Report on a review of selected general and application controls over the Iowa Department of Transportation’s Internal Billing System for the period April 6, 2009 through July 31, 2009

Report on a review of selected general and application controls over the Iowa Department of Transportation’s Internal Billing System for the period April 6, 2009 through July 31, 2009

Choosing a platform for a billing system

Enterprises have a need in use of billing. Before actual choose of a billing system an appropriate platform has to be deployed. This work presents a study of a platform choosing for a billing system and shows the role of optimally chosen platform. In evaluation of a platform several criteria were considered: cost, scalability, reliability, safety, usability, portability and efficiency. In the thesis three different platforms MAC OS, Linux and MS Windows were studied. The results of the evaluation of each platform are shown and according to this results the most suitable platform for a billing system was chosen.

Projecte FacturaCloud, sistema de facturació al núvol

FacturaCloud és un disseny de un sistema de facturació al núvol.

Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center.

OBJECTIVES: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall. DESIGN: Prospective cohort study with 6-month follow-up. SETTING: Swiss academic medical center. PARTICIPANTS: Six hundred ninety persons aged 75 and older hospitalized through the emergency department. MEASUREMENTS: Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death). RESULTS: Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03-3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status. CONCLUSION: Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs.

Cognitive impairment in elderly medical inpatients: detection and associated six-month outcomes.

OBJECTIVE: The authors examined the relationship of cognitive impairment at hospital admission to 6-month outcome (hospital readmission, nursing home admission, and death) in a cohort of elderly medical inpatients. METHODS: A group of 401 medical inpatients age 75 and older underwent a comprehensive geriatric assessment at hospital admission and were followed up for 6 months. Cognitive impairment was defined as a score <24 on the Mini-Mental State Exam. Detection was assessed through blinded review of discharge summary. Follow-up data were gathered from the centralized billing system (hospital and nursing home admissions) and from proxies (death). RESULTS: Cognitive impairment was present in 129 patients (32.3%). Only 48 (37.2%) were detected; these had more severe impairment than undetected cases. During follow-up, cognitive impairment, whether detected or not, was associated with death and nursing home admission. After adjustment for health, functional, and socioeconomic status, an independent association remained only for nursing home admission in subjects with detected impairment. Those with undetected impairment appeared to be at intermediate risk, but this relationship was not statistically significant. CONCLUSION: In these elderly medical inpatients, cognitive impairment was frequent, rarely detected, and associated with nursing home admission during follow-up. Although this association was stronger in those with detected impairment, these results support the view that acute hospitalization presents an opportunity to better detect cognitive impairment in elderly patients and target further interventions to prevent adverse outcomes such as nursing home admission.

Use of the Cognitive Performance Scale (CPS) to detect cognitive impairment in the acute care setting: concurrent and predictive validity.

The Cognitive Performance Scale (CPS) was initially designed to assess cognition in long term care residents. Subsequently, the CPS has also been used among in-home, post-acute, and acute care populations even though CPS' clinimetric performance has not been studied in these settings. This study aimed to determine CPS agreement with the Mini Mental Status Exam (MMSE) and its predictive validity for institutionalization and death in a cohort (N=401) of elderly medical inpatients aged 75 years and over. Medical, physical and mental status were assessed upon admission. The same day, the patient's nurse completed the CPS by interview. Follow-up data were gathered from the central billing system (nursing home stay) and proxies (death). Cognitive impairment was present in 92 (23%) patients according to CPS (score >or= 2). Agreement with MMSE was moderate (kappa 0.52, P<.001). Analysis of discordant results suggested that cognitive impairment was overestimated by the CPS in dependent patients with comorbidities and depressive symptoms, and underestimated in older ones. During follow-up, subjects with abnormal CPS had increased risks of death (adjusted hazard ratio (adjHR) 1.7, 95% CI 1.0-2.8, P=.035) and institutionalization (adjHR 2.7, 95% CI 1.3-5.3, P=.006), independent of demographic, health and functional status. Interestingly, subjects with abnormal CPS were at increased risk of death only if they also had abnormal MMSE. The CPS predicted death and institutionalization during follow-up, but correlated moderately well with the MMSE. Combining CPS and MMSE provided additional predictive information, suggesting that domains other than cognition are assessed by professionals when using the CPS in elderly medical inpatients.

Energiamittauksen kaukoluentajärjestelmän käyttöönotto Kotkan Energia Oy:n jakeluverkoissa

Tulevaisuudessa mittaustulokset siirretään tietoliikenteen välityksellä kulutuspaikalta energiayhtiön laskutusjärjestelmään. Diplomityön tavoitteena oli selvittää sähköverkkoa ja muita kommunikaatio muotoja hyödyntävän kaukoluentajärjestelmän kannattavuus ja käyttöönotto Kotkan Energia Oy:n jakeluverkoissa. Tutkimuksessa selvitettiin yhtiön nykyisen mittalaitekaluston tila ja tehtiin huoltosuunnitelma tuleville vuosille. Lisäksi tutkittiin uuden järjestelmän kannattavuus asiakasryhmittäin ja selvitettiin järjestelmän muut hyödyt asiakkaalle ja yhtiölle. Uusi järjestelmä tehostaa energiayhtiön mittaukseen liittyviä prosesseja. Lisäksi reaaliaikaiset mittaustiedot poistavat arviolaskutuksen ja näin ollen energiayhtiön laskutukseen liittyvä asiakaspalvelu tehostuu ja tilikauden tulosta ei tarvitse ennustaa. Tulokseksi saatiin, että suurimmat säästöt järjestelmä tuo silloin kun mittalaitteet vaihdetaan huoltovaihtona. Energianmittauksen kaukoluentajärjestelmä todettiin tutkimuksessa kannattavaksi investoinniksi nykyiseen mittausjärjestelmään verrattuna.

Finvoice-verkkolaskun muodostus ja siirto laskutusohjelmasta pankkiin

Tällä hetkellä sähköinen liiketoiminta yritysten välillä on tulossa enemmän ja enemmän esille yrityksen jokapäiväisiin toimintoihin. Verkkolasku on suurin tekijä sähköisessä liiketoiminnassa, ja erilaiset verkkolaskustandardit ovat ajamassa sitä eteenpäin. Tässä diplomityössä käsitellään yritysten välistä sähköistä liiketoimintaa, ja perehdytään tarkemmin sen laskutukseen. Laskutuksen osalta käydään läpi erilaisia laskutustapoja ja tutustutaan tarkemmin Suomen Pankkiyhdistyksen Finvoice- verkkolaskustandardiin. Työssä kerrotaan laskutusjärjestelmään toteutetusta Finvoice- verkkolaskukomponentista, ja sen rajapinnoista eri komponenttien välillä. Laskun muodostamisen jälkeen kerrotaan laskun siirrosta pankin järjestelmiin eri yhteystapoja käyttäen.

Sosiaali- ja terveydenhuollon teknisten palveluiden tuotteistaminen

Tämän tutkimuksen tarkoituksena oli tutkia Päijät-Hämeen sosiaali- ja terveydenhuollon kuntayhtymän Tukipalvelukeskuksen teknisten palveluiden tulosalueen tuotteistamista ja tuottaa kustannusten laskutuksen periaatteellinen toteutusmalli. Työssä otetaan kantaa palveluiden hinnoittelumalleihin eli kuinka kiinteistöistä ja teknisistä ylläpitopalveluista syntyvät kustannukset voidaan osoittaa niitä käyttäville tulosalueille. Palveluiden jäsentäminen ja suoritteiden yhdistäminen muodostavat palvelutuotteen, jota palveluita käyttävälle asiakkaalle tarjotaan. Tuotekäsitteelle on tyypillistä, että sitä voidaan tuottaa saman sisältöisenä nyt ja tulevaisuudessa. Tuotteita tarjoavan palveluiden tuottajan tuotekriteerit sisältävät selkeät tuoteryhmät, tuotteiden määrällisen mitattavuuden, kuvaavat tuotenimikkeet ja tuotteilla on ostajan näkökulmasta selkeä sisältö ja hinnoittelu. Tuotteistamisen tärkein hyöty on organisaation kustannusrakenteen selkeytyminen, jonka vuoksi tuotteiden määrä, laatu ja hinta tulee olla määriteltävissä. Asiakkaalle voidaan tarjota valmiiksi hinnoiteltuja palveluosia, jolloin palveluiden räätälöinti ja modulointi ovat mahdollisia palveluiden niputtamisella. Ei-kaupallisten instanssien, kuten kuntayhtymien sisäinen laskutus ja tuotteistus mahdollistavat palveluiden standardoimisen ja johdon päätöksenteko toimialakohtaisen kustannustietoisuuden vuoksi paranee. Tutkimuksen alkuosassa paneudutaan palvelun alle kuuluviin käsitteisiin, kuten tuotteistamisajatteluun, palvelupaketteihin, palveluiden laadun mittaamiseen ja palveluiden hinnoitteluun. Lisäksi tutkimuksessa käsitellään teknisten palveluiden hinnoitteluun käytettävän toimintoperusteisen kustannuslaskennan sekä sisäisen vuokraamisen periaatteita. Teoreettisessa viitekehyksessä käsiteltyjä asioita käytettiin hyödyksi sairaanhoitopiireille laadittuun kyselytutkimukseen. Yhdessä teorian ja kyselytutkimuksen kanssa kohdeorganisaatiolle luotiin malli palveluiden tuotteistamiseksi.

Economic valuation of collecting water to billing in the aspersion irrigated bean in the no tillage system and conventional crop

The law's project n.676/2000 approved the collecting of billing water for farmers in a maximum foreseen value of US$ 0.01 m(-3) of extracted water in the São Paulo State. As the irrigated agriculture is the activity that consumes more water, the farmers profitability can be affected. This work was to analyze the economic impact of billing water in the aspersion irrigated bean crop to consider the system of conventional production and no tillage system in the Paranapanema municipal district, São Paulo State, Brazil. The indicators used to analyze the economic results were unit variable cost, market price and unit profitability. The results showed that for the aspersion irrigated bean crop in conventional system, the participation of cost to the recourse water in cost variable totality was of 2.5% and in no tillage system the participation was of 2.2%. The fall of profitability just the billing water in conventional crop system and in no tillage system was US$ 0.01 kg(-1).

System Level Simulation and Radio Resource Management for Distributed Antenna Systems with Cognitive Radio and Multi-Cell Cooperation

4th International Conference on Future Generation Communication Technologies (FGCT 2015), Luton, United Kingdom.

WATER USE AND SYSTEM RELIABILITY UNDER DIESELGENERATOR AND SOLAR PHOTOVOLTAIC POWERED PUMPING SYSTEMS: A CASE STUDY OF SOLLA TOGO

Access to improved potable water sources is recognized as one of the key factors in improving health and alleviating global poverty. In recently years, substantial investments have been made internationally in potable water infrastructure projects, allowing 2.3 billion people to gain access to potable water from 1990-2012. One such project was planned and installed in Solla, Togo, a rural village in the northern part of the country, from 2010-2012. Ethnographic studies revealed that, while the community has access to potable water, an estimated 45% of the village’s 1500 residents still rely on unprotected sources for drinking and cooking. Additionally, inequality in system use based on income level was revealed, with the higher income groups accessing the system more regularly than lower income groups. Cost, as well as the availability of cheaper sources, was identified as the main deterrent from using the new water distribution system. A new water-pricing scheme is investigated here with the intention of making the system accessible to a greater percentage of the population. Since 2012, a village-level water committee has been responsible for operations and maintenance (O&M), fulfilling the community management model that is recommended by many development theorists in order to create sustainable projects. The water committee received post-construction support, mostly in the form of technical support during system breakdowns, from the Togolese Ministry of Water and Sanitation (MWSVH). While this support has been valuable in maintaining a functional water supply system in Solla, the water committee still has managerial challenges, particularly with billing and fee collection. As a result, the water committee has only received 2% - 25% of the fees owed at each private connection and public tap stand, making their finances vulnerable when future repairs and capital replacements are necessary. A new management structure is proposed by the MWSVH that will pay utilities workers a wage and will hire an accountant in order to improve the local management and increase revenue. This proposal is analyzed under the new water pricing schemes that are presented. Initially, the rural water supply system was powered by a diesel-generator, but in 2013, a solar photo-voltaic power supply was installed. The new system proved a fiscal improvement for the village water committee, since it drastically reduced their annual O&M costs. However, the new system pumps a smaller volume of water on a daily basis and did not meet the community’s water needs during the dry season of 2014. A hydraulic network model was developed to investigate the system’s reliability under diesel-generator (DGPS) and solar photovoltaic (PVPS) power supplies. Additionally, a new system layout is proposed for the PVPS that allows pumping directly into the distribution line, circumventing the high head associated with pumping solely to the storage tank. It was determined that this new layout would allow for a greater volume of water to be provided to the demand points over the course of a day, meeting a greater fraction of the demand than with the current layout.

Obesity And Inflammation And The Effect On The Hematopoietic System.

Bone marrow is organized in specialized microenvironments known as 'marrow niches'. These are important for the maintenance of stem cells and their hematopoietic progenitors whose homeostasis also depends on other cell types present in the tissue. Extrinsic factors, such as infection and inflammatory states, may affect this system by causing cytokine dysregulation (imbalance in cytokine production) and changes in cell proliferation and self-renewal rates, and may also induce changes in the metabolism and cell cycle. Known to relate to chronic inflammation, obesity is responsible for systemic changes that are best studied in the cardiovascular system. Little is known regarding the changes in the hematopoietic system induced by the inflammatory state carried by obesity or the cell and molecular mechanisms involved. The understanding of the biological behavior of hematopoietic stem cells under obesity-induced chronic inflammation could help elucidate the pathophysiological mechanisms involved in other inflammatory processes, such as neoplastic diseases and bone marrow failure syndromes.

The Value Of The 2005 International Society Of Urological Pathology (isup) Modified Gleason Grading System As A Predictor Of Biochemical Recurrence After Radical Prostatectomy.

To compare time and risk to biochemical recurrence (BR) after radical prostatectomy of two chronologically different groups of patients using the standard and the modified Gleason system (MGS). Cohort 1 comprised biopsies of 197 patients graded according to the standard Gleason system (SGS) in the period 1997/2004, and cohort 2, 176 biopsies graded according to the modified system in the period 2005/2011. Time to BR was analyzed with the Kaplan-Meier product-limit analysis and prediction of shorter time to recurrence using univariate and multivariate Cox proportional hazards model. Patients in cohort 2 reflected time-related changes: striking increase in clinical stage T1c, systematic use of extended biopsies, and lower percentage of total length of cancer in millimeter in all cores. The MGS used in cohort 2 showed fewer biopsies with Gleason score ≤ 6 and more biopsies of the intermediate Gleason score 7. Time to BR using the Kaplan-Meier curves showed statistical significance using the MGS in cohort 2, but not the SGS in cohort 1. Only the MGS predicted shorter time to BR on univariate analysis and on multivariate analysis was an independent predictor. The results favor that the 2005 International Society of Urological Pathology modified system is a refinement of the Gleason grading and valuable for contemporary clinical practice.

The Applicability Of Ordered Mesoporous Sba-15 And Its Hydrophobic Glutaraldehyde-bridge Derivative To Improve Ibuprofen-loading In Releasing System.

The mesoporous SBA-15 silica with uniform hexagonal pore, narrow pore size distribution and tuneable pore diameter was organofunctionalized with glutaraldehyde-bridged silylating agent. The precursor and its derivative silicas were ibuprofen-loaded for controlled delivery in simulated biological fluids. The synthesized silicas were characterized by elemental analysis, infrared spectroscopy, (13)C and (29)Si solid state NMR spectroscopy, nitrogen adsorption, X-ray diffractometry, thermogravimetry and scanning electron microscopy. Surface functionalization with amine containing bridged hydrophobic structure resulted in significantly decreased surface area from 802.4 to 63.0 m(2) g(-1) and pore diameter 8.0-6.0 nm, which ultimately increased the drug-loading capacity from 18.0% up to 28.3% and a very slow release rate of ibuprofen over the period of 72.5h. The in vitro drug release demonstrated that SBA-15 presented the fastest release from 25% to 27% and SBA-15GA gave near 10% of drug release in all fluids during 72.5 h. The Korsmeyer-Peppas model better fits the release data with the Fickian diffusion mechanism and zero order kinetics for synthesized mesoporous silicas. Both pore sizes and hydrophobicity influenced the rate of the release process, indicating that the chemically modified silica can be suggested to design formulation of slow and constant release over a defined period, to avoid repeated administration.