a PDF of this issue - Extra
Transcription
a PDF of this issue - Extra
March 5, 2010 http://extra.upmc.com Building project sets the stage to expand Emergency Department, add amenities Inside: A new front door for UPMC Presbyterian Accolades Supporting a culture of performance at UPMC Volunteers needed for Pittsburgh Marathon March 5, 2010 | http://extra.upmc.com A new front door for UPMC Presbyterian Building project sets the stage to expand Emergency Department, add amenities UPMC Presbyterian is getting a facelift and much more. Completion of the three-story building under construction along the main driveway of UPMC Presbyterian will bring major customer service and clinical enhancements to the Oakland hospital. Work on the ground floor is scheduled for completion in mid-May. The ground floor will house the new entrance and lobby to the hospital. From the lobby, patients, visitors, and staff will take an escalator to the first floor, which will offer a number of new retail services. An expanded gift shop is scheduled to open in May, followed by a Starbucks and a PNC Bank branch. “In developing the project, we realized the importance of providing retail services that meet the needs of our patients, visitors, and staff,” says John Innocenti, president, UPMC Presbyterian Shadyside. A convenient location to enjoy a beverage with a family member, friend, or colleague is a customer service priority. Accessibility of a bank is another. “Our PNC will be staffed by tellers and offer many of the same financial services found at larger banking locations,” adds Mr. Innocenti. Remaining space in the new building will be shared by Surgical Services and Radiology. A major upgrade for the ED With the completion of the new ground-floor lobby and entrance, work will begin on a significant expansion of the Emergency Department. “We plan to offer patients a fully renovated Emergency Department with state-of-the-art equipment,” says John Krolicki, vice president, Facilities and Support Services. “Our design also incorporates improvements so that patient flow through the ED is efficient from arrival through discharge.” Work will proceed in multiple phases to add 10 treatment bays and an expanded family lounge. Trauma bay renovations and equipment upgrades also will be completed in phases. Other ED improvements include an advanced air-handling system and security enhancements. “We are working closely with the clinical leadership so that our ED, a Level I adult trauma center, remains in operation as we proceed through the construction phases,” adds Mr. Krolicki. The current timeline estimates completion of the ED project in January 2011. Other improvements Both Mr. Krolicki and Brian Mathie, project manager, Planning, Design, and Construction, note that the project presents opportunities to address other needs. For example, the entire exterior of UPMC Presbyterian will be cleaned so that it matches the limestone facade of the new entranceway structure. Lighting will be improved in the covered portion and canopy area of the UPMC Presbyterian driveway. Other enhancements to the driveway will improve both the aesthetic appearance and traffic flow. The entranceway will not close during the work. 2 Better communication leading to better care Clear communication in health care is important for promoting patient safety. According to a report by The Joint Commission, communication problems between health care providers and patients and families are a common cause of poor outcomes. Addressing health literacy — patients’ ability to get, process, and understand basic health information and services needed to make health decisions — is a major goal for many health care organizations. Patients who understand their care better tend to be safer and more satisfied with their health care experiences. “As health care providers, we often underestimate our patients’ limited health literacy, and misjudge the ability of patients to understand what they have been told,” says Linda Waddell, RN, MSN, CEN, improvement specialist at the Donald D. Wolff Jr. Center for Quality Improvement and Innovation at UPMC. To help patients and their families better understand the information they receive, UPMC is committed to improving communication between patients and providers. One of the ways to do this is by encouraging “Teach Back.“ This involves asking patients to repeat back in their own words what they have heard — for example, what they need to do when they leave the hospital. This method encourages hospital staff to check to make sure that the patient understands his or her instructions. “The Quality Center is launching a campaign to encourage the use of communication methods that improve patient understanding,” Ms. Waddell says. For information on health literacy tips for patients, see the chart attached to this edition of Extra. March 5, 2010 | http://extra.upmc.com Health Plan expands More Energy program UPMC Health Plan is expanding the More Energy program to 18 participating fitness centers, up from the previous 16. More Energy Pass YMCA of Greater Pittsburgh (12 locations) • $50 for 10 visits between April 1 and June 1 The More Energy pass provides discounted temporary memberships to the YMCA of Greater Pittsburgh, the Jewish Community Center of Greater Pittsburgh, the Rivers Club, Gold’s Gym, the Beaver County YMCA, and the Sewickley Valley YMCA. You can earn 75 Take a Healthy Step points for participating. “Interest in this physical activity program continues to grow,” says Kim Jacobs, executive director, Health Promotion Account Management at UPMC Health Plan. “We completed a staff survey a few months ago and responses indicated a high degree of interest in UPMC-sponsored fitness activities. In response, we’ve increased the number of locations for this spring to make the program more convenient.” The participating fitness centers offer a wide variety of exercise classes, cardio and weight lifting equipment, pools, locker room facilities, and much more. Register for fitness center passes through March 19 • www.ymcapgh.org Jewish Community Center of Greater Pittsburgh (two locations) • $60 for unlimited access between April 1 and May 7 • www.jccpgh.org Rivers Club (one location) • $50 for 10 visits between April 1 and July 7 “This is not just a good economic value. This is the easiest way I can think of to get into a gym and get the health benefits from an exercise program,” Mr. Jacobs says. “In fact, we think many people will take out full memberships after their More Energy passes expire, and make a permanent lifestyle change.” • www.riversclub.com More Energy registration runs through Friday, March 19, and the program begins Thursday, April 1. To register and purchase a card, go to My HUB and click on the Human Resources tab. Select MyHealth/MyFlex Advantage and click on MyTools at the top of your screen. Select the “Wellness Event Registration” box located on the right side at the bottom of your screen, then select “Enroll” to register. • $30 for unlimited access between April 1 and May 7 UPMC competition gathers green ideas Sustainable health care is an operation and service that balances quality and performance — conserving resources, minimizing waste, and managing energy use to sustain current and future generations. Do you have an idea for a new green product or a new greening process? Are you interested in helping to advance greening efforts at UPMC, or the health care industry in general? If “yes” is the answer to these questions, consider entering the first UPMC Sustainable Innovation competition. The deadline for submissions is Monday, March 15. For more information and to register, visit the Greening Infonet site (http://greening.infonet.upmc.com/SSI.html). Gold’s Gym (one location) • $50 for unlimited access between April 1 and May 7 • www.goldsgym.com Beaver County YMCA (one location) • www.beavercountyymca.org Sewickley Valley YMCA (one location) • $35 for unlimited access between April 1 and May 7 • www.sewickleyymca.org Daylight saving time begins Sunday, March 14 Get ready to “spring forward.” Daylight saving time will begin at 2 a.m. Sunday, March 14. Remember to move your clocks ahead one hour. 3 March 5, 2010 | http://extra.upmc.com LifeSolutions Corner I think my child may have ADHD. Are there resources available to help us? This is where LifeSolutions’ knowledge of community resources and experts in the field really comes in handy. Attention deficit hyperactivity disorder (ADHD) is one of the most common disorders in children. LifeSolutions is a good place to start to find the treatment and support you and your child may need to manage this disorder successfully. • A LifeSolutions counselor can refer you and your child to a professional who has training or specialization in ADHD. After getting information from you, your child, and your child’s teachers, that professional will be able to determine if ADHD is the proper diagnosis. Effective treatments and supports, which can include behavioral therapy, parent education, and medication, will be recommended if ADHD is present. • Coaching is available to help you establish effective communication with your child’s school personnel, physicians, and family members who also may be concerned about your child. • A LifeSolutions counselor can identify and refer you to community resources, such as support groups, and advocacy services, such as Children and Adults with Attention Deficit/ Hyperactivity Disorder (CHADD). • You can find information and many articles about ADHD on our website (www.lifesolutions foryou.com) by logging in through the WorkLife portal (company code upmc). You also can request a personalized WorkLife search to find out more about ADHD. You’ll receive the information in a few days. These resources and others are available by calling LifeSolutions at 1-800-647-3327. Information and support are just a phone call away. Women’s History Month In March, our nation honors the outstanding contributions of women during Women’s History Month. At UPMC, we salute the achievements of women who have contributed to the advancement of science, industry, and health care throughout history. Across UPMC, there are champions who promote and support dignity and respect every day. The Center for Inclusion in Health Care is looking for nominations of your colleagues who embody these characteristics. You can nominate a co-worker as a Dignity and Respect Champion on the Center for Inclusion Infonet site. In March, as our nation honors the outstanding contributions of women, consider nominating someone who supports and promotes women. Tuition advancement tax withheld today Staff who received tuition advancement for the fall 2009 semester will have applicable state and municipal taxes withheld from the pay received today, Friday, March 5. Staff who are paid monthly will see the tax withheld from the Wednesday, March 31, pay. The withholding rate for Pennsylvania state tax is 3.07 percent. The city of Pittsburgh tax rate is 3 percent. Other state and municipal tax rates vary. Traveling for business? Remember to book your trip online with Travel UPMC, the preferred method for booking all business travel. Travel UPMC is easy to use and is available 24 hours a day, seven days a week for your business air, hotel, and car rental reservations. Log in to My HUB and select the Travel UPMC link from the Supply Chain tab to get started. Looking for more information? An online training tutorial and frequently asked questions are available on the Travel site on Infonet (http://infonet.upmc.com/travel/Online.html). 4 Tuition advancement provides staff members who attend the University of Pittsburgh, Chatham University, Carlow University, Community College of Allegheny County, and schools owned by UPMC with the ability to have their eligible tuition assistance benefit paid directly by UPMC at the beginning of each term. Applications for tuition advancement must be submitted and approved at the beginning of each semester. For more information, call the UPMC Employee Service Center at 1-800-994-2752, option 3. March 5, 2010 | http://extra.upmc.com Accolades Holiday time now part of PTO Congratulations to the following members of the UPMC community who have received recent public recognition. To provide staff with flexibility to better manage their holiday and paid time off (PTO) benefits, UPMC will modify how eligible staff members’ holiday time off is tracked, effective Saturday, March 27. With this change, holiday time hours will be combined with PTO hours and used in the same manner as PTO. Under the new process, holiday time will be loaded into eligible employees’ PTO balances, and will be available for use on the date of the recognized UPMC holiday. Eligible staff members no longer will be limited to using a recognized holiday within the eight weeks before or after the holiday. Instead, the time received for holiday pay will be added to the PTO balance for use whenever the employee likes. Two UPMC physicians have received 2009 service awards from the Allegheny County Medical Society. Paul Dishart, MD, a family medicine physician affiliated with UPMC St. Margaret, received the Frederick M. Jacob Outstanding Service Award, and Michael Tranovich, MD, an orthopaedic surgeon at UPMC McKeesport, received the Physician Volunteer Award. A team of nurses from UPMC Presbyterian has received second place in the fifth annual Nursing Information Technology Innovation Award competition from Health Data Management, a national information technology publication. UPMC Presbyterian’s team received the award for work completed on protocol and quality measures related to Foley catheter necessity, deep vein thrombosis prophylaxis, and flu and pneumonia vaccinations. The project and the award will be highlighted in the March issue of Health Data Management. For a list of the team members, visit Extra online. Staff members who do not work the holiday will continue to submit for holiday time pay the same way as before this change. For employees who track their time on the Kronos timekeeping system, the “Holiday Off” pay code should be used only when taking the actual holiday off. All other scheduled time off on nonholidays should be entered as PTO. Staff members who work on a recognized UPMC holiday can access holiday time by taking another day off as PTO or by receiving pay in lieu of the holiday time. To receive pay in lieu of the holiday, a request is sent to the Payroll Department, with manager approval, in the pay period that includes the holiday. To account for staff members with higher PTO balances, the annual maximum PTO accrual limit will increase by 16 hours. Staff will be able to accrue one and one-half times their annual PTO accrual, plus an additional two days. Some things are not changing: • UPMC has seven paid and recognized holidays, which will remain the same. Daffodil Days delivery coming soon Daffodil delivery for the 2010 American Cancer Society Daffodil Days campaign is scheduled for Tuesday, March 16, or Wednesday, March 17, depending on your location. For more information specific to your campus, read Inside Extra or visit the Daffodil Days website (www.upmccancer centers.com/daffodil). • There is no change to eligibility for holiday benefits for regular full-time, flex full-time, and job share positions. If you have questions regarding these changes, contact your Human Resources representative, or refer to the Paid Time Off Policy (HS-HR0720) and/or the Compensation Manual located on Infonet. Important points for managing and using your PTO hours: • Prior to requesting time off on nonholidays, you are responsible for determining available PTO balances by checking your leave summary in My HUB. • Employees at their new maximum PTO accumulation limit will not receive additional PTO on the holiday. • The department or business unit continues to be responsible for granting PTO so as not to impact proper staffing levels for delivery of patient care and operations. 5 March 5, 2010 | http://extra.upmc.com Volunteers needed for Pittsburgh Marathon UPMC is proud to serve once again as a medical provider for the Dick’s Sporting Goods Pittsburgh Marathon, scheduled for Sunday, May 2. As in years past, volunteers are needed to make the day a success. Area health care professionals — physicians, nurses, certified athletic trainers, paramedics, and emergency medical technicians — are being recruited to staff aid stations and the medical tent at the finish line. Nonmedical volunteers are needed to serve as route guides and distribute water and blankets to the runners. Volunteer now and be a part of this exciting event. For more information or to register, visit www.pittsburghmarathon.com. United Way campaign results For the third year in a row, UPMC staff contributed more than $1 million during the annual United Way campaign. This year, in spite of the difficult economic situation we all are facing, UPMC staff came together to help those who need it most. Staff donated nearly $1.2 million to United Way agencies and services that help children, families, and seniors; provide food and shelter; prevent youth violence; and motivate children to succeed. Thank you for giving back and making a difference. A model for diabetes care Diabetes is the health crisis of the 21st century. This disease, which can damage eyes, kidneys, nerves, and arteries, is the fifth-leading cause of death in the United States. Some 21 million Americans have type 2 diabetes and a third of them don’t know it, but eventually will — perhaps too late. Approximately 1.6 million new cases of type 2 diabetes are diagnosed in the United States each year. But there’s hope, and diabetes education and treatment guidelines are key. To meet the challenge of the deepening diabetes crisis, the University of Pittsburgh Diabetes Institute, an extension of UPMC’s Division of Endocrinology and Metabolism, has established one of the largest diabetes education programs in the country, extending across Pennsylvania. Central to the program’s success are the implementation of American Diabetes Association (ADA) guidelines, an inpatient- and outpatient-based education model, and the presence of local diabetes educators in communities. UPMC’s database comprises 200,000 patients with diabetes cared for at UPMC’s hospitals, outpatient facilities, and clinics; UPMC’s ADA-certified diabetes educator network is one of the three largest in the nation. Community-based studies show that when both patients and physicians are educated on diabetes care standards, there is improvement in measures that include blood sugar control, blood pressure, and lipids. For inpatients, poor blood sugar control is linked with poorer outcomes. Proper treatment protocols, however, can lead to improved results. Research shows that blood sugar management in the hospital could be standardized through educational order sets for insulin. In 2001, UPMC endocrinologists also established a standard protocol for treating inpatients who have hypoglycemia. Working with the Pittsburgh Diabetes Institute Registry and the ADA-certified Diabetes Education Network, UPMC has launched quality improvement initiatives on a scale not possible in almost any other hospital system. UPMC has implemented systemwide computerized provider order entry (CPOE) initiatives targeting inpatient management of hypoglycemia and sliding scale management of hyperglycemia with site-specific and physician-specific reporting of ADA management targets. Inpatient diabetes management translates to cost savings in laboratory, radiology, and pharmacy, as well as reductions in the length of stay in the hospital and in readmission rates. The inpatient care team for patients with diabetes comprises: • the patient’s physician • the bedside nurse • a primary nurse care coordinator responsible for clinical assessment and implementation of a patient care plan • a clinical pharmacist • an advanced practice nurse responsible for patient education • a diabetes expert resource nurse On discharge, inpatients with diabetes are scheduled for an appointment with a certified diabetes educator. Outpatient care is provided by physician-coordinated team that includes the physician, a diabetes educator, nurse, dietitian, and pharmacist. A management plan is developed with strategies and goals for treatment, including self-management and some lifestyle changes. For type 2 diabetics, these changes may include weight loss, healthy diet, moderate-intensity daily exercise of at least 30 minutes, and smoking cessation. For more information, contact the University of Pittsburgh Diabetes Institute at 412-864-0157. 6 March 5, 2010 | http://extra.upmc.com Supporting a culture of performance at UPMC At UPMC, good performance is recognized and rewarded — in part through annual performance evaluations; however, the annual performance evaluation is only part of the process. Performance discussions and feedback should take place throughout the year, as milestones come due and as work is performed. To a large degree, this shared responsibility has been made more difficult by the manual efforts inherent in the current process. That’s one of the reasons UPMC is moving to an online performance evaluation tool. Features of this new process, which will debut this summer, will provide staff members and managers alike with the opportunity to view, comment, and contribute to the performance evaluation at any time throughout the year. That way, performance evaluation becomes an ongoing process, and not just a one-time, annual event. Rewarding performance makes a difference for the employee and the organization. At UPMC, we have been able to reduce our annualized turnover by more than 9 percent over the past seven years. This means we are retaining our most valued resources, our staff, at higher levels than ever before. This translates into better patient care and other services for our customers and lower operating costs. Just as important, we are retaining the right people — those who perform at or above our expected levels. Over the next several weeks, we will be providing information about each of the eight systemwide behaviors on which every UPMC employee is evaluated. In the meantime, here are some tips about how to make the evaluation process a rewarding experience for both staff members and managers. 1. Rely on honest and open feedback While feedback is encouraged throughout the year, the annual performance evaluation provides an opportunity to more formally provide direct, open, and honest feedback to both the staff member and manager. Feedback should flow in both directions, with a goal of continuous improvement. The process begins with setting performance expectations for the coming year, and setting goals, if applicable, at the beginning of the year or performance cycle. In addition to providing feedback about individual performance, the manager will be looking to determine how performance contributed to the team’s or department’s overall goals, and how each individual’s performance played a role in contributing to success for this period. Part of the dialogue should focus on the staff member’s long-term career goals. One of the best ways that an employee can be rewarded for performance is to continue in his or her professional development through new challenges and growth opportunities. 2. Align individual goals with system goals As with feedback, setting goals and adjusting them as needs change is not a once-a-year process; however, once individual goals have been properly aligned with overall business unit goals, the performance evaluation does provide an excellent opportunity for each manager to take the goals for his or her department and then discuss them at a very personal and individual level. When the manager develops and communicates clear and measurable goals, the staff member will understand what is expected in the year ahead. In this way, the goals, which cascade through and across the organization, can be shared with each staff member in a very understandable way. Every area, from administration and support services to our clinical or insurance services, must embrace this philosophy to ensure UPMC’s continued success. We must look at our functions with an eye toward challenging the status quo, and always be willing to explore opportunities to enhance the services that we provide for our patients and customers. 4. Reward performance Some organizations talk about rewarding performance, while others actually do it. In addition to offering a very complete Total Compensation (pay and benefits) package to engage and retain the right people, UPMC believes it is important to recognize the differences in levels of performance across the organization and link pay directly to performance. By rewarding excellence both financially and through growth opportunities, UPMC will continue to challenge and motivate our top performers, while sending a message to poor performers to improve. Next week, we will explore the first systemwide behavior — Accountability. 3. Drive change through continuous improvement We need to be challenging ourselves constantly to improve quality, to improve the customer experience, and to reduce overall costs. These high-level goals must be reflected in each discussion that takes place regarding performance. 7 March 5, 2010 | http://extra.upmc.com EVENTS PERKS RESEARCH STUDIES Seventh Annual Athletic Trainer River Run Sunday, March 7, registration beginning at 8 a.m. UPMC Sports Complex, 3200 S. Water St., Pittsburgh The proceeds from this event support the scholarship fund of the Southwestern Region of the Pennsylvania Athletic Trainers’ Society. Online registration available at www.signmeup.com/ ATRiverRun. For more information, call UPMC Sports Medicine at 412-432-3770. Rock Bottom Restaurant and Brewery What: 20 percent discount on food between Thursday, March 11, and Sunday, April 4. As a tribute to firefighters across the nation and to help raise money for the UPMC Mercy Trauma and Burn Centers, Pittsburgh’s Rock Bottom Restaurant and Brewery is holding a four-week fundraising promotion. Where: 171 E. Bridge St., Pittsburgh, PA 15120. For more information, call 412-462-2739. Company website is www.rockbottom.com/pittsburgh. How: Show UPMC ID at time of purchase. Researchers at the University of Pittsburgh are recruiting men and women with depression who are between 18 and 65 years old to participate in a research study to explore treatments for people with both depression and anxiety. If you qualify for this study, you will receive the FDA-approved antidepressant medication Clexa (citalopram) for 20 weeks. You also will receive talk therapy. Total study participation may be up to eight months. You will receive compensation for study assessments, and all medication, psychotherapy, and assessments are at no cost. For more information, contact the Depression and Manic Depression Prevention Program at 412-246-5566. Disney on Ice presents Disney/ PIXAR's Finding Nemo What: Save up to $4 per ticket for Disney On Ice presents Disney/PIXAR's Finding Nemo at Mellon Arena, Wednesday, March 10, through Sunday, March 14. Where: Mellon Arena, 66 Mario Lemieux Place, Pittsburgh, PA 15219. For a list of show times and ticket prices, visit the Perks Infonet site (http://extra.upmc.com/ perks.htm). For more information, call 412-642-1977 or e-mail groupsales@mellonarena.com. How: Contact Mellon Arena Group Sales at 412-642-1977. Order deadline is Monday, March 8. Does your child have attention deficit hyperactivity disorder (ADHD) and frequently hits or physically hurts others? If so, your child may be eligible to participate in a research study of 6- to 12-year-old children at the University of Pittsburgh. Participants will receive an evaluation and be screened for a research study of an investigational medication for use in aggression. Participants will be compensated. For more information, call 412-246-5661 or visit www.youthandfamilyresearch.com. UPMC Children’s Ball Saturday, March 20, 6 to 9 p.m. Carnegie Science Center, Pittsburgh Rescheduled from February due to the snowstorm. The UPMC Children’s Ball benefits the UPMC Health for Life Summer Camp in Braddock. For more information, contact Gina O’Malley at 412-647-4285. All Sports Expo and Conference Saturday and Sunday, March 20 and 21, 9:30 a.m. to 5 p.m. Heinz Field, Pittsburgh Sponsored by UPMC Sports Medicine, the event is designed for student athletes and those integral to their success — coaches, parents, athletic trainers, and other sports medicine professionals. For more information about the topics or to register for the event, visit www.allsportsexpoandconference.com. Technology for Life and Living Conference 2010 Friday, March 26, 8 a.m. to 4:30 p.m. Omni William Penn Hotel, 530 William Penn Place, Pittsburgh Co-sponsored by UPMC, the University of Pittsburgh Institute on Aging (UPIA), and the Quality of Life Technology Center. Continuing education credits are available for all professionals, including physicians, nurses, social workers, and nursing home administrators. For more information, or to register, visit https://ccehs.upmc.edu/formalCourses.jsp#2380. www.upmc.com Extra is published monthly for staff of UPMC by UPMC Internal Communications, U.S. Steel Tower, PFCC VisionQuest: How-To Guide for Providing Exceptional Care Experiences Friday, April 16, 8 a.m. to 2:30 p.m. (registration begins at 7:15 a.m.) Herberman Conference Center, UPMC Shadyside Cost for UPMC employees, physicians, and affiliated health care providers is $25 if registered on or before Friday, March 26; $50 if registered after March 26. For more information, or to register, visit www.patientandfamilycenteredcare.org. Floor 57, 600 Grant Street, Pittsburgh PA 15219. E-mail story suggestions or comments to extra@upmc.edu. If you have smoked more than one pack of cigarettes per day for at least 10 years and have shortness of breath or a diagnosis of COPD or emphysema, you may qualify for a study at the Emphysema COPD Research Center. Participants will be compensated upon study completion. For more information, call 412-692-4800 or 1-866-948-COPD (2673). Volume 21, No. 3 — March 5, 2010 PUBLISHER: Janet Tripodi EDITOR: Amy Ashbridge DESIGNER: Anthony Latagliata PRODUCTION DIRECTOR: Tana Kutchell CONTRIBUTING WRITERS: Shannon Adam Amy Ashbridge Nikki Coffee Alan Gintzler Martin Kinnunen Stacy Parker Marilyn Pfaff Tammy Sadler Rachel Smith Janet Tripodi UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability, or veteran status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations. © Copyright 2010 UPMC