This study examines specific organizational, operational, financial and environmental characteristics to identify factors that are associated with increased likelihood of hospitals' CPOE adoption decision in six rollout regions of the Leapfrog initiatives.Resource dependence theory provides theoretical basis for the study. The study is retrospective observational in design. Individual hospitals are the unit of analysis. The Leapfrog Group's 2002-survey collection serves the primary data source. Univariate statistical methods along with bivariate and ordinal logistic regression models are used to analyze the data. The models provided support for multiple hypotheses for both the adoption and early adoption decisions of study hospitals. The operational characteristics of ownership, in-house physician staff, case mix index and the environmental characteristic of HMO penetration rate had a positive effect on management's adoption decisions. The operational characteristic excess capacity, the organizational characteristic community orientation, the financial characteristic of operating income per admission, and the environmental characteristic of number of HMO contracts had a significant negative effect on CPOE adoption decisions.

The electronics industry has developed incredibly in last few years and the need for low voltage and low power consuming devices is reflected with its growth. A small extension in battery life can be reflected in an order of magnitude in terms of retail prices. From multimedia gadgets (like laptops, mobiles, notebook etc.) to the biomedical device, all applications have seen a rapid advancement. All these devices need a low voltage and low power transceiver to connect with the wireless networks. This PhD thesis is focused on the development of new designing techniques for low voltage, low power integrated circuits, having close attention on circuits suitable for analog devices. The vast majority of high performance analog circuit cells realized in metal–oxide–semiconductor field-effect transistor (MOSFET) technologies traditionally exploits transistors operating in saturation. Meanwhile there exists a region of weak inversion, which was left unexploited until recently, where the behavior of a MOS transistor is similar to a bipolar transistor in qualitative terms. This region could be exploited for the devices which require operating with low voltage supply. Instead of operating in saturation region, the MOS devices employed in this design, operate in weak inversion. The MOS devices in the proposed circuits are bulk-controlled. In the conventional mode of biasing the bulk terminal is left unused and is connected with lowest supply voltage or ground while the gate is usually chosen for the input signal introduction to bias the circuit. The bulk can be used as an input for signal, can lower the threshold of a transistor if biased properly, ultimately lowering the supply voltage requirement of the transistor. In this work a modified Nauta’s Transconductor, which operates on very low voltages and have a tunable transconductance is employed to design filters. The filter constructed can be tuned in the range of few MHz. The proposed filter is operated using a 0.5V supply and its cutoff frequency can be easily adjusted. All circuits are designed and analyzed using a triple well 0.13μm CMOS process. This OTA is further modified to achieve better performance, in order to implement it in a complex filter. In low IF devices the down-conversion of image signal along with the wanted signal at the same frequency is a major problem. Complex filter can easily remove this image signal by applying a frequency shifting operation. A sixth order complex filter by implementing Leapfrog technique is designed using the differential OTA. The filter is designed to meet the Bluetooth and Zigbee standard requirements. The filter operates on a 0.5V supply voltage, and has very good results for Image rejection, sensitivity, noise and the filter is orthogonally tunable. The performance of the filter has been evaluated through simulation results by employing a triple well 0.13μm CMOS process. This filter design can be implemented in the Bluetooth devices used for the biomedical applications. / Η βιομηχανία της ηλεκτρονικής έχει αναπτυχθεί απίστευτα τα τελευταία χρόνια και η ανάπτυξη αυτή συνδυάζεται με την ανάγκη για συσκευές που λειτουργούν σε χαμηλή τάση και με χαμηλή κατανάλωση ενέργειας. Σε ότι αφορά την εμπορική τιμή, μια μικρή αύξηση της διάρκειας ζωής της μπαταρίας μπορεί να αντανακλάται σε μια αύξηση κατά μία τάξη μεγέθους της τιμής. Όλες οι εφαρμογές, από τις συσκευές πολυμέσων (όπως κινητά τηλέφωνα, φορητούς υπολογιστές, notebook κ.λπ.) έως και τις βιοϊατρικές συσκευές έχουν δει μια ταχεία πρόοδο. Όλες αυτές οι συσκευές, για να συνδέονται με ασύρματα δίκτυα, χρειάζονται πομποδέκτη χαμηλής τάσης και χαμηλής κατανάλωσης ισχύος. Η παρούσα διδακτορική διατριβή επικεντρώνεται στην ανάπτυξη νέων τεχνικών σχεδιασμού για ολοκληρωμένα κυκλώματα με έμφαση στα αναλογικά κυκλώματα, χαμηλής τάσης και χαμηλής ισχύος. Η συντριπτική πλειοψηφία των δομικών βαθμίδων αναλογικών κυκλωμάτων υψηλών επιδόσεων πραγματοποιείται σε τεχνολογία μετάλλου οξειδίου ημιαγωγού τρανζίστορ φαινομένου πεδίου (MOSFET) και εκμεταλλεύεται τα τρανζίστορ που παραδοσιακά λειτουργούν σε κόρο. Ωστόσο, υπάρχει η περιοχή ασθενούς αναστροφής, η οποία αφέθηκε ανεκμετάλλευτη μέχρι πρόσφατα, όπου η συμπεριφορά των τρανζίστορ MOS είναι παρόμοια με αυτήν των διπολικών τρανζίστορ. Αυτή η περιοχή θα μπορούσε να αξιοποιηθεί για τις συσκευές που απαιτούν λειτουργία με χαμηλή τάση τροφοδοσίας. Αντί να λειτουργούν στην περιοχή κόρου, τα τρανζίστορ MOS που χρησιμοποιούνται σε αυτό το σχεδιασμό, λειτουργούν σε ασθενή αναστροφή. Τα τρανζίστορ MOS στα προτεινόμενα κυκλώματα είναι ελεγχόμενα από το υπόστρωμα (bulk-driven). Στο συμβατικό τρόπο οδήγησης το υπόστρωμα παραμένει αχρησιμοποίητο και συνδέεται με την χαμηλότερη τάση τροφοδοσίας ή τη γείωση, ενώ η πύλη συνήθως, επιλέγεται για την εισαγωγή σήματος εισόδου και οδηγεί το κύκλωμα. Το υπόστρωμα μπορεί να χρησιμοποιηθεί ως είσοδος για το σήμα, μπορεί να μειώσει την τάση κατωφλίου (threshold voltage) των τρανζίστορ, και τελικά, χαμηλώνει την τάση λειτουργίας του τρανζίστορ. Σε αυτήν την διδακτορική διατριβή χρησιμοποιείται ως διαγωγός (transconductor) ένα τροποποιημένο κύκλωμα Nauta, ο οποίος λειτουργεί σε πολύ χαμηλές τάσεις. Οι ελεγχόμενοι διαγωγοί χρησιμοποιούνται για το σχεδιασμό των προτεινόμενων συντονιζόμενων φίλτρων. Τα κατασκευασμένα φίλτρα μπορούν να συντονιστούν στην περιοχή των λίγων MHz. Τα προτεινόμενα φίλτρα λειτουργούν χρησιμοποιώντας τάση τροφοδοσίας 0.5V και η συχνότητα αποκοπής τους μπορεί εύκολα να προσαρμοστεί. Όλα τα κυκλώματα σχεδιάζονται και εξομοιώνονται χρησιμοποιώντας μία τεχνολογία CMOS triple well 0.13μm. Ο υπό μελέτη τελεστικός ενισχυτής διαγωγιμότητας (Operational Transconductor Amplifier - OTA) έχει τροποποιηθεί περαιτέρω, για να επιτευχθεί καλύτερη απόδοση και να εφαρμοστεί σε ένα μιγαδικό φίλτρο. Η μετατροπή σήματος από τις μεσαίες συχνότητες (IF) στις χαμηλές συχνότητες παρουσιάζεται ένα σημαντικό πρόβλημα όπου μαζί με το επιθυμητό σήμα εμφανίζεται και το σήμα εικόνας στην ίδια συχνότητα. Τα μιγαδικά (complex) φίλτρα μπορούν να αφαιρέσουν εύκολα το σήμα εικόνας, εφαρμόζοντας μια διαδικασία μετατόπισης συχνότητας. Ένα μιγαδικό Leapfrog φίλτρο έχει σχεδιαστεί χρησιμοποιώντας διαφορικούς ενισχυτές διαγωγιμότητας. Το τελικό μιγαδικό φίλτρο δωδέκατης τάξης έχει σχεδιαστεί για να καλύψει τις απαιτήσεις του προτύπου Bluetooth και Zigbee. Το φίλτρο λειτουργεί με τάση τροφοδοσίας 0.5V και έχει πολύ καλά αποτελέσματα στην απόρριψη εικόνας, την ευαισθησία και το θόρυβο. Επίσης, η κεντρική συχνότητα και το εύρος συχνοτήτων είναι ανεξάρτητα ρυθμιζόμενα. Η απόδοση του φίλτρου έχει επαληθευτεί μέσω προσομοίωσης χρησιμοποιώντας μοντέλα τρανζίστορ μιας τεχνολογίας CMOS triple well 0.13μm. Φίλτρα που σχεδιάζονται με την προτεινόμενη μέθοδο μπορούν να εφαρμοστούν σε συσκευές Bluetooth που χρησιμοποιούνται και σε βιοϊατρικές εφαρμογές.

U.S. healthcare consumers have access to various provider ratings from several organizations that are meant to assist in selecting their healthcare providers. Leapfrog Hospital Safety Grades is one such rating system that professes to allow consumers the ability to select the best hospital for their care. However, since consumers ranking mortality risk as their most important concern, it is essential to determine if Leapfrog grades align with consumer expectations. Andersen's Phase-4 behavioral model of healthcare utilization was used as the foundation for understanding healthcare consumer preferences. This study was designed to determine if Leapfrog grades are predictive of CMS 30-day mortality rates for pneumonia, chronic heart failure, and acute myocardial infarction data, while also adjusting for selected organizational descriptors: state of residency, Medicare expansion, safety-net status, ownership type, teaching classification, and number of licensed beds. Linear regression demonstrated that Leapfrog grades are not reliable predictors of the 3 inpatient mortality rates analyzed. The study demonstrated that ownership type was a significant predictor for 2 of the 3 dependent variables. Furthermore, most of the covariates also provided some predictive value for at least 1 of the included outcomes; however, in most cases, the effect (β) was small. This study can help provide positive social change by elucidating that Leapfrog grades are not reliable predictors of patient outcomes for consumers, while also demonstrating that efforts to reduce 30-day mortality rates, especially for pneumonia, can be targeted by selected states, ownership type, and teaching status.

Thesis (D.P.H.)--University of Michigan.

Thesis (D.P.H.)--University of Michigan.

Operational transconductance amplifier and capacitor (OTA-C) filters have outstood among different types of filter due to high frequency and low power capabilities in the main stream digital CMOS technology. They have been widely used in computer hard disk drive (HDD) and wireless communication transceivers. OTA-C filters based on cascade and passive ladder simulation are well-known. However, multiple loop feedback (MLF) OTA-C filters which have certain advantages still have the scope for further research. So far there have been no explicit formulas for current-mode leapfrog (LF) filter design and performance evaluation of current-mode MLF OTA-C filters are still lacking. From application viewpoints, read channels for computer hard disk drives require very high frequency continuous-time filters. This automatically disqualifies active- RC/MOSFET-C filters and OTA-C filters become the only solution. In wireless communications, active-RC/MOSFET-C filters have been proved useful for mobile systems whose baseband frequency falls below a few MHz. However, for wireless LANs with the frequency of several tens of MHz, OTA-C filters are a strong candidate. Whilst in HDD read channels, cascaded OTA-C architectures have been most utilized and in wireless receivers, OTA-C structures based on ladder simulation have been popular, MLF OTA-C filters have not been practically used in either of the applications. This thesis describes some novel designs and applications of multiple loop feedback OTA-C filters with extensive CMOS simulations. Analogue filters for computer hard disk drive systems are first reviewed; the state of the art and design considerations are provided. Three VHF linear phase lowpass OTA-C filters are then designed, which include a seventh-order and a fifth-order current-mode filter based on the follow-the-leader-feedback (FLF) structure and a seventh-order voltage-mode filter using the inverse FLF (IFLF) configuration. These filters all have very low power consumption. The synthesis and design of general current-mode LF OTA-C filters are conducted next. Iterative design formulas for both all-pole and finite-zero functions are derived and explicit formulas for up to sixth-orders are given. These formulas are very easy to use for designing any type of characteristics. Subsequently, linear phase lowpass OTA-C filter design for HDD read channels using LF structures are investigated in details. A current-mode filter and a voltage-mode filter using the fifth-order LF structure are presented. The two filters can operate up to 800MHz and have very small passband phase ripple. Analogue filters for wireless communication baseband applications are also reviewed thoroughly in this thesis, where the design of a fourth-order current-mode FLF Butterworth lowpass OTA-C filter for multi-standard receivers is presented. Then two fifth-order current-mode elliptic lowpass OTA-C filters based on respective LF and FLF structures for wireless communication baseband are designed. Fifth-order voltage-mode IFLF and LF elliptic lowpass filters are also presented. All these MLF baseband filters designed can operate up to 40MHz to cover all important wireless and mobile standards. Simulations show that the LF structures have better dynamic range and stopband attenuation performances than the FLF and IFLF configurations.

Communicating science in three-dimensional (3D) multimedia is an immersive and interactive way to explore scientific processes (Signals and Communication Technology, 2019). Geovisualization is an emerging 3D multimedia method for visual analysis, synthesis, and presentation of geospatial, geologic, and geophysical data (MacEachren & Kraak, 2001). There is an identified need to develop scientific communication tools to further understand boreal peatland evolution, hydrogeology, ecology, and geochemistry (Bubier et al., 2003) since the International Union of Conservation of Nature asserts that peatlands are among the most valuable ecosystems on Earth, critical for preserving global biodiversity, providing drinking water, minimising flood risk, preventing wildfire, and mitigating climate change (Hama et al., 2000). The intention of this thesis is to communicate a novel approach to geovisualize boreal peatland architecture using Light Detection and Ranging (LiDAR) and Ground Penetrating Radar (GPR). GPR and LiDAR have been used to create 3D subsurface geovisualizations for archaeology (Kenady et al., 2018; Schultz & Martin, 2011) and resource geology (Corradini et al., 2020; Koyan & Tronicke, 2020) although application to peatland hydrogeology is uncommon. Point-source hydrogeological and geochemical data were integrated with 3D geological models to estimate carbon and nitrogen storage in an archetypal boreal peatland near Mariana Lakes, Alberta. Peatland geometry resembled a shallow lake basin with depths greatest in fens (>10 m) and thinnest in bogs (<2 m). Hydraulic conductivity was only a few meters per year and vertical groundwater movement was limited. Sequestered carbon and nutrients increased with depth. The average concentration of dissolved ammonium was 3 grams per cubic metre of peat (g/m3), 5g/m3of Total Kjeldahl Nitrogen, 60g/m3 of dissolved organic carbon and 200g/m3 of dissolved inorganic carbon. Tritium detection from atmospheric atomic weapons radionuclide fallout revealed that in deeper anaerobic peat (catotelm), tritium was absent, signifying groundwater was older than 50 years and not mixed with meteoric waters. Fen catotelm channels are likely acting as gravity-driven hydraulic traps (Tóth, 1999). / Graduate