Mean Utilization Rate Research Articles

Implementation of a 24-hour infection diagnosis protocol in the pediatric cardiac intensive care unit (CICU).

To reduce unnecessary antibiotic exposure in a pediatric cardiac intensive care unit (CICU). Single-center, quality improvement initiative. Monthly antibiotic utilization rates were compared between 12-month baseline and 18-month intervention periods. A 25-bed pediatric CICU. Clinically stable patients undergoing infection diagnosis were included. Patients with immunodeficiency, mechanical circulatory support, open sternum, and recent culture-positive infection were excluded. The key drivers for improvement were standardizing the infection diagnosis process, order-set creation, limitation of initial antibiotic prescription to 24 hours, discouraging indiscriminate vancomycin use, and improving bedside communication and situational awareness regarding the infection diagnosis protocol. In total, 109 patients received the protocol; antibiotics were discontinued in 24 hours in 72 cases (66%). The most common reasons for continuing antibiotics beyond 24 hours were positive culture (n = 13) and provider preference (n = 13). A statistical process control analysis showed only a trend in monthly mean antibiotic utilization rate in the intervention period compared to the baseline period: 32.6% (SD, 6.1%) antibiotic utilization rate during the intervention period versus 36.6% (SD, 5.4%) during the baseline period (mean difference, 4%; 95% CI, -0.5% to -8.5%; P = .07). However, a special-cause variation represented a 26% reduction in mean monthly vancomycin use during the intervention period. In the patients who had antibiotics discontinued at 24 hours, delayed culture positivity was rare. Implementation of a protocol limiting empiric antibiotic courses to 24 hours in clinically stable, standard-risk, pediatric CICU patients with negative cultures is feasible. This practice appears safe and may reduce harm by decreasing unnecessary antibiotic exposure.

Cost and Productivity of Tethered Cut-to-Length Systems in a Dry-Forest Fuel-Reduction Treatment: A Case Study

AbstractFuel-reduction treatments on steep slopes across federal forests of the western United States have been limited by the high costs associated with cable logging on steeper slopes combined with poor market prospects for small-diameter material (Bolding 2003, Rummer 2008, Han et al. 2016). The emergence of tethered cut-to-length harvesting systems and small wood markets (e.g., biochar) could decrease costs and increase revenue generated from treatments. Over the course of 3 weeks, we observed both tethered (steeper slopes) and untethered cut-to-length fuel-reduction treatment on the Fremont-Winema National Forest in south-central Oregon and interviewed operators. We used those data to derive and contrast hourly costs and productivity for the harvester and forwarder. This was the first time a tethered harvester and forwarder were used in a fuel-reduction treatment on federal forests in this region. We developed and tested a variety of work time model forms for each machine. The mean utilization rate for the harvester was 64 percent on 17 tethered consolidated corridors but 87 percent on 28 untethered consolidated corridors. Similarly, the forwarder had a mean utilization rate of 76 percent on 30 tethered trips and 89 percent on 114 untethered trips. This reduced utilization rate could be because of the direct effects of tethering, the increased complexities of operations associated with steeper slopes, and the stand characteristics (e.g., lower stand density and tree sweep) associated with steeper slopes. Costs during tethered operations were higher than during nontethered operations, but lower than previous reports using cable logging.

Disparities in Utilization of Hepatitis C Virus Positive Hearts for Transplantation

Purpose The goal of this study was to utilize data from the United Network of Organ Sharing (UNOS) database to assess disparities in utilization of hepatitis C virus (HCV)+ hearts for transplant. Methods We obtained de-identified data from UNOS from 2/1/16-1/31/18. We divided these donors into three categories: HCV -, HCV antibody+/ nucleic acid test negative (HCV+/ NAT-) and HCV NAT+. Utilization rate was calculated as a percentage of number of hearts successfully transplanted / number of donors recovered. Organ quality was indirectly assessed using donor age and ejection fraction (EF). Differences in means were assessed via ANOVA and categorical variables via chi2 analysis. Results Among 20,442 donors, 18,948 were HCV-, 511 were HCV+ NAT- and 983 were HCV NAT+. The overall mean utilization rate of HCV- hearts was 33.7% (standard deviation, SD 1.74) whereas the HCV+/NAT- was 11.6% (SD 7.15) and NAT+ was 7.1% (SD 4.94, p organ procurement organizations (OPOs) out of 5 in the Region that facilitated 73% of donors. Proportion of transplanted hearts with EF>55% was similar (HCV- 93.1% vs. HCV+/NAT- 89.8% vs. NAT+ 97.3%, p=0.73). Proportion of transplanted hearts with donor age Conclusion We note disparities at a national, regional, and OPO level in the utilization of hearts for transplantation based on HCV status. Given early outcomes of HCV+ heart transplant , we believe there is opportunity to increase heart transplantation rates in the US.

Productivity assessment of timber harvesting techniques for supporting sustainable forest management of secondary Atlantic Forests in southern Brazil

The Atlantic Forest in southern Brazil has been subject to overexploitation in the past prompting the formulation of a rigorous conservation orientated policy by the government including a strict ban of timber harvesting. In the region, the forestland is owned by farmers. The economic value of the forest is rather limited for those farmers, because of the prohibition of commercial timber harvesting as a source of income. Sustainable forest management systems can offer great potential as new income opportunities for land holders, and further actively support the process of ecosystem rehabilitation and protection for these ecosystems. Yet, successful implementation of such sustainable management systems requires feasible and adapted timber harvesting systems. In order to develop such harvesting systems, a regional comparative case study was conducted at a typical smallholder forestry venture with the objective to analyze and evaluate harvesting methods supporting sustainable management of the Atlantic Forest. This study assessed production rates and associated costs of a common conventional timber harvesting method (CM) and a proposed alternative method (AM). CM was performed by a selected, typical forest landowner who had only basic training in chainsaw operations, but 20 years of experience at the wood yard of his small sawmill. In contrast, the AM employed a professional chainsaw operator from the Amazon forest, trained and experienced in reduced impact logging techniques using state of the art equipment, supplemented by a snatch block and a skidding cone for improved extraction. Time study based models identified tree volume, winching distance and skidding distance to the landing as the most significant independent variables affecting productivity. Total net productivity ranged from 4.9 m³ PMH0-1 for CM to 3.1 m³ PMH0-1 for AM. Corresponding gross-productivity ranged from 3.0 m³ SMH-1 to 1.9 m³ SMH-1 with an overall mean utilization rate of 60.8 % and 60.9 %, respectively for CM and AM. Associated harvesting costs ranged from 12.05 € m-3 to 20.94 € m-3 with an estimated annual production of 4000 m³ and 2700 m³, respectively. Although AM showed overall lower productivity and higher costs, it represented an important improvement in terms of occupational health and safety. In conclusion, a suitable harvesting system should integrate local experiences of CM and proposed technical improvements of AM.

Layered constraint united scheduling model of multi-line lock

Inland river multi-line lock united scheduling is an important issue during navigation, and scheduling arrangement directly influences waterborne logistic efficiency. The research designs a kind of multi-line lock layered constraint united scheduling algorithm model. A three-layered scheduling constraint algorithm is created based on analyzing lock scheduling principle and influencing factors. The first layer builds lock chamber area matching ship branch lock model, distributing lock with lock chamber priority constraint algorithm model. The second layer builds single lock chamber quick schedule arrangement model, distributing ship to be locked of single lock chamber into lock chamber with constraint arrangement rule and algorithm process. The third layer builds time constraint lock passing model, constructing flexible lockage time algorithm based on size and speed of ship. Optimal solution of multi-line and multi-layer overall scheduling model can maximize utilization of multiple lock chambers and minimize lockage time. Actual measurement data of Changzhou four-line lock scheduling in Xijiang watershed Guangxi China shows that the mean lockage time decreases 37.50% and the mean utilization rate of lock chambers increases 31.31%. The multi-line lock layered constraint united scheduling model can effectively increase lock passing efficiency.

Utilization rates of knee-arthroplasty in OECD countries

The number of knee arthroplasties and the prevalence of obesity are increasing exponentially. To date there have been no published reviews on utilization rates of knee arthroplasty in OECD countries. We analysed economic, medical and population data relating to knee arthroplasty surgeries performed in OECD countries. Gross domestic product (GDP), health expenditures, obesity prevalence, knee arthroplasty utilization rates and growth in knee arthroplasty rates per 100,000 population were assessed for total population, for patients aged 65 years and over, and patients aged 64 years and younger. Obesity prevalence and utilization of knee arthroplasty have increased significantly in the past. The mean utilization rate of knee arthroplasty was 150 (22-235) cases per 100,000 total population in 2011. The strongest annual increase (7%) occurred in patients 64 years and under. Differences between individual countries can be explained by economic and medical patterns, with countries with higher medical expenditures and obesity prevalence having significantly higher utilization rates. Countries with lower utilization rates have significantly higher growth in utilization rates. The future demand for knee prostheses will increase x-fold by 2030, with exact rates dependant upon economic, social and medical factors. We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030.

Clofibrate Increases Long-Chain Fatty Acid Oxidation by Neonatal Pigs

Background:Utilization of energy-dense lipid fuels is critical to the rapid development and growth of neonates. Objective:To increase efficiency of milk fat utilization by newborn pigs, the effect of clofibrate on in vivo and in vitro long-chain fatty acid (LCFA) oxidation was evaluated. Methods:Newborn male pigs were administered 5 mL of vehicle (2% Tween 80) with or without clofibrate (75 mg/kg body weight) once daily via i.g. gavage for 4 d. Total LCFA oxidative capacity was measured in respiration chambers after gastric infusion (n = 5 per treatment) with isoenergetic amounts of [1-14C]triglycerides (TGs), either oleic acid (18:1n–9) TG [3.02 mmol/kg body weight (BW)0.75] or erucic acid (22:1n–9) TG (2.46 mmol/kg BW0.75). Total expired 14CO2 was collected and quantified at 20-min intervals over 24 h. Hepatic in vitro LCFA oxidation was determined simultaneously using [1-14C]oleic acid and erucic acid substrates. Results:The in vivo 24-h accumulative [1-14C]TG oxidation (percentage of energy intake/kg BW0.75) tended to increase with clofibrate supplementation (P = 0.10), although there was no difference in the peak or mean utilization rate. The maximal extent of oleic acid TG oxidation was 1.6-fold that of erucic acid TG (P < 0.006). Hepatic in vitro LCFA oxidation increased 61% with clofibrate (P < 0.0008). The increase in mitochondria was 4-fold greater than in peroxisomes. The relative abundance of mRNA increased 2- to 3-fold for hepatic peroxisome proliferator-activated receptor α and its target genes (fatty acyl-coenzyme A oxidase and carnitine palmitoyltransferase) in the pigs that were administered clofibrate (P < 0.04). Conclusion:Clofibrate may improve in vivo LCFA oxidative utilization in neonatal pigs.

Longitudinal analyses of geographic differences in utilization rates of children with developmental delays who participation in early intervention services

The purposes of the present study were to describe the longitudinal utilization rates of participation in early intervention services of children with developmental delays, and to examine the geographical difference of services in this vulnerable population. We analyzed service utilization of the developmentally delayed children based on data of governmental reported early intervention services from year 2003 to 2009 in Taiwan. Results show that, the utilization rate of early intervention services was 9.18‰ (range=6.96-12.09‰) of children in 0-5 years during the past 7 years. Mean utilization rate in age group of 0-2 years was 8.32‰ (range=5.73-10.93‰), and age group of 3-5 years was 9.92‰ (range=7.78-13.78‰). We found that the utilization rate in all children aged 0-5 years (R(2)=0.93; p<0.001), boy group (R(2)=0.93; p<0.001) and girl group (R(2)=0.92; p=0.001) were significant increased gradually. The higher utilization rate of early intervention services (aged 0-5 years) were more likely to locate in the north cities (Keelung City=14.65‰; Taipei City=13.49‰), east areas--Hualien County (14.03‰), Taitung County (11.76‰) and central or south counties such as, Chiayi City (14.05‰), Tainan City (12.47‰), and Miaoli County (12.38‰). Hsinchu County (5.97‰), Kaohsiung City (6.21‰), Taichung County (6.74‰), Taipei County (6.95‰) have lower utilization rates of early intervention in Taiwan. The study highlights that the health care system should close the gaps in geographic disparities of early intervention services for children with developmental delays, and respond timely to the needs of these vulnerable children and their families.

A nationwide production analysis of state park attendance in the United States

This study examined the production of U.S. states' park visits from 1984 to 2010 by state. In specifying the production equation in terms of the influences of the states' parklands, labor, and capital investments on the annual attendances, we found that state governments will experience an ongoing need for more labor to maintain their parklands if attendance is to increase in the future. Results also indicated that more capital expenditures are not likely to increase park utilization rates. Post-estimation procedures involved the application of the response residuals to identify the capacity utilization rates of the states' park systems over the past 27 years. Past utilization rates revealed operators met or exceeded capacity utilization expectations from 1984 through 1990. However, beginning in 1991, the annual mean utilization rate for the nation's supply of states' parks signaled a trend toward excess capacity. Our forecast revealed the mean utilizations over the next three years will vary between 90% and 95%. Post-estimation procedures also examined the relationship between state park management orientations (towards either public-lands preservation or recreational development) and projected annual capacity utilization rates. Results indicate that the quantity of added facilities to broaden their appeal to the public (i.e., a recreation orientation) was not important in explaining utilization capacities. However, an orientation toward public-lands preservation related significantly to greater utilization rates. In our view, the public will continue to accept current cost structures for continued operations of the states' parks on the compelling need for access to outdoor recreation to contribute to the visitor well-being.

Medicaid Reforms in Oregon and Suboptimal Utilization of Dental Care by Women of Childbearing Age

The authors conducted a study of dental services used by women of childbearing age who were enrolled in Medicaid in Oregon during the early 2000s, a period of reform during which health care coverage was expanded. They compared claims for pregnant women, women who were not pregnant and had children and women who were not pregnant and did not have children. They also compared differences in claims between those for women enrolled in managed care and those for women enrolled in fee-for-service plans. The authors computed the proportion of women for whom a dental claim was submitted in six-month spans for 2000, 2001, 2002 (before reform) and 2005 (after reform). Before and after reforms, the mean utilization rate for pregnant women, adjusted for the proportion of the period covered, decreased from 0.36 (standard deviation [SD] = 0.025) to 0.22 (SD = 0.028). Among women who were not pregnant and had children, the average adjusted rates decreased from 0.49 (SD = 0.201) to 0.21 (SD = 0.078). The pattern was similar among women who had no dependent children: rates decreased from 0.50 (SD = 0.028) to 0.19 (SD = 0.078). Most of the claims were for diagnostic services. The authors found no differences between women enrolled in managed care and those enrolled in fee-for-service plans. Contrary to their intention, health care reforms in Oregon were detrimental to the vulnerable populations that Medicaid is intended to serve. Dental care is important for maternal and child health. However, utilization is unlikely to improve without changes in Medicaid and the dental care delivery system.

Variations Among Spanish Regions in the Use of Three Cardiovascular Technologies

There is evidence that some geographic variations in the use of medical technologies are not explained by differences in disease burden. The objectives of this study were to quantify variability in the use of percutaneous coronary intervention (PCI), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) in Spanish autonomous regions and to try to explain the variability found for the first two technologies. Linear regression models were developed in which the number of procedures performed per million population (pmp) in 2003 in each autonomous region was the dependent variable. Independent variables used included indices of technology provision, regional wealth, and disease burden. For PCI, the mean utilization rate for the whole of Spain was 1038 procedures pmp, with a high-low ratio of 1.95. Differences in gross domestic product explained 21% of the variability, but there was no relationship between the number of procedures performed and disease burden. For ICDs, the mean number of procedures performed in the whole of Spain was 46 pmp, with a high-low ratio of 3.04. As for PCI, differences in regional wealth explained 40% of the variability, with disease burden making no contribution. For CRT, the mean number of procedures performed in Spain in 2003 was 15 pmp, with a high-low ratio of 15.7. The considerable regional variation that exists in the use of these three medical technologies is principally explained by differences in regional wealth and not in disease burden.

Characteristics of an external employee assistance programme in Japan

Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan. This study sought to clarify the characteristics of an external EAP in Japan. The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis. The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes. EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

Employee Assistance Program Utilization

Abstract In the EAP field, utilization rates are an important concept routinely used as a descriptor of EAP success, yet there has been little formal research conducted in this area. In a study of 154 Canadian EAPs, 102 organizations reported their utilization rates along with how they defined both utilization and a case. Mean utilization rate was 9.2% with utilization being greater in organizations with a union where labor was involved in establishing the program, providing assistance in accessing the program and in managing the program through participation on a joint labor-management committee. Utilization rates were also found to be greater where there was an EAP policy in place and where ongoing program promotion occurred. However, what was also discovered was that most of these statistical conclusions were questionable as there was a lack of consistency in how utilization rates were calculated by various organizations, nor was there any agreement on what even constituted a case. This brings into question the utility of EAP utilization rates in any comparative program monitoring or evaluation. A comprehensive EAP Utilization Scorecard is offered as a response to this situation. The scorecard counts the actual number of employees, retirees and family members who use the EAP, either face-to-face, through telephone counselling or via e-counselling. Also presented is the idea of a new calculation, penetration rate. This value would include counselling offered by the EAP along with the other services, including group counselling, critical incident debriefings, consultations and mediations, workshops and seminars, peer referral contacts and telephone inquiries. This approach would provide a more comprehensive understanding of what EAPs do and would also allow for longitudinal program comparison as well as comparisons between programs.

German and American wage and price dynamics: Differences and common themes

The theoretical section of this paper develops a new nonstructural model of wage and price adjustment that integrates several concepts that have often been treated separately, including Phillips curve ‘level effects’, hysteresis ‘change effects’, the error-correction mechanism, and the role of changes in labor's share that act as a supply shock. The empirical analysis reaches two striking conclusions. First, during 1973–1990 coefficients in our German wage equations are remarkably similar to those in the U.S., with almost identical estimates of the Phillips curve slope, of the hysteresis effect, and of the NAIRU. The two countries also share similar inflation behavior, in that inflation depends more closely on the capacity utilization rate than on the unemployment rate. The big difference between the two countries is that there seems to be no feedback from wages to prices in Germany, and so high unemployment does not put downward pressure on the inflation rate. During the 1970s and 1980s in Germany there emerged a growing mismatch between the labor market and industrial capacity, so that the unemployment rate consistent with the mean (constant-inflation) utilization rate (‘MURU’) increased sharply, while in the U.S. the MURU was relatively stable.

Basal Glucagon Replacement in Chronic Glucagon Deficiency Increases Insulin Resistance

To evaluate the role of glucagon in insulin-mediated glucose metabolism, we studied four men and four women, ranging in age from 30-73 yr (mean +/- SEM, 54 +/- 5) who had undergone complete pancreatic resection for cancer or chronic pancreatitis 16-58 mo previously. The patients had undetectable C-peptide levels and established lack of biologically active 3500 mol wt glucagon. Euglycemic insulin clamp studies were performed with a 40 mU X m-2 X min-1 insulin infusion in the basal, post-absorptive, insulin-withdrawn state, before and during the last 3 h of a 72-h glucagon replacement-dose infusion (1.25 ng X kg-1 X min-1). In four patients, hepatic glucose production was determined by a primed-constant infusion of 3-[3H]glucose. Monocyte insulin-binding studies, pre- and postglucagon, were performed in all patients. The 72-h glucagon infusion, resulting in mean plasma glucagon levels of 124 +/- 7 pg/ml, caused a significant rise in the mean plasma glucose level (249 +/- 8 versus 170 +/- 13 mg/dl preglucagon) and a sixfold increase in mean 24-h glucose excretion. Both with and without glucagon, euglycemic hyperinsulinemia achieved identical and complete suppression of hepatic glucose production. The mean glucose utilization rate (4.70 +/- 0.36 mg X kg-1 X min-1 preglucagon) was significantly decreased by glucagon replacement (3.83 +/- 0.31 mg X kg-1 X min-1, P less than 0.02). Mean glucose clearance was also diminished with glucagon (4.49 +/- 0.32 versus 5.73 +/- 0.45 ml X kg-1 X min-1 preglucagon, P less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)