Relationship of provider characteristics to outcomes, process, and costs of care for community-acquired pneumonia

OBJECTIVES: The authors describe the relation of provider characteristics to processes, costs, and outcomes of medical care for elderly patients hospitalized for community-acquired pneumonia. METHODS: Using Medicare claims data, Medicare beneficiaries discharged from Pennsylvania hospitals during 1990 with community-acquired pneumonia were identified. Claims data were used to ascertain mortality, readmissions, use of procedures and physician consultations, and the costs of care. The relationship of these measures to provider characteristics was analyzed using regression techniques to adjust for patient characteristics, including comorbidity and microbial etiology. RESULTS: Among 22,294 pneumonia episodes studied, 30-day mortality was 17.0%. After adjusting for patient characteristics, 30-day mortality and readmission rates were unrelated to hospital teaching status or urban location or to physician specialty. Use of procedures and physician consultations was more common and costs were 11% higher among patients discharged from teaching hospitals compared with nonteaching hospitals. Similarly, costs were 15% higher at urban hospitals compared with rural hospitals. General internists and medical subspecialists used more procedures and had higher costs than family practitioners. CONCLUSIONS: Processes and costs of care for community-acquired pneumonia varied by provider characteristics, but neither mortality nor readmission rates did. These differences cannot be explained by clinical variables in the database. Further studies should determine whether less costly patterns of care for pneumonia, and perhaps other conditions, could replace more costly ones without compromising patient outcomes.     

蛋白质与原卟啉Ⅸ及复合物发光机理探讨

对原卟啉Ⅸ（ＰｒｏｔｏｐｏｒｐｈｙｒｉｎⅨ）与蛋白质结合物的吸收、荧光的激发、发射光谱等的研究，表明了在光作用下，其可见区发光（λｍａｘ６３５ｎｍ左右）与卟啉有关，而紫外区发光（λｍａｘ４２２ｎｍ左右）与蛋白质的色氨酸残基有关，其光谱特性与临床诊断选择的癌固有荧光特征峰基本相符。该研究结果为探讨癌的发光机理积累了有益资料．     

Free vibration of laminated plates using a finite strip method based on a higher-order plate theory

The finite strip method based on the higher-order plate theory is developed for determining the natural frequencies of laminated plates. This method can accurately predict the through thickness effect of transverse shear deformation. Furthermore, only a few degress of freedom are required in the finite strip method. Some numerical results for various span-to-thickness ratios, material properties and stack sequences are presented for illustrative purposes. The present model provides a better way to obtain more accurate natural frequency results.     

A comparison study of the two-tier and the single-tier personal communications services systems

A two-tier PCS system integrates the high tier PCS system and the low tier PCS systems into a single system to provide the advantages of both tiers. Such a system is expected to provide better service (more available and more cost effective to the users) at the expense of the extra tier switching management. We compare the performance of the two-tier PCS system and the single low tier system in two aspects: the registration traffic and the service availability. Because of the tier management, the two-tier system generates more registration traffic than the single low tier system. Under the range of the input parameters in our study, we show that the two-tier system generates less than 10% extra registration traffic than the single low tier system in most cases and generates less than 20% registration traffic in the worst cases. It is clear that for the service availability, the two-tier system is better than the single one tier system. We also study the probability that a call is forced terminated in the single low tier system because the low tier becomes unavailable during the call (such a call can be continued in the two-tier system).     

One-stage sternal stenting with homograft bone after cardiac operation in pediatric patients

Low cardiac output after open heart operations in neonates and infants carries a high mortality. Delayed sternal closure may be life-saving but may prolong hospital stay and increase costs. To circumvent these issues, we shaped homograft bone and interposed it between the sternal edges to allow primary wound closure in 2 pediatric patients. Midterm results are satisfactory.     

Self-care behaviors, self-efficacy, and social support effect on the glycemic control of patients newly diagnosed with non-insulin-dependent diabetes mellitus

The purpose of this study was to explore the glycemic control and influencing factors in outpatients newly diagnosed with non-insulin-dependent diabetes mellitus (NIDDM). By purposeful sampling, data were collected from 130 outpatients with NIDDM at one medical center in Kaohsiung. The results indicated: (1) the mean value for HbA1C was 7.12%; and 63.1% of the patients belonged to moderate to well controlled group; (2) male patient's HbA1C value was significantly lower than female patient's; patients with no religious belief also had a lower HbA1C value than patients with a religious background; (3) there were strongly negative correlations between self-care behaviors, social support, and self-efficacy and HbA1C; (4) using a multiple stepwise regression analysis, religious belief and self-care behaviors were found to explain 10.9% variance of HbA1C level. The results of this study could be used as a reference for diabetes health education program.     

A new process of fabricating inverted-staggered tri-layer thin-filmtransistors

A new method of fabricating a-Si:H TFT with etching-stop structure has been proposed. Only one plasma-enhanced chemical vapor deposition is required in this new method and a PH₃/H₂ plasma treatment during the deposition has been used to form the TFT contact and thus saved another plasma deposition. With this method, a TFT of 500 Å active layer has been fabricated successfully. The drain current and saturation mobility of this device is 2.4×10^-7 A and 0.1 cm²/V sec, respectively, which is comparable to the conventional fabricating method. The plasma treatment will also form an additional leakage path on the TFT top surface and increase the TFT subthreshold slope. However, a current of less than 1 pA at V_G=-2.4 V can still be obtained. The possible mechanism of the contact formation by the plasma treatment is also discussed     

连铸坯的液芯轧制

研究了连铸坯的液芯轧制，并结合日本川崎永岛厂的实例，证实了连铸坯液芯轧制的可行性，指出了钢锭和连铸坯液芯轧制的区别，及如何制造压应力状态，推导了坯壳应力与轧辊直径压下量，坯壳厚度的关系，并提出了用振摆式轧机实施连铸机液芯轧制的方案。     

用过零时间法分析的中能重离子探测器望远镜

本文描述了中能重离子探测器望远镜ＮＥ１０２Ａ＋ＣｓＩ（Ｔｌ）＋ＰＭＴ采用过零时间的方法鉴别粒子，实验结果表明可清楚地分辨ｐ、ｄ、ｔ同位素和探测到的全部碎片。     

测量高功率激光的体吸收能量计

叙述了体吸收激光能量计的特点，介绍了其标定方法，给出了其技术参数。体吸收激光地的推广应用取得了广泛的社会效益。