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Journal articles on the topic 'Multihospital systems – United States'

Author: Grafiati

Published: 29 July 2024

Last updated: 30 July 2024

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1

Hu, Jianhui, and David R. Nerenz. "Performance of Multihospital Health Systems’ Flagship Hospitals in the CMS Star Rating Program." Journal of Hospital Medicine 15, no. 7 (June 17, 2020): 407–10. http://dx.doi.org/10.12788/jhm.3421.

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Using the Hospital Compare overall hospital quality star ratings and other publicly available data on acute care hospitals, we examined star ratings for the flagship hospitals of a set of multihospital health systems in the United States. We compared star ratings and hospital characteristics of flagship and nonflagship hospitals across and within 113 health systems. The system flagship hospitals had significantly lower star ratings than did nonflagship hospitals, and they did not generally have the highest star ratings in their own systems. Higher teaching intensity, larger bed size, higher uncompensated care, and higher disproportionate share hospital (DSH) patient percentage were all significantly associated with lower star ratings of flagship hospitals when compared with nonflagship hospitals across all health systems; the flagship hospital of a system was more likely to have the lowest star rating in its system if the difference in DSH percentage was relatively large between the flagship and nonflagship hospitals in that system.

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2

Schmitt, Matt. "Multimarket Contact in the Hospital Industry." American Economic Journal: Economic Policy 10, no. 3 (August 1, 2018): 361–87. http://dx.doi.org/10.1257/pol.20170001.

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Hospitals in the United States increasingly belong to multihospital systems that operate in numerous geographic markets. A large literature in management and economics suggests that competition between firms may be softened as a result of multimarket contact—i.e., firms competing with one another in multiple markets simultaneously. Exploiting plausibly exogenous variation in multimarket contact generated by out-of-market consolidation, I find that increases in multimarket contact over the 2000–2010 period led to higher hospital prices. These results suggest that continued hospital consolidation may produce higher prices even if that consolidation only minimally affects within-market concentration. (JEL G34, G38, I11, I18, K21, L41)

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3

Trinh, Hanh Q., and James W. Begun. "Strategic Differentiation of High-Tech Services in Local Hospital Markets." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 56 (January 2019): 004695801988259. http://dx.doi.org/10.1177/0046958019882591.

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This study assesses organizational and market factors related to high-tech service differentiation in local hospital markets. The sample includes 1704 nonfederal, general acute hospitals in urban counties in the United States. We relate organizational and market factors in 2011 to service differentiation in 2013, using ordinary least squares regression. Data are compiled from the American Hospital Association Annual Survey of Hospitals, Area Resource File, and Centers for Medicare and Medicaid Services. Results show that hospitals differentiate more services relative to market rivals if they are larger than the rival and if the hospitals are further apart geographically. Hospitals differentiate more services if they are large, teaching, and nonprofit or public and if they face more market competition. Hospitals differentiate fewer services from rivals if they belong to multihospital systems. The findings underscore the pressures that urban hospitals face to offer high-tech services despite the potential of high-tech services to drive hospital costs upward.

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4

Shealy, Stephanie, Joseph Kohn, Emily Yongue, Casey Troficanto, Brandon Bookstaver, Julie A. Justo, Michelle Crenshaw, Hana Winders, Sangita Dash, and Majdi Al-Hasan. "Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s321. http://dx.doi.org/10.1017/ice.2020.918.

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Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

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5

Krause, Robert B. "United States Launch Vehicle Systems." International Astronomical Union Colloquium 123 (1990): 325–32. http://dx.doi.org/10.1017/s025292110007723x.

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AbstractUnited States policy for national space launch capability provides for a balanced mix of launches, utilizing the Space Shuttle and Expendable Launch Vehicles (ELVs). It also directs government agencies to encourage and support the development of a domestic commercial expendable launch vehicle industry. This is to be accomplished by contracting for necessary ELV launch services directly from the private sector and by facilitating access by commercial launch firms to national launch and launch-related property and services they request to support these commercial operations.The current mixed fleet includes the Space Shuttle and four expendable launch vehicles - Titan, Atlas, Delta and Scout. New small class launch vehicles, including Pegasus, are in development. In addition, studies are underway to assure that the United States has cost-effective, reliable access to space, heavy-lift launch capability, and a new manned spacecraft after the current Space Shuttle reaches the end of its operational life. This paper will highlight the current capabilities of the mixed fleet and summarize the plans for new or modified United States launch vehicles through the first decade of the next century.

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6

Loomis, Meagan, Tracy Kosinski, and Stacy Wucherer. "Development and Implementation of a Standardized Sterile Compounding Training Program." Hospital Pharmacy 54, no. 4 (July 18, 2018): 259–65. http://dx.doi.org/10.1177/0018578718788841.

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Purpose: The purpose of the study is to develop and implement a standardized sterile compounding training program in a multihospital system that incorporates sterile compounding best practice recommendations and ensures compliance with United States Pharmacopeia (USP) Chapters 797 and 800 standards. Methods: Baseline sterile compounding training data were collected and reviewed for sterile compounding facilities across a multihospital health system, which included 37 distinct sterile compounding operations. Current sterile compounding personnel across the system completed preintervention assessments consisting of a written, knowledge-based exam; media-fill challenge test; and an observed assessment of aseptic technique. The personnel then completed refresher training of sterile compounding concepts by completing online and in-person courses. A postintervention assessment was then conducted to evaluate training methods and topics. Based on the intervention data, a training program for new sterile compounding personnel was developed and implemented. A program to provide annual, ongoing training to existing sterile compounding personnel was also developed and implemented. Results: There was a statistically significant improvement in sterile compounding written exam scores ( P < .0001) and aseptic technique observation scores ( P < .0001) after implementation of refresher training. The validated training program was then included in the development and implementation of standardized training for all new and existing sterile compounding personnel across a multihospital health system. Conclusion: A standardized and consistent, sterile compounding training program was developed for all new and existing sterile compounding personnel incorporating a live, in-person training course, as well as online and hands-on training.

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7

Charlottestille, Elke Rost-Ruffner. "United States." Journal of Neuroscience Nursing 32, no. 2 (April 2000): 128. http://dx.doi.org/10.1097/01376517-200004000-00015.

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8

Charlottesville, Susan Goode. "United States." Journal of Neuroscience Nursing 32, no. 3 (June 2000): 182–83. http://dx.doi.org/10.1097/01376517-200006000-00013.

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9

Charlottesville, Elke Rost-Ruffner. "United States." Journal of Neuroscience Nursing 32, no. 3 (June 2000): 184. http://dx.doi.org/10.1097/01376517-200006000-00016.

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10

Spangenberg, Robert L., and Marea L. Beeman. "Indigent Defense Systems in the United States." Law and Contemporary Problems 58, no. 1 (1995): 31. http://dx.doi.org/10.2307/1192166.

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11

Cantirino, John, and Susanna S. Fodor. "Construction delivery systems in the United States." Journal of Corporate Real Estate 1, no. 2 (April 1999): 169–77. http://dx.doi.org/10.1108/14630019910811015.

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12

McCallum, Sally H. "Linked Systems Project in the United States." IFLA Journal 11, no. 4 (December 1985): 313–24. http://dx.doi.org/10.1177/034003528501100408.

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13

Blackwell, Thomas, James F. Kellam, and Michael Thomason. "Trauma care systems in the United States." Injury 34, no. 9 (September 2003): 735–39. http://dx.doi.org/10.1016/s0020-1383(03)00152-9.

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14

Heinlein, EdwinB. "United States information systems security — A myth?" Computer Fraud & Security Bulletin 1993, no. 5 (May 1993): 13–15. http://dx.doi.org/10.1016/0142-0496(93)90219-m.

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15

Montgomery, Christina. "Personal Response Systems in the United States." Home Health Care Services Quarterly 13, no. 3-4 (May 20, 1993): 201–22. http://dx.doi.org/10.1300/j027v13n03_17.

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16

&NA;. "Trauma Systems Origins in the United States." Journal of Trauma Nursing 17, no. 3 (2010): 135–36. http://dx.doi.org/10.1097/jtn.0b013e3181f52026.

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17

Boyd, David R. "Trauma Systems Origins in the United States." Journal of Trauma Nursing 17, no. 3 (2010): 126–34. http://dx.doi.org/10.1097/jtn.0b013e3181f5d382.

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18

L., J. F. "MANAGEMENT STRATEGIES HAVE LITTLE IMPACT ON FINANCIAL PERFORMANCE OF RURAL HOSPITALS." Pediatrics 95, no. 5 (May 1, 1995): 656. http://dx.doi.org/10.1542/peds.95.5.656.

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Management strategies adopted in response to a changing hospital market apparently have little impact on the financial performance of rural hospitals in the United States, concludes a study supported by the Agency for Health Care Policy and Research (HS05998). Stephen S. Mick, PhD, of the University of Michigan, and colleagues examined the effect of thirteen management strategies on the financial performance of a national sample of 797 US rural hospitals from 1983 to 1988. Examples of these strategies are group purchasing; multihospital, HMO, or nursing home affiliation; and adoption of outpatient services either inside or outside of the hospital service area. The researchers found no widespread or consistent connection between a hospital's strategic action and positive financial performance ... The researchers conclude from these findings that implementing strategic activities may not be sufficient for rural hospitals to maintain viable networks of acute care facilities in rural areas ...

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19

Gunstone, Frank D. "The United States." Lipid Technology 20, no. 1 (January 2008): 24. http://dx.doi.org/10.1002/lite.200700095.

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20

Adeniran, Rita. "The United Kingdom and United States Health Care Systems: a Comparison." Home Health Care Management & Practice 16, no. 2 (February 2004): 109–16. http://dx.doi.org/10.1177/1084822303258617.

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21

Hoveland, Carl S. "Beef-Forage Systems for the Southeastern United States." Journal of Animal Science 63, no. 3 (September 1, 1986): 978–85. http://dx.doi.org/10.2527/jas1986.633978x.

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22

Furukawa, Michael F., Rachel M. Machta, Kirsten A. Barrett, David J. Jones, Stephen M. Shortell, Dennis P. Scanlon, Valerie A. Lewis, A. James O’Malley, Ellen R. Meara, and Eugene C. Rich. "Landscape of Health Systems in the United States." Medical Care Research and Review 77, no. 4 (January 23, 2019): 357–66. http://dx.doi.org/10.1177/1077558718823130.

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Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U.S. Health Systems, a data resource to support research on comparative health system performance. In this article, we describe the methods used to create the Compendium and present a picture of vertical integration in the United States. We identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. These systems varied by key structural attributes, including size, ownership, and geographic presence. The Compendium can be used to study the characteristics of the U.S. health care system and address policy issues related to provider organizations.

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23

Savage, Ian. "Scale economies in United States rail transit systems." Transportation Research Part A: Policy and Practice 31, no. 6 (November 1997): 459–73. http://dx.doi.org/10.1016/s0965-8564(97)00003-7.

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24

EGUZ, Sule. "Contemporary Education Systems: The Case of United States." Eurasia Proceedings of Educational and Social Sciences 33 (January 3, 2024): 126–34. http://dx.doi.org/10.55549/epess.1413353.

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Modernization efforts for the development of education systems were carried out in parallel with the needs of the age. In this direction, societies that have taken the step of modernization have first tried to revise their existing education systems and identify the prominent obstacles. Education systems have followed a very different course in history; It has been affected by many historical, geographical, economic, social, and cultural factors. The United States education system is an education system that is managed locally due to the history and structure of the country, where the education program, academic calendar, programs, school system structuring, and teacher appointments are determined by the states. In this study, first the political and cultural history of the country and then the functioning and structure of the education system are discussed. The study also compared the Turkish education system and US education. Finally, the study was concluded by including the problems encountered in the US education system.

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25

Monsanto, Rafael da Costa, Henrique Furlan Pauna, Michael M. Paparella, and Sebahattin Cureoglu. "Otopathology in the United States." Otology & Neurotology 39, no. 9 (October 2018): 1210–14. http://dx.doi.org/10.1097/mao.0000000000001942.

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26

Brown, Donald S., and Sherwood C. Reed. "Inventory of Constructed Wetlands in the United States." Water Science and Technology 29, no. 4 (February 1, 1994): 309–18. http://dx.doi.org/10.2166/wst.1994.0215.

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During 1990 and 1991 the U.S. Environmental Protection Agency (EPA) sponsored an effort to identify existing and planned constructed wetlands in the U.S., and to collect readily available information from operating systems. In addition to inquiries by telephone and mail, the effort included site visits to over 20 operating subsurface flow constructed wetlands. The inventory documented the presence of over 150 constructed wetland systems for wastewater treatment, including both free water surface (FWS) and subsurface flow (SF) systems. The majority of the systems identified were SF systems for treating municipal wastewater. FWS systems were separated into three groups based on the design level of effluent water quality. SF systems were separated into three groups based on the basic design approach. The inventory indicated that neither between nor within these groups was there consensus regarding basic hydraulic and engineering design criteria, system configuration, or any other aspect, such as type of vegetation, size and type of media, or pretreatment. Information on location, type of system, design approach, hydraulic and organic loading rates, costs, and other aspects is presented. Information gathered and "lessons learned" from the site visits are presented. Insufficient oxygen for nitrification appears to be a problem for both FWS and SF systems. Insufficient hydraulic design appears to be a problem for SF systems.

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27

Vrabec, Jeffrey T., and Newton J. Coker. "Stapes Surgery in the United States." Otology & Neurotology 25, no. 4 (July 2004): 465–69. http://dx.doi.org/10.1097/00129492-200407000-00011.

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28

McDonald, Robert J., Jennifer S. McDonald, David F. Kallmes, Giuseppe Lanzino, and Harry J. Cloft. "Periprocedural safety of Pipeline therapy for unruptured cerebral aneurysms: Analysis of 279 Patients in a multihospital database." Interventional Neuroradiology 21, no. 1 (February 2015): 6–10. http://dx.doi.org/10.1177/1591019915576289.

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The relative safety of unruptured aneurysm treatment with coiling versus flow diversion therapy is unknown. Most data available on flow diversion reflect highly focused patient groups and very experienced operators. We evaluated a national, multihospital patient database to examine periprocedural morbidity and mortality in patients treated with endovascular flow diversion therapy. The Premier Perspective database was used to identify patients hospitalized between May 2011 and March 2013 for unruptured aneurysm who underwent flow diversion therapy with a Pipeline embolization device. The risk of in-hospital mortality and morbidity was determined using ICD 9 codes. A total of 279 unruptured aneurysm patients at 18 medical centers underwent endovascular therapy with a Pipeline device. Adverse outcomes included in-hospital mortality in two cases (0.7%), discharge to long-term care in 22 cases (7.9%), ischemic complications in 14 cases (5.0%), hemorrhagic complications in four cases (1.4%), and postoperative neurological complications in nine cases (3.2%). This study of a large cohort of patient hospitalizations in the United States provides preliminary data on flow diversion in a “real world” scenario and demonstrates that the periprocedural morbidity and mortality is not negligible and must be considered in the context of the natural history of the aneurysms that are being treated.

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29

Jones, Will, and Alexander Teytelboym. "Matching Systems for Refugees." Journal on Migration and Human Security 5, no. 3 (September 2017): 667–81. http://dx.doi.org/10.1177/233150241700500306.

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Executive Summary1 Design of matching systems between refugees and states or local areas is emerging as one of the most promising solutions to problems in refugee resettlement. We describe the basics of two-sided matching theory used in a number of allocation problems, such as school choice, where both sides need to agree to the match. We then explain how these insights can be applied to international refugee matching in the context of the European Union and examine how refugee matching might work within the United Kingdom, Canada, and the United States.

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30

Greer, Scott L., Holly Jarman, and Peter D. Donnelly. "Lessons for the United States From Single-Payer Systems." American Journal of Public Health 109, no. 11 (November 2019): 1493–96. http://dx.doi.org/10.2105/ajph.2019.305312.

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31

Glickenstein, Harvey. "High-speed rail for the United States? [Transportation systems." IEEE Vehicular Technology Magazine 4, no. 3 (September 2009): 16–23. http://dx.doi.org/10.1109/mvt.2009.933467.

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32

Kahhat, Ramzy, Junbeum Kim, Ming Xu, Braden Allenby, Eric Williams, and Peng Zhang. "Exploring e-waste management systems in the United States." Resources, Conservation and Recycling 52, no. 7 (May 2008): 955–64. http://dx.doi.org/10.1016/j.resconrec.2008.03.002.

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33

Krakoff, Lawrence R. "Systems for Care of Hypertension in the United States." Journal of Clinical Hypertension 8, no. 6 (June 2006): 420–26. http://dx.doi.org/10.1111/j.1076-7460.2006.05385.x.

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34

Fabrycky, Wolter J., and Elizabeth A. McCrae. "6.1.2 Systems Engineering Degree Programs in the United States." INCOSE International Symposium 15, no. 1 (July 2005): 833–47. http://dx.doi.org/10.1002/j.2334-5837.2005.tb00713.x.

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35

Ranavaya, Mohammed I., and James B. Talmage. "Impairment and Disability Compensation Systems in the United States." Guides Newsletter 4, no. 6 (November 1, 1999): 1–13. http://dx.doi.org/10.1001/amaguidesnewsletters.1999.novdec01.

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Abstract Although several states use the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) when they evaluate individuals with impairments and disabilities, various disability systems exist in the United States. Disability and compensation systems have arisen to ensure that disadvantaged members of society with a medically determinable impairment, which may lead to a disability, have recourse to compensation from various sources, including state and federal workers’ compensation laws, veterans’ benefits, social welfare programs, and legal avenues. Each of these has differing definitions of disability, entitlement, benefits, procedures of claims application, adjudication, and the roles and relative weights assigned to medical vs administrative deliberations. Workers’ compensation statutes were enacted because of inadequacies of recovery from claims for injured workers under common law. Workers’ compensation is a no-fault system adopted to resolve the dilemmas of tort claims by providing automatic coverage to employees injured during the course of employment; in exchange for coverage, employees forego the right to sue the employer except for wanton neglect. Other workers’ compensation programs in the United States include the Federal Employees Compensation Act; the Federal Employers Liability Act (railroads); the Jones Act (Merchant Marine Act); the Longshore and Harbor Workers’ Compensation Act; the Department of Veterans Affairs; Social Security; and private, long-term disability insurance.

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36

Klein, Rudolf. "Comparing the United States and United Kingdom: contrasts and correspondences." Health Economics, Policy and Law 7, no. 4 (October 2012): 385–91. http://dx.doi.org/10.1017/s1744133112000199.

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AbstractThe conventionally antithetical stereotypes of the United Kingdom and United States health care systems needs to be modified in the case of the elderly. Relative to the rest of the population, the over-65s in the United States are more satisfied with their medical care than their UK counterparts. There is also much common ground: shared worries about the quality of elderly care and similar attitudes towards assisted death. Comparison is further complicated by within country variations: comparative studies should take account of the fact that even seemingly polar models may have pools of similarity.

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McAlister, Margaret, and Joey D. Helton. "A Comparison of the United States and Austrian Healthcare Needs and Systems." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 58 (January 2021): 004695802110001. http://dx.doi.org/10.1177/00469580211000162.

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Austria and the United States have very different healthcare systems with Austria following a social insurance model and the United States following an out of pocket model however;gross domestic product on healthcare expenditures. There is a current gap in literature on how the United States and Austrian healthcare systems comparatively impact patient outcomes, especially when considering the mediating effects of societal norms such as exercise and mental self-care habits. The information presented could benefit the United States healthcare system if they adopted Austria’s model, which expands access, and the Austrian healthcare system regulators could look to American standards of communication and care coordination to improve their healthcare system overall.

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38

Nicholson, Craig A. "Surgical training in the United States." Bulletin of the Royal College of Surgeons of England 89, no. 2 (February 1, 2007): 56–57. http://dx.doi.org/10.1308/147363507x171285.

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Surgical education in the United States has developed along with the graduate medical education (GME) system. Changes in health care delivery and payment systems, changes in the practice and specialisation of surgery, attempts to improve the system of graduate medical training and even generational changes among those entering surgical training have influenced and changed the way surgeons are trained in the US. Although a thorough examination of these factors and their influence on surgical training is beyond the scope of this brief review, some of these influences and our current surgical training system will be described.

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39

Rosko, Michael, Herbert S. Wong, and Ryan Mutter. "Characteristics of High- and Low-Efficiency Hospitals." Medical Care Research and Review 75, no. 4 (February 5, 2017): 454–78. http://dx.doi.org/10.1177/1077558716689197.

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We compared performance, operating characteristics, and market environments of low- and high-efficiency hospitals in the 37 states that supplied inpatient data to the Healthcare Cost and Utilization Project from 2006 to 2010. Hospital cost-inefficiency estimates using stochastic frontier analysis were generated. Hospitals were then grouped into the 100 most- and 100 least-efficient hospitals for subsequent analysis. Compared with the least efficient hospitals, high-efficiency hospitals tended to have lower average costs, higher labor productivity, and higher profit margins. The most efficient hospitals tended to be nonteaching, investor-owned, and members of multihospital systems. Hospitals in the high-efficiency group were located in areas with lower health maintenance organization penetration and less competition, and they had a higher share of Medicaid and Medicare admissions. Results of the analysis suggest there are opportunities for public policies to support improved efficiency in the hospital sector.

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40

Parker, Matthew D., and David A. Ahijevych. "Convective Episodes in the East-Central United States." Monthly Weather Review 135, no. 11 (November 1, 2007): 3707–27. http://dx.doi.org/10.1175/2007mwr2098.1.

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Abstract Nine years of composited radar data are investigated to assess the presence of organized convective episodes in the east-central United States. In the eastern United States, the afternoon maximum in thunderstorms is ubiquitous over land. However, after removing this principal diurnal peak from the radar data, the presence and motion of organized convective systems becomes apparent in both temporally averaged fields and in the statistics of convective episodes identified by an objective algorithm. Convective echoes are diurnally maximized over the Appalachian chain, and are repeatedly observed to move toward the east. Partly as a result of this, the daily maximum in storms is delayed over the Piedmont and coastal plain relative to the Appalachian Mountains and the Atlantic coast. During the 9 yr studied, the objective algorithm identified 2128 total convective episodes (236 yr−1), with several recurring behaviors. Many systems developed over the elevated terrain during the afternoon and moved eastward, often to the coastline and even offshore. In addition, numerous systems formed to the west of the Appalachian Mountains and moved into and across the eastern U.S. study domain. In particular, many nocturnal convective systems from the central United States entered the western side of the study domain, frequently arriving at the eastern mountains around the next day’s afternoon maximum in storm frequency. A fraction of such well-timed systems succeeded in crossing the Appalachians and continuing across the Piedmont and coastal plain. Convective episodes were most frequent during the high-instability, low-shear months of summer, which dominate the year-round statistics. Even so, an important result is that the episodes still occurred almost exclusively in above-average vertical wind shear. Despite the overall dominance of the diurnal cycle, the data show that adequate shear in the region frequently leads to long-lived convective episodes with mesoscale organization.

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41

Craun, Michael F., Gunther F. Craun, Rebecca L. Calderon, and Michael J. Beach. "Waterborne outbreaks reported in the United States." Journal of Water and Health 4, S2 (December 1, 2006): 19–30. http://dx.doi.org/10.2166/wh.2006.016.

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Epidemic waterborne risks are discussed in this paper. Although the true incidence of waterborne illness is not reflected in the currently reported outbreak statistics, outbreak surveillance has provided information about the important waterborne pathogens, relative degrees of risk associated with water sources and treatment processes, and adequacy of regulations. Pathogens and water system deficiencies that are identified in outbreaks may also be important causes of endemic waterborne illness. In recent years, investigators have identified a large number of pathogens responsible for outbreaks, and research has focused on their sources, resistance to water disinfection, and removal from drinking water. Outbreaks in surface water systems have decreased in the recent decade, most likely due to recent regulations and improved treatment efficacy. Of increased importance, however, are outbreaks caused by the microbial contamination of water distribution systems. In order to better estimate waterborne risks in the United States, additional information is needed about the contribution of distribution system contaminants to endemic waterborne risks and undetected waterborne outbreaks, especially those associated with distribution system contaminants.

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42

Gunstone, Frank D. "United States of America year." Lipid Technology 22, no. 6 (June 24, 2010): 144. http://dx.doi.org/10.1002/lite.201000031.

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43

Anderson, James G., and E. Andrew Balas. "Computerization of Primary Care in the United States." International Journal of Healthcare Information Systems and Informatics 1, no. 3 (July 2006): 1–23. http://dx.doi.org/10.4018/jhisi.2006070101.

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Webb, David W., and David R. Hoffpauir. "Critical Incident Management and Geographically–Based Systems." International Journal of Applied Geospatial Research 1, no. 3 (July 2010): 69–75. http://dx.doi.org/10.4018/jagr.2010070105.

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In the United States there is a strong dependence on decentralized policing services, distributed by thousands of police departments. As a primary police professional development management institute in the United States, the Law Enforcement Management Institute of Texas (LEMIT) identified that there existed a paucity of management development opportunities for police command staff engaged in critical incident management. This paper describes how LEMIT met this challenge and became a leading U.S. institute in this exciting field of operation.

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45

Stuckey, Roy. "The Evolution of Legal Education in the United States and the United Kingdom: How one system became more faculty-oriented while the other became more consumer-oriented." International Journal of Clinical Legal Education 6 (July 18, 2014): 101. http://dx.doi.org/10.19164/ijcle.v6i0.102.

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<p>This paper explores how our approaches to preparing lawyers for practice became so different. It traces the evolution of the systems for preparing lawyers for practice in the United Kingdom and the United States, and it examines the relative merits of our current situations. Part I describes the key differences in our systems. Part II recounts major events in the histories of legal education in the United States and the United Kingdom. Part III describes new initiatives in the United Kingdom and the United States that may improve legal education.</p>

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Silverstein, Herbert, Hayes Wanamaker, John Flanzer, and Seth Rosenberg. "VESTIBULAR NEURECTOMY IN THE UNITED STATES???1990." Otology & Neurotology 13, no. 1 (January 1992): 23???30. http://dx.doi.org/10.1097/00129492-199201000-00007.

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Harwell, Kevin R. "United States Patent and Trademark Office." Journal of Business & Finance Librarianship 8, no. 1 (February 2002): 47–54. http://dx.doi.org/10.1300/j109v08n01_05.

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Roe, Abbie McClintock, and Aaron Liberman. "A Comparative Analysis of the United Kingdom and the United States Health Care Systems." Health Care Manager 26, no. 3 (July 2007): 190–212. http://dx.doi.org/10.1097/01.hcm.0000285010.03526.f5.

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Hanzlick, Randy. "The Conversion of Coroner Systems to Medical Examiner Systems in the United States." American Journal of Forensic Medicine and Pathology 28, no. 4 (December 2007): 279–83. http://dx.doi.org/10.1097/paf.0b013e31815b4d5a.

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Cooke, R., and S. Verma. "Performance of drainage water management systems in Illinois, United States." Journal of Soil and Water Conservation 67, no. 6 (November 1, 2012): 453–64. http://dx.doi.org/10.2489/jswc.67.6.453.

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