Use of spatiotemporal couplings and an axiparabola to control the velocity of peak intensity.

This paper presents the first experimental realization of a scheme that allows for the tuning of the velocity of peak intensity of a focal spot with relativistic intensity. By combining a tunable pulse-front curvature with the axial intensity deposition characteristics of an axiparabola, an aspheric optical element, this system provides control over the dynamics of laser-wakefield accelerators. We demonstrate the ability to modify the velocity of peak intensity of ultrashort laser pulses to be superluminal or subluminal. The experimental results are supported by theoretical calculations and simulations, strengthening the case for the axiparabola as a pertinent strategy to achieve more efficient acceleration.

Simple few-shot method for spectrally resolving the wavefront of an ultrashort laser pulse.

We present a novel, to the best of our knowledge, and straightforward approach for the spatio-spectral characterization of ultrashort pulses. This minimally intrusive method relies on placing a mask with specially arranged pinholes in the beam path before the focusing optic and retrieving the spectrally resolved laser wavefront from the speckle pattern produced at focus. We test the efficacy of this new method by accurately retrieving chromatic aberrations, such as pulse-front tilt (PFT), pulse-front curvature (PFC), and higher-order aberrations introduced by a spherical lens. The simplicity and scalability of this method, combined with its compatibility with single-shot operation, make it a strong complement to existing tools for high-intensity laser facilities.

Comparing the Financial Impact of Several Hospitals on Their Local Markets.

Several studies that measured the financial impact of hospitals on their local markets are examined. Descriptive analyses were performed to ascertain if there are any identifying characteristics and emerging patterns in the data. After hospitals were categorized into small, medium, and large classifications based on the number of employees, various predictive insights were discovered. Smaller hospitals could be expected to contribute approximately 7.3% to the local economy, whereas medium-sized hospitals would likely contribute approximately 11.4% to the financial value of the local market. Finally, larger hospitals may contribute approximately 16% to their local economies.

Regional Interrelationships: A Leadership Opportunity for Health Care.

Given the impact that the health care industry has on the national economy, health care executives need to move beyond simply providing health care treatments and instead focus on strategically leading their regions, including the other key industry contributors in their specific regions. Geographic and economic regions can be viewed as concentric circles of influence, with each circle recognizing the resources and contributions that are specific to a region. An acknowledgement by health care executives of the regional interrelationships that exist in a specific region is necessary for health care managers to strategically lead regional interrelationships. A template for implementation of this process is included. To understand the various factors that exist within circles of influence, several distinct yet interrelated vertical bases of knowledge will be discussed. The 5 bases of knowledge examined here include the following: Health Care, Tourism, Defense and Technology, Education, and Retail. It is important to note that the resources identified in the Tourism, Defense and Technology, Education, and Retail knowledge bases all have a direct influential relationship upon the health care resources of the region. For description purposes, the Central Florida geographic and economic region will be examined for interrelationships between the 5 knowledge bases.

Health Care Affordability: How to Make It a Reality.

Health care is a big business. US health care expenditures reached $2.9 trillion in 2013. Patient spending accounted for 28% of the total, which means patients spent approximately $810 billion in 2013 for insurance premiums, deductibles, copays, coinsurance, and noncovered health care services. How are patients expected to pay almost a trillion dollars in health care expenses? There is a need to find a health care financing methodology that will make health care affordable for all patients and families. An alternative method for funding health care is discussed that includes creating a government-funded annuity during the first decade of one's life. When this annuity matures later in life, many individuals will have amassed a large pot of money with which to pay for their (and their family's) health care treatment and products.

The financial impact of hospitals on the local economy--2 new factors.

This research effort presents a descriptive analysis of the financial impact that several hospitals have on their local economy. An earlier study published by the authors included 3 distinct, yet overlapping components of financial impact: (1) the hospital system as a major health care provider, (2) the hospital system as a large employer, and (3) the hospital system as an entity whose employees contribute greatly to their local community. This new study added additional financial impact factors: (4) the hospital system as an organization committed to major construction projects in pursuit of its health services mission, and (5) the hospital system as an entity that pays taxes to government agencies. The inextricable relationship of these 5 categories both increases and enhances the impact of the hospital system on the local region. The results of this updated and expanded analysis suggest strongly that the hospital system represents 1 of the primary contributors to the economy of the region. The hospital system adds $3 billion to the $28 billion local economy, which means that the hospital system and its employees are responsible for 10.7% of the total economic prowess of the region.

Emergency department utilization at a large regional hospital: a strategy for survivability.

This research effort provides a brief picture of the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system located in the southeastern United States. The results are presented anonymously as a descriptive case study. A multifaceted strategy is presented to assist hospital leaders as they strive to ensure the survivability of their emergency departments in this era of high uncompensated care.

The effects of national health care reform on local businesses--part 1. The law and its applicability.

This is part 1 of a 3-part series that presents a comprehensive examination of the results that can be expected from the 2010 national Health Care Reform legislation. Political pundits have speculated endlessly on the many changes mandated by the legislation, titled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that members of the business community and their employees will benefit from the legislation early on (years 1-3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). Businesses will likely be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly-insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

The effects of national health care reform on local businesses--part II: study methodology and primary research questions.

This is the second part of a 3-part examination of what may be potentially expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that, nationally, members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (year 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be-newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

The effects of national health care reform on local businesses--Part III: secondary research questions--discoveries and implications.

This is the third part of a 3-part examination of what may potentially be expected from the 2010 national health care reform legislation. Political researchers and pundits have speculated endlessly on the many changes mandated by the 2010 national health care reform legislation, styled the Patient Protection and Affordable Care Act. A review and assessment of this legislation at several levels (federal, state, state agency, local region, and individual business leaders) were undertaken. The results of this expanded analysis suggest strongly that nationally members of the business community and their employees will benefit from the legislation early on (years 1 through 3) and then likely will be impacted adversely as the payment mechanisms driving the legislation are tightened by new federal regulations (years 4 onward). As a result of this research, it is surmised that businesses will be immediately impacted by the legislation, with small business owners being the prime beneficiaries of the new legislation, owing to the availability of coverage to approximately 32 million individuals who previously had no access to coverage. In that regard, the soon-to-be newly insured population also will be a prime beneficiary of the legislation as the limitations on chronic illnesses and other preexisting conditions will be reduced or eliminated by the legislation.

Toward the adoption of complexity science in health care: implications for risk-taking and decision-making activities.

This article explores the issues of risk taking and decision making in health care. An analysis of various sociocultural and psychological influences is provided for understanding of the dominant mind set in this industry. In tandem with this analysis, the evolution of system theories is described so as to promote understanding of the relative merits of the mechanistic and complexity philosophies. These philosophies are at odds with each other, conceptually and practically speaking; however, it seems that the complexity approach offers more promising strategies for the growth and development of health care. Recommendations for improving employee competencies and the organizational structure and culture in health care are offered in light of this analysis. These recommendations are relevant to activities that are clinical and administrative in nature.

Health care transitions and the aging population: a framework for measuring the value of rapid rehabilitation.

A study was undertaken to establish a framework to measure the value of rapid rehabilitation and identify indicators to quantify effective outcomes and efficient processes as health care services are delivered to the aging population across providers, services, and settings. The rapid rehabilitation protocol serving as intervention in this research provides patients (≥65 years old) the option to transition from the acute-care hospital, early in the continuum of care, to an outpatient, skilled nursing facility operated by a division of the hospital organization. A quasi-experimental, cross-sectional, retrospective study is designed to identify and quantify the relationships present in processes and outcomes inherent in health care transitions. Statistical analysis yields unexpected relationships with limited explanatory power for the selected indicators: length of stay, cost of care, discharge delays, 30-day readmissions, falls, and patient satisfaction. However, this research finds 4 imperatives for hospital and clinical leadership: (1) increase collaboration across providers, settings, and stakeholders; (2) educate workforce to optimize risk assessment of aging population; (3) standardize critical to quality measures as scientific foundation for management of services; (4) invest in technologies to ensure the integrity, validity, and reliability of information used to draw inferences about services, risk, and performance.

Demand study for advanced dental hygiene educational degrees: part 2: assessing educational demand.

Currently, the debate over the addition of the midlevel provider position for dental hygienists rages on. The midlevel provider (similar to the physician's assistant) in dentistry exists in a handful of states in various forms, but is hotly contested in many other states. This is the second half of a 2-part study undertaken to add to the current body of knowledge by addressing the clinical needs changing in our population and the associated demand study for additional educational degrees for dental hygienists to address these changing needs. Part 1 addressed a literature update on oral health and systemic correlations contributing to our populations' declining health conditions, whereas part 2 illustrates the results of the demand study. It attempts to benchmark "adequate demand" and applies the stakeholder theory as its theoretical framework.

Demand study for advanced dental hygiene educational degrees: Part 1: Assessing the clinical changes of our population.

The debate over the addition of the midlevel provider position for dental hygienists currently rages on. The midlevel provider (similar to the physician's assistant) in dentistry exists in a handful of states but is hotly contested in many other states. This is a 2-part study to add to the current body of knowledge by addressing the changing clinical needs in our population and the associated demand study for additional educational degrees for dental hygienists to address these changing needs. Part 1 addresses a literature update on oral health and systemic correlations contributing to our populations' declining health conditions, whereas part 2 illustrates the results of the demand study.

Sexuality in the workplace: where do we stand?

Increasingly, organizational leaders must face the perplexing problem of dealing with sexual relationships in the workplace. Given recent changes in the composition of our workforce, there is a critical need for leaders to manage sexual workplace relationships and to do so in a way that acknowledges both individual and organizational needs. As a result, organizations must distinguish between appropriate and inappropriate sexual behaviors. For organizations to set effective and realistic behavioral guidelines, it is imperative that leaders gain a clearer understanding of the issues that surround sexuality in the workplace. In response to this need, this article discusses the characteristics of sexual workplace relationships, explain the individual and organizational factors that encourage these relationships to form, and outline the individual and organizational consequences that are likely to ensue. Lastly, this article evaluates some contemporary approaches to managing sexual workplace behaviors so that organizational leaders can gain some insight on how to manage interpersonal attractions among employees in a positive, productive, and nonthreatening manner.

Hospital in-house laboratories: examining the external environment.

As hospitals fight for their portion of reimbursed health care expenditures, it will become increasingly necessary to investigate alternative funding mechanisms. In-house laboratories, which have likely been seen in the past as pure cost centers, can be repositioned to provide additional revenue to hospitals. This opportunity for in-house laboratories to be remade into profit centers is predicated upon a thorough understanding of the environmental factors affecting hospital laboratories. This article examines 4 distinct environmental factors: demographic and socioeconomic trends, reimbursement and financing, government policy, and clinical events. Each of these external environmental factors provides 2 broad sources of interest to hospitals and their in-house laboratory components: opportunities on which to capitalize and hazards against which to defend.

Emergency department utilization by insured users: a study of motivating factors.

Emergency departments (EDs) represent a critical entryway into America's health care delivery system and are under significant pressure. This study seeks to understand why insured patients use EDs rather than more appropriate medical alternatives available to reduce the strain they are placing on this critical portal of entry. This exploratory research study surveyed insured patients presenting to 1 of 4 Central Florida EDs. Factor analysis and cluster analysis were used to identify groups of insured ED users defined by motivating factors. This study found that there exists a disconnect between insured individuals and the primary care system.

Understanding the barriers to physician error reporting and disclosure: a systemic approach to a systemic problem.

INTRODUCTION: The issues of medical errors and medical malpractice have stimulated significant interest in establishing transparency in health care, in other words, ensuring that medical professionals formally report medical errors and disclose related outcomes to patients and families. However, research has amply shown that transparency is not a universal practice among physicians. METHODS: A review of the literature was carried out using the search terms "transparency," "patient safety," "disclosure," "medical error," "error reporting," "medical malpractice," "doctor-patient relationship," and "physician" to find articles describing physician barriers to transparency. RESULTS: The current literature underscores that a complex Web of factors influence physician reluctance to engage in transparency. Specifically, 4 domains of barriers emerged from this analysis: intrapersonal, interpersonal, institutional, and societal. CONCLUSION: Transparency initiatives will require vigorous, interdisciplinary efforts to address the systemic and pervasive nature of the problem. Several ethical and social-psychological barriers suggest that medical schools and hospitals should collaborate to establish continuity in education and ensure that knowledge acquired in early education is transferred into long-term learning. At the institutional level, practical and cultural barriers suggest the creation of supportive learning environments and private discussion forums where physicians can seek moral support in the aftermath of an error. To overcome resistance to culture transformation, incremental change should be considered, for example, replacing arcane transparency policies and complex reporting mechanisms with clear, user-friendly guidelines.

Coding, reimbursement, and managed care.

This article will discuss the vital link, emerging role, and high financial impact of medical coding to health care reimbursement and managed care. Medical (clinical) coding represents the data requirements needed to support the following: