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Background Population-based studies on physical therapy use in acute care are lacking.
Objectives The purpose of this study was to examine population-based, hospital discharge data from North Carolina to describe the demographic and diagnostic characteristics of individuals who receive physical therapy and, for common diagnostic subgroups, to identify factors associated with the receipt of and intensity of physical therapy use.
Design This was a cross-sectional, descriptive study.
Methods Hospital discharge data for 2006–2007 from the 128 acute care hospitals in the state were examined to identify the most common diagnoses that receive physical therapy and to describe the characteristics of physical therapy users. For 2 of the most common diagnoses, logistic and linear regression analyses were conducted to identify factors associated with the receipt and intensity of physical therapy.
Results Of the more than 2 million people treated in acute care hospitals, 22.5% received physical therapy (mean age=66 years; 58% female). Individuals with osteoarthritis (admitted for joint replacement) and stroke were 2 of the most common patient types to receive physical therapy. Almost all individuals admitted for a joint replacement received physical therapy, with little between-hospital variation. Between-hospital variation in physical therapy use for stroke was greater. Demographic and hospital-related factors were associated with physical therapy use and physical therapy intensity for both diagnoses, after controlling for illness severity and comorbidities.
Limitations Data from only one state were examined, and the studied variables were limited.
Conclusions The use and intensity of physical therapy for stroke and joint replacement in acute care hospitals in North Carolina vary by clinical and nonclinical factors. Reasons behind the association of hospital characteristics and physical therapy use need further investigation.
In the past 2 decades, population-based databases, patient registries, and administrative health care databases have become much more common. These databases, which often are quite large, also have become more accessible. Advances in computer technology and more robust statistical software packages have significantly decreased the cost and computational time needed to analyze these large databases.
Despite the growth in and access to large health care databases, use of these databases to conduct research relevant to physical therapy has been modest. Much of the work has focused on the delivery of physical therapy in the outpatient setting.1–4 Some studies also have focused on physical therapy use by Medicare beneficiaries5,6 and patients in skilled nursing facilities.7 Few studies have been conducted on physical therapy use in the acute care setting.
We found 2 studies that examined University HealthSystem Consortium (UHC) data from 1996 to determine the relationship between physical therapy use in the acute care setting and outcomes of care for stroke and joint replacement.8,9 One limitation of these 2 studies is that the data were limited to academic health center hospitals that were members of the UHC. Findings from these studies may not be generalizable to other types of acute care hospitals. Data from these studies also are outdated considering the dramatic changes in Medicare and other health insurance plan payment policies over the past 15 years.
Current data on hospital inpatient stays in the United States are available to researchers through the Healthcare Cost and Utilization Project (HCUP). The HCUP is a family of health care databases, software tools, and other products developed through a federal-state-industry partnership sponsored by the Agency for Healthcare Research and Quality (AHRQ).10 The HCUP databases can be used to research a broad range of health policy issues, including the cost and quality of health care, patterns of health care use, access to health care, and outcomes of health care. The Nationwide Inpatient Sample (NIS), one of several HCUP databases, is the largest all-payer inpatient care database in the United States. Although the NIS is a powerful database for examining national trends in access to, use of, and quality of hospital inpatient care, its data are currently not detailed enough to examine physical therapy use in particular.
The State Inpatient Databases (SIDs), another set of HCUP databases, do have the detail needed to examine physical therapy use. The SIDs consist of state-specific hospital databases from 40 states.11 Each state database contains all inpatient discharge abstracts from community hospitals in the state, essentially making the database population-based. The SIDs contain clinical and nonclinical variables, including: diagnoses, procedures, admission and discharge status, patient demographics, insurance information, length of stay (LOS), and total charges. Many of the SIDs also include detailed information on hospital charges, which allows for the examination of physical therapy use and intensity. Some SIDs contain hospital, county, and ZIP code identifiers that allow linkage to other data.11
The SIDs have a number of strengths.12 They are relatively inexpensive to obtain and use when compared with the cost of similar data collected through surveys or medical record abstraction; they are more reliable than other sources of data, such as patient self-reporting of medical expenditures or diagnosis; they are superior to data obtained from third-party payers due to the inclusion of information on patients without insurance; they cover entire populations (ie, all acute care admissions in a state); and they often can be linked to other databases to gather additional information that may be useful. Studies also support the validity of hospital discharge data for accurately identifying diagnoses, procedures (eg, joint replacement), and patient comorbidities.13–16
Population-based databases, such as the NIS and SIDs, can be used to answer basic questions about the prevalence of diseases and conditions that are treated by physical therapists. For example, one could determine the number of hospital admissions with diagnoses commonly treated by physical therapists (eg, stroke, hip fracture) and examine changes over time to better understand current and future workforce needs. Population-based databases also can be examined to identify the proportion of and types of individuals receiving physical therapy for a given diagnosis, condition, or disability to determine if there are variations in care (eg, by hospital, by state, over time), if patients are receiving appropriate care (eg, Are current practice guidelines being followed?), and whether there are potential problems with access to care (eg, Are people who are underinsured and minority populations less likely to receive physical therapy?). Information garnered from examinations of population-based health care databases can be used to identify areas that need improvement and to inform the development of initiatives or interventions to improve the delivery and quality of health care.
This study examined 2006 and 2007 data from the North Carolina SID to describe the demographic and diagnostic characteristics of individuals who receive physical therapy in North Carolina community hospitals, to identify common diagnostic subgroups, and to identify factors associated with the receipt of and intensity of physical therapy use.
North Carolina State Inpatient Database
Our primary source of data was the North Carolina SID (2006–2007), which contains discharge abstracts from the universe of all inpatient stays at short-term, acute care hospitals (N=128) in North Carolina. Data were retrieved from the UB-92 (Uniform/Universal Billing) claim form, which is used by hospitals and health care centers when submitting bills to Medicare and other third-party payers for reimbursement of health care services.11 The database contains one record for each hospital discharge. Data include the following sociodemographic information: age, race, sex; insurance information; geographic information: patient county, patient zip code, hospital county, hospital zip code; clinical information: diagnoses, procedures, LOS, source of admission (eg, home, emergency department, nursing home), discharge status (eg, home, skilled nursing facility); and charge data: revenue codes and charges for services provided (eg, intensive care unit charges, physical therapy charges), and total charges. Hospital identification numbers (ie, Centers for Medicare and Medicaid Services IDs; American Hospital Association IDs), as well as the county and zip code information, allow linkage to other data sets.
Hospital-Level Data
Data on hospital characteristics were obtained from the Centers for Medicare and Medicaid Services (CMS) Provider of Services (POS) Files,17 CMS Hospital Cost Reports,18 and the Area Resource File (ARF).19
POS Files.
CMS POS files are created quarterly from the Online Survey and Certification Reporting System (OSCAR) database. The OSCAR database is maintained by CMS in cooperation with state surveying agencies. State surveying agencies gather information from Medicare- and Medicaid-certified institutional providers (eg, hospitals, skilled nursing facilities, home health agencies) via survey and standard CMS forms, every 1 to 3 years, depending on institution type.20 Data collected include information on staffing, number of beds, type of facility, and services provided. These data are entered electronically into the OSCAR database by the state surveying agency and are used by CMS to certify or maintain certification of institutional providers. Data elements are checked during data entry for extreme values or extreme changes in values from the previous data collection year.20 The POS file (last quarter of 2006) was used to obtain data on hospital size (ie, number of beds), for-profit status, medical school affiliation, and physical therapist full-time equivalents (FTEs).
Hospital Cost Reports.
Hospital Cost Report data are obtained from the Healthcare Cost Report Information System (HCRIS) database maintained by CMS. Information in the HCRIS database are collected and supplied by Medicare fiscal intermediaries.21 Data from 2006 were used to determine whether the hospital used contract physical therapists and had an affiliated inpatient rehabilitation facility.
Final Analytic Data Set
Our final analytic data set, created by merging the North Carolina SID data and the hospital-level data, consisted of 2,285,793 discharge records from 128 hospitals. Because this data set was a different subset for each study objective and because results of our analyses for objective 1 guided the analyses for objective 2, we present the remainder of the methods by study objective.
Objective 1: Demographic and Diagnostic Characteristics of Patients Who Received Physical Therapy
We first identified all records that had one or more physical therapy charges associated with them (n=512,018) (Fig. 1). Because there were more than 500 primary ICD-9-CM diagnostic codes associated with these records, we used AHRQ's Single-Level Clinical Classification Software (CCS)23 to group these codes into broader diagnostic categories. These diagnostic categories may be more useful for conducting descriptive and other types of analyses, particularly when examining a diverse clinical group. The specific ICD-9-CM codes associated with each CCS diagnostic category are presented in the CCS user's manual.23
Once the diagnostic categories were assigned, we tabulated these categories overall and by age categories. We also conducted descriptive analyses of the demographic and hospital-related characteristics of the sample. All analyses were conducted using Stata version 10.1 (StataCorp, College Station, Texas).
Objective 2: Factors Associated With Use and Intensity of Physical Therapy for Common Diagnostic Subgroups
Based on our analyses for objective 1, the 3 most common diagnostic categories for individuals who received physical therapy were osteoarthritis (OA), rehabilitation care, and acute cerebrovascular disease (Tab. 1). Because almost all individuals with a primary diagnosis of OA were in the hospital for a lower-extremity joint replacement, our first common diagnostic subgroup comprised patients with lower-extremity joint replacement. Any individual record with a diagnostic category of OA and a primary procedure of a hip or knee joint replacement or revision (ICD-9-CM procedure codes: 81.51–81.55) was placed in this subgroup (n=49,653).
Rehabilitation care was the second most common diagnostic category (Tab. 1). Individuals in this diagnostic category had one of the following primary ICD-9-CM codes: V52.0, V52.1, V52.4, V52.8, V52.9, V53.8, V57.0, V57.1, V57.2, V57.21, V57.22, V57.3, V57.4, V57.81, V57.89, V57.9, and V58.82, which are associated with the fitting of prostheses and rehabilitation care use. The V-codes are supplementary and intended to indicate a reason for care in patients who have already been treated for a disease or injury not currently present, who have residual impairments, or who may be receiving care to prevent recurrence.24 Because individuals in this category represent a heterogeneous group in regard to underlying diagnosis, we chose cardiovascular accident (CVA) (the next most common diagnostic subgroup) as our second diagnostic subgroup.
To conduct analyses examining factors associated with physical therapy use, we needed to include participants in the same diagnostic categories who did not receive physical therapy. Our final samples for the joint replacement and stroke subgroups were n=49,653 and n=26,422, respectively (Fig. 1).
Study variables.
Based on clinical experience and the body of literature on health care utilization, we hypothesized that individual and hospital-level factors would affect whether and the extent to which individuals received physical therapy in the acute care setting. For each diagnostic subgroup, we generated 2 dependent variables: (1) a dichotomous variable to indicate whether the individual received any physical therapy and (2) a measure of "physical therapy intensity" for those who did receive physical therapy. Because information on number of visits was not available, we used data on physical therapy charges to create our measure. In preliminary analyses we found that charging practices varied across hospitals and that hospitals with high total charges also had high physical therapy charges. We, therefore, chose to standardize our measure of physical therapy intensity by dividing physical therapy charges by total charges. This measure also accounts for the fact that charges often are not reflective of "true costs" (eg, what is paid by the insurer or what it costs the hospital to deliver the care). Because our measure of physical therapy intensity (total physical therapy charges/total charges) was derived, we conducted sensitivity analyses to determine how our results changed using total physical therapy charges and physical therapy charges per day as measures of physical therapy intensity.
Independent variables included patient-level demographic characteristics: age, sex, race (white, non-white, missing), and insurance (Medicare/private/other, Medicaid, or uninsured); and measures of illness severity: admission through the emergency department, LOS (categorized by tertiles because of the skewed nature of the data), and comorbidities. We created our comorbidity measures based on the work of Elixhauser et al,25 who developed a comprehensive set of 30 comorbidity measures for use with large administrative inpatient databases. These measures were created using secondary ICD-9-CM diagnostic codes and include comorbidities such as diabetes, hypertension, congestive heart failure, and so on. A table of the codes associated with each of the comorbidity measures is available on AHRQ's Web site.26 Because Elixhauser and colleagues found the independent effects of each of the comorbidity measures varied by patient population, they suggested using the comorbidity measures as separate indicators in analyses, rather than creating a count.
Rather than including all 30 comorbidities, we limited our list to those that had support for inclusion based on the literature, those that occurred with a frequency of at least 2%, and those that were related to our outcomes in preliminary analyses. For the joint replacement data, we included the following indicators (0=no, 1=yes): diabetes (with or without complications), obesity, chronic pulmonary disease, rheumatoid arthritis, neurological disorder or paralysis, and congestive heart failure27–29; and for the stroke data: congestive heart failure, diabetes with complications, depression, psychoses, renal failure, and chronic obstructive pulmonary disease.30–33
We also included condition-specific variables for both data sets. For the joint replacement data set, we created dichotomous variables to indicate whether the procedure was a revision or a hip replacement (versus knee replacement) and whether the individual had a hip fracture.34 For the stroke data set, we created dichotomous variables to indicate whether the stroke was hemorrhagic and whether the individual had atrial fibrillation.31,35 The condition-specific variables were created by examining the ICD-9-CM procedure and diagnostic codes.
Hospital variables included hospital bed size (categorized by tertiles), which served as an indirect measure of procedure or diagnosis volume (both stroke and joint replacement volume have been shown to be positively associated with higher quality of care36–39); whether the hospital had a major medical school affiliation, an additional indicator of higher-quality care40,41; urban or rural location of hospital; whether the hospital had an affiliated rehabilitation facility; the use of contract physical therapists; and physical therapist FTEs per 1,000 admissions (categorized by tertiles). The latter 2 variables represented measures of physical therapist supply. We also included a variable to indicate the for-profit status of the hospital, as literature suggests that patient outcomes and incentives at for-profit hospitals differ from those at other hospitals.36,42
Data Analysis.
For both the stroke and joint replacement samples, we conducted multivariable logistic regression analyses to identify determinants of physical therapy use and multivariable linear regression analyses to identify factors associated with physical therapy intensity (physical therapy charges/total charges), conditional on receiving physical therapy. Due to the skewed distribution of physical therapy charges/total charges, we transformed this variable by taking its natural log. Our multivariable analyses were limited to individuals who survived their inpatient stay and to hospitals that had at least 10 admissions for stroke or joint replacement over the 2-year period (n=32,139 for the stroke sample; n=49,684 for the joint replacement sample). When conducting our multivariable analyses, we used the cluster option in Stata to account for the fact that measures from the same hospital were not independent and were likely more highly correlated than measures from different hospitals.43 The cluster option uses the Huber-White sandwich estimator of variance to correct the standard errors of the parameter estimates (eg, the odds ratio in the logistic regression analysis or the beta coefficient in the linear regression analysis), which may be smaller due to the correlation of measures within hospitals. Not correcting the standard errors can lead to the conclusion that findings are statistically significant when they are not.
Less than 0.1% of the records (n=907 for joint replacement sample; n=511 for stroke sample) had missing insurance data. These records were dropped from the multivariable analyses. Because a large percentage of race data were missing, we created a dummy variable to identify those records with missing data. This variable allowed us to retain those records, which otherwise would have been dropped in the multivariable analyses. No other variables had missing values.
Role of the Funding Source
This study was funded, in part, by the Division of Physical Therapy, University of North Carolina at Chapel Hill.
Of the more than 2 million patients discharged from short-term, acute care hospitals in North Carolina in 2006–2007, 22.4% received physical therapy during their inpatient stay.
Common Diagnostic Categories
Table 1 presents the 15 most common diagnostic categories associated with physical therapy use for the entire sample and by age category. Osteoarthritis was the most common category overall and for individuals older than 45 years of age. Leg fractures were the most common diagnostic category for individuals 1 to 45 years of age. Rehabilitation was the second or third most common category overall and for all age categories.
The 5 most common secondary diagnoses associated with individuals who had rehabilitation as the primary diagnostic category were: V54.81 aftercare after joint replacement, V599.0 urinary tract infection, V427.31 atrial fibrillation, V438.20 late effects of cerebrovascular disease, and V428.0 congestive heart failure. These 5 diagnoses accounted for 20% of the records.
Characteristics of Physical Therapy Users
Demographic and hospital-related characteristics for physical therapy users and for individuals who had a stroke or joint replacement are presented in Table 2. Physical therapy users had a mean age of 66 years, 58% were female, and 42% were white, although race data were missing for almost half of the sample. A majority of the sample was 65 years or older and had Medicare insurance. Median total physical therapy charges were $1,121 for all physical therapy users, which represented approximately 5% of the total charges. Almost 50% of the sample was admitted to the hospital through the emergency department, and more than half of the sample was discharged to post-acute care (ie, home health, rehabilitation facility, skilled nursing facility). Differences in demographic and hospital-related characteristics by diagnosis were present.
Variation of Physical Therapy Use by Hospital
Figure 2 presents data on variation in physical therapy use by hospital for the stroke and joint replacement samples. There was considerable between-hospital variation in use of physical therapy for stroke. The mean (SD) and median (interquartile range [IQR]) percentages of patients with stroke who received physical therapy at each hospital (n=122) were 71% (12%) and 73% (66%–79%), respectively. In contrast, there was very little between-hospital variation in the use of physical therapy for joint replacement. The mean (SD) and median (IQR) percentages of patients who received physical therapy at each hospital (n=93) were 98% (2%) and 99% (99%–100%), respectively. Hospitals with percentages lower than 90 (n=7) had fewer admissions overall. Three of these hospitals had 10 or fewer joint replacement admissions over the 2-year period.
Factors Associated With the Receipt and Intensity of Physical Therapy
Table 3 presents results of our multivariable regression analyses on physical therapy use for stroke. Factors positively associated with physical therapy use (odds ratios significantly greater than 1.00) included older age, being on Medicaid insurance relative to Medicare/private/other, being uninsured relative to Medicare/private/other, having an emergency department admission, having an LOS greater than 4 days, or being seen at a hospital with a major medical school affiliation. Having congestive heart failure, atrial fibrillation, or a hemorrhagic stroke was negatively associated with physical therapy use (odds ratios significantly less than 1.00).
Of those who received physical therapy, intensity of physical therapy use was higher (beta coefficients positive and significantly greater than 0) for older individuals, individuals on Medicaid relative to Medicare/private/other, individuals with an LOS from 4 to 6 days, relative to those with an LOS less than 4 days, and individuals with depression. Intensity of physical therapy use was lower (ie, beta coefficients significantly less than 0) for females and individuals with hemorrhagic stroke, renal failure, or chronic obstructive pulmonary disease.
Factors positively associated with physical therapy use for joint replacement (Tab. 4) included longer LOS, being seen at larger hospitals, and being seen at hospitals with major medical school affiliations. Factors negatively associated with physical therapy use were having a revision procedure, hip fracture, or hip replacement (relative to knee); and being seen at a hospital that used contract physical therapists. Of particular note is the imprecision of some parameter estimates (ie, LOS variables, medical school affiliation variable). This imprecision was because most people received physical therapy, which led to small cell sizes for some of the cross tabulations (eg, physical therapy use by medical school affiliation).
Of those who received physical therapy, older individuals, females, and those with a longer LOS received a higher intensity of physical therapy. The presence of comorbidities, having a hip fracture, having a revision procedure, or having a hip replacement was associated with a lower intensity of physical therapy. Individuals seen in urban hospitals received higher-intensity physical therapy, whereas those in for-profit hospitals or hospitals that used contract physical therapists received lower-intensity physical therapy.
Sensitivity Analyses
Findings of our multivariable linear regression analyses using physical therapy charges or physical therapy charges per day (rather than physical therapy charges/total charges) were similar, with the exception of one variable: urban location of the hospital. In the stroke models, urban location became significant. In the joint replacement models, urban location became nonsignificant.
To our knowledge, this is one of the first population-based studies examining physical therapy use in acute care. We have reported on a number of findings related to the characteristics of patients who receive physical therapy in acute care settings, as well as determinants of physical therapy use and intensity for individuals with stroke or lower-extremity joint replacement. Approximately one quarter of patients admitted to short-term, acute care hospitals in North Carolina receive physical therapy. These users are older, with a majority insured by Medicare. Osteoarthritis and stroke were 2 of the most common diagnostic categories to receive physical therapy, which is consistent with the literature on the growth in joint replacement procedures44,45 and the incidence of stroke.46 Both are common reasons for acute care hospitalizations.
Our analyses of determinants of physical therapy use for joint replacement and stroke provide an opportunity to compare and contrast findings on 2 very different problems. Joint replacement often is an elective procedure, with patients having a choice of physicians and hospitals. Stroke, on the other hand, is an event that occurs unexpectedly. Where the patient is (ie, geographically) at the time of the stroke will greatly affect where he or she is admitted.
On average, 98% of individuals who were admitted for a joint replacement procedure in North Carolina hospitals received physical therapy. There also was little variation in physical therapy use across hospitals. Although we do not understand fully the effectiveness of physical therapy in the acute care of patients after joint replacement, particularly in regard to longer-term outcomes, some studies suggest that starting rehabilitation as soon as possible after surgery leads to better outcomes.47–49 Most current guidelines for postoperative, acute care after joint replacement also recommend physical therapy.50 In addition, patients and health care providers believe physical therapy is useful in the acute care setting.51 The fact that most individuals who undergo joint replacement in North Carolina hospitals receive physical therapy is consistent with current best evidence and guidelines.
On average, 70% of patients admitted to North Carolina hospitals for treatment of stroke received physical therapy. Between-hospital variation in the percentage of patients who received physical therapy was greater than for joint replacement. Although a shorter LOS was associated with a decreased likelihood of physical therapy use, even when we limited our sample to individuals who survived their inpatient stay and were in the hospital for at least 3 days, only 85% of the sample received any physical therapy. When looking at the percentage of individuals who received physical therapy by hospital, 5 of the hospitals had proportions below 70%.
As with joint replacement, our understanding of the effectiveness of physical therapy for the acute care of patients with stroke is limited. Several current stroke guidelines recommend mobilization and assessment by rehabilitation professionals as soon as possible after an acute care admission.52–55 Recommendations of the Northeast Cerebrovascular Consortium are that all patients admitted to the hospital for stroke be evaluated by a physical therapist and an occupational therapist.56 Incorporating rehabilitation into stroke unit care also has been shown to be one of the key components in disability reduction after stroke.57 Considering current evidence and guidelines, variation in the use of physical therapy in the acute care setting needs further exploration and may be indicative of suboptimal care.
Although demographic characteristics were not associated with physical therapy use for joint replacement, we found older age, being on Medicaid, and being uninsured associated with physical therapy use for stroke. One explanation for these findings is these variables are capturing unmeasured illness severity. Individuals who are older have more comorbidities, complications, and problems in response to a CVA and have greater functional limitations.58,59 People with Medicaid coverage or no insurance, proxies for lower socioeconomic status, have poorer health relative to individuals of higher socioeconomic status.60–62
In both the stroke and joint replacement models, several of the illness severity and comorbidity measures were associated with physical therapy use in the expected directions. For example, individuals with a hemorrhagic stroke and those who had a joint replacement after hip fracture were less likely to receive physical therapy. These 2 variables are proxies for greater illness severity.34,62
With respect to hospital characteristics, we found that individuals who were seen at hospitals with major medical school affiliations (ie, academic health centers) were more likely to receive physical therapy for stroke and joint replacement. Assuming the receipt of physical therapy for these conditions is appropriate and necessary (considering current evidence and guidelines), this finding supports other literature that suggests, at least for some aspects of care, academic health centers deliver higher-quality care.40,41
We also found that hospital size was associated with use of physical therapy for joint replacement. The reasons for this finding are unclear. Although imprecise, hospital size may be a proxy measure for joint replacement procedure volume. Larger hospitals are likely to perform more procedures than smaller hospitals. In some of our work with other hospital databases, we found joint procedure volume and hospital size were moderately correlated (r=.60). Studies have shown a positive relationship between joint replacement procedure volume and quality of care.37,38 Whether use of physical therapy is more likely at hospitals with higher procedure volumes needs further exploration, along with the relationship between physical therapy use and quality of care for joint replacement.
In both the stroke and joint replacement models, individuals seen at hospitals who used contract physical therapists were less likely to receive physical therapy. This may suggest potential physical therapy supply issues. Physical therapy FTEs per admissions, however, were not significantly associated with physical therapy use in any of the models. The reasons for this finding are unclear. Further exploration of the accuracy of the measure may provide some insight. Although there is a growing body of literature on the relationship between higher nurse staffing and better quality of care,63,64 little has been done in the area of rehabilitation staffing. Such information would be useful for determining optimal staffing levels for physical therapy.
In the models that examine factors associated with the intensity of physical therapy use, females with stroke received lower-intensity physical therapy, whereas females with joint replacement received higher-intensity physical therapy. These findings need further exploration to determine whether these differences are indicative of sex disparities or potential confounding. For example, data suggest that females delay joint replacement and, therefore, are more disabled than males preoperatively.65
In both models, for-profit status of the hospitals was associated with lower-intensity physical therapy use. This finding also warrants further exploration to determine whether it is indicative of differences in care delivery or differences in patient populations (eg, patients at for-profit hospitals tend to be healthier).
Although urban location was not associated with physical therapy intensity for the stroke sample, it was for the joint replacement sample. In our sensitivity analyses using other measures of physical therapy intensity, we found the effect of urban location changed, suggesting that charging practices at urban and nonurban hospitals may vary. These findings also lend support to our choice of physical therapy charges/total charges as our measure of physical therapy intensity.
This study has several limitations. First, it is based on data from one state, which limits its external validity. The analyses also were limited by the type and availability of data. We did not have measures of function. Instead, we used proxy measures of illness severity and comorbidities. Other measures of illness severity, such as intensive care unit use66 or APR-DRG (all patient refined diagnosis related groups) measures of severity and mortality, may have been useful. The APR-DRGs expand the traditional diagnosis related group classification by adding a 4-level measure of illness severity and a 4-level measure of mortality risk.67 In addition, race data were missing for almost 50% of the sample, which may have been the reason for the generally nonsignificant findings on race. National efforts are under way to improve the reporting of race/ethnicity data in health care databases such as the SIDs.68 Another limitation was the manner in which we assessed physical therapy intensity. A measure of physical therapy costs, adjusted for factors such as hospital location, may have been better. Although not used in our study, cost-to-charge ratios, which take into account geography, have been developed from CMS data and can be used to convert hospital charge data to costs.69
Clinical Implications
Hospital discharge data can be used to identify the extent to which physical therapy is used in acute care and factors associated with use. Such information is helpful for determining whether patients are receiving appropriate care and whether there are indications of disparities in care. Variation in care also can be examined and may identify potential areas of overuse of care (ie, instances in which health care resources and procedures are used even when there is no reason or evidence to suggest they are the best way to help a patient)70 or underuse of care (ie, instances in which evidence-based, effective health care practices are not used).70 Our findings suggest that hospital characteristics influence whether individuals receive physical therapy and the intensity of their physical therapy, particularly for patients with joint replacement. Future investigations should focus on a better understanding of the reasons for this variation and the influence of hospital characteristics.
Although hospital discharge data have been used in numerous studies examining health care use and outcomes of care,12 little has been done with these data in the area of rehabilitation care. State Inpatient Databases from several other states are available for minimal to moderate fees through HCUP. Although not all SIDs have detailed information on physical therapy use, efforts are under way to improve this situation. In 2006, the AHRQ developed a new data element to indicate physical therapy use based on information from the UB-92 revenue.71 Looking at the SIDs available for purchase in 2008 (N=26), 19 of the states captured the physical therapy utilization data element. As the availability of this data element increases, it also may be represented in HCUP's NIS database.72 Having information on physical therapy use in the NIS would facilitate understanding of physical therapy use in acute care at the national level.
We used a population-based data set to describe the physical therapy use in North Carolina acute care hospitals. Osteoarthritis associated with lower-extremity joint replacement and CVA were 2 of the most common diagnostic categories that received physical therapy. Almost all patients admitted for joint replacement received physical therapy, with little between-hospital variation. Use of physical therapy for patients with stroke was more varied. Both clinical and nonclinical factors were associated with the use and intensity of physical therapy for joint replacement and stroke.
Dr Freburger and Dr Montmeny provided concept/idea/research design and writing. Dr Freburger provided data collection, project management, fund procurement, and institutional liaisons. All authors provided data analysis. Ms Knauer provided clerical support. Ms Heatwole Shank and Ms Knauer provided consultation (including review of manuscript before submission).
This research, in part, was presented orally at the Combined Sections Meeting of the American Physical Therapy Association; February 17–20, 2010; San Diego, California.
This study was funded, in part, by the Division of Physical Therapy, University of North Carolina at Chapel Hill.
- Received October 15, 2010.
- Accepted August 15, 2011.
- © 2012 American Physical Therapy Association


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Arkansas Society of Respiratory Care was established in 1962.
Today there are over 500 members who have discovered the benefit
of the professional society. The
Arkansas Society of Respiratory Care is a chartered affiliate of the American Association for Respiratory Care.
Results soon....
The AARC House of Delegates welcomes Tom Jones M.Ed, RRT, CPFT (Pictured Right)-Junior Arkansas Delegate Pictured left: Art Middleton B.S., RRT (Senior Arkansas Delegate) Thank you both for all of your hard work and dedication!
Kimberly Brown RRT receives "Central District Respiratory Care Practitioner of the Year Award"
Pictured from left to Right (David Gibson RRT, RPFT-NPS, Kim Brown BS, RRT and Nichole Drewry RRT (Central District Chair)
Thank you Kimberly for all of your hard work and commitment. We are all very proud of you!
Team ASRC participated in today's Great Strides Cystic Fibrosis walk at the Little Rock Zoo! Thank you to everyone that participated!
Southeast Arkansas College
Excellence, Clinical Excellence and Outstanding performance and dedication awards.
Mallory Roberson, Senior class president passed it to junior class president Allyson Lowery. One picture is of the class and all their children who made the journey with them. Also the 2016 Graduating class.
UAMS RT Graduating Class of 2016- University of Arkansas for Medical Sciences
ASRC Board of Directors participate in Fight For Air Climb sponsored by the
American Lung Association.
Nominate a hardworking RT for "Clinical Practitioner of the Year".
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Fight For AIR CLIMB
March 12, 2016
Simmons Tower
Think you are in shape? Want to prove it and help raise money for research, education and patient programs to help people affected by lung disease. Come Climb with us!!
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Arkansas Society for Respiratory Care meets with Smoke Free Little Rock. David Gibson, Jennifer Parr, Chuck Burke and Olivia Powers.
Arkansas Delegates attend International Congress Meeting in Tampa, Florida.
Pictured left to right (Art Middleton BS, RRT, RPFT and Heather Neal-Rice Med, RRT-NPS)
Heather and Art recently represented Arkansas during the International Congress Meeting in Tampa, Florida. We would like to say a special "thank you" to Heather Neal-Rice for serving as Delegate for the past 8 years. Heather's leadership and direction has made a tremendous impact in our state.
The ASRC mission is to provide effective leadership that promotes the Respiratory Care Profession and its skilled practitioners as leaders in the field of pulmonary medicine through patient, community and healthcare provider education.

subset: commoncrawl


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The campus is a partnership between the Augusta-based college and the University of Georgia. A 4 p.m. dedication ceremony is planned for Monday, with Gov. Sonny Perdue and University System of Georgia Chancellor Erroll Davis expected to attend.
The new campus is part of a statewide plan to alleviate a shortage of physicians by increasing the size of each MCG class from 190 to 300 by the end of the decade.
The Athens campus will feature a four-year medical education unit with an inaugural class of 40 students. Eventually the campus will have 60 slots for students.


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Everest College
1311 N. 6th St.
Milwaukee, WI 53212
Telephone: (414) 831-8400
Tags: Education/Schools
Everest College in Milwaukee campus, located in Haymarket Square, understands the need to be involved at the community level in ways that will help drive positive change and make a difference in the lives of its people. The campus, located in the Haymarket Square, is dedicated to helping in every way possible to make personal educational goals and career dreams a reality for each student. Student and faculty volunteerism is an ongoing mission at the Milwaukee campus.
Programs Offered at the Milwaukee Campus:
Dental Assistant
Medical Administrative Assistant
Medical Assistant
Medical Insurance Billing
Coding Pharmacy Technician
1311 N 6th St
United States


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…effectively controlling a segment without an operator. And add remotely controlled robotic cameras as input sources, without the need to add camera operators. Virtual Sets With TriCaster 410 system's virtual sets, you can elevate your look with realistic foregrounds and live moving backgrounds.…
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Item #: TRICASTER-410
…You can store up to 16 kinds of camera direction and camera status into the camera. In the case of the infrared remote commander, 6 kinds can be stored.* You can use the LAN cable for external communication. This will make system construction easier.* The camera can be set for a variety of HD video…
Related Products: Camera Ceiling Mount
Item #: SNY-SRG300H
Sony's new Broadband Remote Camera, the BRC-300, is an entire category unto itself. It's Sony's first robotic camera to offer the quality of three individual mega pixel CCDs for brilliant resolution. Specifically designed for remote video-shooting applications, the BRC-300 incorporates three…
Related Products: Video Camera | Ptz Camera
Item #: BRC-300
…remote controller currently used with the BRC-300 and BRC-H700 cameras can also be used with the BRC-Z700. The RM-BR300 can simultaneously control up to 7 cameras from a distance. Features * All-in-one stylish robotic camera with a robust body * 1/4- type HD 3-ClearVid CMOS* Carl Zeiss Vario-Sonnar…
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Item #: BRCZ700
…is a robotic pan, tilt and zoom video production camera. It's the first PTZ camera that features JVC's unique IP communications engine providing network connection via WiFi, 4G-LTE, or cabled LAN. It's designed to be used as a stand alone remote camera or as part of a multi-camera system in both…
Item #: JVC-KY-PZ100B
…dynamic range covers both light and dark contrasted areas and a Color Capture light system produces vivid color images without color saturation or filtering. The PowerVIEW HD-22 is the industry's first robotic PTZ camera to use the new MOS 1/2.8-Progressive Scan imaging sensor. By suppressing uneven…
Item #: VAD-999-6966-000
…Sony introduces the new BRC-H700 HD Color Video Camera with three 1/3-inch type HD CCDs boasting 1,070,000 effective pixels each for high resolution and high sensitivity. The BRC-H700 is an all-in-one compact robotic color video camera system, which achieves high accuracy and wide-range…
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Item #: VAD-999-6960-000
Item #: JVC-KY-PZ100B-W
…can be integrated into permanent AV systems in studios, reality TV shows, churches, or auditoriums. A Powerful Tool - Total remote camera operation becomes possible with the MC100 system. Whether it is mounted on a jib or crane, placed on a tripod as a 'robotic cameraman', or in a fixed location in…
Item #: VZ-MC100
Item #: VZ-MC100DUAL
…in a PTZ camera? If your answer is stunning image quality coupled with smooth robotic control at an affordable price, take a look at Sony's new SRG Camera Series. The new SRG series joins Sony's widely used EVI and BRC product lines, giving customers a greater choice of high-quality remote camera…
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Item #: SNY-SRG120DH
The First Robotic PTZ Camera to Use the New MOS 1/2.8-Progressive Scan Imaging Sensor! Vaddio's PowerVIEW PTZ cameras bring 3-Chip broadcast camera performance to a Single-Chip camera. Based on third-generation Maicovicon MOS imaging sensor technology, the HD-30 improves color and brightness…
Item #: VAD-999-6970-000
…images in 1080p, 1080i, 720p & 720i. The operational control of camera is via VISCA Command (RS232/485) protocol or IR Remote Control. AV-1330 comes with DVI, HDSDI and CVBS outputs.Features:* Remote Operation: Remote operated HD camera with pan, tilt, zoom, focus, iris, and shutter speed control*…
Item #: AV-1330
…heads, we back the MC50 with our full two-year warranty. A Powerful Tool - Total remote camera operation becomes possible with the MC50 system. Whether it is mounted on a jib or crane, placed on a tripod as a 'robotic cameraman,' or in a fixed location in an auditorium or church, you will have full…
Related Products: Pan Tilt | Motorized Pan And Tilt | Motorized Pan And Tilt Head
Item #: VZ-MC50
…On/Off Lens Specification: * Focus System: Auto, One-push AF, Manual* Focal Length: 4.42 - 88.5 mm* Zoom Ratio: 20x (Optical) 32x (Digital)* Horizontal Viewing Angle: 60.7° ~ 3.36°* Vertical Angle of View: 34.1° ~ 1.89° Robotic Controls: * Interface: RS-232C/RS-485/RJ45*…
Related Products: H.265
Item #: SWIT-AV-1360
…streaming video sources; and third-party partner solutions* Robotic Camera Support Access up to 4 live Pan-Tilt-Zoom (PTZ) robotic cameras via standard serial* and network protocols, with preset system and user interface control over camera orientation, zoom, focus and iris* Media 4 integrated…
Related Products: Tricaster 460 | Tricaster | 3play
Item #: TRI-TC460
Related Products: Tricaster 460 | Newtek | Tricaster
Item #: TRI-TC460E
…or 1RU rack mount panels offer system designers flexibility in the implementation. The two-channel, two-way data system handles camera control and PTZ signals for the robotic head. Installers can select RS-232, RS-422 or RS-485 data formats. Each of the POV cameras can be equipped with an "On-Air"…
Item #: HD-3521-GERXSTS
Item #: HD-3521-GETXSTS
Item #: HD-3521-RX-53-ST
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…WallVIEW HD-USB SR System package.* Operating Temperature:32° to 104° F (0° to 40° C) / 20% to 80% Relative Humidity.* Dimensions/Weight:7.81" (198.37mm) H x 6.67" (169.42mm) W x 7.057" (179.25. mm) D / 6.04 lbs. (2.7397kg.).Item Includes:* HD-USB PTZ Camera.* PowerRiteT 12 VDC, 3.0…
Item #: VAD-999-6994-000
…HD-USB PRO is built around the ClearVIEW HD-USB high definition PTZ camera, the world s first broadcast-quality HD PTZ camera with USB and Ethernet streaming built right into the camera. Now you can directly plug an HD PTZ camera directly into your PC without the need for a separate capture…
Item #: VAD-999-6995-000
Related Categories: Tricaster | Camera | Sony Srg-300h | Newtek | Hdmi Video Mixer | Hdsdi Recorder | Robotic Camera | Sony Brc300
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Item #: HF-OC4M-0250
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Item #: HF-OC4M-1000
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About Armstrong
Armstrong Faculty Member Selected for NEH Institute
(May 2, 2011) Thomas Howard, Armstrong Atlantic State University professor of geography in the Department of History, has been selected as a National Endowment for the Humanities (NEH) Summer Scholar for an NEH institute titled "The Cultural and Historical Development of Modern India." The program will run from July 4-29 in Delhi, Agra, and Varanasi, India. A group of 24 participants, from colleges and universities around the United States, has been selected for the institute, which is one of 21 summer study opportunities supported by the National Endowment for the Humanities.
The program features a series of presentations by scholars, from India and other countries, on subjects ranging in time from the Indus Valley civilization of 2000 B.C., the age of the Mahabharata, the Mughal Empire, the independence movement led by Nehru and Gandhi, to the establishment of India in world popular culture through Bollywood movies. The lectures will be interspersed with site visits and field trips relevant to the topics of presentations.
Howard teaches a Geography and History of South Asia course and expects the NEH program to yield new material for use in that course as well as for his courses in world regional and cultural geography. He holds a Ph.D. in geography from the University of California at Berkeley and earned a master's in anthropology and a bachelor's in history from the University of Chicago.
Latest Headlines
Armstrong Partners With Small Business Institute to Help Local Companies Succeed
Two Professors Secure Grant to Foster Interest in Technology and the Arts
University Receives $1.1 Million Grant for Student Support Services
University Signs MOU With China's Yichun University
Jeanne McGowan Joins Armstrong as Director of the Counseling Center


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Vanderbilt University Medical Center accepts the following insurance plans. For information about specific contract coverage, please contact your health plan directly.
What area of Vanderbilt University Medical Center would you like to leave feedback?
Note: feedback is for non-emergency questions and suggestions regarding patient services and website functionality.
If you require immediate care, please call 911 or visit the Emergency Room.
The Vanderbilt Breast Center at One Hundred Oaks in Nashville provides the most complete range of services for breast health in Middle Tennessee. In one location, we offer:
The Vanderbilt Hereditary Cancer Clinic offers testing and guidance for patients with inherited risk of developing breast cancer.
The Vanderbilt Breast Center is affiliated with Vanderbilt-Ingram Cancer Center, a national leader in patient care and cancer research. We are also an National Comprehensive Cancer Network affiliate, performing the latest research into breast cancer.
In recognition for our world-class care, we have been honored with an NAPBC certification and a Breast Imaging Center of Excellence designation. We are certified under the Breast Patient Navigator Program of the National Consortium of Breast Centers for excellence in guiding patients through all steps of cancer treatment.
Women over 40 are encouraged to have a screening mammogram every year. A screening mammogram is for those who do not have a specific breast concern or symptom, such as a lump. If you have a lump or other concern, your provider will want to perform diagnostic testing.
Schedule a screening mammogram by calling the center at (615) 322-2064, using our online Request an Appointment form, or through your My Health At Vanderbilt account.
Thank you for visiting our website. You have been selected to participate in a brief customer satisfaction survey to let us know how we can improve your experience.


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For immediate assistance, we have loads of help in our customer service area that covers most customer queries.
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We do not offer custom stickers or custom printing.
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Fax Line Australia 07 3036 5727, Fax Line International +61 7 3036 5727
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Home > Sunglasses > Pierre Cardin > P.C. 6174/S (DRX/BZ)
P.C. 6174/S is available in 5 additional attractive styles
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30-day money-back guarantee
Low prices
P.C. 6174/S/DRX/BZ Ophthalmic Glasses
These sunglasses complement your look with an accessory that is a cut above the rest. True to the Edel-Optics motto "SEE AND BE SEEN", you are on a par with celebrities, impressing in every environment. Would another colour not be a better match for your favourite outfit? Check also the other styles of P.C. 6174/Sin our 2015, and 2016 Pierre Cardin range.
With no frills and state-of-the-art materials and craftsmanship, these men's glasses stand for stylish design and self-confidence. Full rim frames completely enclose the lenses within the frame. For a convinced eyeglass wearer, any other frame style is ruled out, with very few exceptions. The panto optic of the frame belongs to the classics. Since its design in the 20s, it has celebrated one comeback after another. Today it combines the vintage style with hip fashion trends and puts the finishing touch to any outfit. Plastic is a very lightweight and flexible material. This ensures a long life and a high level of comfort. Brown is currently a trend colour and also an absolute timeless classic. The colour provides a nice contrast ratio between the skin and the colour of the eyeglass frame. Thus, the transition from eyeglasses to the face is harmonious and unobtrusive. Brown is the dominant colour for sunglass lenses. They radiate warmth and look very soft. Functionally, you are, of course, on the safe side, too. With 100% UV eye protection, the sun can immediately start shining.
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Sea Shell Charters wants to turn your vacation into an enduring lifetime of memories. Captain Phil with 36 years of charter and tour experience in and around the Negril area knows where to go. You will feel like royalty as Captain Phil and his crew tend to your every need.
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How broke am I? Would you like to buy my car, my house or my kidney?
Published 10/01/2013 | 06:00
'So how d'you get over the Christmas?" They're all asking me in the staff room this week. My answer is the standard, "Well, maybe this will give you an idea: do you want to buy a car, a house, a kidney? That's how broke I am."
It's not like I'm the most generous bloke in the world. In the couple of days in the run-up to the grand event I withdraw the princely sum of €50 and leave the house in the care of my young fellow. Grade Junior is pretty much your average Irish teenage boy, a 16-year-old deadbeat addicted to gaming and online porn and so unlikely to stir for hours.
Parking the car in the underground car park at the local shopping centre from hell, I try to avoid the attention of three of my pupils leaning against a concrete wall covered in graffiti written in handwriting that I actually recognise.
I'm strongly tempted to buy a red paint spray can and correct the spelling mistakes but I resist. Inevitably they spot me and start shouting, "Hey Gradey, you queer!" followed by puzzled looks and grins from shoppers queuing to pay their parking tickets.
Making for the discount bookstore I soon find the perfect gift for my unemployed big brother, F: Irish Fly-fishing in Ireland – it's only €2.99 and redolent of suggestions with what he should do with himself.
Leaving the store I manage to bump into this former pillar of the business community whose scorn for all public servants knows no boundaries and before I can utter a word he's off bragging about his plans to spend the holidays in his apartment in Bulgaria.
I tell him I don't know where he gets the money from and all I get is a sly wink. With lots of false seasonal jollity we part, he heading into the same discount store, no doubt to buy me some rubbish I'll never read either and I for the nearest café.
Peace at last. A tall medium cappuccino and today's Irish Independent and I'm all sorted till it's time to spend the rest of my mean Christmas budget.
Should have known it couldn't last. Ear-splitting screeches approach me as four female members of staff, well-oiled on mulled and unmulled wine, hone in on me and drown me in a torrent of festive clichés.
I try to respond in kind but there's no point as I can't make myself heard over the noise.
And here we are in 2013, it's the start of the new term and they're sitting at the opposite side of the staff room, back to their customary gossip whispering, while the guys around me are boring me to tears with the same old predictions about how the deputy principal is definitely going to suffer a nervous breakdown by mid-term.
Mid-term? I'd almost forgotten. The thought of those distant rain-filled and freezing February days is enough to bring a smile to my face. That'll get me there.
Irish Independent


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Affordable Insurance Center, Inc. is focused on providing high-quality service and customer satisfaction! We will do everything we can to meet your expectations. Affordable Insurance, Inc. has been serving Duplin and surrounding counties for over 10 years.
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Herb Edwin Stecke
Jessie and Todd Stecke of Perham are proud to announce the birth of their son, Herb Edwin Stecke, born at 11:52 p.m. on Sept. 29, 2013.
He weighed 9 pounds, 5 ounces and was 21-1/4 inches long. He was delivered by Dr. Bobbi Adams at Tri-County Health Care in Wadena.
Herb is welcomed home by brothers, Gary and John.


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Wine Tasting Events
Liberty has a long history of supporting charities in the Vancouver community and we are thrilled that we've been able to help so many.
Throughout the year, Liberty hosts numerous tasting events that directly benefit local charities. In 1993, we launched Taste BC, a local celebration of food and drink, to benefit BC Children's Hospital's - Oak Tree Clinic. Our Tastings-in-the-Park series, which take place four times a year at the Vancouver Rowing Club, provides funding for amateur sport in Vancouver.
- $233,910 - Raised for BC Children's Hospital - Oak Tree Clinic through Taste BC
- $117,439 - Raised for Amateur Sports in BC through 'Tastings-in-the-Park' events
- $28,401 - Raised for the BCSPCA through Granville Island's Fall into the Market
- $5,971 - Raised for the Dr. Peter Centre through Wines in the West End
- $26,682 - Raised for the Canadian Breast Cancer Foundation through Rosé Revival
- $31,393- Raised for the Greater Vancouver Food Bank Society through East Side Beer Fest & Best of the Craft BC Beer Fest.
View Liberty Tasting Event photos on Flickr
Fall Into The Market - November 7th 2016
Liberty Merchant Company proudly presents its annual Fall into the Market tasting event. This Liberty-sponsored event is in support of the BC SPCA, to protect and enhance the quality of life for domestic, farm and wild animals in British Columbia. All proceeds from both ticket sales and the silent auction directly support the BC SPCA.
The evening will feature coastal wines along with tasty samplings from Granville Island food purveyors. It's the perfect autumn event! Join us on Monday, November 7th, from 7:00 - 9:00pm at the beautiful Bridges Restaurant on Granville Island.
Tickets are just $29.99 and available at all Liberty Wine Merchants locations. For more information on this and future events, please visit http://
Follow Us on Twitter for Event Updates
Upcoming Events:
10th Annual Fall Into The Market
Monday, November 7th 2016
Bridges Restaurant
Tickets: $29.99 at any Liberty Wine Merchant location


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The Hunger Games: Catching Fire continues to roll out portrait posters. All week, Lionsgate has been debuting character posters on various sites, including our exclusive Caesar Flickerman poster from Monday.
Today brings three new posters for Games fans to enjoy.
The first one debuted over on PerezeHilton.com this morning and features Peeta Mellark. Described as "solid as a rock with just the right touch of shyness," Peeta joins Katniss and other former Games winners in the 75th Quarter Quell in Catching Fire. Check out his poster below and click on all the posters for larger versions.
The second poster of the day was revealed this afternoon on Pop Sugar and features the other man in Katniss' life – Gale.
The final poster of the day made its debut on MTV and features the newest heartthrob to the Hunger Games franchise, Finnick Odair.
Finnick was the male victor from District 4 of the 65th Hunger Games and is a skilled fighter with spears and knives. His signature weapon is a trident and will be portrayed in the film by Sam Claflin.
Finally, fans have been enjoying this recent run of Games posters and have begun to merge their favorite characters together in alternative fan-made posters. Here's one of the popular ones featuring Katniss and Peeta. You can also find an alternate Buttercup the Cat portrait here.
If you missed any of the other portrait posters from the past couple of days, check out yesterday's duo of Beetee and Johanna Mason, Tuesday's batch featuring Katniss, Haymitch and Cinna and the poster that kicked off the series, Effie Trinket.
What do you think of today's posters?
The Hunger Games: Catching Fire arrives in theaters November 22, 2013. Want to know when tickets go on sale? Sign up for a Fan Alert!
Follow along on Twitter @TheHungerGames, @DerrickDeane and @Fandango


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On whether the Warriors can challenge the 1995-96 Chicago Bulls' record 72-win season: –Christie: "At first I was thinking 'I don't know.' As I continue to watch them, The key term everyone glazes over is 'team.' This Warriors team is a team. They play together, they play for each other. When you look at 70, 72 wins that is a tough dish to get ahold of, but this Warriors team you've got to think (it's possible). … This is a young team, a team that has really come together. I think they have an opportunity. Whether they do it or not …
Doug Christie RumorsAll NBA Players
Doug Christie
Position: None
Born: 05/09/70
Height: 6-6 / 1.98
Weight:205 lbs. / 93 kg.
Born: 05/09/70
Height: 6-6 / 1.98
Weight:205 lbs. / 93 kg.
"You figure last year you get 67 wins, you're five away. … This is a better team, a more cohesive team, a deeper team. When you look at Draymond Green, Harrison Barnes, these guys have truly improved. When you add all that together and a more confident Steph Curry, oh my goodness. It is a scary thing. They do have a chance."
–On how he would defend Curry: –Christie: "One way is to get a blindfold and a cigarette and just pray. I wouldn't do that one. I would stick him like I stuck Steve Nash, and a lot of the times we met up in the playoffs with Dallas. What I would do … I was bigger than Nash and I moved better than Nash so that gave me a positive. I would pick him up fullcourt. I would make it difficult. Now it's not fullcourt like I'm trying to steal the ball. That's not the key.
"What I'm trying to do is push him left, push him right, make him turn, use his legs. Because he's a jump shooter. Steph Curry is a jump shooter. I'm not doing this for right now in the first two quarters. It's for the second half. It's for him to start missing jump shots. Steph has a better handle, is a little bit more aggressive than Steve. Steve was more looking to pass a lot. You're going to have to pick him up, you're going to have to be physical with him. I haven't seen anyone test him yet. Steph is a nice guy and he's got the baby-face and everyone plays into that. Kind of like Michael Jordan, and he used to murder you.
"Rick didn't win the 'ship (championship)," continued Christie, "and as badly as I feel for the Sacramento fans, I wanted to win it for him, too. He was my favorite coach. He identifies what a player can do and brings out the best in him. I definitely don't think he gets enough respect as an elite coach." His bio in the NBA record book reads in part like a Hall of Fame legal brief. In his 22 full seasons as a head coach, Adelman twice took the Portland Trail Blazers to the NBA Finals, endured losing seasons only four times, led the Kings to the playoffsin each of his eight seasons in Sacramento, and ranks as one of only eight coaches to win 1,000 or more games. He also is highly regarded for his innovative "corners" series, an offensive set that requires a big man who can pass out of the high post and players who can read and react.
Dennis Rodman has named a team of former NBA players to participate in an exhibition basketball game in Pyongyang, North Korea. Rodman leads a team that includes former NBA All-Stars Kenny Anderson, Cliff Robinson, and Vin Baker. Craig Hodges, Doug Christie and Charles D. Smith are on the team, as well. They will play against a top North Korean Senior National team on Wednesday, marking North Korean leader Kim Jong Un's birthday. Rodman is the highest profile American to meet Kim since the leader inherited power after his father died in late 2011. Rodman calls the game his version of "basketball diplomacy."


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Here you'll find restored and re-purposed furniture and other home decor finds. Re-purposing furniture and home decor with Mustard Seeds Milk Paint and American Paint Company products! Take time to smell the wonderful hand-poured, highly fragranced candles. Locally made goat milk soaps & lotion are the best! There is something for everyone in this locally owned boutique. Custom work and paint classes offered.
Whitey's Ice Cream Stores - Quad Cities
Created in the Quad Cities, outstanding flavors of ice cream, malts, shakes of every kind, banana splits, sundaes. Squeeky clean Ice Cream Shops all done up in White and Red and the ice cream servers are dressed white uniforms with red and white caps.
Whitewater Junction - Aquatic Park
Whitewater Junction is a railroad-themed aquatic facility. Two water slides, spray toys, zero depth edge and shallow water play area.
CITY:Rock Island
Kids will love this railroad themed aquatic center featuring a spiral slide, tube slide, water geysers and playful water features. Open during the summer months 7 days a week, Whitewater Junction is located inside the lovely Longview Park in Rock Island, Illinois.
CITY:Rock Island
Are you in need of a home away from home? Consider this lower level, one bedroom furnished apartment. Utilities, cable, laundry facilities, parking space, and private entrance are among the amenities included.
Gifts, gourmet items, children's books and classic toys.
Village Florist Gifts & Antiques
Beautiful hand-prepared floral arrangements are delightfully appealing. The selection of home decor and antiques will please any decorator or collector. Three floors of merchandise to select from. Stop in soon!
Victorian home built in 1876 and added in 1905. The home has 20 rooms and 6 guest rooms. All of the rooms have private baths and 2 have working fireplaces.
CITY:Rock Island
Come join us for a great day of golf, then relax in our lounge and have a cool refreshment and something to eat! Located at 9701 1/2 Illinois Highway 82 in Cambridge, IL. This is a 18 hole golf course.
Watch and bet on telecast thoroughbred and harness racing from all over the United States. A restaurant and lounge offer daily drink and lunch specials.
CITY:East Moline
Built on the site of a former Arabian horse farm, this beautiful 18-hole, par 71 championship golf course stretches along wooded ravines on the Rock River. The course is home of the John Deere Classic, a PGA Tour event that draws top golf talent.
Tournament Players Club Deere Run - Quad Cities
The Midwest's premier semi-private golf facility - in a setting of mature hardwood trees, rolling hills, and the serene Rock River Valley. Designed to host the PGA Tour's John Deere Classic. A la carte & events dining, full service Golf Shop.
"Torment at Twelve Hundred" the theatrical haunted attraction, continues its daunting saga of "Torment," exceeding the boundaries of fear, sending you on a walking path through dark winding tunnels, outdoor wooded trails, highly detailed buildings and more. One of the top 10 haunts in Illinois by USA Today. Not recommended for 12 years and younger. Open all weekends in October! Fridays & Saturdays: 7 pm – 12 am, Sundays 7 pm – 10 pm. General Admission $15.00
Top O' the Morning Bed & Breakfast
1912 brick prairie style home of Rock Island Railroad President. On hill overlooking Mississippi River above downtown Rock Island. Three acres of wooded grounds.
CITY:Rock Island
Prairie-style brick mansion, built by Hiram S. Cable, President of the Rock Island Railroad, circa 1912. Original country estate used as the summer home for the Cable family. Beautiful view. Central location on the hill in Rock Island, overlooking the Mississippi River Valley across from Long View Park. Enjoy the unique experience of an overnight stay in a private home. Special features include a 600 square foot parlor with gold concert harp, grand piano, chandeliers, and large wood-burning fireplace. A full breakfast of fruit, rolls, juice, and three entrees is served either in the Dining Room or on the deck, weather permitting.
CITY:Rock Island
Coffee house with deli sandwiches, pastries, soups and light fare. Located in the heart of the Downtown Rock Island Arts & Entertainment District.
CITY:Rock Island
Large mature trees covering 50 acres surrounds a 5 acre lake for you to unwind in nature's glory. Activities for all ages - swim, fish, play horseshoes, volleyball or swing at the playground. 30 and 50 amp sites all with water and electric hookup. Pull through and tent sites are available.
Enjoy comedians, big bands, burlesque, drag shows, and more at the Speakeasy. This intimate club offers live performances throughout the year to fit a variety of tastes. The Speakeasy features a bar, simple menu, and performance seating at small and large tables. To see what's coming up next at the Speakeasy visit http://circa21.com/speakeasy.asp
CITY:Rock Island
Enjoy this intimate theatre featuring live music, comedy and more. Located right next door to the Circa '21 Dinner Playhouse, the Speakeasy is the newest edition to the Downtown Rock Island Arts & Entertainment District. Open Thursday through Saturday, check the website for upcoming event schedule.
CITY:Rock Island
The Original Huckleberry's Great Pizza and Calzones
A fun, casual Italian restaurant featuring good pizza, pasta and calzones in the heart of the District.
CITY:Rock Island
German Restaurant with a large German menu and beer selection. Enjoy the outdoor Beer Garden and live music on weekends.
Stoney Creek Hotel & Conference Center
The Northwoods theme runs through this 140 room, 10,000 sq.ft. of meeting space hotel. A walk-through lobby & glass elevator greet each guest. The Wilderness Park indoor/outdoor pool area is a great place to relax. Suites are available with hot tubs & fireplaces! Internet access & meeting space is available for the business traveler & meeting planner. An atmosphere that is uniquely different. This is a very family-friendly hotel property and close to attractions including the John Deere Pavilion, John Deere Store, Celebration Belle Riverboat, Channel Cat Water Taxi, shopping, dining and nightlife. The hotel provides complimentary shuttle airport shuttle service, High-speed wireless internet access, and complimentary hot breakfast. The hotel property is located conveniently right off Interstate 74.
Homemade soups, daily specials, and freshly baked goods are just a few of the reasons to give this locally-owned stop a try.
Enjoy indoor shopping throughout the year at SouthPark Mall. This mall features some 200 stores that include larger department stores like Dillards, VonMaur, and Yonkers. Specialty and gift shops, well-known clothing stores, and large food court make this a great place to shop.


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Index of content:
Volume 118, Issue 5, November 2005
Informational masking of speech in children: Effects of ipsilateral and contralateral distracters118(2005); http://dx.doi.org/10.1121/1.2082567View Description Hide Description
Using a closed-set speech recognition paradigm thought to be heavily influenced by informational masking, auditory selective attention was measured in 38 children (ages ) and 8 adults (ages ). The task required attention to a monaural target speech message that was presented with a time-synchronized distracter message in the same ear. In some conditions a second distracter message or a speech-shaped noise was presented to the other ear. Compared to adults, children required higher target∕distracter ratios to reach comparable performance levels, reflecting more informational masking in these listeners. Informational masking in most conditions was confirmed by the fact that a large proportion of the errors made by the listeners were contained in the distracter message(s). There was a monotonic age effect, such that even the children in the oldest age group demonstrated poorer performance than adults. For both children and adults, presentation of an additional distracter in the contralateral ear significantly reduced performance, even when the distracter messages were produced by a talker of different sex than the target talker. The results are consistent with earlier reports from pure-tone masking studies that informational masking effects are much larger in children than in adults.
The interaction of glottal-pulse rate and vocal-tract length in judgements of speaker size, sex, and agea)118(2005); http://dx.doi.org/10.1121/1.2047107View Description Hide Description
Glottal-pulse rate (GPR) and vocal-tract length (VTL) are related to the size, sex, and age of the speaker but it is not clear how the two factors combine to influence our perception of speaker size, sex, and age. This paper describes experiments designed to measure the effect of the interaction of GPR and VTL upon judgements of speaker size, sex, and age. Vowels were scaled to represent people with a wide range of GPRs and VTLs, including many well beyond the normal range of the population, and listeners were asked to judge the size and sex/age of the speaker. The judgements of speaker size show that VTL has a strong influence upon perceived speaker size. The results for the sex and age categorization (man, woman, boy, or girl) show that, for vowels with GPR and VTL values in the normal range, judgements of speaker sex and age are influenced about equally by GPR and VTL. For vowels with abnormal combinations of low GPRs and short VTLs, the VTL information appears to decide the sex/age judgement.
Listening experience with iterated rippled noise alters the perception of 'pitch' strength of complex sounds in the chinchilla118(2005); http://dx.doi.org/10.1121/1.2049107View Description Hide Description
Behavioral responses obtained from chinchillas trained to discriminate a cosine-phase harmonic tone complex from wideband noise indicate that the perception of 'pitch' strength in chinchillas is largely influenced by periodicity information in the stimulus envelope. The perception of 'pitch' strength was examined in chinchillas in a stimulus generalization paradigm after animals had been retrained to discriminate infinitely iterated rippled noise from wideband noise. Retrained chinchillas gave larger behavioral responses to test stimuli having strong fine structure periodicity, but weak envelope periodicity. That is, chinchillas learn to use the information in the fine structure and consequently, their perception of 'pitch' strength is altered. Behavioral responses to rippled noises having similar periodicity strengths, but large spectral differences were also tested. Responses to these rippled noises were similar, suggesting a temporal analysis can be used to account for the behavior. Animals were then retested using the cosine-phase harmonic tone complex as the expected signal stimulus. Generalization gradients returned to those obtained originally in the naïve condition, suggesting that chinchillas do not remain "fine structure listeners," but rather revert back to being "envelope listeners" when the periodicity strength in the envelope of the expected stimulus is high.
Forward masking of amplitude modulation: Basic characteristicsa)118(2005); http://dx.doi.org/10.1121/1.2042970View Description Hide Description
In this study we demonstrate an effect for amplitude modulation (AM) that is analogous to forward making of audio frequencies, i.e., the modulation threshold for detection of AM (signal) is raised by preceding AM (masker). In the study we focused on the basic characteristics of the forward-masking effect. Functions representing recovery from AM forward masking measured with a masker AM and a signal AM of the same rate imposed on the same broadband-noise carrier, showed an exponential decay of forward masking with increasing delay from masker offset. Thresholds remained elevated by more than over an interval of at least following the masker. Masked-threshold patterns, measured with a fixed signal rate (20, 40, and ) and a variable masker rate, showed tuning of the AM forward-masking effect. The tuning was approximately constant across signal modulation rates used and consistent with the idea of modulation-rate selective channels. Combining two equally effective forward maskers of different frequencies did not lead to an increase in forward masking relative to that produced by either component alone. Overall, the results are consistent with modulation-rate selective neural channels that adapt and recover from the adaptation relatively quickly.
The temporal effect in listeners with mild to moderate cochlear hearing impairmenta)118(2005); http://dx.doi.org/10.1121/1.2074787View Description Hide Description
This study examines the relationship between a temporal masking effect and cochlear hearing impairment. The threshold level of a long-duration broadband masker needed to mask a short-duration tonal signal was measured for signals presented 2 ms (short-delay) or 202 ms (long-delay condition) after masker onset. The difference between these thresholds is the temporal effect. In two previous studies with normal-hearing listeners, estimates of gain of the cochlear active process derived from such data suggested a decrease in gain during the course of the masker. This hypothesis was further examined in the present study by testing listeners with mild to moderate cochlear hearing impairment. Results are consistent with a decrease in gain in the short-delay condition with increasing hearing impairment, and also less change in gain with increasing hearing impairment.
Comparing monaural and interaural temporal windows: Effects of a temporal fringe on sensitivity to intensity differences118(2005); http://dx.doi.org/10.1121/1.2047247View Description Hide Description
In an effort to provide a unifying framework for understanding monaural and binaural processing of intensity differences, an experiment was performed to assess whether temporal weighting functions estimated in two-interval monaural intensity-discrimination tasks could account for data in single-interval interaural intensity-discrimination tasks. In both tasks, stimuli consisted of a burst of noise with a probe segment at temporal positions ranging between the onset and offset of the overall stimulus. During the probe segment, one monaural interval or binaural channel of each trial contained an intensity increment and the other contained a decrement. Listeners were instructed to choose the interval/channel containing the increment. The pattern of monaural thresholds was roughly symmetrical (an inverted U) across temporal position of the probe but interaural thresholds were substantially higher for a brief time interval following stimulus onset. A two-sided exponential temporal window fit to the monaural data accounted for the interaural data well when combined with a post-onset-weighting function that described greatest weighting of binauralinformation at stimulus onset. A second experiment showed that the specific procedure used in measuring fringed interaural-intensity-difference-discrimination thresholds affects thresholds as a function of fringe duration and influences the form of the best-fitting post-onset-weighting function.
The effect of diotic and dichotic level-randomization on the binaural masking-level difference118(2005); http://dx.doi.org/10.1121/1.2047167View Description Hide Description
Detection thresholds for tones in narrow-band noise were measured for two binaural configurations: and . The noise band had a mean overall level of SPL and was centered on 250, 500, or . Signals and noise were simultaneously gated for 500, 110, or . Three conditions of level randomization were tested: (1) no randomization; (2) diotic randomization—the stimulus level (common to both ears) was randomly chosen from an uniformly distributed range every presentation interval; and (3) dichotic randomization—the stimulus levels for each ear were each independently and randomly chosen from the range. Regardless of binaural configuration, level randomization had small effects on thresholds at 500 and , implying that binaural masking-level differences (BMLDs) do not depend on interaural level differences for individual stimuli. For stimuli, both diotic and dichotic randomization led to markedly poorer performance than at 500- and 110-ms durations; BMLDs diminished with no randomization and dichotic randomization but not with diotic randomization. The loss of BMLDs at , with degrees-of-freedom (2WT) approximately 1, implies that changes in intracranial parameters occurring during the course of the observation interval are necessary for BMLDs when mean-level and mean-intracranial-position cues have been made unhelpful.
Precedence-based speech segregation in a virtual auditory environment118(2005); http://dx.doi.org/10.1121/1.2082557View Description Hide Description
When a masking sound is spatially separated from a target speech signal, substantial releases from masking typically occur both for speech and noise maskers. However, when a delayed copy of the masker is also presented at the location of the target speech (a condition that has been referred to as the front target, right-front masker or F-RF configuration), the advantages of spatial separation vanish for noise maskers but remain substantial for speech maskers. This effect has been attributed to precedence, which introduces an apparent spatial separation between the target and masker in the F-RF configuration that helps the listener to segregate the target from a masking voice but not from a masking noise. In this study, virtual synthesis techniques were used to examine variations of the F-RF configuration in an attempt to more fully understand the stimulus parameters that influence the release from masking obtained in that condition. The results show that the release from speech-on-speech masking caused by the addition of the delayed copy of the masker is robust across a wide variety of source locations, masker locations, and masker delay values. This suggests that the speech unmasking that occurs in the F-RF configuration is not dependent on any single perceptual cue and may indicate that F-RF speech segregation is only partially based on the apparent left-right location of the RF masker.


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