funzione di dissipare, disaccoppiare il moto e mantenere spostamenti accettabili) alternati a lamine in acciaio (aventi la funzione di mantenere una buona resistenza allo schiacciamento) che ne rendono trascurabile la deformabilità in direzione verticale. Gli strati in elastomero manifestano una bassa rigidezza nei confronti degli spostamenti orizzontali. La procedura di ottimizzazione viene applicata ad un telaio shear-type ad N gradi di libertà con smorzatori viscosi aggiunti. Con l’introduzione dell’isolatore alla base si passa da un sistema ad N gradi di libertà ad un sistema a N+1 gradi di libertà, in quanto l’isolatore viene modellato alla stregua di un piano della struttura considerando una rigidezza e uno smorzamento equivalente dell’isolatore. Nel caso di sistema sheat-type isolato alla base, poiché l’isolatore agisce sia sugli spostamenti di interpiano, sia sulle accelerazioni trasmesse alla struttura, si considera una nuova funzione obiettivo che minimizza la somma incrementata degli scarti quadratici medi degli spostamenti di interpiano e delle accelerazioni. Le quantità di progetto sono i coefficienti di smorzamento e le rigidezze di piano della sovrastruttura. Al termine della procedura si otterrà una nuova ridistribuzione delle variabili di progetto nei piani della struttura. In tal caso, però, la sovrastruttura risulterà molto meno sollecitata in quanto tutte le deformazioni vengono assorbite dal sistema di isolamento. Infine, viene effettuato un controllo sull’entità dello spostamento alla base dell’isolatore perché potrebbe raggiungere valori troppo elevati. Infatti, la normativa indica come valore limite dello spostamento alla base 25cm; valori più elevati dello spostamento creano dei problemi soprattutto per la realizzazione di adeguati giunti sismici. La procedura di ottimizzazione di sistemi isolati alla base viene applicata numericamente mediante l’utilizzo di un programma di calcolo in linguaggio Matlab nel sesto capitolo. La procedura viene applicata a sistemi a tre e a cinque gradi di libertà. Inoltre si effettua il controllo degli spostamenti alla base sollecitando la struttura con il sisma di El Centro e il sisma di Northridge. I risultati hanno mostrato che la procedura di calcolo è efficace e inoltre gli spostamenti alla base sono contenuti entro il limite posto dalla normativa. Giova rilevare che il sistema di isolamento riduce sensibilmente le grandezze che interessano la sovrastruttura, la quale si comporta come un corpo rigido al di sopra dell’isolatore. In futuro si potrà studiare il comportamento di strutture isolate considerando diverse tipologie di isolatori alla base e non solo dispositivi elastomerici. Si potrà, inoltre, modellare l’isolatore alla base con un modello isteretico bilineare ed effettuare un confronto con i risultati già ottenuti per il modello lineare.

Bioremediation of PAHs - Limitations and soultions

Introduction 1.1 Occurrence of polycyclic aromatic hydrocarbons (PAH) in the environment Worldwide industrial and agricultural developments have released a large number of natural and synthetic hazardous compounds into the environment due to careless waste disposal, illegal waste dumping and accidental spills. As a result, there are numerous sites in the world that require cleanup of soils and groundwater. Polycyclic aromatic hydrocarbons (PAHs) are one of the major groups of these contaminants (Da Silva et al., 2003). PAHs constitute a diverse class of organic compounds consisting of two or more aromatic rings with various structural configurations (Prabhu and Phale, 2003). Being a derivative of benzene, PAHs are thermodynamically stable. In addition, these chemicals tend to adhere to particle surfaces, such as soils, because of their low water solubility and strong hydrophobicity, and this results in greater persistence under natural conditions. This persistence coupled with their potential carcinogenicity makes PAHs problematic environmental contaminants (Cerniglia, 1992; Sutherland, 1992). PAHs are widely found in high concentrations at many industrial sites, particularly those associated with petroleum, gas production and wood preserving industries (Wilson and Jones, 1993). 1.2 Remediation technologies Conventional techniques used for the remediation of soil polluted with organic contaminants include excavation of the contaminated soil and disposal to a landfill or capping - containment - of the contaminated areas of a site. These methods have some drawbacks. The first method simply moves the contamination elsewhere and may create significant risks in the excavation, handling and transport of hazardous material. Additionally, it is very difficult and increasingly expensive to find new landfill sites for the final disposal of the material. The cap and containment method is only an interim solution since the contamination remains on site, requiring monitoring and maintenance of the isolation barriers long into the future, with all the associated costs and potential liability. A better approach than these traditional methods is to completely destroy the pollutants, if possible, or transform them into harmless substances. Some technologies that have been used are high-temperature incineration and various types of chemical decomposition (for example, base-catalyzed dechlorination, UV oxidation). However, these methods have significant disadvantages, principally their technological complexity, high cost , and the lack of public acceptance. Bioremediation, on the contrast, is a promising option for the complete removal and destruction of contaminants. 1.3 Bioremediation of PAH contaminated soil & groundwater Bioremediation is the use of living organisms, primarily microorganisms, to degrade or detoxify hazardous wastes into harmless substances such as carbon dioxide, water and cell biomass Most PAHs are biodegradable unter natural conditions (Da Silva et al., 2003; Meysami and Baheri, 2003) and bioremediation for cleanup of PAH wastes has been extensively studied at both laboratory and commercial levels- It has been implemented at a number of contaminated sites, including the cleanup of the Exxon Valdez oil spill in Prince William Sound, Alaska in 1989, the Mega Borg spill off the Texas coast in 1990 and the Burgan Oil Field, Kuwait in 1994 (Purwaningsih, 2002). Different strategies for PAH bioremediation, such as in situ , ex situ or on site bioremediation were developed in recent years. In situ bioremediation is a technique that is applied to soil and groundwater at the site without removing the contaminated soil or groundwater, based on the provision of optimum conditions for microbiological contaminant breakdown.. Ex situ bioremediation of PAHs, on the other hand, is a technique applied to soil and groundwater which has been removed from the site via excavation (soil) or pumping (water). Hazardous contaminants are converted in controlled bioreactors into harmless compounds in an efficient manner. 1.4 Bioavailability of PAH in the subsurface Frequently, PAH contamination in the environment is occurs as contaminants that are sorbed onto soilparticles rather than in phase (NAPL, non aqueous phase liquids). It is known that the biodegradation rate of most PAHs sorbed onto soil is far lower than rates measured in solution cultures of microorganisms with pure solid pollutants (Alexander and Scow, 1989; Hamaker, 1972). It is generally believed that only that fraction of PAHs dissolved in the solution can be metabolized by microorganisms in soil. The amount of contaminant that can be readily taken up and degraded by microorganisms is defined as bioavailability (Bosma et al., 1997; Maier, 2000). Two phenomena have been suggested to cause the low bioavailability of PAHs in soil (Danielsson, 2000). The first one is strong adsorption of the contaminants to the soil constituents which then leads to very slow release rates of contaminants to the aqueous phase. Sorption is often well correlated with soil organic matter content (Means, 1980) and significantly reduces biodegradation (Manilal and Alexander, 1991). The second phenomenon is slow mass transfer of pollutants, such as pore diffusion in the soil aggregates or diffusion in the organic matter in the soil. The complex set of these physical, chemical and biological processes is schematically illustrated in Figure 1. As shown in Figure 1, biodegradation processes are taking place in the soil solution while diffusion processes occur in the narrow pores in and between soil aggregates (Danielsson, 2000). Seemingly contradictory studies can be found in the literature that indicate the rate and final extent of metabolism may be either lower or higher for sorbed PAHs by soil than those for pure PAHs (Van Loosdrecht et al., 1990). These contrasting results demonstrate that the bioavailability of organic contaminants sorbed onto soil is far from being well understood. Besides bioavailability, there are several other factors influencing the rate and extent of biodegradation of PAHs in soil including microbial population characteristics, physical and chemical properties of PAHs and environmental factors (temperature, moisture, pH, degree of contamination). Figure 1: Schematic diagram showing possible rate-limiting processes during bioremediation of hydrophobic organic contaminants in a contaminated soil-water system (not to scale) (Danielsson, 2000). 1.5 Increasing the bioavailability of PAH in soil Attempts to improve the biodegradation of PAHs in soil by increasing their bioavailability include the use of surfactants , solvents or solubility enhancers.. However, introduction of synthetic surfactant may result in the addition of one more pollutant. (Wang and Brusseau, 1993).A study conducted by Mulder et al. showed that the introduction of hydropropyl-ß-cyclodextrin (HPCD), a well-known PAH solubility enhancer, significantly increased the solubilization of PAHs although it did not improve the biodegradation rate of PAHs (Mulder et al., 1998), indicating that further research is required in order to develop a feasible and efficient remediation method. Enhancing the extent of PAHs mass transfer from the soil phase to the liquid might prove an efficient and environmentally low-risk alternative way of addressing the problem of slow PAH biodegradation in soil.

The Effect of Weight on the Perception of Political Candidates

Chris Christie recently visited the famous “Wailing Wall” in Jerusalem, Israel, during his first trip abroad as governor of New Jersey. The New York Post reported on his trip with the headline “The Whale at the Wall” (Campanile 2012). Given headlines like this, it is easy to see anecdotal evidence of the stigmatization that surrounds obesity within contemporary American society. What’s more important is that these social stigmas that Americans are faced with every day are not merely surface level jokes bantered about for a cheap laugh. They are often prejudices that permeate every aspect of human life. Whether it comes to finding a date, looking for a job, or trying to be taken serious by one’s peers, weight is always a topic of concern. In an effort to understand how far entrenched these biases are in society, this thesis studies the ramifications of obesity in politics. In this thesis, I attempt to understand to what extent, if any, obesity matters in regard to candidate appearance, voters' choices, and political behavior.

Hardystonite From the Desert View Mine, California

The fluorescent mineral hardystonite is confirmed in a specimen from the Desert View Mine, California. Hardystonite had been known only from Franklin, New Jersey for over 100 years.

Does Mental Illness Affect Consumer Direction of Community-Based Care? Lessons From the Arkansas Cash and Counseling Program

Purpose: Previous research from the Cash and Counseling Demonstration and Evaluation (CCDE) in Arkansas, New Jersey, and Florida suggests that giving consumers control over their personal care greatly increases their satisfaction and improves their outlook on life. Still, some argue that consumerdirected care may not be appropriate for consumers with intellectual disabilities or mental health diagnoses. This study examined how Cash and Counseling— a new option allowing consumers to manage an individualized budget equivalent to what agencies would have spent on their care—changes the way consumers with mental health diagnoses meet their personal care needs and how that affects their wellbeing. Design and Methods: Using the Arkansas CCDE baseline and the 9-month follow-up data for individuals in the treatment and control groups, we compared and contrasted the experience of elderly consumers with and without mental health diagnoses utilizing logit regression. Results: After examining several outcome measures, including satisfaction with care arrangements and the paid caregiver’s reliability and schedule, unmet needs, and satisfaction with the relationship with paid caregivers, this study found evidence that, from the perspective of consumers, the Cash and Counseling program works well for participants with mental health diagnoses. Implications: Considering the growing need for long-term-care services and the limited resources available, a consumer-directed option makes sense, and it can be a valuable alternative for persons with mental health needs.

Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials

OBJECTIVES: The purpose of this research was to determine the relative safety and efficacy of multiple (> or =2) overlapping Cypher sirolimus-eluting stents (SES) (Johnson ; Johnson, New Brunswick, New Jersey). BACKGROUND: Overlapping coronary stents are common. The periprocedural and late clinical and angiographic consequences of overlapped coronary stents are not clearly defined, particularly for drug-eluting stents. METHODS: All patients enrolled into five clinical trials of the SES were analyzed. Three of these trials were prospective randomized comparisons of the SES to the bare-metal stent (BMS), and two were prospective non-randomized trials of SES-treated patients with historical controls. All clinical and angiographic outcomes in overlap-stent-treated patients were compared by stent type and with single-stent-treated patients for the same stent device. RESULTS: In all, 575 patients with stent overlap (337 SES, 238 BMS) and 1,162 patients with single stents (697 SES, 465 BMS) were analyzed. Stent overlap was associated with a greater late lumen loss in stent and more frequent angiographic restenosis regardless of stent type. Among overlap-stent-treated patients, the SES provided similar magnitude of restenosis benefit as observed for single-stent-treated patients. Overlapped SES was not associated with an increase in myocardial infarction. CONCLUSIONS: The strategy of SES overlap, when required, is both safe and efficacious in reducing restenosis with no increase in the incidence of myocardial infarction or major adverse cardiovascular events, when compared with a bare metal coronary stent prosthesis.

Factors determining the use of universal precautions by emergency department nurses

The Health Belief Model (HBM) provided the theoretical framework for examining Universal Precautions (UP) compliance factors by Emergency Department nurses. A random sample of Emergency Nurses Association (ENA) clinical nurses (n = 900) from five states (New York, New Jersey, California, Texas, and Florida), were surveyed to explore the factors related to their decision to comply with UP. Five-hundred-ninety-eight (598) useable questionnaires were analyzed. The responders were primarily female (84.9%), hospital based (94.6%), staff nurses (66.6%) who had a mean 8.5 years of emergency nursing experience. The nurses represented all levels of hospitals from rural (4.5%) to urban trauma centers (23.7%). The mean UP training hours was 3.0 (range 0-38 hours). Linear regression was used to analyze the four hypotheses. The first hypothesis evaluating perceived susceptibility and seriousness with reported UP use was not significant (p = $>$.05). Hypothesis 2 tested perceived benefits with internal and external barriers. Both perceived benefits and internal barriers as well as the overall regression were significant (F = 26.03, p = $<$0.001). Hypothesis 3 which tested modifying factors, cues to action, select demographic variables, and the main effects of the HBM with self reported UP compliance, was also significant (F = 12.39, p = $<$0.001). The additive effects were tested by use of a stepwise regression that assessed the contribution of each of the significant variables. The regression was significant (F = 12.39, p = $<$0.001) and explained 18% of the total variance. In descending order of contribution, the significant variables related to compliance were: internal barriers (t = $-$6.267; p = $<$0.001) such as the perception that because of the nature of the emergency care environment there is sometimes inadequate time to put on UP; cues to action (t = 3.195; p = 0.001) such as posted reminder signs or verbal reminders from peers; the number of Universal Precautions training hours (t = 3.667; p = $<$0.001) meaning that as the number of training hours increase so does compliance; perceived benefits (t = 3.466; p = 0.001) such as believing that UP will provide adequate barrier protection; and perceived susceptibility (t = 2.880; p = 0.004) such as feeling that they are at risk of exposure. ^

The origin of oriented lakes: evidence from the Bolivian Amazon

The presence of hundreds of rectangular and oriented lakes is one of the most striking characteristics of the Llanos de Moxos (LM) landscape in the Bolivian Amazon. Oriented lakes also occur in the Arctic coastal plains of Russia, Alaska and Canada and along the Atlantic Coastal Plain from northeast Florida to southeast New Jersey and along the coast of northeast Brazil. Many different mechanisms have been proposed for their formation. In the LM, Plafker's (1964) tectonic model, in which subsidence results from the propagation of bedrock faults through the foreland sediments, is the most accepted. However, this model has not been verified. Here, we present new results from stratigraphic transects across the borders of three rectangular and oriented lakes in the LM. A paleosol buried under mid-Holocene sediments is used as a stratigraphic marker to assess the vertical displacement of sediments on both sides of the alleged faults. Our results show that there is no vertical displacement and, therefore, that Plafker's model can be ruled out. We suggest that, among all the proposed mechanisms behind lake formation, the combined action of wind and waves is the most likely. The evidence from the LM provides new hints for the formation of oriented lakes worldwide.

Na 1 Nachlass Max Horkheimer, 44 - Korrespondenzen u.a. mit Marthe Roth (p. I 21, 313-463)

2 Briefe und 1 Lebenslauf von Max Horkheimer an Arthur Rosenberg, 1939, 1941; 2 Briefe zwischen Kurt Rosenfeld und Karl Brandt, 22.04.1937, 27.04.1937; 5 Briefe von Kurt Rosenfeld an Max Horkheimer, 1937-19378; 4 Brief und Beilage an Kurt Rosenfeld, 1937-1943; 11 Briefe zwischen Hans W. Rosenhaupt und Max Horkheimer, 1935, 1941, 1942, 1947; 4 Briefe zwischen Samuel I. Roseman und Max Horkheimer, 1939, 03.01.1940; 2 Briefe zwischen J. Rosenstock und Max Horkheimer, 15.07.1946; 2 Briefe zwischen Joseph Adolphe Rosenthal und Max Horkheimer, 09.04.1941, 08.05.1941, sowie Briefwechsel mit Sophie Ries; 2 Briefe zwischen Sophie Ries und Max Horkheimer, 08.05.1941, 11.05.1941; 1 Brief von Max Horkheimer an Lore Woedthke, 08.05.1941; 2 Briefe zwischen Morris Rosenthal und Max Horkheimer, 01.10.1935, 04.10.1935; 1 Brief von Max Horkheimer an das Rosenwald Capital Outlay Fund New York, 30.01.1940; 1 Brief B. Lifschitz an Marthe Roth, 21.04.1937; 1 Brief von Chamorel et Simond an Marthe Roth, 11.06.1937; 1 Brief von F.K. Sung an Marthe Roth, 24.06.1937; 12 Briefe zwischen Marthe Roth und Max Horkheimer, Juli 1937-1938, sowie Briefwechsel mit Louis Vogt; 4 Briefe zwischen Louis Vogt und Max Horkheimer, 10.08.1937, 1937; 1 Brief von Max Horkheimer an Dr. Rothen, 31.01.1935; 1 Umzugsmitteilung von Hans Rothmann; 2 Briefe zwischen Richard C. Rothschild und Max Horkheimer, 11.05.1940, 13.05.1940; 4 Briefe zwischen Ludwig Rothschild, Hilde Rothschild und Max Horkheimer, 1936-15.09.1939; 2 Briefe zwischen S. Rothschildt und Max Horkheimer, 23.11.1940, 29.11.1940; 4 Brief zwischen J. S. Roucek und Max Horkheimer, 1941; 1 Brief von Joseph Rovan an Max Horkheimer, 11.05.1948; 2 Brief zwischen Wilmina Rowland und Max Horkheimer, 13.03.1949, 11.04.1949; 2 Briefe zwischen dem Royal Automobile Club und Max Horkheimer, 26.08.1937, 22.09.1937; 2 Briefe zwischen Royal Motors Inc. und Max Horkheimer, 05.02.1940, 06.03.1940; 1 Beitrag von Nina Rubinstein zur Soziologie des Fremden; 1 Brief von Theodor W. Adorno an Rudd, 09.09.1940; 1 Brief von Jay Rumney an Goldstein, 18.06.1936; 20 Briefe und Beilage zwischen Jay Rumney und Max Horkheimer, 1934- 1937, 1949 sowie Briefwechsel mit D. Mitrany; 3 Briefe zwischen D. Mitrany und Max Horkheimer, 01.12.1937, 1937; 3 Briefe von Theodor W. Adorno an Dagobert D. Runes, 1941; 1 Brief und 1 Beilage von N. Waterman an Georg Rusche, 03.05.1939; 12 Briefe und Beilage zwischen Georg Rusche und Max Horkheimer, 1939-1942 sowie Briefwechsel mit N. Waterman; 1 Brief von N. Waterman an Georg Rusche, 03.04.1939; 2 Briefe zwischen N. Waterman und Max Horkheimer, 21.04.1939, 05.05.1939; 1 Brief von Ruth an Max Horkheimer;

Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

An evaluation of the centers for Medicare & Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program

Objective: This dissertation evaluated three aspects of the Centers for Medicare and Medicaid Services' Hospital Acquired Conditions and Present on Admission Indicator Reporting program (HACPOA program) to produce three journal articles for publication. ^ Methods: All payer admission records from state inpatient databases from Arizona, New Jersey and Washington states were analyzed for the year 2008. However some analyses required a sample of adult only Medicare patients in the first two studies. California's inpatient data (2004 – 2010) was also analyzed in the third study to examine the reporting and non-payment program elements' impact on the incidence of hospital acquired conditions. ^ Results: Majority diagnoses reported in inpatient prospective payment systems hospitals were present on admission. However, some diagnoses are still coded as "not present on admission" and "insufficient documentation to determine whether or not conditions are present on admission or not". This is important because it reveals that hospital complications still occur in hospitals. Hospital fall and trauma injuries were the most common hospital acquired conditions observed in this study. Predictors of hospital fall injuries include age, gender, number of diagnoses, number of procedures, number of chronic conditions while predictors of hospital trauma injuries include number of e-codes, number of diagnoses and the presence of chronic conditions on a patient's admission records. Finally, the implementation of the present on admission reporting requirement increased reports of certain hospital acquired conditions while the non-payment policy element in the Hospital Acquired Conditions program reduced the incidence of hospital fall and trauma injuries in particular. ^ Conclusion: The implementation of the Hospital Acquired Conditions and Present on Admission Indicator Reporting program has made the state inpatient database a more useful source of data capable of now identifying hospital complications. The reporting and nonpayment program elements in the HACPOA program have also impacted the incidence of hospital acquired conditions. ^