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BACKGROUND Hospital medical groups use various staffing models that may systematically affect care continuity during the admission process. OBJECTIVE To compare the effect of 2 hospitalist admission service models (“general” and “admitter-rounder”) on patient disposition and length of stay. DESIGN Retrospective observational cohort study with difference-in-difference analysis. SETTING Large tertiary academic medical center in the United States. PARTICIPANTS Patients (n = 19,270) admitted from the emergency department to hospital medicine and medicine teaching services from July 2010 to June 2013. INTERVENTIONS Admissions to hospital medicine staffed by 2 different service models, compared to teaching service admissions. MEASUREMENTS Incidence of transfer to critical care within the first 24 hours of hospitalization, hospital and emergency department length of stay, and hospital readmission rates ≤30 days postdischarge. RESULTS The change of hospitalist services to an admitter-rounder model was associated with no significant change in transfer to critical care or hospital length of stay compared to the teaching service (difference-in-difference P = 0.32 and P = 0.87, respectively). The admitter-rounder model was associated with decreased readmissions compared to the teaching service on difference-in-difference analysis (odds ratio difference: −0.21, P = 0.01). Adoption of the hospitalist admitter-rounder model was associated with an increased emergency department length of stay compared to the teaching service (difference of +0.49 hours, P < 0.001). CONCLUSIONS Rates of transfer to intensive care and overall hospital length of stay between the hospitalist admission models did not differ significantly. The hospitalist admitter-rounder admission service structure was associated with extended emergency department length of stay and a decrease in readmissions. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine

This study tests the neoclassical concept of interregional migration in post-World War II Japan. The lead-lag relationship between net migration to a core area and regional income inequalities is examined by modeling an ARIMA transfer function. Until 1961 there was a rapid growth in net migration from the periphery to the core area that was accompanied by rapid divergence in regional income inequalities. Since then migration to the core apparently has declined due to a convergence of regional income inequalities. The time series analysis indicates there has been short-run as well as long-run volatility in migration related to cyclical variations in economic performance in the core. (EXCERPT)

The American system of federalism creates frequent opportunities for clashes between state and federal environmental regulators.State and federal environmental laws overlap but are not easily reconciled. Most federal environmental law provides no clear answer as to how to reconcile differing mandates of state and federal environmental regulators. In this article, they will examine these state-federal conflicts as they played out in 1994 in the cleanup of contaminated sites in the state of Washington. This article describes the way a regional office of the Environmental Protection Agency and the state`s Department of Ecology developed a novel approach to managing the essential tension between overlapping state and federal cleanup laws.

Public Service Company of Colorado (PSCo), in cooperation with the US Department of Energy (DOE) and the Electric Power Research Institute (EPRI), is testing the Integrated Dry NO{sub x}/SO{sub 2} Emissions Control system. This system combines low-NO{sub x} burners, overfire air, selective non-catalytic reduction (SNCR), and dry sorbent injection with humidification to reduce by up to 70% both NO{sub x} and SO{sub 2} emissions from a 100 MW coal-fired utility boiler. The project is being conducted at PSCo`s Arapahoe Unit 4 located in Denver, Colorado as part of the DOE`s Clean Coal Technology Round 3 program. The urea-based SNCR system, supplied by Noell, Inc., was installed in late 1991 and was tested with the unmodified boiler in 1992. At full load, it reduced NO{sub x} emissions by about 35% with an associated ammonia slip limit of 10 ppm. Babcock & Wilcox XLS{reg_sign} burners and a dual-zone overfire air system were retrofit to the top-fired boiler in mid-1992 and demonstrated a NO{sub x} reduction of nearly 70% across the load range. Integrated testing of the combustion modifications and the SNCR system were conducted in 1993 and showed that the SNCR system could reduce NO{sub x} emissions by an additional 45% whilemore » maintaining 10 ppm of ammonia slip limit at full load. Lower than expect4ed flue-gas temperatures caused low-load operation to be less effective than at high loads. NO{sub x} reduction decreased to as low as 11% at 60 MWe at an ammonia slip limit of 10 ppm. An ammonia conversion system was installed to improve performance at low loads. Other improvements to increase NO{sub x} removal at low-loads are planned. The combined system of combustion modifications and SNCR reduced NO{sub x} emissions by over 80% from the original full-load baseline. 11 figs.« less

This paper examines the concept of metropolitan dominance as measured by the concentration of corporate activity in large urban centres in the Canadian urban system. Specifically, it explores the extent of corporate concentration in various sectors of the economy; isolates those urban centres in which that concentration occurs; and identifies the extent and location of international penetration of the Canadian economy. Dans cette etude, nous examinons le concept de l'importance des metropoles en fonction de la concentration des diverses entreprises dans le systeme urbain du Canada. Plus specifiquement, nous examinons le degre de cette concentration dans divers secteurs economiques; nous isolons les centres urbain ou a lieu cette concentration; nous identifions l'etendue et les points de penetration internationale dans l'economie du Canada.