目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理...目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理系统中病例33935例中未入组病例300例,并对所有的未入组病例进行深入分析。结果未入组病例原因主要为主要诊断编码或者手术编码为灰码、医保版本切换导致原本入组的有效主诊断变成无效主诊断、主要诊断编码国家临床版医保版没有做好对照和临床医师主要诊断选择错误等方面。结论通过对医院DRGs结算模式下未入组病例的全面分析,找到改进措施,不断加强对临床医师和编码员的培训、加强病案首页质控、加强信息系统建设,从而提高DRGs入组率。展开更多
In this paper is illustrated a mathematical added variability of the classical Terzaghi primary consolidation equation(1923)considering independently as variables the Consolidation Coefficient Cv and as well the Heigh...In this paper is illustrated a mathematical added variability of the classical Terzaghi primary consolidation equation(1923)considering independently as variables the Consolidation Coefficient Cv and as well the Height Hi of the consolidating Laboratory Consolidation Test soil sample in order to finally grasp the low permeability layer time behaviour.It is easy to show that,when the Cv variation is positive,each of these two added variabilities differentiations has as maximum a factor 2 related to the laboratory evaluated coefficient of consolidation,for a certain incremental load of reference in a Laboratory Consolidation Test.At this scope,it is analysed the overall behaviour of a typical clayey material,from the mineralogical point of view,namely especially either composed by lean clay with main kaolinite mineralogical content or fat namely with Illite mineralogical content or even very dilatant namely principally constituted by Montmorillonite.The Montmorillonite variability with Cv is negative,and consequently the differentiation enhancement factor can become naught.As it is known so far,in normal conditions of a soft clay,a difference in Construction Values of the Coefficient of Consolidation is up to 23 times greater than laboratory evaluated results,and this according to the author’s experience,may be also mainly explained not starting from Laboratory Consolidation Test Data,but through a more general macroscopic behaviour of the soil underneath the newly loaded area,putting aside the case of temperature-induced changes.In conclusion,it is suggested how to model the analytical problem of the so modified Terzaghi Primary Consolidation differential equation in order to better manage the construction unknowns of the phenomenon.展开更多
It is well known that soft silty clayey and even peaty soils especially existing in Great River Deltas Swampy Areas,under important Earth Fill Embankment Construction experience huge and hardly bearable primary consol...It is well known that soft silty clayey and even peaty soils especially existing in Great River Deltas Swampy Areas,under important Earth Fill Embankment Construction experience huge and hardly bearable primary consolidations settlements along with the minor but not negligible consequent secondary consolidation effects.In order to properly manage these particular huge settlements environments,it is very important to follow up the settlements monitoring data,by a macroscopic soil volume interpretation along with some amendments namely some mathematical added variabilities of the classic Terzaghi Primary Consolidation Equation,which are examined in a companion paper recently published in this Journal.In this paper some indications are given about how to face the macroscopic soil volume primary consolidation settlements,and especially it is suggested how to interpret the misleading laboratory consolidation test values of the coefficient of consolidation.Moreover,some design alternative solutions are examined to grasp both the potential technical and economic benefits along with their consequent disadvantages.Finally,this paper underlined the primary role of the supervision engineer to get a good estimate in the settlements forecasting and his related ability to understand the meaning of anomalous monitoring data and to timely make and match the primary consolidation settlements forecasting calculation adjustments.展开更多
Prefabricated vertical drains(PVDs)are commonly used to shorten the drainage path for consolidation as part of the improvement of marine soft ground.Many studies that focus on the primary consolidation settlement of P...Prefabricated vertical drains(PVDs)are commonly used to shorten the drainage path for consolidation as part of the improvement of marine soft ground.Many studies that focus on the primary consolidation settlement of PVD-improved soft ground have been conducted;however,residual settlement has been scarcely investigated.Residual settlement is the net effect of secondary compression and the remaining primary consolidation and generally occurs while the facilities are operating.In this study,residual settlement was investigated using the measured field settlement data obtained from the surface settlement plate and multilayer settlement gauges.This study determined that PVD still has some effect on residual settlement and can reduce the settlement times.Residual settlement is only related to the PVD-improved soil layer and only occurs significantly in the middle zone of that layer over a few months.The middle zone may be related to the time delay of excess pore water pressure dissipation.This study concluded that the remaining primary consolidation in the PVD-improved soil layer is the primary cause of residual settlement,whereas secondary compression in the PVD-improved soil layer is only a minor cause.展开更多
为解决软岩隧道开挖过程中初期支护整体下沉普遍较大的工程难题,依托郑州至西安高速铁路大断面黄土隧道及成昆铁路第三系昔格达地层软弱围岩隧道工程,通过理论计算及现场实测,对软弱围岩隧道初期支护普遍沉降较大的原因以及采取的工程...为解决软岩隧道开挖过程中初期支护整体下沉普遍较大的工程难题,依托郑州至西安高速铁路大断面黄土隧道及成昆铁路第三系昔格达地层软弱围岩隧道工程,通过理论计算及现场实测,对软弱围岩隧道初期支护普遍沉降较大的原因以及采取的工程措施的可靠性进行分析,得到以下成果:1)软弱围岩隧道下沉量往往超过20 cm,现场实测的拱脚承受最大荷载为897.4 k N,初期支护整体下沉大的主要原因是拱脚压力较承载力大一个数量级;2)锁脚锚杆靠近钢架位置的轴力最大,为55 k N。大拱脚的承压特性显著,其压力极值达到0.9~1.7 MPa;3)增设锁脚锚杆(管)、扩大拱脚和及时闭合仰拱是控制软岩隧道初期支护沉降的关键措施。展开更多
文摘目的分析某专科医院在疾病诊断相关组(diagnosis related groups,DRGs)结算模式下存在的未入组病例问题,并提出相应的改进措施。方法通过回顾性分析和专家讨论,选取并总结某专科医院2021年1月—2022年6月上传至市医保平台病例信息管理系统中病例33935例中未入组病例300例,并对所有的未入组病例进行深入分析。结果未入组病例原因主要为主要诊断编码或者手术编码为灰码、医保版本切换导致原本入组的有效主诊断变成无效主诊断、主要诊断编码国家临床版医保版没有做好对照和临床医师主要诊断选择错误等方面。结论通过对医院DRGs结算模式下未入组病例的全面分析,找到改进措施,不断加强对临床医师和编码员的培训、加强病案首页质控、加强信息系统建设,从而提高DRGs入组率。
文摘In this paper is illustrated a mathematical added variability of the classical Terzaghi primary consolidation equation(1923)considering independently as variables the Consolidation Coefficient Cv and as well the Height Hi of the consolidating Laboratory Consolidation Test soil sample in order to finally grasp the low permeability layer time behaviour.It is easy to show that,when the Cv variation is positive,each of these two added variabilities differentiations has as maximum a factor 2 related to the laboratory evaluated coefficient of consolidation,for a certain incremental load of reference in a Laboratory Consolidation Test.At this scope,it is analysed the overall behaviour of a typical clayey material,from the mineralogical point of view,namely especially either composed by lean clay with main kaolinite mineralogical content or fat namely with Illite mineralogical content or even very dilatant namely principally constituted by Montmorillonite.The Montmorillonite variability with Cv is negative,and consequently the differentiation enhancement factor can become naught.As it is known so far,in normal conditions of a soft clay,a difference in Construction Values of the Coefficient of Consolidation is up to 23 times greater than laboratory evaluated results,and this according to the author’s experience,may be also mainly explained not starting from Laboratory Consolidation Test Data,but through a more general macroscopic behaviour of the soil underneath the newly loaded area,putting aside the case of temperature-induced changes.In conclusion,it is suggested how to model the analytical problem of the so modified Terzaghi Primary Consolidation differential equation in order to better manage the construction unknowns of the phenomenon.
文摘It is well known that soft silty clayey and even peaty soils especially existing in Great River Deltas Swampy Areas,under important Earth Fill Embankment Construction experience huge and hardly bearable primary consolidations settlements along with the minor but not negligible consequent secondary consolidation effects.In order to properly manage these particular huge settlements environments,it is very important to follow up the settlements monitoring data,by a macroscopic soil volume interpretation along with some amendments namely some mathematical added variabilities of the classic Terzaghi Primary Consolidation Equation,which are examined in a companion paper recently published in this Journal.In this paper some indications are given about how to face the macroscopic soil volume primary consolidation settlements,and especially it is suggested how to interpret the misleading laboratory consolidation test values of the coefficient of consolidation.Moreover,some design alternative solutions are examined to grasp both the potential technical and economic benefits along with their consequent disadvantages.Finally,this paper underlined the primary role of the supervision engineer to get a good estimate in the settlements forecasting and his related ability to understand the meaning of anomalous monitoring data and to timely make and match the primary consolidation settlements forecasting calculation adjustments.
基金This research was supported by the Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education(No.2020R1I1A3067248).
文摘Prefabricated vertical drains(PVDs)are commonly used to shorten the drainage path for consolidation as part of the improvement of marine soft ground.Many studies that focus on the primary consolidation settlement of PVD-improved soft ground have been conducted;however,residual settlement has been scarcely investigated.Residual settlement is the net effect of secondary compression and the remaining primary consolidation and generally occurs while the facilities are operating.In this study,residual settlement was investigated using the measured field settlement data obtained from the surface settlement plate and multilayer settlement gauges.This study determined that PVD still has some effect on residual settlement and can reduce the settlement times.Residual settlement is only related to the PVD-improved soil layer and only occurs significantly in the middle zone of that layer over a few months.The middle zone may be related to the time delay of excess pore water pressure dissipation.This study concluded that the remaining primary consolidation in the PVD-improved soil layer is the primary cause of residual settlement,whereas secondary compression in the PVD-improved soil layer is only a minor cause.
文摘为解决软岩隧道开挖过程中初期支护整体下沉普遍较大的工程难题,依托郑州至西安高速铁路大断面黄土隧道及成昆铁路第三系昔格达地层软弱围岩隧道工程,通过理论计算及现场实测,对软弱围岩隧道初期支护普遍沉降较大的原因以及采取的工程措施的可靠性进行分析,得到以下成果:1)软弱围岩隧道下沉量往往超过20 cm,现场实测的拱脚承受最大荷载为897.4 k N,初期支护整体下沉大的主要原因是拱脚压力较承载力大一个数量级;2)锁脚锚杆靠近钢架位置的轴力最大,为55 k N。大拱脚的承压特性显著,其压力极值达到0.9~1.7 MPa;3)增设锁脚锚杆(管)、扩大拱脚和及时闭合仰拱是控制软岩隧道初期支护沉降的关键措施。
