45 CFR 1355.54 - Submittal of advance planning documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 4 2011-10-01 2011-10-01 false Submittal of advance planning documents. 1355.54 Section 1355.54 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL...

45 CFR 1355.54 - Submittal of advance planning documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 4 2012-10-01 2012-10-01 false Submittal of advance planning documents. 1355.54 Section 1355.54 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... FAMILIES, FOSTER CARE MAINTENANCE PAYMENTS, ADOPTION ASSISTANCE, AND CHILD AND FAMILY SERVICES GENERAL...

42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology implementation... CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.338 Health information technology implementation advance planning document...

Advance Care Planning Documentation in Electronic Health Records: Current Challenges and Recommendations for Change.

PubMed

Lamas, Daniela; Panariello, Natalie; Henrich, Natalie; Hammes, Bernard; Hanson, Laura C; Meier, Diane E; Guinn, Nancy; Corrigan, Janet; Hubber, Sean; Luetke-Stahlman, Hannah; Block, Susan

2018-04-01

To develop a set of clinically relevant recommendations to improve the state of advance care planning (ACP) documentation in the electronic health record (EHR). Advance care planning (ACP) is a key process that supports goal-concordant care. For preferences to be honored, clinicians must be able to reliably record, find, and use ACP documentation. However, there are no standards to guide ACP documentation in the electronic health record (EHR). We interviewed 21 key informants to understand the strengths and weaknesses of EHR documentation systems for ACP and identify best practices. We analyzed these interviews using a qualitative content analysis approach and subsequently developed a preliminary set of recommendations. These recommendations were vetted and refined in a second round of input from a national panel of content experts. Informants identified six themes regarding current inadequacies in documentation and accessibility of ACP information and opportunities for improvement. We offer a set of concise, clinically relevant recommendations, informed by expert opinion, to improve the state of ACP documentation in the EHR.

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... computerized support enforcement systems. 307.15 Section 307.15 Public Welfare Regulations Relating to Public... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS § 307.15 Approval of advance planning documents for computerized support enforcement systems. (a...

Is an advance care planning model feasible in community palliative care? A multi-site action research approach.

PubMed

Blackford, Jeanine; Street, Annette

2012-09-01

This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. © 2011 Blackwell Publishing Ltd.

Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities.

PubMed

Street, Maryann; Ottmann, Goetz; Johnstone, Megan-Jane; Considine, Julie; Livingston, Patricia M

2015-09-01

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan. © 2014 John Wiley & Sons Ltd.

Effect of the PREPARE Website vs an Easy-to-Read Advance Directive on Advance Care Planning Documentation and Engagement Among Veterans: A Randomized Clinical Trial.

PubMed

Sudore, Rebecca L; Boscardin, John; Feuz, Mariko A; McMahan, Ryan D; Katen, Mary T; Barnes, Deborah E

2017-08-01

Documentation rates of patients' medical wishes are often low. It is unknown whether easy-to-use, patient-facing advance care planning (ACP) interventions can overcome barriers to planning in busy primary care settings. To compare the efficacy of an interactive, patient-centered ACP website (PREPARE) with an easy-to-read advance directive (AD) to increase planning documentation. This was a comparative effectiveness randomized clinical trial from April 2013 to July 2016 conducted at multiple primary care clinics at the San Francisco VA Medical Center. Inclusion criteria were age of a least 60 years; at least 2 chronic and/or serious conditions; and 2 or more primary care visits; and 2 or more additional clinic, hospital, or emergency room visits in the last year. Participants were randomized to review PREPARE plus an easy-to-read AD or the AD alone. There were no clinician and/or system-level interventions or education. Research staff were blinded for all follow-up measurements. The primary outcome was new ACP documentation (ie, legal forms and/or discussions) at 9 months. Secondary outcomes included patient-reported ACP engagement at 1 week, 3 months, and 6 months using validated surveys of behavior change process measures (ie, 5-point knowledge, self-efficacy, readiness scales) and action measures (eg, surrogate designation, using a 0-25 scale). We used intention-to-treat, mixed-effects logistic and linear regression, controlling for time, health literacy, race/ethnicity, baseline ACP, and clustering by physician. The mean (SD) age of 414 participants was 71 (8) years, 38 (9%) were women, 83 (20%) had limited literacy, and 179 (43%) were nonwhite. No participant characteristic differed significantly among study arms at baseline. Retention at 6 months was 90%. Advance care planning documentation 6 months after enrollment was higher in the PREPARE arm vs the AD-alone arm (adjusted 35% vs 25%; odds ratio, 1.61 [95% CI, 1.03-2.51]; P = .04). PREPARE also resulted in higher self-reported ACP engagement at each follow-up, including higher process and action scores; P <.001 at each follow-up). Easy-to-use, patient-facing ACP tools, without clinician- and/or system-level interventions, can increase planning documentation 25% to 35%. Combining the PREPARE website with an easy-to-read AD resulted in higher planning documentation than the AD alone, suggesting that PREPARE may increase planning documentation with minimal health care system resources. clinicaltrials.gov Identifier: NCT01550731.

Advance care planning in a community setting.

PubMed

Connolly, Josaleen; Milligan, Stuart; Stevens, Elaine; Jackson, Susan; Rooney, Kevin

2015-02-10

To evaluate the effects of implementing an advance care planning process within pilot sites in North Ayrshire in 2010, focusing on people with palliative care needs. Data were collected from participants in advance care planning training using a questionnaire. Semi-structured interviews were conducted and an audit of documentation was undertaken. Thirty nine questionnaires were returned, a response rate of 16%. Twenty four out of 25 (96%) participants rated the training as having improved their understanding of the advance care planning process. The general consensus in interviews was that advance care planning is a worthwhile process. Participants reported patients achieving their preferred place of end of life care and greater consultation regarding hospitalisation. Within the pilot sites, advance care planning training enhanced the ability of professionals to implement the advance care planning process and record the wishes of patients and residents.

Using highways during evacuation operations for events with advance notice

DOT National Transportation Integrated Search

2006-12-01

This document constitutes the first of a primer series titled 'Routes to Effective Evacuation planning' and covers the use of the highway system during evacuation operations when advance planning is possible [...] This is a basic-level guide on condu...

Implementation Plan for Qualification of Sodium-Cooled Fast Reactor Technology Information

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moe, Wayne; Honma, George

This document identifies and discusses implementation elements that can be used to facilitate consistent and systematic evaluation processes relating to quality attributes of technical information (with focus on SFR technology) that will be used to support licensing of advanced reactor designs. Information may include, but is not limited to, design documents for SFRs, research-and-development (R&D) data and associated documents, test plans and associated protocols, operations and test data, international research data, technical reports, and information associated with past U.S. Nuclear Regulatory Commission (NRC) reviews of SFR designs. The approach for determining acceptability of test data, analysis, and/or other technical informationmore » is based on guidance provided in INL/EXT-15-35805, “Guidance on Evaluating Historic Technology Information for Use in Advanced Reactor Licensing.” The implementation plan can be adopted into a working procedure at each of the national laboratories performing data qualification, or by applicants seeking future license application for advanced reactor technology.« less

Embracing a broad spirituality in end of life discussions and advance care planning.

PubMed

Churchill, Larry R

2015-04-01

Advance care planning for end of life typically focuses on the mechanics of completing living wills and durable power of attorney documents. Even when spiritual aspects of end of life care are discussed, the dominant assumptions are those of traditional religious systems. A broad view of spirituality is needed, one that may involve traditional religious beliefs but also includes personal understandings of what is holy or sacred. Embracing this broad practice of spirituality will help both familial and professional caregivers honor an essential aspect of end of life discussions and promote greater discernment of the deep meaning in advance care documents.

Joint Department of Defense, Advance Planning Briefing to Industry, Held at Kissimmee, Florida, on 30 April - 2 May 1996

DTIC Science & Technology

1996-05-01

Systems 17 Motion Bases Upgraded Aero Misc > Contact Info • AMC, Lt Col Letica , Phone (618) 256-5696 L8 Upgrade Flow Plan Advance Planning Briefing...Projected Schedule: FY 05 > Requirement Document: AMMP >• Projected Program Size: ? < $40M > Funding Status/Stability: > POCs: • AMC, Lt Col Letica

How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.

PubMed

Biondo, Patricia D; Lee, Lydia D; Davison, Sara N; Simon, Jessica E

2016-09-01

Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown. To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP. Systematic review. Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality. A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework. Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context. © The Author(s) 2016.

Room for improvement: An examination of advance care planning documentation among gynecologic oncology patients.

PubMed

Brown, Alaina J; Shen, Megan Johnson; Urbauer, Diana; Taylor, Jolyn; Parker, Patricia A; Carmack, Cindy; Prescott, Lauren; Kolawole, Elizabeth; Rosemore, Carly; Sun, Charlotte; Ramondetta, Lois; Bodurka, Diane C

2016-09-01

The goals of this study were: (1) to evaluate patients' knowledge regarding advance directives and completion rates of advance directives among gynecologic oncology patients and (2) to examine the association between death anxiety, disease symptom burden, and patient initiation of advance directives. 110 gynecologic cancer patients were surveyed regarding their knowledge and completion of advance directives. Patients also completed the MD Anderson Symptom Inventory (MDASI) scale and Templer's Death Anxiety Scale (DAS). Descriptive statistics were utilized to examine characteristics of the sample. Fisher's exact tests and 2-sample t-tests were utilized to examine associations between key variables. Most patients were white (76.4%) and had ovarian (46.4%) or uterine cancer (34.6%). Nearly half (47.0%) had recurrent disease. The majority of patients had heard about advance directives (75%). Only 49% had completed a living will or medical power of attorney. Older patients and those with a higher level of education were more likely to have completed an advance directive (p<0.01). Higher MDASI Interference Score (higher symptom burden) was associated with patients being less likely to have a living will or medical power of attorney (p=0.003). Higher DAS score (increased death anxiety) was associated with patients being less likely to have completed a living will or medical power of attorney (p=0.03). Most patients were familiar with advance directives, but less than half had created these documents. Young age, lower level of education, disease-related interference with daily activities, and a higher level of death anxiety were associated with decreased rates of advance directive completion, indicating these may be barriers to advance care planning documentation. Young patients, less educated patients, patients with increased disease symptom burden, and patients with increased death anxiety should be targeted for advance care planning discussions as they may be less likely to engage in advance care planning. Copyright © 2016. Published by Elsevier Inc.

Room for Improvement: An Examination of Advance Care Planning Documentation among Gynecologic Oncology Patients

PubMed Central

Brown, Alaina J.; Shen, Megan Johnson; Urbauer, Diana; Taylor, Jolyn; Parker, Patricia A.; Carmack, Cindy; Prescott, Lauren; Kowaloe, Elizabeth; Rosemore, Carly; Sun, Charlotte; Ramondetta, Lois; Bodurka, Diane C.

2017-01-01

Objectives The goals of this study were: (1) to evaluate patients’ knowledge regarding advance directives and completion rates of advance directives among gynecologic oncology patients and (2) to examine the association between death anxiety, disease symptom burden, and patient initiation of advance directives. Methods 110 gynecologic cancer patients were surveyed regarding their knowledge and completion of advance directives. Patients also completed the MD Anderson Symptom Inventory (MDASI) scale and Templer’s Death Anxiety Scale (DAS). Descriptive statistics were utilized to examine characteristics of the sample. Fisher’s exact tests and 2-sample t-tests were utilized to examine associations between key variables. Results Most patients were white (76.4%) and had ovarian (46.4%) or uterine cancer (34.6%). Nearly half (47.0%) had recurrent disease. The majority of patients had heard about advance directives (75%). Only 49% had completed a living will or medical power of attorney. Older patients and those with a higher level of education were more likely to have completed an advance directive (p<0.01). Higher MDASI Interference Score (higher symptom burden) was associated with patients being less likely to have a living will or medical power of attorney (p=0.003). Higher DAS score (increased death anxiety) was associated with patients being less likely to have completed a living will or medical power of attorney (p=0.03). Conclusion Most patients were familiar with advance directives, but less than half had created these documents. Young age, lower level of education, disease-related interference with daily activities, and a higher level of death anxiety were associated with decreased rates of advance directive completion, indicating these may be barriers to advance care planning documentation. Young patients, less educated patients, patients with increased disease symptom burden, and patients with increased death anxiety should be targeted for advance care planning discussions as they may be less likely to engage in advance care planning. PMID:27439968

Concordance of Advance Care Plans With Inpatient Directives in the Electronic Medical Record for Older Patients Admitted From the Emergency Department.

PubMed

Grudzen, Corita R; Buonocore, Philip; Steinberg, Jonathan; Ortiz, Joanna M; Richardson, Lynne D

2016-04-01

Measuring What Matters identified quality indicators to examine the percentage of patients with documentation of a surrogate decision maker and preferences for life-sustaining treatments. To determine the rate of advance care planning in older adults presenting to the emergency department (ED) and translation into medical directives in the electronic medical record (EMR). A convenience sample of adults 65 years or older was recruited from a large urban ED beginning in January 2012. We administered a baseline interview and survey in English or Spanish, including questions about whether patients had a documented health care proxy or living will. For patients admitted to the hospital who had a health care proxy or living will, chart abstraction was performed to determine whether their advance care preferences were documented in the EMR. From February 2012 to May 2013, 53.8% (367 of 682) of older adults who completed the survey in the ED reported having a health care proxy, and 40.2% (274 of 682) had a living will. Of those admitted to the hospital, only 4% (4 of 94) of patients who said they had a living will had medical directives documented in the EMR. Similarly, only 4% (5 of 115) of patients who had a health care proxy had the person's name or contact information documented in their medical record. About half of the patients 65 years or older arriving in the ED have done significant advance care planning, but most plans are not recorded in the EMR. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Mississippi Curriculum Framework for Metal Trades (Program CIP: 48.0590--Metal Trades). Secondary Programs.

ERIC Educational Resources Information Center

Mississippi Research and Curriculum Unit for Vocational and Technical Education, State College.

This document, which reflects Mississippi's statutory requirement that instructional programs be based on core curricula and performance-based assessment, contains outlines of the instructional units required in local instructional management plans and daily lesson plans for metal trades I, IIA (advanced welding), and IIB (advanced machine shop).…

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise

2006-09-01

The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

Social workers' involvement in advance care planning: a systematic narrative review.

PubMed

Wang, Chong-Wen; Chan, Cecilia L W; Chow, Amy Y M

2017-07-10

Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers' attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers' perspectives and experiences regarding implementation of advance care planning. Six databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically. Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers' attitudes toward advance care planning; social workers' knowledge, education and training regarding advance care planning; social workers' involvement in advance care planning; social workers' perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities. This study provides useful knowledge for implementing advance care planning through illustrating social workers' perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers' involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts.

Advance care planning in Australia: what does the law say?

PubMed

Carter, Rachel Z; Detering, Karen M; Silvester, William; Sutton, Elizabeth

2016-09-01

Advance care planning (ACP) assists people to plan for their future health and personal care. ACP encourages a person to legally appoint a substitute decision maker (SDM) and to document any specific wishes regarding their future health care in an advance care directive (ACD). Formal documentation of wishes increases the chances that a person's wishes will be known and followed. However, one of the biggest impediments for doctors following the person's wishes is uncertainty surrounding the law, which is complicated and varies between the states and territories of Australia. SDM legislation varies regarding who can be appointed, how they are appointed, the powers that an SDM can be given and the decision-making principles that the SDM needs to follow. In circumstances where an SDM has not been appointed, the hierarchy for determining the default SDM for a person also varies between states. Although many states have legislated ACD forms allowing for documentation of a person's health care wishes, these forms allow for different things to be documented and have different requirements to be valid. The Australian population is mobile, with patients frequently moving between states. The status of ACP documentation created in a state other than the state in which a patient requires treatment also varies, with some states recognising interstate ACDs whereas others do not. This article outlines the legal status of ACDs, within Australian jurisdictions, including the legal validity of interstate ACDs, and argues that uniform laws and documents would assist with awareness and understanding of, and compliance with, ACDs.

Planning for Advanced Cancer

Cancer.gov

Find out what issues need to be addressed when dealing with an advanced or metastatic cancer diagnosis. Completing advance directives, looking at health insurance, organizing records and documents, and looking at the meanings in your life are some of the things to think about.

Readiness to participate in advance care planning: A qualitative study of renal failure patients, families and healthcare providers.

PubMed

Hutchison, Lauren A; Raffin-Bouchal, Donna S; Syme, Charlotte A; Biondo, Patricia D; Simon, Jessica E

2017-09-01

Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.

Advance care planning: Beyond the living will.

PubMed

Messinger-Rapport, Barbara J; Baum, Elizabeth E; Smith, Martin L

2009-05-01

For a variety of reasons, the most commonly used advance directive documents (eg, the living will) may not be very useful in many situations that older adults encounter. The durable power of attorney for health care is a more versatile document. We advocate focusing less on "signing away" certain interventions and more on clarifying the goals of care in the ambulatory setting.

Building successful coalitions for promoting advance care planning.

PubMed

Marchand, Lucille; Fowler, Kathryn J; Kokanovic, Obrad

2006-01-01

Advance care planning (ACP) has had few successful initiatives. This qualitative study explores the challenges and successes of an advance care planning coalition in Wisconsin called Life Planning 2000 using key informant interviews (n = 24) and grounded theory. Major themes included: commitment (the need for leadership, recruitment of key members, and funding); cohesiveness (disparate groups collaborating toward a common purpose), and outcomes (shift in paradigm from signing documents to process of advanced care planning, new-found collaborative relationships, and educational tool development). Coalitions need to define short-, intermediate-, and long-term goals that result in measurable outcomes and an evaluation process. Resources must be commensurate with goals. Strong leadership, paid staff adequate funding, and the collaboration of diverse groups working toward common goals are the basic requirements of a successful coalition.

45 CFR 95.610 - Submission of advance planning documents.

Code of Federal Regulations, 2012 CFR

2012-10-01

... and implementation; (v) A commitment to conduct/prepare the problem(s) needs assessment, feasibility... statement of the problem/need that the existing capabilities can not resolve, new or changed program..., planning activities/deliverables, State and contractor resource needs, planning project procurement...

45 CFR 95.610 - Submission of advance planning documents.

Code of Federal Regulations, 2013 CFR

2013-10-01

... and implementation; (v) A commitment to conduct/prepare the problem(s) needs assessment, feasibility... statement of the problem/need that the existing capabilities can not resolve, new or changed program..., planning activities/deliverables, State and contractor resource needs, planning project procurement...

45 CFR 95.610 - Submission of advance planning documents.

Code of Federal Regulations, 2014 CFR

2014-10-01

... and implementation; (v) A commitment to conduct/prepare the problem(s) needs assessment, feasibility... statement of the problem/need that the existing capabilities can not resolve, new or changed program..., planning activities/deliverables, State and contractor resource needs, planning project procurement...

Advance care planning in CKD/ESRD: an evolving process.

PubMed

Holley, Jean L

2012-06-01

Advance care planning was historically considered to be simply the completion of a proxy (health care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that advance care planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical care, prepare for death, and clarify goals of care. Some advance directives, notably designated health care proxy documents, remain appropriate expressions of advance care planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as advance directives, their completion, when appropriate, is an integral component of advance care planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that advance care planning discussions adapt to a patient's situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to advance care planning in this population and are events each nephrologist will at some time confront. Advance care planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.

Los Angeles congestion reduction demonstration (Metro ExpressLanes) program. National evaluation : traffic system data test plan.

DOT National Transportation Integrated Search

1997-01-01

This document reports on the formal evaluation of the targeted (limited but highly focused) deployment of the Advanced Driver and Vehicle Advisory Navigation ConcEpt (ADVANCE), an in-vehicle advanced traveler information system designed to provide sh...

Earth Observing System/Advanced Microwave SoundingUnit-A (EOS/AMSU-A): Acquisition activities plan

NASA Technical Reports Server (NTRS)

Schwantje, Robert

1994-01-01

This is the acquisition activities plan for the software to be used in the Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) system. This document is submitted in response to Contract NAS5-323 14 as CDRL 508. The procurement activities required to acquire software for the EOS/AMSU-A program are defined.

Origination of medical advance directives among nursing home residents with and without serious mental illness.

PubMed

Cai, Xueya; Cram, Peter; Li, Yue

2011-01-01

Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with (N=1,769) and without (N=11,738) serious mental illness. Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; do-not-resuscitate and do-not-hospitalize orders; and orders concerning restriction of feeding tube, medication, or other treatments. The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66-.87, p<.001). Similar results were found for individual documented plans. Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding.

TSHIPS : Transportation shipping harmonization and integration planning system

DOT National Transportation Integrated Search

2001-03-01

This report documents the development of the Transportation Shipping Harmonization and Integration Planning System (TSHIPS). The TSHIPS project was developed to advance the state of the art in transportation systems analysis. Existing approaches and ...

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert

2005-01-01

The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management andmore » software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.« less

South Florida freight advanced traveler information system.

DOT National Transportation Integrated Search

2013-10-01

This Demonstration Plan has been prepared to provide guidance and a common definition to all parties of the testing program that will be conducted for the South Florida FRATIS Demonstration Project. More specifically, this document provides: Plan...

Earth Observing System/Meteorological Satellite (EOS/METSAT). Advanced Microwave Sounding Unit-A (AMSU-A) Contamination Control Plan

NASA Technical Reports Server (NTRS)

Fay, M.

1998-01-01

This Contamination Control Plan is submitted in response the Contract Document requirements List (CDRL) 007 under contract NAS5-32314 for the Earth Observing System (EOS) Advanced Microwave Sounding Unit A (AMSU-A). In response to the CDRL instructions, this document defines the level of cleanliness and methods/procedures to be followed to achieve adequate cleanliness/contamination control, and defines the required approach to maintain cleanliness/contamination control through shipping, observatory integration, test, and flight. This plan is also applicable to the Meteorological Satellite (METSAT) except where requirements are identified as EOS-specific. This plan is based on two key factors: a. The EOS/METSAT AMSU-A Instruments are not highly contamination sensitive. b. Potential contamination of other EOS Instruments is a key concern as addressed in Section 9/0 of the Performance Assurance Requirements for EOS/METSAT Integrated Programs AMSU-A Instrument (MR) (NASA Specification S-480-79).

76 FR 63660 - Sunshine Act Meetings; Notice

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-13

... Daylight Time. ** The meeting of the Institutional Advancement Committee will run concurrently with the...** 2:15 p.m. 3. Institutional Advancement Committee** 3:00 p.m. 4. Audit Committee** 3:30 p.m. Tuesday... benefits plan document, to consider and act on the report of the Institutional Advancement Committee...

Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A): Instrumentation interface control document

NASA Technical Reports Server (NTRS)

1994-01-01

This Interface Control Document (ICD) defines the specific details of the complete accomodation information between the Earth Observing System (EOS) PM Spacecraft and the Advanced Microwave Sounding Unit (AMSU-A)Instrument. This is the first submittal of the ICN: it will be updated periodically throughout the life of the program. The next update is planned prior to Critical Design Review (CDR).

Grid Integration Studies: Advancing Clean Energy Planning and Deployment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Katz, Jessica; Chernyakhovskiy, Ilya

2016-07-01

Integrating significant variable renewable energy (VRE) into the grid requires an evolution in power system planning and operation. To plan for this evolution, power system stakeholders can undertake grid integration studies. This Greening the Grid document reviews grid integration studies, common elements, questions, and guidance for system planners.

Rural applications of advanced traveler information systems : recommended actions

DOT National Transportation Integrated Search

1997-07-01

The Recommended Action Plan is one in a series of interim documents for the Rural Applications of Advanced Traveler Information Systems (ATIS) project. Based on the investigation of user needs, a technology review, and concept development and assessm...

Connected Vehicle Pilot Deployment Program Phase 1, Outreach Plan – Tampa (THEA).

DOT National Transportation Integrated Search

2016-07-06

This document presents the Outreach Plan for the Tampa Hillsborough Expressway Authority (THEA) Connected Vehicle (CV) Pilot Deployment. The goal of the pilot deployment is to advance and enable safe, interoperable, networked wireless communications ...

Origination of Medical Advance Directives Among Nursing Home Residents With and Without Serious Mental Illness

PubMed Central

Cai, Xueya; Cram, Peter; Li, Yue

2013-01-01

Objective Nursing home residents with serious mental illness need a high level of general medical and end-of-life services. This study tested whether persons with serious mental illness are as likely as other nursing home residents to make informed choices about treatments through medical advance care plans. Methods Secondary analyses were conducted with data from a 2004 national survey of nursing home residents with serious mental illness (N=1,769) and without (N=11,738). Bivariate and multivariate analyses determined differences in documented advance care plans, including living wills; “do not resuscitate” and “do not hospitalize” orders; and orders concerning restriction of feeding tube, medication, or other treatments. Results The overall rates of having any of the four advance care plans were 57% and 68% for residents with and without serious mental illness, respectively (p<.001). Residents with serious mental illness also showed lower rates for individual advance care plans. In a multivariate analysis that adjusted for resident and facility characteristics (N=1,174 nursing homes) as well as survey procedures, serious mental illness was associated with a 24% reduced odds of having any advance directives (adjusted odds ratio=.76, 95% confidence interval=.66–.87, p<.001). Similar results were found for individual documented plans. Conclusions Among U.S. nursing home residents, those with serious mental illness were less likely than others to have written medical advance directives. Future research is needed to help understand both resident factors (such as inappropriate behaviors, impaired communication skills, and disrupted family support) and provider factors (including training, experience, and attitude) that underlie this finding. PMID:21209301

Engagement in Multiple Steps of the Advance Care Planning Process: A Descriptive Study Among Diverse Older Adults

PubMed Central

Sudore, Rebecca L.; Schickedanz, Adam D.; Landefeld, C. Seth; Williams, Brie A.; Lindquist, Karla; Pantilat, Steven Z.; Schillinger, Dean

2017-01-01

Objectives Advance care planning (ACP) research and policy has focused on documentation, ignoring other ACP steps. We propose an ACP model based on the behavior change framework. We assess engagement in multiple steps of ACP six months after exposure to an advance directive. Design Descriptive study Setting County General Medicine clinic in San Francisco Participants 147 English/Spanish-speakers, aged ≥50 years (mean 61) given a standard (12th-grade reading level) and easy-to-read (5th grade) advance directive. Measurements Six months after exposure to advance directives, we measured self-reported ACP contemplation; discussions with family/friends and clinicians; and documentation. We examined associations between ACP steps and explored subject characteristics associated with ACP. Results Most participants (73%) were non-white and 31% had < high school education. Sixty one percent contemplated ACP, 56% discussed ACP with family/friends, 22% discussed with clinicians, and 13% documented ACP wishes. Compared to subjects who had not discussed ACP with family/friends, those who had were more likely to discuss ACP with their clinicians (36% vs. 2%, P<.001) and document ACP wishes (18% vs. 4%, P=.009). Latinos and subjects with < high school education more often discussed ACP with family/friends (P<.06) and clinicians (P<.03) than other ethnic groups and subjects with more education. Conclusion ACP involves distinct steps including contemplation, discussions, and documentation. The ACP paradigm should be broadened to include contemplation and discussions. Promoting discussions among family/friends may be one of the most important targets for ACP interventions, and literacy/language appropriate advance directives may help reverse patterns of socio-demographic disparities in ACP. PMID:18410324

Space Station Program Description Document. Books 1-7

NASA Technical Reports Server (NTRS)

1984-01-01

The Space Station Program Description Document is summarized. The six volumes include: (1) introduction and summary; (2) mission description; (3) systems requirements and characteristics; (4) advanced development; (6) system operations; and (7) program plan. Volume 5 was deleted as a separate book.

'Nurses don't deal with these issues': nurses' role in advance care planning for lesbian, gay, bisexual and transgender patients.

PubMed

Carabez, Rebecca; Scott, Megan

2016-12-01

We used a question from the Healthcare Equality Index to explore nurses' knowledge and understanding of medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients. Until the landmark ruling in Obergefell vs. Hodges, lesbian, gay, bisexual and transgender individuals and same-sex couples have had limited relationship rights as only a few states recognised marriages and provided legal protections for same-sex couples. Health care providers' knowledge of and attitudes towards advance care planning plays a significant role in determining whether or not individuals successfully complete advance directives, yet advance care planning for lesbian, gay, bisexual and transgender individuals is poorly understood among both health care providers and same-sex couples. These data were part of a larger research study that explored the current state of lesbian, gay, bisexual and transgender-sensitive nursing practice. Undergraduate nursing students recruited and interviewed nurse key informants (n = 268) about medical advance directives, medical power of attorney and other legal documents for lesbian, gay, bisexual and transgender patients. Nearly 50% of key informants indicated a lack of knowledge of advance directives, over 26% reported the difficulties nurses face regarding advance directives are the same for both lesbian, gay, bisexual and transgender and heterosexual patients, and nearly 25% indicated difficulties including having to decide who has the legal right to make decisions for the patient. The study demonstrated the need for education and training for practising nurses in advance care planning for lesbian, gay, bisexual and transgender patients and same-sex couples. Nurses are in a position to act as educators, advocates and decision makers for their patients. Nurse's lack of understanding of advance care planning may negatively impact the type and quality of care lesbian, gay, bisexual and transgender patients receive. © 2016 John Wiley & Sons Ltd.

NASA sea ice and snow validation plan for the Defense Meteorological Satellite Program special sensor microwave/imager

NASA Technical Reports Server (NTRS)

Cavalieri, Donald J. (Editor); Swift, Calvin T. (Editor)

1987-01-01

This document addresses the task of developing and executing a plan for validating the algorithm used for initial processing of sea ice data from the Special Sensor Microwave/Imager (SSMI). The document outlines a plan for monitoring the performance of the SSMI, for validating the derived sea ice parameters, and for providing quality data products before distribution to the research community. Because of recent advances in the application of passive microwave remote sensing to snow cover on land, the validation of snow algorithms is also addressed.

Connected vehicle pilot deployment program phase 1, safety management plan – Tampa (THEA).

DOT National Transportation Integrated Search

2016-04-01

This document presents the Safety Management Plan for the THEA Connected Vehicle (CV) Pilot Deployment. The THEA CV Pilot Deployment goal is to advance and enable safe, interoperable, networked wireless communications among vehicles, the infrastructu...

Freight Advanced Traveler Information System (FRATIS) : Dallas-Fort Worth demonstration plan.

DOT National Transportation Integrated Search

2013-06-01

This document describes the Demonstration Plan for the FRATIS system. The demonstration component of this task will serve to test the technical feasibility of the FRATIS prototype while also facilitating the collection of baseline and performance dat...

U.S. DOT roadway transportation data business plan (phase 1) : data business plan.

DOT National Transportation Integrated Search

1999-12-01

This report documents the results of an evaluation of satellite communication systems for mayday applications conducted as part of the Rural Applications of Advanced Traveler Information Systems (ATIS) study. It focuses on satellite communications sy...

Integrated Advanced Microwave Sounding Unit-A (AMSU-A). Test Report, Electromagnetic Interference (EMI)/Electromagnetic Radiation(EMR) and Electromagnetic Capability (EMC) for the EOS/AMSU-A1

NASA Technical Reports Server (NTRS)

Paliwoda, L.

1998-01-01

This document contains the procedure and the test results of the Advanced Microwave Sounding Unit-A (AMSU-A) Earth Observing System (EOS) Project, assembly part number 1356008-1, serial number 202, Electromagnetic Interference (EMI) and Electromagnetic Susceptibility (EMC) qualification test. The test was conducted in accordance with the approved EMI/EMC Test Plan/Procedure, Specification number AE-26151/8B, dated 10 September 1998. Aerojet intends that the presentation and submittal of this document, prepared in accordance with the objectives established by the aforementioned Test Plan/Procedure, document number AE-26151/8B, will satisfy the data requirement with respect to the AMSU-A/EOS instrument operational compliance of the EMI/EMC test requirement. Test for the AMSU-A/EOS instrument have been completed and all the requirements per General Interface Requirement Document (GIRD), GSFC 422-11-12-01, for EOS Common Spacecraft/Instruments, paragraph 10.11, were met with the exceptions of the test methods CE03, RE01, and RE02, as described in this document.

Transportation Network Data Requirements for Assessing Criticality for Resiliency and Adaptation Planning

DOT National Transportation Integrated Search

2017-11-01

This report is one of two NCST Research Report documents produced as part of a project to advance the technical modeling tools for resiliency and adaptation planning, especially those used for criticality rankings. The official final technical report...

"I'm still here": Exploring what matters to people with intellectual disability during advance care planning.

PubMed

McKenzie, Nicola; Mirfin-Veitch, Brigit; Conder, Jennifer; Brandford, Sharon

2017-11-01

This study sought to identify, from the perspective of people with intellectual disabilities and life limiting conditions, the factors that strengthened and inhibited their Advance Care Planning. This in depth qualitative study explored the experiences of four people with intellectual disability and life limiting conditions, through interviews and documentation reviews. There was strong agreement across all participants about what positively influenced Advance Care Planning, namely; going at my pace; supporting me to make my own choices; adapting the process to suit me, and, most importantly; continuing to support and plan the life I'm still living. With the exception of being comfortable/skilled in end-of-life support, the skills required of facilitators were similar to those required for all forms of person-centred planning. The findings are encouraging and demonstrate that Advance Care Planning is a useful tool in ensuring that people with intellectual disability have control and choice over their lives, right to the end. © 2017 John Wiley & Sons Ltd.

Advanced Medical Technology and Network Systems Research.

DTIC Science & Technology

1999-09-01

for image-guided therapies . Advanced technologies included in this report are impedance imaging and a palpation training system. 14. SUBJECT...Summary 1 Virtual Clinic for Patients with Chronic Illness Project Planning Document • 2 Telemedicine for Hemodialysis 21 A...imaging systems and’ surgical procedures effort is accomplished in part by establishing the technology requirements for image-guided therapies . Advanced

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia

PubMed Central

Ruseckaite, Rasa; Detering, Karen M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-01-01

Introduction Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people’s self-reported use of ACP and views about the process. Methods and analysis Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person’s records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. Ethics and dissemination This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. Trial registration number ACTRN12617000743369 PMID:29101142

Advanced crew procedures development techniques: Procedures and performance program training plan

NASA Technical Reports Server (NTRS)

Arbet, J. D.; Benbow, R. L.

1975-01-01

A plan developed to support the training of PPP users in the operations associated with PPP usage is described. This document contains an overview of the contents of each training session and a detailed outline to be used as the guideline for each session.

42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

Code of Federal Regulations, 2013 CFR

2013-10-01

... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology implementation...

42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

Code of Federal Regulations, 2012 CFR

2012-10-01

... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology implementation...

42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

Code of Federal Regulations, 2014 CFR

2014-10-01

... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology implementation...

42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

Code of Federal Regulations, 2010 CFR

2010-10-01

... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology implementation...

42 CFR 495.364 - Review and assessment of administrative activities and expenses of Medicaid provider health...

Code of Federal Regulations, 2011 CFR

2011-10-01

... and expenses of Medicaid provider health information technology adoption and operation. 495.364... administrative activities and expenses of Medicaid provider health information technology adoption and operation... its approved HIT planning advance planning document and health information technology implementation...

NASA Education Implementation Plan 2015-2017

ERIC Educational Resources Information Center

National Aeronautics and Space Administration, 2015

2015-01-01

The NASA Education Implementation Plan (NEIP) provides an understanding of the role of NASA in advancing the nation's STEM education and workforce pipeline. The document outlines the roles and responsibilities that NASA Education has in approaching and achieving the agency's and administration's strategic goals in STEM Education. The specific…

75 FR 66319 - State Systems Advance Planning Document (APD) Process

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

...) equipment and services. The APD process was designed to mitigate financial risks, avoid incompatibilities... develop a General Systems Design (GSD). Implementation APD means a recorded plan of action to request Federal financial participation (FFP) in the costs of designing, developing and implementing the system...

Design Document. EKG Interpretation Program.

ERIC Educational Resources Information Center

Webb, Sandra M.

This teaching plan is designed to assist nursing instructors assigned to advanced medical surgical nursing courses in acquainting students with the basic skills needed to perform electrocardiographic (ECG or EKG) interpretations. The first part of the teaching plan contains a statement of purpose; audience recommendations; a flow chart detailing…

NASCOM system development plan: System description, capabilities, and plans, FY 94-2

NASA Technical Reports Server (NTRS)

1994-01-01

The Nascom System Development Plan (NSDP) for FY 94-2 contains 17 sections. It is a management document containing the approved plan for maintaining the Nascom Network System. Topics covered include an overview of Nascom systems and services, major ground communication support systems, low-speed data system, voice system, high-speed data system, Nascom support for NASA networks, Nascom planning for NASA missions, and network upgrade and advanced systems developments and plans.

Joint crisis plans and psychiatric advance directives in German psychiatric practice.

PubMed

Radenbach, Katrin; Falkai, Peter; Weber-Reich, Traudel; Simon, Alfred

2014-05-01

This study explores the attitude of German psychiatrists in leading positions towards joint crisis plans and psychiatric advance directives. This topic was examined by contacting 473 medical directors of German psychiatric hospitals and departments. They were asked to complete a questionnaire developed by us. That form contained questions about the incidence and acceptance of joint crisis plans and psychiatric advance directives and previous experiences with them. 108 medical directors of psychiatric hospitals and departments responded (response rate: 22.8%). Their answers demonstrate that in their hospitals these documents are rarely used. Among the respondents, joint crisis plans are more accepted than psychiatric advance directives. There is a certain uncertainty when dealing with these instruments. Our main conclusion is that German psychiatry needs an intensified discussion on the use of instruments for patients to constitute procedures for future critical psychiatric events. For this purpose it will be helpful to collect more empirical data. Furthermore, the proposal of joint crisis plans in psychiatric hospitals and departments should be discussed as well as the possibility of consulting an expert during the preparation of a psychiatric advance directive.

ESL for Hotel/Hospitality Industry. Level: Advanced Beginner/Intermediate.

ERIC Educational Resources Information Center

Western Suffolk County Board of Cooperative Educational Services, Northport, NY.

This document contains 16 lesson plans for an advanced beginning and intermediate course in work-related English for non-English- or limited-English-speaking entry-level employees in the hotel and hospitality industry. Course objectives are as follows: helping participants understand and use job-specific vocabulary; receive and understand…

33 CFR 157.12g - Plan approval requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... OIL IN BULK Design, Equipment, and Installation § 157.12g Plan approval requirements. Adequate documentation must be prepared well in advance of the intended installation of a monitoring system and must be... ballast handling manuals. Special considerations will be given to installations in oil tankers, which have...

Advanced planning for ISS payload ground processing

NASA Astrophysics Data System (ADS)

Page, Kimberly A.

2000-01-01

Ground processing at John F. Kennedy Space Center (KSC) is the concluding phase of the payload/flight hardware development process and is the final opportunity to ensure safe and successful recognition of mission objectives. Planning for the ground processing of on-orbit flight hardware elements and payloads for the International Space Station is a responsibility taken seriously at KSC. Realizing that entering into this operational environment can be an enormous undertaking for a payload customer, KSC continually works to improve this process by instituting new/improved services for payload developer/owner, applying state-of-the-art technologies to the advanced planning process, and incorporating lessons learned for payload ground processing planning to ensure complete customer satisfaction. This paper will present an overview of the KSC advanced planning activities for ISS hardware/payload ground processing. It will focus on when and how KSC begins to interact with the payload developer/owner, how that interaction changes (and grows) throughout the planning process, and how KSC ensures that advanced planning is successfully implemented at the launch site. It will also briefly consider the type of advance planning conducted by the launch site that is transparent to the payload user but essential to the successful processing of the payload (i.e. resource allocation, executing documentation, etc.) .

Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.

PubMed

Myers, Jeff; Cosby, Roxanne; Gzik, Danusia; Harle, Ingrid; Harrold, Deb; Incardona, Nadia; Walton, Tara

2018-01-01

Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.

Working with the Mental Capacity Act: findings from specialist palliative and neurological care settings.

PubMed

Wilson, Eleanor; Seymour, Jane E; Perkins, Paul

2010-06-01

Since October 2007 staff across health and social care services in England and Wales have been guided by the Mental Capacity Act (2005) in the provision of care for those who may lack capacity to make some decisions for themselves. This paper reports on the findings from a study with 26 staff members working in three palliative and three neurological care centres. Semistructured interviews were used to gain an understanding of their knowledge of the Mental Capacity Act, the issue of capacity itself and the documentation processes associated with the introduction of the Act and in line with advance care planning. Within this setting advance care planning is a key part of care provision and the mental capacity of service users is a regular issue. Findings show that staff generally had a good understanding of issues around capacity but felt unclear about some of the terminology related to the Mental Capacity Act, impacting on their confidence to discuss issues with service users and complete the documentation. Many felt the Act and its associated documentation had aided record-keeping in an area staff already delivered well in practice. Advance care planning in the context of the Mental Capacity Act is not as well embedded in practice as providers would like and consideration needs to be given to how and when staff should approach these issues with service users.

42 CFR 495.340 - As-needed HIT PAPD update and as-needed HIT IAPD update requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.340 As... document or the HIT implementation advance planning document. (d) A change in implementation concept or a change to the scope of the project. (e) A change to the approved cost allocation methodology. ...

42 CFR 495.340 - As-needed HIT PAPD update and as-needed HIT IAPD update requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.340 As... document or the HIT implementation advance planning document. (d) A change in implementation concept or a change to the scope of the project. (e) A change to the approved cost allocation methodology. ...

The quality of paper-based versus electronic nursing care plan in Australian aged care homes: A documentation audit study.

PubMed

Wang, Ning; Yu, Ping; Hailey, David

2015-08-01

The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P<0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P<0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes. The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs.

PubMed

Kok, Maaike; van der Werff, Gertruud F M; Geerling, Jenske I; Ruivenkamp, Jaap; Groothoff, Wies; van der Velden, Annette W G; Thoma, Monique; Talsma, Jaap; Costongs, Louk G P; Gans, Reinold O B; de Graeff, Pauline; Reyners, Anna K L

2018-05-24

Advance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient's specific situation if held by a patient's clinical healthcare team. This study assesses the feasibility of ACP by a patient's clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains. This multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively. One hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and < 1% spiritual. Half of the anticipated non-physical problems originated from hospital III. Hospital-initiated ACP documentation by a patient's clinical healthcare team is feasible: the number of documents received per time period increased throughout the study period, and overall, documentation rates were high. Nonetheless, symptom documentation predominantly regards physical symptoms. With the involvement of specialist palliative care nurses, psychological and spiritual problems are addressed more frequently. Whether palliative care education for non-palliative care experts will improve identification and documentation of non-physical problems remains to be investigated.

Completing advance directives for health care decisions: getting to yes.

PubMed

Shewchuk, T R

1998-09-01

The concept of advance directives for health care decision making has been judicially condoned, legislatively promoted, and systematically implemented by health care institutions, yet the execution rate of advance directives remains low. Physicians should discuss with their patients advance care planning generally and end-of-life issues specifically, preferably when patients are in good health and not when they face an acute medical crisis. The physician-hospital relationship poses particular challenges for the optimal implementation of advance directives that must be addressed. Hospital administrators must improve education of patients and physicians on the value of such documents as well as internal mechanisms to ensure better implementation of directives. Health insurance plans may be better able to ensure optimal gathering and implementation of directives. Patients must become more familiar and more comfortable with advance care planning and the reality of death and dying issues. Full acceptance of the value of directives ultimately rests on achieving full participation of all involved--providers, patients, families, and payors--in this most profound process.

Increasing advance personal planning: the need for action at the community level.

PubMed

Waller, Amy; Sanson-Fisher, Rob; Ries, Nola; Bryant, Jamie

2018-05-09

Advance personal planning is the process by which people consider, document and communicate their preferences for personal, financial and health matters in case they lose the ability to make decisions or express their wishes in the future. Advance personal planning is most often undertaken by individuals who are seriously ill, often in the context of a medical crisis and/or at the time of admission to hospital. However, the clinical utility and legal validity of the planning process may be compromised in these circumstances. Patients may lack sufficient capacity to meaningfully engage in advance personal planning; there may be insufficient time to adequately reflect on and discuss wishes with key others; and there may also be limited opportunity for inter-professional input and collaboration in the process. Here, we propose an agenda for research to advance the science of advance personal planning by promoting a 'whole community' approach. Adoption of advance personal planning at a community level may be achieved using a variety of strategies including public media campaigns, intervening with professionals across a range of health care and legal settings, and mobilising support from influential groups and local government. One potentially promising method for encouraging earlier adoption of advance personal planning among a broader population involves a community action approach, whereby multiple evidence-based strategies are integrated across multiple access points. Community action involves calling on community members, professionals, community and/or government organisations to work collaboratively to design and systematically implement intervention strategies with the aim of bringing about desired behaviour change. An example of a community action trial to improving uptake and quality of advance personal planning is described. While promising, there is a need for rigorous evidence to demonstrate whether a community action approach is effective in establishing whole community adoption of advance personal planning.

Automated documentation generator for advanced protein crystal growth

NASA Technical Reports Server (NTRS)

Maddux, Gary A.; Provancha, Anna; Chattam, David

1994-01-01

To achieve an environment less dependent on the flow of paper, automated techniques of data storage and retrieval must be utilized. This software system, 'Automated Payload Experiment Tool,' seeks to provide a knowledge-based, hypertext environment for the development of NASA documentation. Once developed, the final system should be able to guide a Principal Investigator through the documentation process in a more timely and efficient manner, while supplying more accurate information to the NASA payload developer. The current system is designed for the development of the Science Requirements Document (SRD), the Experiment Requirements Document (ERD), the Project Plan, and the Safety Requirements Document.

Microgravity strategic planning exercise

NASA Technical Reports Server (NTRS)

Halpern, Richard; Downey, Jim; Harvey, Harold

1991-01-01

The Center for Space and Advanced Technology supported a planning exercise for the Microgravity Program management at the Marshall Space Flight Center. The effort focused on the status of microgravity work at MSFC and elsewhere with the objective of preparing a goal-oriented strategic planning document which could be used for informational/brochure purposes. The effort entailed numerous interactions and presentations with Field Center programmatic components and Headquarters personnel. Appropriate material was consolidated in a draft format for a MSFC Strategic Plan.

Protocol for a national prevalence study of advance care planning documentation and self-reported uptake in Australia.

PubMed

Ruseckaite, Rasa; Detering, Karen M; Evans, Sue M; Perera, Veronica; Walker, Lynne; Sinclair, Craig; Clayton, Josephine M; Nolte, Linda

2017-11-03

Advance care planning (ACP) is a process between a person, their family/carer(s) and healthcare providers that supports adults at any age or stage of health in understanding and sharing their personal values, life goals and preferences regarding future medical care. The Australian government funds a number of national initiatives aimed at increasing ACP uptake; however, there is currently no standardised Australian data on formal ACP documentation or self-reported uptake. This makes it difficult to evaluate the impact of ACP initiatives. This study aims to determine the Australian national prevalence of ACP and completion of Advance Care Directives (ACDs) in hospitals, aged care facilities and general practices. It will also explore people's self-reported use of ACP and views about the process. Researchers will conduct a national multicentre cross-sectional prevalence study, consisting of a record audit and surveys of people aged 65 years or more in three sectors. From 49 participating Australian organisations, 50 records will be audited (total of 2450 records). People whose records were audited, who speak English and have a decision-making capacity will also be invited to complete a survey. The primary outcome measure will be the number of people who have formal or informal ACP documentation that can be located in records within 15 min. Other outcomes will include demographics, measure of illness and functional capacity, details of ACP documentation (including type of document), location of documentation in the person's records and whether current clinical care plans are consistent with ACP documentation. People will be surveyed, to measure self-reported interest, uptake and use of ACP/ACDs, and self-reported quality of life. This protocol has been approved by the Austin Health Human Research Ethics Committee (reference HREC/17/Austin/83). Results will be submitted to international peer-reviewed journals and presented at international conferences. ACTRN12617000743369. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

76 FR 5774 - Planning and Establishment of Consumer Operated and Oriented Plan Program; Request for Comments...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-02

...This document is a request for comments regarding the provisions of section 1322 of the Patient Protection and Affordable Care Act (the Affordable Care Act), enacted on March 23, 2010, which requires the Secretary to establish the Consumer Operated and Oriented Plan program. The Secretary of Health and Human Services invites public comments in advance of future rulemaking and grant and loan solicitations.

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs.

PubMed

Bond, William F; Kim, Minchul; Franciskovich, Chris M; Weinberg, Jason E; Svendsen, Jessica D; Fehr, Linda S; Funk, Amy; Sawicki, Robert; Asche, Carl V

2018-04-01

Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. This was a case-control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6-54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02-1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (-0.37 admissions, 95% CI -0.66 to -0.08), and inpatient days (-3.66 days, 95% CI -6.23 to -1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI -$16,207 to -$2,793). ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients.

STAR-CCM+ Verification and Validation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pointer, William David

2016-09-30

The commercial Computational Fluid Dynamics (CFD) code STAR-CCM+ provides general purpose finite volume method solutions for fluid dynamics and energy transport. This document defines plans for verification and validation (V&V) of the base code and models implemented within the code by the Consortium for Advanced Simulation of Light water reactors (CASL). The software quality assurance activities described herein are port of the overall software life cycle defined in the CASL Software Quality Assurance (SQA) Plan [Sieger, 2015]. STAR-CCM+ serves as the principal foundation for development of an advanced predictive multi-phase boiling simulation capability within CASL. The CASL Thermal Hydraulics Methodsmore » (THM) team develops advanced closure models required to describe the subgrid-resolution behavior of secondary fluids or fluid phases in multiphase boiling flows within the Eulerian-Eulerian framework of the code. These include wall heat partitioning models that describe the formation of vapor on the surface and the forces the define bubble/droplet dynamic motion. The CASL models are implemented as user coding or field functions within the general framework of the code. This report defines procedures and requirements for V&V of the multi-phase CFD capability developed by CASL THM. Results of V&V evaluations will be documented in a separate STAR-CCM+ V&V assessment report. This report is expected to be a living document and will be updated as additional validation cases are identified and adopted as part of the CASL THM V&V suite.« less

Research and development program plan for the Center for Engineering Systems Advanced Research (CESAR)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weisbin, C.R.; Hamel, W.R.; Barhen, J.

1986-02-01

The Oak Ridge National Laboratory has established the Center for Engineering Systems Advanced Research (CESAR) for the purpose of addressing fundamental problems of intelligent machine technologies. The purpose of this document is to establish a framework and guidelines for research and development within ORNL's CESAR program in areas pertaining to intelligent machines. The specific objective is to present a CESAR Research and Development Plan for such work with a planning horizon of five to ten years, i.e., FY 1985 to FY 1990 and beyond. As much as possible, the plan is based on anticipated DOE needs in the area ofmore » productivity increase and safety to the end of this century.« less

Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.

PubMed

Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George

2018-03-01

In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p < 0.001). Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.

Planning for Serious Illness by the General Public: A Population-Based Survey

PubMed Central

Quinlan, Elizabeth; Venne, Rosemary; Hunter, Paulette; Surtees, Doug

2013-01-01

Background. While rates of advance care documentation amongst the general public remain low, there is increasing recognition of the value of informal planning to address patient preferences in serious illness. Objectives. To determine the associations between personal attributes and formal and informal planning for serious illness across age groups. Methods. This population-based, online survey was conducted in Saskatchewan, Canada, in April, 2012, using a nonclinical sample of 827 adults ranging from 18 to 88 years of age and representative of age, sex, and regional distribution of the province. Associations between key predictor variables and planning for serious illness were assessed using binary logistic regression. Results. While 16.6% of respondents had completed a written living will or advance care plan, half reported having conversations about their treatment wishes or states of health in which they would find it unacceptable to live. Lawyers were the most frequently cited source of assistance for those who had prepared advance care plans. Personal experiences with funeral planning significantly increased the likelihood of activities designed to plan for serious illness. Conclusions. Strategies designed to increase the rate of planning for future serious illness amongst the general public must account for personal readiness. PMID:25025030

Research and technology goals and objectives for Integrated Vehicle Health Management (IVHM)

NASA Technical Reports Server (NTRS)

1992-01-01

Integrated Vehicle Health Management (IVHM) is defined herein as the capability to efficiently perform checkout, testing, and monitoring of space transportation vehicles, subsystems, and components before, during, and after operational This includes the ability to perform timely status determination, diagnostics, and prognostics. IVHM must support fault-tolerant response including system/subsystem reconfiguration to prevent catastrophic failures; and IVHM must support the planning and scheduling of post-operational maintenance. The purpose of this document is to establish the rationale for IVHM and IVHM research and technology planning, and to develop technical goals and objectives. This document is prepared to provide a broad overview of IVHM for technology and advanced development activities and, more specifically, to provide a planning reference from an avionics viewpoint under the OAST Transportation Technology Program Strategic Plan.

Indianapolis Area ITS Early Deployment Plan Final Report

DOT National Transportation Integrated Search

1996-07-01

PUBLIC-PRIVATE PARTNERSHIP, TRAFFIC SIGNAL CONTROL, REGIONAL MULTIMODAL TRAVEL INFORMATION, ADVANCED RURAL TRANSPORTATION SYSTEMS OR ARTS : THIS DOCUMENT LAYS OUT A 20-YEAR SCHEDULE FOR THE IMPLEMENTATION OF ITS IN THE INDIANAPOLIS AREA. THE REPOR...

Conceptual definition of a technology development mission for advanced solar dynamic power systems

NASA Technical Reports Server (NTRS)

Migra, R. P.

1986-01-01

An initial conceptual definition of a technology development mission for advanced solar dynamic power systems is provided, utilizing a space station to provide a dedicated test facility. The advanced power systems considered included Brayton, Stirling, and liquid metal Rankine systems operating in the temperature range of 1040 to 1400 K. The critical technologies for advanced systems were identified by reviewing the current state of the art of solar dynamic power systems. The experimental requirements were determined by planning a system test of a 20 kWe solar dynamic power system on the space station test facility. These requirements were documented via the Mission Requirements Working Group (MRWG) and Technology Development Advocacy Group (TDAG) forms. Various concepts or considerations of advanced concepts are discussed. A preliminary evolutionary plan for this technology development mission was prepared.

Wave Energy Prize - 1/50th Testing - Advanced Ocean Energy @ VT

DOE Data Explorer

Wesley Scharmen

2016-01-29

This submission of data includes all the 1/50th scale testing data completed on the Wave Energy Prize for the for the Advanced Ocean Energy @VT team, and includes: 1/50th test data (raw & processed) 1/50th test data video and pictures 1/50th Test plans and testing documents SSTF_Submission (summarized results)

Implementation of advanced LCNG fueling infrastructure in Texas along the I-35/NAFTA Clean Corridor Project. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, Stan; Hightower, Jared; Knight, Koby

This report documents the process of planning, siting, and permitting recent LCNG station projects; identifying existing constraints in these processes, and recommendations for improvements; LCNG operating history.

Integrated Advanced Microwave Sounding Unit-A (AMSU-A. Engineering Report: Electromagnetic Interface (EMI)/Electromagnetic Radiation (EMR) and Electromagnetic Compatibility (EMC), for the METSAT/METOP AMSU-A1

NASA Technical Reports Server (NTRS)

Valdez, A.

1999-01-01

This document contains the procedure and the test results of the Advanced Microwave Sounding Unit-A (AMSU-A) Electromagnetic Interference (EMI), Electromagnetic Susceptibility, and Electromagnetic Compatibility (EMC) qualification test for the Meteorological Satellite (METSAT) and the Meteorological Operation Platform (METOP) projects. The test was conducted in accordance with the approved EMI/EMC Test Plan/Procedure, Specification number AE-26151/5D. This document describes the EMI/EMC test performed by Aerojet and it is presented in the following manner: Section-1 contains introductory material and a brief summary of the test results. Section 2 contains more detailed descriptions of the test plan, test procedure, and test results for each type of EMI/EMC test conducted. Section 3 contains supplementary information that includes test data sheets, plots, and calculations collected during the qualification testing.

Advance care planning within survivorship care plans for older cancer survivors: A systematic review.

PubMed

O'Caoimh, Rónán; Cornally, Nicola; O'Sullivan, Ronan; Hally, Ruth; Weathers, Elizabeth; Lavan, Amanda H; Kearns, Tara; Coffey, Alice; McGlade, Ciara; Molloy, D William

2017-11-01

Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors' mainly positive views of ACP. Another discussed the use of a SCP supported by a 'distress inventory' that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs. Copyright © 2017 Elsevier B.V. All rights reserved.

Care of Patients at the End of Life: Advance Care Planning.

PubMed

Ackermann, Richard J

2016-08-01

Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Advance care planning: challenges and approaches for pediatricians.

PubMed

Heckford, Emma; Beringer, Antonia Jane

2014-09-01

There is increasing recognition of the value of advance care planning for children with life-limiting conditions. It is important that we acknowledge and reflect on the challenges that this work presents in order to optimize practice. Our aim was to review advance care planning for children with life-threatening or life-limiting conditions (LTLLCs) in our local area. We conducted a retrospective case note review. Study subjects were from two National Health Service (NHS) Trusts in Bristol in the United Kingdom. Cases were identified from Child Death Overview Panel data. Forty-two sets of case notes were reviewed in relation to 20 children. Measurements included quantitative and qualitative review of advance care planning in relation to standards set by The Association for Children's Palliative Care (ACT). In 25% of cases there was no documented discussion with families about the approach to end of life (EOL). In 25% of cases there was no evidence of an advance care plan, and the content and accessibility of those that did exist was variable. Forty-five percent of families were not offered a choice with regard to location of care (LOC) in the last months of life and 50% were not offered a choice about location of death (LOD). We hope that acknowledgement of some of the challenges, alongside recognition of the clear benefits, of planning will help pediatricians to deliver this important area of care.

Basic nursing care: retrospective evaluation of communication and psychosocial interventions documented by nurses in the acute care setting.

PubMed

Juvé-Udina, Maria-Eulàlia; Pérez, Esperanza Zuriguel; Padrés, Núria Fabrellas; Samartino, Maribel Gonzalez; García, Marta Romero; Creus, Mònica Castellà; Batllori, Núria Vila; Calvo, Cristina Matud

2014-01-01

This study aimed to evaluate the frequency of psychosocial aspects of basic nursing care, as e-charted by nurses, when using an interface terminology. An observational, multicentre study was conducted in acute wards. The main outcome measure was the frequency of use of the psychosocial interventions in the electronic nursing care plans, analysed over a 12 month retrospective review. Overall, 150,494 electronic care plans were studied. Most of the intervention concepts from the interface terminology were used by registered nurses to illustrate the psychosocial aspects of fundamentals of care in the electronic care plans. The results presented help to demonstrate that the interventions of this interface terminology may be useful to inform psychosocial aspects of basic and advanced nursing care. The identification of psychosocial elements of basic nursing care in the nursing documentation may lead to obtain a deeper understanding of those caring interventions nurses consider essential to represent nurse-patient interactions. The frequency of psychosocial interventions may contribute to delineate basic and advanced nursing care. © 2013 Sigma Theta Tau International.

Advanced space-based InSAR risk analysis of planned and existing transportation infrastructure.

DOT National Transportation Integrated Search

2017-03-21

The purpose of this document is to summarize activities by Stanford University and : MDA Geospatial Services Inc. (MDA) to estimate surface deformation and associated : risk to transportation infrastructure using SAR Interferometric methods for the :...

45 CFR 307.0 - Scope of this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) The requirement for computerized support enforcement systems; (b) The functional requirements that a statewide computerized support enforcement system must meet; (c) Security and confidentiality requirements... to approving an advance planning document (APD); (e) The requirements and procedures for the...

Creation of impacTX : improved mobility plan for advancing connected transportation.

DOT National Transportation Integrated Search

2017-03-01

The state is at a pivotal moment in transportation, where the rate of population growth, infrastructure : deterioration, and congestion are outpacing Texass ability to provide quality service. This document introduces : the Texas Technology Task F...

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

PubMed

Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

2017-01-01

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

CASL Verification and Validation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mousseau, Vincent Andrew; Dinh, Nam

2016-06-30

This report documents the Consortium for Advanced Simulation of LWRs (CASL) verification and validation plan. The document builds upon input from CASL subject matter experts, most notably the CASL Challenge Problem Product Integrators, CASL Focus Area leaders, and CASL code development and assessment teams. This document will be a living document that will track progress on CASL to do verification and validation for both the CASL codes (including MPACT, CTF, BISON, MAMBA) and for the CASL challenge problems (CIPS, PCI, DNB). The CASL codes and the CASL challenge problems are at differing levels of maturity with respect to validation andmore » verification. The gap analysis will summarize additional work that needs to be done. Additional VVUQ work will be done as resources permit. This report is prepared for the Department of Energy’s (DOE’s) CASL program in support of milestone CASL.P13.02.« less

Planning and Management in Tertiary Education. Report on Study Tour. Cost Effectiveness in Colleges of Advanced Education.

ERIC Educational Resources Information Center

Peters, Howard

This document presents the data gathered by the author when he made an international study tour in 1970. The purpose of the tour was the investigation of planning and management in tertiary education, with particular reference to the cost effectiveness of colleges of higher education in Australia. The tour began with visits to the cities of…

The Technical Work Plan Tracking Tool

NASA Technical Reports Server (NTRS)

Chullen, Cinda; Leighton, Adele; Weller, Richard A.; Woodfill, Jared; Parkman, William E.; Ellis, Glenn L.; Wilson, Marilyn M.

2003-01-01

The Technical Work Plan Tracking Tool is a web-based application that enables interactive communication and approval of contract requirements that pertain to the administration of the Science, Engineering, Analysis, and Test (SEAT) contract at Johnson Space Center. The implementation of the application has (1) shortened the Technical Work Plan approval process, (2) facilitated writing and documenting requirements in a performance-based environment with associated surveillance plans, (3) simplified the contractor s estimate of the cost for the required work, and (4) allowed for the contractor to document how they plan to accomplish the work. The application is accessible to over 300 designated NASA and contractor employees via two Web sites. For each employee, the application regulates access according to the employee s authority to enter, view, and/or print out diverse information, including reports, work plans, purchase orders, and financial data. Advanced features of this application include on-line approval capability, automatic e-mail notifications requesting review by subsequent approvers, and security inside and outside the firewall.

Advance Care Planning in an Accountable Care Organization Is Associated with Increased Advanced Directive Documentation and Decreased Costs

PubMed Central

Kim, Minchul; Franciskovich, Chris M.; Weinberg, Jason E.; Svendsen, Jessica D.; Fehr, Linda S.; Funk, Amy; Sawicki, Robert; Asche, Carl V.

2018-01-01

Abstract Background: Advance care planning (ACP) documents patient wishes and increases awareness of palliative care options. Objective: To study the association of outpatient ACP with advanced directive documentation, utilization, and costs of care. Design: This was a case–control study of cases with ACP who died matched 1:1 with controls. We used 12 months of data pre-ACP/prematch and predeath. We compared rates of documentation with logit model regression and conducted a difference-in-difference analysis using generalized linear models for utilization and costs. Setting/subjects: Medicare beneficiaries attributed to a large rural-suburban-small metro multisite accountable care organization from January 2013 to April 2016, with cross reference to ACP facilitator logs to find cases. Measurements: The presence of advance directive forms was verified by chart review. Cost analysis included all utilization and costs billed to Medicare. Results: We matched 325 cases and 325 controls (51.1% female and 48.9% male, mean age 81). 320/325 (98.5%) ACP versus 243/325 (74.8%) of controls had a Healthcare Power of Attorney (odds ratio [OR] 21.6, 95% CI 8.6–54.1) and 172/325(52.9%) ACP versus 145/325 (44.6%) controls had Practitioner Orders for Life Sustaining Treatment (OR 1.40, 95% CI 1.02–1.90) post-ACP/postmatch. Adjusted results showed ACP cases had fewer inpatient admissions (−0.37 admissions, 95% CI −0.66 to −0.08), and inpatient days (−3.66 days, 95% CI −6.23 to −1.09), with no differences in hospice, hospice days, skilled nursing facility use, home health use, 30-day readmissions, or emergency department visits. Adjusted costs were $9,500 lower in the ACP group (95% CI −$16,207 to −$2,793). Conclusions: ACP increases documentation and was associated with a reduction in overall costs driven primarily by a reduction in inpatient utilization. Our data set was limited by small numbers of minorities and cancer patients. PMID:29206564

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

Business planning: can the health service move from strategy into action?

PubMed

Bennett, A R

1994-01-01

Advances the case for the use of one particular business planning technique within a National Health Service Trust. At the present time, NHS trusts are required to write strategic direction statements. Evidence suggests that these documents provide an accurate account of past performance and present position of the trust, but do not express the future position intended to be achieved. These documents also tend to be lengthy and lack strategic focus, which means that they are not helpful to managers who want clear organizational goals and objectives to which to work. Attempts to address the difficulties associated with determining how existing skills and resources can be used as the platform for future growth strategies by using the Ansoff Matrix and SWOT Analysis planning tools, given the external changes in the marketplace. Also attempts to shed light on some of the important links between busines strategy and management development by extending planning theory into practice.

45 CFR 95.610 - Submission of advance planning documents.

Code of Federal Regulations, 2011 CFR

2011-10-01

... system failure and disaster recovery/business continuity procedures available or to be implemented; and... generally applies to large statewide system developments and/or major hardware acquisitions. States with large, independent counties requesting funding at the regular match rate for county systems are strongly...

7 CFR 274.1 - Issuance system approval standards.

Code of Federal Regulations, 2011 CFR

2011-01-01

... computer database and electronically accessed by households at the point of sale via reusable plastic cards... submission of advance planning documents (APDs). (1) Pilot project approval requirements. To the extent the State is moving EBT to new technology or incorporating enhancements or upgrades that significantly...

Los Angeles-Gateway Freight Advanced Traveler Information System : prototype development and small-scale demonstrations for FRATIS.

DOT National Transportation Integrated Search

2013-06-01

This Demonstration Plan has been prepared to provide guidance and a common definition to all parties of the testing program that will be conducted for the LA-Gateway FRATIS Demonstration Project. More specifically, this document provides: Plannin...

7 CFR 274.1 - Issuance system approval standards.

Code of Federal Regulations, 2013 CFR

2013-01-01

... computer database and electronically accessed by households at the point of sale via reusable plastic cards... submission of advance planning documents (APDs). (1) Pilot project approval requirements. To the extent the State is moving EBT to new technology or incorporating enhancements or upgrades that significantly...

7 CFR 274.1 - Issuance system approval standards.

Code of Federal Regulations, 2014 CFR

2014-01-01

... computer database and electronically accessed by households at the point of sale via reusable plastic cards... submission of advance planning documents (APDs). (1) Pilot project approval requirements. To the extent the State is moving EBT to new technology or incorporating enhancements or upgrades that significantly...

7 CFR 274.1 - Issuance system approval standards.

Code of Federal Regulations, 2012 CFR

2012-01-01

... computer database and electronically accessed by households at the point of sale via reusable plastic cards... submission of advance planning documents (APDs). (1) Pilot project approval requirements. To the extent the State is moving EBT to new technology or incorporating enhancements or upgrades that significantly...

Earth Observing System/Advanced Microwave Sounding Unit-A (EOS/AMSU-A) software management plan

NASA Technical Reports Server (NTRS)

Schwantje, Robert

1994-01-01

This document defines the responsibilites for the management of the like-cycle development of the flight software installed in the AMSU-A instruments, and the ground support software used in the test and integration of the AMSU-A instruments.

Level-2 Milestone 5588: Deliver Strategic Plan and Initial Scalability Assessment by Advanced Architecture and Portability Specialists Team

DOE Office of Scientific and Technical Information (OSTI.GOV)

Draeger, Erik W.

This report documents the fact that the work in creating a strategic plan and beginning customer engagements has been completed. The description of milestone is: The newly formed advanced architecture and portability specialists (AAPS) team will develop a strategic plan to meet the goals of 1) sharing knowledge and experience with code teams to ensure that ASC codes run well on new architectures, and 2) supplying skilled computational scientists to put the strategy into practice. The plan will be delivered to ASC management in the first quarter. By the fourth quarter, the team will identify their first customers within PEMmore » and IC, perform an initial assessment and scalability and performance bottleneck for next-generation architectures, and embed AAPS team members with customer code teams to assist with initial portability development within standalone kernels or proxy applications.« less

Use of Electronic Documentation for Quality Improvement in Hospice

PubMed Central

Cagle, John G.; Rokoske, Franziska S.; Durham, Danielle; Schenck, Anna P.; Spence, Carol; Hanson, Laura C.

2015-01-01

Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

Health System Advance Care Planning Culture Change for High-Risk Patients: The Promise and Challenges of Engaging Providers, Patients, and Families in Systematic Advance Care Planning.

PubMed

Reidy, Jennifer; Halvorson, Jennifer; Makowski, Suzana; Katz, Delila; Weinstein, Barbara; McCluskey, Christine; Doering, Alex; DeCarli, Kathryn; Tjia, Jennifer

2017-04-01

The success of a facilitator-based model for advance care planning (ACP) in LaCrosse, Wisconsin, has inspired health systems to aim for widespread documentation of advance directives, but limited resources impair efforts to replicate this model. One promising strategy is the development of interactive, Internet-based tools that might increase access to individualized ACP at minimal cost. However, widespread adoption and implementation of Internet-based ACP efforts has yet to be described. We describe our early experiences in building a systematic, population-based ACP initiative focused on health system-wide deployment of an Internet-based tool as an adjunct to a facilitator-based model. With the sponsorship of our healthcare system's population health leadership, we engaged a diverse group of clinical stakeholders as champions to design an Internet-based ACP tool and facilitate local practice change. We describe how we simultaneously began to train clinicians in ACP conversations, engage patients and health system employees in thinking about ACP, redesign clinic workflows to accommodate ACP discussions, and integrate the Internet-based tool into the electronic medical record (EMR). Over 18 months, our project engaged two subspecialty clinics in a systematic ACP process and began work with a large primary care practice with a large Medicare Accountable Care Organization at-risk population. Overall, 807 people registered at the Internet site and 85% completed ACPs. We learned that changing culture and systems to promote ACP requires a comprehensive vision with simultaneous, interconnected strategies targeting patient education, clinician training, EMR documentation, and community awareness.

Advanced Life Support Systems

NASA Technical Reports Server (NTRS)

Barta, Daniel J.

2004-01-01

This presentation is planned to be a 10-15 minute "catalytic" focused presentation to be scheduled during one of the working sessions at the TIM. This presentation will focus on Advanced Life Support technologies key to future human Space Exploration as outlined in the Vision, and will include basic requirements, assessment of the state-of-the-art and gaps, and include specific technology metrics. The presentation will be technical in character, lean heavily on data in published ALS documents (such as the Baseline Values and Assumptions Document) but not provide specific technical details or build to information on any technology mentioned (thus the presentation will be benign from an export control and a new technology perspective). The topics presented will be focused on the following elements of Advanced Life Support: air revitalization, water recovery, waste management, thermal control, habitation systems, food systems and bioregenerative life support.

Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?

PubMed

Lyon, Cheryl

2007-12-01

Background  Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. Objectives  The objectives of the study were to document implementation of best practice in advance care planning in a residential aged care facility using a cycle of audit, feedback and re-audit cycle audit with a clinical audit software program, the Practical Application of Clinical Evidence System. The evidence-based guidelines found in 'Guidelines for a Palliative Approach in Residential Aged Care' were used to inform the process of clinical practice review and to develop a program to implement advance care planning. Results  The pre-implementation audit results showed that advance care planning practice was not based on high level evidence as initial compliance with five audit criteria was 0%. The barriers to implementation that became apparent during the feedback stage included the challenge of creating a culture where advance care planning policy, protocols and guidelines could be implemented, and advance care planning discussions held, by adequately prepared health professionals and carers. Opportunities were made to equip the resident to discuss their wishes with family, friends and healthcare staff. Some residents made the decision to take steps to formally document those wishes and/or appoint a Medical Enduring Power of Attorney to act on behalf of the resident when they are unable to communicate wishes. The post-implementation audit showed a clear improvement as compliance ranged from 15-100% for the five audit criteria. Strong leadership by the project team was effective in engaging staff in this quality improvement program. Conclusion  The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.

Earth Observing System (EOS)/Advanced Microwave Sounding Unit-A (AMSU-A) software assurance plan

NASA Technical Reports Server (NTRS)

Schwantje, Robert; Smith, Claude

1994-01-01

This document defines the responsibilities of Software Quality Assurance (SOA) for the development of the flight software installed in EOS/AMSU-A instruments, and the ground support software used in the test and integration of the EOS/AMSU-A instruments.

Choosing the route to traveler information systems deployment : decision factors for creating public-private business plans : an action guide

DOT National Transportation Integrated Search

1998-01-01

This document presents a guide designed to help public private partnerships in their efforts to provide Advanced Traveler Information Systems (ATIS) services. It first examines why ATIS can be useful in managing transportation networks and increasing...

Equipment concept design and development plans for microgravity science and applications research on space station: Combustion tunnel, laser diagnostic system, advanced modular furnace, integrated electronics laboratory

NASA Technical Reports Server (NTRS)

Uhran, M. L.; Youngblood, W. W.; Georgekutty, T.; Fiske, M. R.; Wear, W. O.

1986-01-01

Taking advantage of the microgravity environment of space NASA has initiated the preliminary design of a permanently manned space station that will support technological advances in process science and stimulate the development of new and improved materials having applications across the commercial spectrum. Previous studies have been performed to define from the researcher's perspective, the requirements for laboratory equipment to accommodate microgravity experiments on the space station. Functional requirements for the identified experimental apparatus and support equipment were determined. From these hardware requirements, several items were selected for concept designs and subsequent formulation of development plans. This report documents the concept designs and development plans for two items of experiment apparatus - the Combustion Tunnel and the Advanced Modular Furnace, and two items of support equipment the Laser Diagnostic System and the Integrated Electronics Laboratory. For each concept design, key technology developments were identified that are required to enable or enhance the development of the respective hardware.

Comparison of Quality Oncology Practice Initiative (QOPI) Measure Adherence Between Oncology Fellows, Advanced Practice Providers, and Attending Physicians.

PubMed

Zhu, Jason; Zhang, Tian; Shah, Radhika; Kamal, Arif H; Kelley, Michael J

2015-12-01

Quality improvement measures are uniformly applied to all oncology providers, regardless of their roles. Little is known about differences in adherence to these measures between oncology fellows, advance practice providers (APP), and attending physicians. We investigated conformance across Quality Oncology Practice Initiative (QOPI) measures for oncology fellows, advance practice providers, and attending physicians at the Durham Veterans Affairs Medical Center (DVAMC). Using data collected from the Spring 2012 and 2013 QOPI cycles, we abstracted charts of patients and separated them based on their primary provider. Descriptive statistics and the chi-square test were calculated for each QOPI measure between fellows, advanced practice providers (APPs), and attending physicians. A total of 169 patients were reviewed. Of these, 31 patients had a fellow, 39 had an APP, and 99 had an attending as their primary oncology provider. Fellows and attending physicians performed similarly on 90 of 94 QOPI metrics. High-performing metrics included several core QOPI measures including documenting consent for chemotherapy, recommending adjuvant chemotherapy when appropriate, and prescribing serotonin antagonists when prescribing emetogenic chemotherapies. Low-performing metrics included documentation of treatment summary and taking action to address problems with emotional well-being by the second office visit. Attendings documented the plan for oral chemotherapy more often (92 vs. 63%, P=0.049). However, after the chart audit, we found that fellows actually documented the plan for oral chemotherapy 88% of the time (p=0.73). APPs and attendings performed similarly on 88 of 90 QOPI measures. The quality of oncology care tends to be similar between attendings and fellows overall; some of the significant differences do not remain significant after a second manual chart review, highlighting that the use of manual data collection for QOPI analysis is an imperfect system, and there may be significant inter-observer variability.

A Randomized Controlled Trial of a Cardiopulmonary Resuscitation Video in Advance Care Planning for Progressive Pancreas and Hepatobiliary Cancer Patients

PubMed Central

Volandes, Angelo E.; Chen, Ling Y.; Gary, Kristen A.; Li, Yuelin; Agre, Patricia; Levin, Tomer T.; Reidy, Diane L.; Meng, Raymond D.; Segal, Neil H.; Yu, Kenneth H.; Abou-Alfa, Ghassan K.; Janjigian, Yelena Y.; Kelsen, David P.; O'Reilly, Eileen M.

2013-01-01

Abstract Background Cardiopulmonary resuscitation (CPR) is an important advance directive (AD) topic in patients with progressive cancer; however such discussions are challenging. Objective This study investigates whether video educational information about CPR engenders broader advance care planning (ACP) discourse. Methods Patients with progressive pancreas or hepatobiliary cancer were randomized to an educational CPR video or a similar CPR narrative. The primary end-point was the difference in ACP documentation one month posttest between arms. Secondary end-points included study impressions; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation; and longitudinal patient outcomes. Results Fifty-six subjects were consented and analyzed. Rates of ACP documentation (either formal ADs or documented discussions) were 40% in the video arm (12/30) compared to 15% in the narrative arm (4/26), OR=3.6 [95% CI: 0.9–18.0], p=0.07. Post-intervention knowledge was higher in both arms. Posttest, preferences for CPR had changed in the video arm but not in the narrative arm. Preferences regarding mechanical ventilation did not change in either arm. The majority of subjects in both arms reported the information as helpful and comfortable to discuss, and they recommended it to others. More deaths occurred in the video arm compared to the narrative arm, and more subjects died in hospice settings in the video arm. Conclusions This pilot randomized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects. This trend, as well as other video effects, is the subject of ongoing study. PMID:23725233

Guideline for Performing Systematic Approach to Evaluate and Qualify Legacy Documents that Support Advanced Reactor Technology Activity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honma, George

The establishment of a systematic process for the evaluation of historic technology information for use in advanced reactor licensing is described. Efforts are underway to recover and preserve Experimental Breeder Reactor II and Fast Flux Test Facility historical data. These efforts have generally emphasized preserving information from data-acquisition systems and hard-copy reports and entering it into modern electronic formats suitable for data retrieval and examination. The guidance contained in this document has been developed to facilitate consistent and systematic evaluation processes relating to quality attributes of historic technical information (with focus on sodium-cooled fast reactor (SFR) technology) that will bemore » used to eventually support licensing of advanced reactor designs. The historical information may include, but is not limited to, design documents for SFRs, research-and-development (R&D) data and associated documents, test plans and associated protocols, operations and test data, international research data, technical reports, and information associated with past U.S. Nuclear Regulatory Commission (NRC) reviews of SFR designs. The evaluation process is prescribed in terms of SFR technology, but the process can be used to evaluate historical information for any type of advanced reactor technology. An appendix provides a discussion of typical issues that should be considered when evaluating and qualifying historical information for advanced reactor technology fuel and source terms, based on current light water reactor (LWR) requirements and recent experience gained from Next Generation Nuclear Plant (NGNP).« less

45 CFR 95.612 - Disallowance of Federal Financial Participation (FFP).

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Disallowance of Federal Financial Participation... Financial Participation (FFP) Specific Conditions for Ffp § 95.612 Disallowance of Federal Financial... approved advance planning document to the detriment of the proper and efficient operation of the affected...

Development Activities on Airbreathing Combined Cycle Engines

NASA Technical Reports Server (NTRS)

McArthur, J. Craig; Lyles, Garry (Technical Monitor)

2000-01-01

Contents include the following: Advanced reusable transportation(ART); aerojet and rocketdyne tests, RBCC focused concept flowpaths,fabricate flight weigh, test select components, document ART project, Istar (Integrated system test of an airbreathing rocket); combined cycle propulsion testbed;hydrocarbon demonstrator tracebility; Istar engine system and vehicle system closure study; and Istar project planning.

Public Health Education in Florida.

ERIC Educational Resources Information Center

Florida State Dept. of Education, Tallahassee.

This report documents issues related to the work of the Florida Comprehensive Health Professions Education Plan. Public health education prepares students for initial employment or advancement in a number of positions. While the public health work force is primarily employed in various units in local, state, and federal governments, industry also…

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES COMPUTERIZED SUPPORT ENFORCEMENT SYSTEMS..., organization, services and constraints related to the computerized support enforcement system; (4) The APD must... design, development, installation or enhancement; (5) The APD must contain a description of each...

7 CFR 1717.152 - Required documentation for all mergers.

Code of Federal Regulations, 2010 CFR

2010-01-01

... mergers. In order for RUS to advance funds, send bills, and otherwise conduct business with a successor..., borrowers must submit: (1) A transmittal letter on corporate letterhead signed by the manager of each active... evidence the merger pursuant to applicable law. Examples include plan of merger, articles of merger...

Improved resident physician confidence with advance care planning after an ambulatory clinic intervention.

PubMed

Tung, Ericka E; Wieland, Mark L; Verdoorn, Brandon P; Mauck, Karen F; Post, Jason A; Thomas, Matthew R; Bundrick, John B; Jaeger, Thomas M; Cha, Stephen S; Thomas, Kris G

2014-05-01

Many primary care providers feel uncomfortable discussing end-of-life care. The aim of this intervention was to assess internal medicine residents' advance care planning (ACP) practices and improve residents' ACP confidence. Residents participated in a facilitated ACP quality improvement workshop, which included an interactive presentation and chart audit of their own patients. Pre- and postintervention surveys assessed resident ACP-related confidence. Only 24% of the audited patients had an advance directive (AD), and 28% of the ACP-documentation was of no clinical utility. Terminally ill patients (odds ratio 2.8, P < .001) were more likely to have an AD. Patients requiring an interpreter were less likely to have participated in ACP. Residents reported significantly improved confidence with ACP and identified important training gaps. Future studies examining the impact on ACP quality are needed.

A systematic review of nursing research priorities on health system and services in the Americas.

PubMed

Garcia, Alessandra Bassalobre; Cassiani, Silvia Helena De Bortoli; Reveiz, Ludovic

2015-03-01

To systematically review literature on priorities in nursing research on health systems and services in the Region of the Americas as a step toward developing a nursing research agenda that will advance the Regional Strategy for Universal Access to Health and Universal Health Coverage. This was a systematic review of the literature available from the following databases: Web of Science, PubMed, LILACS, and Google. Documents considered were published in 2008-2014; in English, Spanish, or Portuguese; and addressed the topic in the Region of the Americas. The documents selected had their priority-setting process evaluated according to the "nine common themes for good practice in health research priorities." A content analysis collected all study questions and topics, and sorted them by category and subcategory. Of 185 full-text articles/documents that were assessed for eligibility, 23 were selected: 12 were from peer-reviewed journals; 6 from nursing publications; 4 from Ministries of Health; and 1 from an international organization. Journal publications had stronger methodological rigor; the majority did not present a clear implementation or evaluation plan. After compiling the 444 documents' study questions and topics, the content analysis resulted in a document with 5 categories and 16 subcategories regarding nursing research priorities on health systems and services. Research priority-setting is a highly important process for health services improvement and resources optimization, but implementation and evaluation plans are rarely included. The resulting document will serve as basis for the development of a new nursing research agenda focused on health systems and services, and shaped to advance universal health coverage and universal access to health.

Planning: supporting and optimizing clinical guidelines execution.

PubMed

Anselma, Luca; Montani, Stefania

2008-01-01

A crucial feature of computerized clinical guidelines (CGs) lies in the fact that they may be used not only as conventional documents (as if they were just free text) describing general procedures that users have to follow. In fact, thanks to a description of their actions and control flow in some semiformal representation language, CGs can also take advantage of Computer Science methods and Information Technology infrastructures and techniques, to become executable documents, in the sense that they may support clinical decision making and clinical procedures execution. In order to reach this goal, some advanced planning techniques, originally developed within the Artificial Intelligence (AI) community, may be (at least partially) resorted too, after a proper adaptation to the specific CG needs has been carried out.

Space Station Furnace Facility Preliminary Project Implementation Plan (PIP). Volume 2, Appendix 2

NASA Technical Reports Server (NTRS)

Perkey, John K.

1992-01-01

The Space Station Furnace Facility (SSFF) is an advanced facility for materials research in the microgravity environment of the Space Station Freedom and will consist of Core equipment and various sets of Furnace Module (FM) equipment in a three-rack configuration. This Project Implementation Plan (PIP) document was developed to satisfy the requirements of Data Requirement Number 4 for the SSFF study (Phase B). This PIP shall address the planning of the activities required to perform the detailed design and development of the SSFF for the Phase C/D portion of this contract.

Advanced Risk Reduction Tool (ARRT) Special Case Study Report: Science and Engineering Technical Assessments (SETA) Program

NASA Technical Reports Server (NTRS)

Kirsch, Paul J.; Hayes, Jane; Zelinski, Lillian

2000-01-01

This special case study report presents the Science and Engineering Technical Assessments (SETA) team's findings for exploring the correlation between the underlying models of Advanced Risk Reduction Tool (ARRT) relative to how it identifies, estimates, and integrates Independent Verification & Validation (IV&V) activities. The special case study was conducted under the provisions of SETA Contract Task Order (CTO) 15 and the approved technical approach documented in the CTO-15 Modification #1 Task Project Plan.

NASA's Microgravity Technology Report, 1996: Summary of Activities

NASA Technical Reports Server (NTRS)

Kierk, Isabella

1996-01-01

This report covers technology development and technology transfer activities within the Microgravity Science Research Programs during FY 1996. It also describes the recent major tasks under the Advanced Technology Development (ATD) Program and identifies current technology requirements. This document is consistent with NASA,s Enteprise for the Human Exploration and development of Space (HEDS) Strategic Plan. This annual update reflects changes in the Microgravity Science Research Program's new technology activities and requirements. Appendix A. FY 1996 Advanced Technology Development. Program and Project Descriptions. Appendix B. Technology Development.

Assessment of the NASA AvSTAR Project Plan

NASA Technical Reports Server (NTRS)

Ulrey, Michael L.; Haraldsdottir, Aslaug; Berge, Matthew E.; Hopperstad, Craig A.; Schwab, Robert W.

2004-01-01

This report is a preliminary evaluation of NASA's proposed Aviation System Technology Advanced Research (AvSTAR) Program during the early stages of its definition, in the first half of the year 2001. This evaluation focuses on how well the program goals address the needs of the U.S. National Airspace System, the technical feasibility of the program goals, and the logistical feasibility of the program plan. This report also provides recommendations on how the AvSTAR program could be strengthened and improved. This document has two appendices.

Development of advanced acreage estimation methods

NASA Technical Reports Server (NTRS)

Guseman, L. F., Jr. (Principal Investigator)

1982-01-01

The development of an accurate and efficient algorithm for analyzing the structure of MSS data, the application of the Akaiki information criterion to mixture models, and a research plan to delineate some of the technical issues and associated tasks in the area of rice scene radiation characterization are discussed. The AMOEBA clustering algorithm is refined and documented.

Final Technical Report on the Institute for Advanced Study in Student Personnel Work.

ERIC Educational Resources Information Center

Callis, Robert

This document reports the planning, implementation, and evaluation of a 9-month institute held at the University of Missouri-Columbia to prepare participants (approximately 20) for leadership positions in student personnel work at junior colleges and technical institutes. The following aspects of the instructional program are discussed and…

45 CFR 307.15 - Approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... feasibility of the proposed effort and provide for the conduct of a requirements analysis study which address... indicate how the results of the requirements analysis study will be incorporated into the proposed system... address requirements analysis, program design, procurement and project management; and, a description of...

NIF Operations Management Plan, August 2011

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Wonterghem, Bruno M.

Lawrence Livermore National Laboratory’s (LLNL) National Ignition Facility (NIF) is a key component of the National Nuclear Security Administration’s (NNSA) Stockpile Stewardship Program, whose purpose is to maintain the safety, reliability, and effectiveness of our nation’s nuclear stockpile without underground nuclear testing. The NIF is crucial to the Stockpile Stewardship Program because it is the only facility that can create the conditions of extreme temperature and pressure—conditions that exist only in stars or in exploding nuclear weapons—that are relevant to understanding how our modern nuclear weapons operate. As such, the NIF’s primary mission is to attain fusion ignition in themore » laboratory. Fusion ignition not only supports Stockpile Stewardship needs, but also provides the basis for future decisions about fusion’s potential as a long-term energy source. Additionally, NIF provides scientists with access to high-energy-density regimes that can yield new insight and understanding in the areas of astrophysics, hydrodynamics, material properties, plasma physics, and radiative properties. The use of the NIF to support the Stockpile Stewardship Program and the advancement of basic high-energy-density science understanding is planned and managed through program-level execution plans and NIF directorate-level management teams. An example of a plan is the National Ignition Campaign Execution Plan. The NIF Operations Management Plan provides an overview of the NIF Operations organization and describes how the NIF is supported by the LLNL infrastructure and how it is safely and responsibly managed and operated. Detailed information on NIF management of the organization is found in a series of supporting plans, policies, and procedures. A list of related acronyms can be found in Appendix A of this document. The purpose of this document is to provide a roadmap of how the NIF Operations organization functions. It provides a guide to understanding the requirements, document flow down, organizational vision and mission, performance metrics, and interrelationship of the NIF Operations organization with other directorate and laboratory organizations. This document also provides a listing of roles and responsibilities, core processes, procedures, authority matrices, change control boards, and other information necessary for successfully functioning in the NIF Operations organization. This document, the NIF Shot Operations Plan, and the NIF Maintenance Plan together represent the primary documents satisfying our Conduct of Operations compliance requirement.« less

Nursing informatics, outcomes, and quality improvement.

PubMed

Charters, Kathleen G

2003-08-01

Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

Changes in advance care planning in nursing homes before and after the patient Self-Determination Act: report of a 10-state survey.

PubMed

Teno, J M; Branco, K J; Mor, V; Phillips, C D; Hawes, C; Morris, J; Fries, B E

1997-08-01

The Patient Self-Determination Act (PSDA) implemented in 1991 has focused national attention on the right of patients to be involved in decision-making and on the use of written advance directives. We report changes in advance care planning with the PSDA and other historical events in nursing homes in 10 states. Pre- and Post-observational cohort study. Nursing home residents, residing in 270 long-term care facilities in 10 states, stratified to ensure representation of urban and rural facilities in each state. In 1990, 2175 patients were sampled, and 2088 different patients from the same facilities were sampled in 1993. Six-month follow-up was obtained at both time periods. Advance care planning was defined as the documentation in the medical record of a living will, a durable power of attorney, a "Do Not Resuscitate" (DNR) order, a "Do Not Hospitalize" (DNH) order, or an order to forgo artificial nutrition or hospitalization. The rate of chart documentation of living wills increased from 4.2% in 1990 to 13.3% in 1993, and DNR orders increased dramatically from 31.1% to 51.5%. The rates of DNH and orders to forgo artificial hydration and nutrition remained less than 8% in both years. We found striking variations in advance care planing among the 10 states. In 1990, having a DNR order varied from 10.1% to 69.2% across the 10 states. With the exception of Oregon, where 69.2% of patients already had a DNR order, the states saw a 1.5 to 3.1 times increase in the rate of DNR orders in 1993 compared with 1990. With the implementation of the PSDA, there was modest increase in documentation of living wills, but DNH and orders to forgo artificial hydration and nutrition remained the same. There was a substantial increase in DNR orders that began before the PSDA implementation. This increase was associated both with the implementation of the PSDA and the increased debate about the appropriateness of CPR for nursing home residents. This increase varied considerably among geographic areas from the 10 states. Future research is needed to understand this geographic variation.

Integrated Baseline System (IBS), Version 1. 03. [Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

Space Station Systems Technology Study. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1984-01-01

The four study areas addressed are: (1) attitude control, (2) data management, (3) long-life thermal management, and (4) automated housekeeping integration. The design concepts in each area were refined. The cost benefits, schedules, and life cycle costs for the options were evaluated. Technology advancement plans were prepared for each of the selected items, and documentation was prepared.

The Effect of School Counselors' Domain Specialization on Seniors' Milestone Completion and College Access Planning

ERIC Educational Resources Information Center

Bond, Nancy J.

2013-01-01

The purpose of this study was to determine the effect of senior high school counselors' domain specializations--academic, advanced education, career, and personal/social--from two urban high schools, on alphabetically assigned graduating seniors' with low, mid-range, and high Grade Point Averages documented college and career readiness milestone…

PROGRAM ASTEC (ADVANCED SOLAR TURBO ELECTRIC CONCEPT). PART IV. SOLAR COLLECTOR DEVELOPMENT SUPPORT TASKS. VOL. VII. ENGINEERING DEVELOPMENT GROUND TEST PLAN FOR THE ASTEC SOLAR ENERGY COLLECTOR.

DTIC Science & Technology

optical, and structural integrity of the full scale ASTEC solar collector before further development proceeds. This document specifies these initial...engineering ground tests recommended for testing petals and other critical components of the ASTEC collector. It defines the requirements and

2015 Enterprise Strategic Vision

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2015-08-01

This document aligns with the Department of Energy Strategic Plan for 2014-2018 and provides a framework for integrating our missions and direction for pursuing DOE’s strategic goals. The vision is a guide to advancing world-class science and engineering, supporting our people, modernizing our infrastructure, and developing a management culture that operates a safe and secure enterprise in an efficient manner.

Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.

PubMed

Schicktanz, Silke

2009-06-01

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

Advance care planning and end-of-life care in a network of rural Western Australian hospitals.

PubMed

Auret, Kirsten; Sinclair, Craig; Averill, Barbara; Evans, Sharon

2015-08-01

To provide a current perspective on end-of-life (EOL) care in regional Western Australia, with a particular focus on the final admission prior to death and the presence of documented advance care planning (ACP). Retrospective medical notes audit. One regional hospital (including colocated hospice) and four small rural hospitals in the Great Southern region of Western Australia. Ninety recently deceased patients, who died in hospitals in the region. Fifty consecutive patients from the regional hospital and 10 consecutive patients from each of the four rural hospitals were included in the audit. A retrospective medical notes audit was undertaken. A 94-item audit tool assessed patient demographics, primary diagnosis, family support, status on admission and presence of documented ACP. Detailed items described the clinical care delivered during the final admission, including communication with family, referral to palliative care, transfers, medical investigations, medical treatments and use of EOL care pathways. Fifty-two per cent were women; median age was 82 years old. Forty per cent died of malignancy. Median length of stay was 7 days. Thirty-nine per cent had formal or informal ACP documented. Rural hospitals performed comparably with the regional hospital on all measures. This study provides benchmarking information that can assist other rural hospitals and suggests ongoing work on optimal methods of measuring quality in EOL care. © 2015 National Rural Health Alliance Inc.

Use of a Computer Program for Advance Care Planning with African American Participants.

PubMed

Markham, Sarah A; Levi, Benjamin H; Green, Michael J; Schubart, Jane R

2015-02-01

The authors wish to acknowledge the support and assistance of Dr. William Lawrence for his contribution to the M.A.UT model used in the decision aid, Making Your Wishes Known: Planning Your Medical Future (MYWK), Dr. Cheryl Dellasega for her leadership in focus group activities, Charles Sabatino for his review of legal aspects of MYWK, Dr. Robert Pearlman and his collaborative team for use of the advance care planning booklet "Your Life, Your Choices," Megan Whitehead for assistance in grant preparation and project organization, and the Instructional Media Development Center at the University of Wisconsin as well as JPL Integrated Communications for production and programming of MYWK. For various cultural and historical reasons, African Americans are less likely than Caucasians to engage in advance care planning (ACP) for healthcare decisions. This pilot study tested whether an interactive computer program could help overcome barriers to effective ACP among African Americans. African American adults were recruited from traditionally Black churches to complete an interactive computer program on ACP, pre-/post-questionnaires, and a follow-up phone interview. Eighteen adults (mean age =53.2 years, 83% female) completed the program without any problems. Knowledge about ACP significantly increased following the computer intervention (44.9% → 61.3%, p=0.0004), as did individuals' sense of self-determination. Participants were highly satisfied with the ACP process (9.4; 1 = not at all satisfied, 10 = extremely satisfied), and reported that the computer-generated advance directive accurately reflected their wishes (6.4; 1 = not at all accurate, 7 = extremely accurate). Follow-up phone interviews found that >80% of participants reported having shared their advance directives with family members and spokespeople. Preliminary evidence suggests that an interactive computer program can help African Americans engage in effective advance care planning, including creating an accurate advance directive document that will be shared with loved ones. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

Advance care planning and proxy decision making for patients with advanced Parkinson disease.

PubMed

Kwak, Jung; Wallendal, Maggie S; Fritsch, Thomas; Leo, Gary; Hyde, Trevor

2014-03-01

To examine advance care planning practices and proxy decision making by family healthcare proxies for patients with advanced Parkinson disease (PD). Sixty-four spouses and adult children, self-designated as a/the healthcare proxy for advanced patients with PD, participated in a cross-sectional survey study. Sixty patients with PD (95%) had completed a living will, but only 38% had shared the document with a physician. Among three life-support treatments--cardiopulmonary resuscitation (CPR), ventilator, and feeding tube--47% of patients opted for CPR, 16% for ventilator, and 20% for feeding tube. Forty-two percent of proxies did not know patients' preferences for one or more of the three life-support treatments. Only 28% of proxies reported that patients wanted hospice. Patients who shared advance directives with a physician were significantly less likely to choose CPR and a feeding tube and they were more likely to choose hospice. In a hypothetical end-of-life (EOL) scenario, the majority of proxies chose comfort care as the EOL goal of care (53%) and pain and symptom management only as the course of treatment option (72%); these proxy choices for patients, however, were not associated with patients' preferences for life support. Patients' proxies preferred a form of shared decision making with other family members and physicians. Advance care planning is effective when patients, families, and healthcare professionals together consider future needs for EOL care decisions. Further efforts are needed by healthcare professionals to provide evidence-based education about care options and facilitate advanced discussion and shared decision making by the patient and families.

Planning for Pre-Exascale Platform Environment (Fiscal Year 2015 Level 2 Milestone 5216)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Springmeyer, R.; Lang, M.; Noe, J.

This Plan for ASC Pre-Exascale Platform Environments document constitutes the deliverable for the fiscal year 2015 (FY15) Advanced Simulation and Computing (ASC) Program Level 2 milestone Planning for Pre-Exascale Platform Environment. It acknowledges and quantifies challenges and recognized gaps for moving the ASC Program towards effective use of exascale platforms and recommends strategies to address these gaps. This document also presents an update to the concerns, strategies, and plans presented in the FY08 predecessor document that dealt with the upcoming (at the time) petascale high performance computing (HPC) platforms. With the looming push towards exascale systems, a review of themore » earlier document was appropriate in light of the myriad architectural choices currently under consideration. The ASC Program believes the platforms to be fielded in the 2020s will be fundamentally different systems that stress ASC’s ability to modify codes to take full advantage of new or unique features. In addition, the scale of components will increase the difficulty of maintaining an errorfree system, thus driving new approaches to resilience and error detection/correction. The code revamps of the past, from serial- to vector-centric code to distributed memory to threaded implementations, will be revisited as codes adapt to a new message passing interface (MPI) plus “x” or more advanced and dynamic programming models based on architectural specifics. Development efforts are already underway in some cases, and more difficult or uncertain aspects of the new architectures will require research and analysis that may inform future directions for program choices. In addition, the potential diversity of system architectures may require parallel if not duplicative efforts to analyze and modify environments, codes, subsystems, libraries, debugging tools, and performance analysis techniques as well as exploring new monitoring methodologies. It is difficult if not impossible to selectively eliminate some of these activities until more information is available through simulations of potential architectures, analysis of systems designs, and informed study of commodity technologies that will be the constituent parts of future platforms.« less

Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention.

PubMed

Sinclair, Craig; Auret, Kirsten Anne; Evans, Sharon Frances; Williamson, Fiona; Dormer, Siobhan; Wilkinson, Anne; Greeve, Kim; Koay, Audrey; Price, Dot; Brims, Fraser

2017-02-24

Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. A multicentre open-label randomised controlled trial with preference arm. Metropolitan teaching hospital and a rural healthcare network. 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion of formal documents. Awareness of symptom burden, readiness to engage in ACP and relevant psychosocial factors may facilitate effective tailoring of ACP interventions and achieve greater uptake. ACTRN12614000255684. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Residential aged care residents and components of end of life care in an Australian hospital.

PubMed

Leong, Laurence Jee Peng; Crawford, Gregory Brian

2018-06-09

With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By describing the components of EOL care, it is hoped providers and policy makers have more information to assist with making decisions about what is the most appropriate care for this population.

14 CFR 77.75 - Establishment of antenna farm areas.

Code of Federal Regulations, 2011 CFR

2011-01-01

... indicated on an FAA planning document or military service military airport planning document. Planned or...; any other FAA planning document, or military service military airport planning document. Public use... layout plan, a military service approved military airport layout plan, or by any planning document...

Fabrication Control Plan for ORNL RH-LOCA ATF Test Specimens to be Irradiated in the ATR

DOE Office of Scientific and Technical Information (OSTI.GOV)

Field, Kevin G.; Howard, Richard; Teague, Michael

2014-06-01

The purpose of this fabrication plan is (1) to summarize the design of a set of rodlets that will be fabricated and then irradiated in the Advanced Test Reactor (ATR) and (2) provide requirements for fabrication and acceptance criteria for inspections of the Light Water Reactor (LWR) – Accident Tolerant Fuels (ATF) rodlet components. The functional and operational (F&OR) requirements for the ATF program are identified in the ATF Test Plan. The scope of this document only covers fabrication and inspections of rodlet components detailed in drawings 604496 and 604497. It does not cover the assembly of these items tomore » form a completed test irradiation assembly or the inspection of the final assembly, which will be included in a separate INL final test assembly specification/inspection document. The controls support the requirements that the test irradiations must be performed safely and that subsequent examinations must provide valid results.« less

Outcomes that Define Successful Advance Care Planning: A Delphi Panel Consensus

PubMed Central

Sudore, Rebecca L.; Heyland, Daren K.; Lum, Hillary D.; Rietjens, Judith A.C.; Korfage, Ida J.; Ritchie, Christine S.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Lorenz, Karl; Howard, Michelle; Green, Michael J.; Simon, Jessica E.; Feuz, Mariko A.; You, John J.

2017-01-01

Context Standardized outcomes that define successful advance care planning (ACP) are lacking. Objective To create an Organizing Framework of ACP outcome constructs and rate the importance of these outcomes. Methods This study convened a Delphi panel consisting of 52 multidisciplinary, international ACP experts including clinicians, researchers, and policy leaders from four countries. We conducted literature reviews and solicited attendee input from 5 international ACP conferences to identify initial ACP outcome constructs. In 5 Delphi rounds, we asked panelists to rate patient-centered outcomes on a 7-point “not-at-all” to “extremely important” scale. We calculated means and analyzed panelists’ input to finalize an Organizing Framework and outcome rankings. Results Organizing Framework outcome domains included process (e.g., attitudes), actions (e.g., discussions), quality of care (e.g., satisfaction), and healthcare (e.g., utilization). The top 5 outcomes included (1) care consistent with goals, mean 6.71 (±SD 0.04); (2) surrogate designation, 6.55 (0.45); (3) surrogate documentation, 6.50 (0.11); (4) discussions with surrogates, 6.40 (0.19); and (5) documents and recorded wishes are accessible when needed 6.27 (0.11). Advance directive documentation was ranked 10th, 6.01 (0.21). Panelists raised caution about whether “care consistent with goals” 6.01 (0.21). Panelists raised can be reliably measured. Conclusion A large, multidisciplinary Delphi panel developed an Organizing Framework and rated the importance of ACP outcome constructs. Top rated outcomes should be used to evaluate the success of ACP initiatives. More research is needed to create reliable and valid measurement tools for the highest rated outcomes, particularly “care consistent with goals.” PMID:28865870

MAPGEN Planner: Mixed-Initiative Activity Planning for the Mars Exploration Rover Mission

NASA Technical Reports Server (NTRS)

Ai-Chang, Mitch; Bresina, John; Charest, Leonard; Hsu, Jennifer; Jonsson, Ari K.; Kanefsky, Bob; Maldague, Pierre; Morris, Paul; Rajan, Kanna; Yglesias, Jeffrey

2003-01-01

This document describes the Mixed-initiative Activity Plan Generation system MAPGEN. The system is be- ing developed as one of the tools to be used during surface operations of NASA's Mars Exploration Rover mission (MER). However, the core technology is general and can be adapted to different missions and applications. The motivation for the system is to better support users that need to rapidly build activity plans that have to satisfy complex rules and fit within resource limits. The system therefore combines an existing tool for activity plan editing and resource modeling, with an advanced constraint-based reasoning and planning framework. The demonstration will show the key capabilities of the automated reasoning and planning component of the system, with emphasis on how these capabilities will be used during surface operations of the MER mission.

Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study.

PubMed

Sudore, Rebecca L; Cuervo, Isabel Arellano; Tieu, Lina; Guzman, David; Kaplan, Lauren M; Kushel, Margot

2018-05-09

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. We conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. We assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). We used multivariable logistic regression to examine factors associated with ACP discussions and documentation. The median age of the cohort was 59 (range 52-82), 75.2% were male, and 82.1% were black. Sixty-one percent reported a potential surrogate, 21.5% had discussed ACP, and 19.0% reported ACP documentation. In multivariable models, having 1 to 5 confidants versus none (adjusted odds ratio (aOR)=5.8, 95% confidence interval (CI)=1.7-20.0), 3 or more chronic conditions versus none (aOR=2.3, 95% CI=0.9-5.6), and a recent primary care visit (aOR=2.1, 95% CI=1.0-4.4) were associated with higher odds of ACP discussions and each additional 5 years of homelessness (aOR=0.7, 95% CI=0.5-0.9) with lower odds. Having 1 to 5 confidants (aOR=5.0, 95% CI=1.4-17.5), being black (aOR=5.5, 95% CI=1.5-19.5), and having adequate versus limited literacy (aOR=7.0, 95% CI=1.5-32.4) were associated with higher odds of ACP documentation and illicit drug use (aOR=0.3, 95% CI=0.1-0.9) with lower odds. Although the majority of older homeless-experienced adults have a potential surrogate, few have discussed or documented their ACP wishes; the odds of both were greater with larger social networks. Future interventions must be customized for individuals with limited social networks and address the instability of homelessness, health literacy, and the constraints of safety-net healthcare settings. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Advance Care Planning Discussions with Adolescent and Young Adult Cancer Patients Admitted to a Community Palliative Care Service: A Retrospective Case-Note Audit.

PubMed

Fletcher, Sophie; Hughes, Rachel; Pickstock, Sarah; Auret, Kirsten

2018-02-01

Adolescents and young adults (AYA) with cancer are a cohort requiring specialized healthcare models to address unique cognitive and physical challenges. Advance care planning (ACP) discussions likely warrant age-appropriate adaptation, yet, there is little Australian research data available to inform best practice for this group. The goal of this work is to inform future models of ACP discussions for AYA. Retrospective medical record audit of AYA patients and an adult comparison group, diagnosed with a malignancy and referred to a community hospice service, in Western Australia, in the period between January 1, 2012 and December 1, 2015. Information was collected regarding end-of-life care discussions, documentation of agreed plan of care, and care received. Twenty-seven AYA and 37 adult medical records were reviewed. Eighteen (66.7%) AYA patients died at home, compared with 19 (51.4%) adults (p = 0.028). Desire to pursue all available oncological therapies, including clinical trials, was documented for 14 (51.9%) AYA patients compared with 9 (24.3%) of the adult group (p = 0.02). Eleven AYA patients (40.7%) received chemotherapy during the last month of life compared with two (5.4%) adults (p = 0.001). The results indicate that end-of-life care preferences for this unique cohort may differ from those of the adult population and need to be captured and understood. An ACP document incorporating a discussion regarding goals of care, preferred location of care, preference for place of death, and consent to future intervention, including cardiopulmonary resuscitation and prompts for review, could assist in pursuing this objective.

Flooding the Zone: A Ten-Point Approach to Assessing Critical Thinking as Part of the AACSB Accreditation Process

ERIC Educational Resources Information Center

Cavaliere, Frank; Mayer, Bradley W.

2012-01-01

Undergoing the accreditation process of the Association to Advance Collegiate Schools of Business (AACSB) can be quite daunting and stressful. It requires prodigious amounts of planning, record-keeping, and document preparation. It is not something that can be thrown together at the last minute. The same is true of the five-year reaccreditation…

45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... covered under a waiver granted in accordance with § 307.5. Federal funding will be disallowed as described... under paragraph (a) shall remain in effect until the Office determines that actions required for Federal funding in the future, as specified in the notice of suspension, have been taken and the Office so...

45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... covered under a waiver granted in accordance with § 307.5. Federal funding will be disallowed as described... under paragraph (a) shall remain in effect until the Office determines that actions required for Federal funding in the future, as specified in the notice of suspension, have been taken and the Office so...

45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... covered under a waiver granted in accordance with § 307.5. Federal funding will be disallowed as described... under paragraph (a) shall remain in effect until the Office determines that actions required for Federal funding in the future, as specified in the notice of suspension, have been taken and the Office so...

45 CFR 307.40 - Suspension of approval of advance planning documents for computerized support enforcement systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... covered under a waiver granted in accordance with § 307.5. Federal funding will be disallowed as described... under paragraph (a) shall remain in effect until the Office determines that actions required for Federal funding in the future, as specified in the notice of suspension, have been taken and the Office so...

Developing State Leadership for Education in North Dakota. Educational Development for North Dakota, 1967-1975.

ERIC Educational Resources Information Center

North Dakota State Dept. of Public Instruction, Bismarck.

Attention is directed in this document to the North Dakota State Department of Public Instruction and its necessary role in refining and implementing a comprehensive plan for educational improvement in North Dakota. The thesis is advanced that expanded leadership at the state level is crucial for educational improvement in North Dakota. It is also…

A Cost-Effective Strategy for Integrating Technology into the Advanced and Remedial Mathematics Curriculum in the Community College.

ERIC Educational Resources Information Center

Johnson, Marvin L.

Technology can be an effective educational device if it is part of a well-conceived plan blending together other factors that also positively influence achievement. The body of research documenting the benefits of integrating technology into academic programs grows each day, particularly concerning the use of calculators and computers in the…

Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning.

PubMed

Litzelman, Debra K; Cottingham, Ann H; Griffin, Wilma; Inui, Thomas S; Ivy, Steven S

2016-12-01

Although patients want to participate in discussions and decisions about their end-of-life care, studies show that providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of our demonstration project was to provide education and coaching to individuals, health providers, and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care during the final stages of life. Education and training engaged community members as well as healthcare providers to: (1) improve participant comfort and facility discussing end-of-life issues; (2) improve knowledge of healthcare choices, including palliative and hospice care; and (3) prepare all participants to explore and document personal values, life goals, and priorities as well as goals of care. Between January of 2013 and June of 2015, the team educated close to 5,000 participants. Participants' ratings of the quality and perceived usefulness of the educational events ranged from 4 to 5 (using a 5-point scale, with 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well during an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for "sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who will develop trusting relationships with patients in home-based services, and fostering self-awareness and self-care among palliative care providers.

Advanced Reactor Technologies - Regulatory Technology Development Plan (RTDP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moe, Wayne L.

This DOE-NE Advanced Small Modular Reactor (AdvSMR) regulatory technology development plan (RTDP) will link critical DOE nuclear reactor technology development programs to important regulatory and policy-related issues likely to impact a “critical path” for establishing a viable commercial AdvSMR presence in the domestic energy market. Accordingly, the regulatory considerations that are set forth in the AdvSMR RTDP will not be limited to any one particular type or subset of advanced reactor technology(s) but rather broadly consider potential regulatory approaches and the licensing implications that accompany all DOE-sponsored research and technology development activity that deal with commercial non-light water reactors. However,more » it is also important to remember that certain “minimum” levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial “first step” in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by technology development studies, the anticipated regulatory importance of key DOE reactor research initiatives should be assessed early in the technology development process. Quality assurance requirements supportive of later licensing activities must also be attached to important research activities to ensure resulting data is usable in that context. Early regulatory analysis and licensing approach planning thus provides a significant benefit to the formulation of research plans and also enables the planning and development of a compatible AdvSMR licensing framework, should significant modification be required.« less

Advanced Reactor Technology -- Regulatory Technology Development Plan (RTDP)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moe, Wayne Leland

This DOE-NE Advanced Small Modular Reactor (AdvSMR) regulatory technology development plan (RTDP) will link critical DOE nuclear reactor technology development programs to important regulatory and policy-related issues likely to impact a “critical path” for establishing a viable commercial AdvSMR presence in the domestic energy market. Accordingly, the regulatory considerations that are set forth in the AdvSMR RTDP will not be limited to any one particular type or subset of advanced reactor technology(s) but rather broadly consider potential regulatory approaches and the licensing implications that accompany all DOE-sponsored research and technology development activity that deal with commercial non-light water reactors. However,more » it is also important to remember that certain “minimum” levels of design and safety approach knowledge concerning these technology(s) must be defined and available to an extent that supports appropriate pre-licensing regulatory analysis within the RTDP. Final resolution to advanced reactor licensing issues is most often predicated on the detailed design information and specific safety approach as documented in a facility license application and submitted for licensing review. Because the AdvSMR RTDP is focused on identifying and assessing the potential regulatory implications of DOE-sponsored reactor technology research very early in the pre-license application development phase, the information necessary to support a comprehensive regulatory analysis of a new reactor technology, and the resolution of resulting issues, will generally not be available. As such, the regulatory considerations documented in the RTDP should be considered an initial “first step” in the licensing process which will continue until a license is issued to build and operate the said nuclear facility. Because a facility license application relies heavily on the data and information generated by technology development studies, the anticipated regulatory importance of key DOE reactor research initiatives should be assessed early in the technology development process. Quality assurance requirements supportive of later licensing activities must also be attached to important research activities to ensure resulting data is usable in that context. Early regulatory analysis and licensing approach planning thus provides a significant benefit to the formulation of research plans and also enables the planning and development of a compatible AdvSMR licensing framework, should significant modification be required.« less

Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

PubMed

Sellars, Marcus; Detering, Karen M; Silvester, William

2015-04-23

Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

77 FR 16501 - Certain Preventive Services Under the Affordable Care Act

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-21

...This advance notice of proposed rulemaking announces the intention of the Departments of Health and Human Services, Labor, and the Treasury to propose amendments to regulations regarding certain preventive health services under provisions of the Patient Protection and Affordable Care Act (Affordable Care Act). The proposed amendments would establish alternative ways to fulfill the requirements of section 2713 of the Public Health Service Act and companion provisions under the Employee Retirement Income Security Act and the Internal Revenue Code when health coverage is sponsored or arranged by a religious organization that objects to the coverage of contraceptive services for religious reasons and that is not exempt under the final regulations published February 15, 2012. This document serves as a request for comments in advance of proposed rulemaking on the potential means of accommodating such organizations while ensuring contraceptive coverage for plan participants and beneficiaries covered under their plans (or, in the case of student health insurance plans, student enrollees and their dependents) without cost sharing.

Integrated Baseline System (IBS), Version 1.03. User guide: Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bailey, B.M.; Burford, M.J.; Downing, T.R.

The Integrated Baseline System (IBS), operated by the Federal Emergency Management Agency (FEMA), is a system of computerized tools for emergency planing and analysis. This document is the user guide for the IBS and explains how to operate the IBS system. The fundamental function of the IBS is to provide tools that civilian emergency management personnel can use in developing emergency plans and in supporting emergency management activities to cope with a chemical-releasing event at a military chemical stockpile. Emergency management planners can evaluate concepts and ideas using the IBS system. The results of that experience can then be factoredmore » into refining requirements and plans. This document provides information for the general system user, and is the primary reference for the system features of the IBS. It is designed for persons who are familiar with general emergency management concepts, operations, and vocabulary. Although the IBS manual set covers basic and advanced operations, it is not a complete reference document set. Emergency situation modeling software in the IBS is supported by additional technical documents. Some of the other LBS software is commercial software for which more complete documentation is available. The IBS manuals reference such documentation where necessary. IBS is a dynamic system. Its capabilities are in a state of continuing expansion and enhancement.« less

District-Charter Partnerships: Collaboration to Advance Teaching and Learning in New York City. Year 1 Evaluation Results (2016-17)

ERIC Educational Resources Information Center

Litt, J.; Fishel, G.

2017-01-01

The Office of School Design and Charter Partnerships (OSDCP) at the New York City Department of Education (DOE) developed and executed a plan for district-charter collaboration, which they called the District-Charter Partnerships (DCP) initiative. This document describes the results of a mixed-method study of DCP conducted during the 2016-17…

NASA's Morphing Project Research Summaries in Fiscal Year 2002

NASA Technical Reports Server (NTRS)

McGowan, Anna-Maria R.; Waszak, Martin R.

2005-01-01

The Morphing Project at the National Aeronautics and Space Agency s (NASA) Langley Research Center (LaRC) is part of the Breakthrough Vehicle Technologies Project, Vehicle Systems Program that conducts fundamental research on advanced technologies for future flight vehicles. The objectives of the Morphing Project are to develop and assess the advanced technologies and integrated component concepts to enable efficient, multi-point adaptability of flight vehicles; primarily through the application of adaptive structures and adaptive flow control to substantially alter vehicle performance characteristics. This document is a compilation of research summaries and other information on the project for fiscal year 2002. The focus is to provide a brief overview of the project content, technical results and lessons learned. At the time of publication, the Vehicle Systems Program (which includes the Morphing Project) is undergoing a program re-planning and reorganization. Accordingly, the programmatic descriptions of this document pertain only to the program as of fiscal year 2002.

Proposal for continued research in intelligent machines at the Center for Engineering Systems Advanced Research (CESAR) for FY 1988 to FY 1991

DOE Office of Scientific and Technical Information (OSTI.GOV)

Weisbin, C.R.

1987-03-01

This document reviews research accomplishments achieved by the staff of the Center for Engineering Systems Advanced Research (CESAR) during the fiscal years 1984 through 1987. The manuscript also describes future CESAR objectives for the 1988-1991 planning horizon, and beyond. As much as possible, the basic research goals are derived from perceived Department of Energy (DOE) needs for increased safety, productivity, and competitiveness in the United States energy producing and consuming facilities. Research areas covered include the HERMIES-II Robot, autonomous robot navigation, hypercube computers, machine vision, and manipulators.

Subsonic Ultra Green Aircraft Research Phase II: N+4 Advanced Concept Development

NASA Technical Reports Server (NTRS)

Bradley, Marty K.; Droney, Christopher K.

2012-01-01

This final report documents the work of the Boeing Subsonic Ultra Green Aircraft Research (SUGAR) team on Task 1 of the Phase II effort. The team consisted of Boeing Research and Technology, Boeing Commercial Airplanes, General Electric, and Georgia Tech. Using a quantitative workshop process, the following technologies, appropriate to aircraft operational in the N+4 2040 timeframe, were identified: Liquefied Natural Gas (LNG), Hydrogen, fuel cell hybrids, battery electric hybrids, Low Energy Nuclear (LENR), boundary layer ingestion propulsion (BLI), unducted fans and advanced propellers, and combinations. Technology development plans were developed.

Community-Based Palliative Care and Advance Care Planning Documentation: Evidence from a Multispecialty Group.

PubMed

Tai-Seale, Ming; Yang, Yan; Dillon, Ellis; Tapper, Sharon; Lai, Steve; Yu, Peter; Allore, Heather; Ritchie, Christine

2018-02-01

With the growing public demand for access to critical health data across care settings, it is essential that advance care planning (ACP) information be included in the electronic health record (EHR) so that multiple clinicians can access it and understand individuals' preferences for end-of-life care. Community-based palliative care programs often incorporate ACP services. This study examined whether a community-based palliative care program is associated with digitally extractable ACP documentation in the EHR. Observational study using propensity score-weighted generalized estimation equations to examine patterns of digitally extractable ACP documentation. Palo Alto Medical Foundation (PAMF), a multispecialty ambulatory healthcare system in northern California. Individuals aged 65 and older with serious illnesses between January 1, 2013, and December 31, 2014 (N = 3,444). Community-based palliative care program in PAMF. Digitally extractable ACP in EHR. We found that only 14% (n = 483) of individuals with serious illnesses had digitally extractable ACP in electronic health records. Of the 6% of individuals receiving palliative care, 65% had ACP, versus 11% of those not receiving palliative care. Study results showed a strong positive association between palliative care and ACP. Only a small percentage of individuals with serious illnesses had ACP documentation in the EHR. Individuals with serious illnesses infrequently used palliative care delivered by board-certified palliative care specialists. Palliative care service use was associated with higher rates of ACP after controlling for organizational and individual characteristics using a propensity score weighting method. Scalable interventions targeted at non-palliative care clinicians for universal access to ACP are needed. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Automation of the Environmental Control and Life Support System

NASA Technical Reports Server (NTRS)

Dewberry, Brandon S.; Carnes, J. Ray

1990-01-01

The objective of the Environmental Control and Life Support System (ECLSS) Advanced Automation Project is to recommend and develop advanced software for the initial and evolutionary Space Station Freedom (SSF) ECLS system which will minimize the crew and ground manpower needed for operations. Another objective includes capturing ECLSS design and development knowledge for future missions. This report summarizes our results from Phase I, the ECLSS domain analysis phase, which we broke down into three steps: 1) Analyze and document the baselined ECLS system, 2) envision as our goal an evolution to a fully automated regenerative life support system, built upon an augmented baseline, and 3) document the augmentations (hooks and scars) and advanced software systems which we see as necessary in achieving minimal manpower support for ECLSS operations. In addition, Phase I included development of an advanced software life cycle testing tools will be used in the development of the software. In this way, we plan in preparation for phase II and III, the development and integration phases, respectively. Automated knowledge acquisition, engineering, verification, and can capture ECLSS development knowledge for future use, develop more robust and complex software, provide feedback to the KBS tool community, and insure proper visibility of our efforts.

Strategic Plan. Volume 2

NASA Technical Reports Server (NTRS)

2002-01-01

The Mission of the NSBRI will be to lead a National effort for accomplishing the integrated, critical path, biomedical research necessary to support the long term human presence, development, and exploration of space and to enhance life on Earth by applying the resultant advances in human knowledge and technology acquired through living and working in space. To carry out this mission, the NSBRI focuses its activities on three Strategic Programs: Strategic Program 1: Countermeasure Research Strategic Program 2: Education, Training and Outreach Strategic Program 3: Cooperative Research and Development. This document contains the detailed Team Strategic Plans for the 11 research teams focused on Strategic Program 1, and the Education and Outreach Team focused on Strategic Program 2. There is overlap and integration among the Programs and Team Strategic Plans, as described in each of the Plans.

Advance Directives among Nursing Home Residents with Mild, Moderate, and Advanced Dementia.

PubMed

Tjia, Jennifer; Dharmawardene, Marisa; Givens, Jane L

2018-01-01

To describe prevalence and content of AD documentation among NH residents by dementia stage. The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear. Population-based, cross-sectional study of all licensed NHs in five U.S. states. Subjects included all long-stay (>90 day) NH residents with dementia, aged ≥65 years, and a Cognitive Performance Scale (CPS) score ≥1 from the 2007 to 2008 Minimum Data Set 2.0 (n = 180,621). Dementia severity was classified as follows: mild (CPS 1-2), moderate (CPS 3-4), and advanced (CPS 5-6). ADs were defined as the presence of a living will, do-not-resuscitate order, do-not-hospitalize order, medication restriction, or feeding restriction). Overall, 59% of residents had any AD and 17% had a living will. Prevalence of any AD increased by dementia severity: mild (51.2%), moderate (58.2%), and advanced (61.5%) (p < 0.001). In adjusted analysis, resident characteristics associated with any AD documentation included older age, female gender, being white, and having more severe dementia. Having a living will was associated with higher education (≥high school graduate vs. some high school or less) and being married. While dementia severity was associated with greater likelihood of having documented any AD, almost 4 in 10 residents with dementia lacked any AD. Effective outreach may focus efforts on subgroups with lower odds of any AD or living wills, including non-white, less educated, and unmarried NH residents. A greater understanding of how such factors impact care planning will help to address barriers to patient-centered care for this population.

Center of Excellence for Geospatial Information Science research plan 2013-18

USGS Publications Warehouse

Usery, E. Lynn

2013-01-01

The U.S. Geological Survey Center of Excellence for Geospatial Information Science (CEGIS) was created in 2006 and since that time has provided research primarily in support of The National Map. The presentations and publications of the CEGIS researchers document the research accomplishments that include advances in electronic topographic map design, generalization, data integration, map projections, sea level rise modeling, geospatial semantics, ontology, user-centered design, volunteer geographic information, and parallel and grid computing for geospatial data from The National Map. A research plan spanning 2013–18 has been developed extending the accomplishments of the CEGIS researchers and documenting new research areas that are anticipated to support The National Map of the future. In addition to extending the 2006–12 research areas, the CEGIS research plan for 2013–18 includes new research areas in data models, geospatial semantics, high-performance computing, volunteered geographic information, crowdsourcing, social media, data integration, and multiscale representations to support the Three-Dimensional Elevation Program (3DEP) and The National Map of the future of the U.S. Geological Survey.

ARM Unmanned Aerial Systems Implementation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schmid, Beat; Ivey, Mark

Recent advances in Unmanned Aerial Systems (UAS) coupled with changes in the regulatory environment for operations of UAS in the National Airspace increase the potential value of UAS to the U.S. Department of Energy (DOE) Atmospheric Radiation Measurement (ARM) Climate Research Facility. UAS include unmanned aerial vehicles (UAV) and tethered balloon systems (TBS). The roles UAVs and TBSs could play within the ARM Facility, particularly science questions they could help address, have been discussed in several workshops, reports, and vision documents, including: This document describes the implementation of a robust and vigorous program for use of UAV and TBS formore » the science missions ARM supports.« less

Characteristics of Patients With Existing Advance Directives: Evaluating Motivations Around Advance Care Planning.

PubMed

Genewick, Joanne E; Lipski, Dorothy M; Schupack, Katherine M; Buffington, Angela L H

2018-04-01

Although 80% of patients endorse an advance directive (AD), less than 35% of American adults have a documented AD. Much research has been done on barriers to creating ADs; however, there is a paucity of research addressing motivations for creating ADs. Previous research has identified 4 categories of influence for engaging in advance care planning (ACP). This study aimed to quantify the influence of these 4 motivating categories in creating an AD. Participants included 238 adults with documented ADs. Participants completed an 11-item questionnaire addressing 1 of the 4 hypothesized categories of influence in addressing ACP: concern for self; concern for others; expectations about the impact of ACP; and anecdotes, stories, and experiences. Principle component analysis yielded 2 factors representing dignity and personal control (intrinsic factors) and societal and familial influence (extrinsic factors). Intrinsic factors were the primary and most influential motivating factors among participants. A regression analysis of individual motivating factors showed that prior to age 50, the desire to provide guidance about personal preferences for end-of-life care significantly predicted the creation of an AD, whereas after age 50, the urging of family members significantly predicted the creation of an AD. Results indicated that intrinsic factors were the most influential motivator among participants of all ages. Extrinsic factors appeared to be less influential in the decision to create an AD. Motivating factors were also found to vary by age. These results may help physicians be more targeted in discussions surrounding ADs, thus saving time, which physicians identify as the main barrier in engaging in such discussions, while meeting patients' wishes for their physicians to bring up the topic of ADs.

Instrumentation Guidelines for the Advanced National Seismic System

USGS Publications Warehouse

Working Group on Instrumentation, Siting

2008-01-01

This document provides guidelines for the seismic-monitoring instrumentation used by long-term earthquake-monitoring stations that will sense ground motion, digitize and store the resulting signals in a local data acquisition unit, and optionally transmit these digital data. These guidelines are derived from specifications and requirements for data needed to address the nation's emergency response, engineering, and scientific needs as identified in U.S. Geological Survey Circular 1188 (1999). Data needs are discussed in terms of national, regional, and urban scales of monitoring in section 3. Functional performance specifications for instrumentation are introduced in section 4.3 and discussed in detail in section 6 in terms of instrument classes and definitions described in section 5. System aspects and testing recommendations are discussed in sections 7 and 8, respectively. Although U.S. Geological Survey Circular 1188 (1999) recommends that the Advanced National Seismic System (ANSS) include portable instrumentation, performance specifications for this element are not specifically addressed in this document. Nevertheless, these guidelines are largely applicable to portable instrumentation. Volcano monitoring instrumentation is also beyond the scope of this document. Guidance for ANSS structural-response monitoring is discussed briefly herein but details are deferred to the ANSS document by the ANSS Structural Response Monitoring Committee (U.S. Geological Survey, 2005). Aspects of station planning, siting, and installation other than instrumentation are beyond the scope of this document.

14 CFR 77.2 - Definition of terms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... planning document or military service military airport planning document. Precision instrument runway means... military airport layout plan; any other FAA planning document, or military service military airport planning document. Utility runway means a runway that is constructed for and intended to be used by...

Motivational aftercare planning to better care: Applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness.

PubMed

Kisely, Steve; Wyder, Marianne; Dietrich, Josie; Robinson, Gail; Siskind, Dan; Crompton, David

2017-02-01

Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ 2  = 23.3, d.f. =1, P < 0.001). This did not occur in the control wards. The qualitative data (n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation. © 2016 Australian College of Mental Health Nurses Inc.

What we were asked to do

NASA Technical Reports Server (NTRS)

1991-01-01

Recommendations are made after 32 interviews, lesson identification, lesson analysis, and mission characteristics identification. The major recommendations are as follows: (1) to develop end-to-end planning and scheduling operations concepts by mission class and to ensure their consideration in system life cycle documentation; (2) to create an organizational infrastructure at the Code 500 level, supported by a Directorate level steering committee with project representation, responsible for systems engineering of end-to-end planning and scheduling systems; (3) to develop and refine mission capabilities to assess impacts of early mission design decisions on planning and scheduling; and (4) to emphasize operational flexibility in the development of the Advanced Space Network, other institutional resources, external (e.g., project) capabilities and resources, operational software and support tools.

Evaluation of Advanced Composite Structures Technologies for Application to NASA's Vision for Space Exploration

NASA Technical Reports Server (NTRS)

Messinger, Ross

2008-01-01

An assessment was performed to identify the applicability of composite material technologies to major structural elements of the NASA Constellation program. A qualitative technology assessment methodology was developed to document the relative benefit of 24 structural systems with respect to 33 major structural elements of Ares I, Orion, Ares V, and Altair. Technology maturity assessments and development plans were obtained from more than 30 Boeing subject matter experts for more than 100 technologies. These assessment results and technology plans were combined to generate a four-level hierarchy of recommendations. An overarching strategy is suggested, followed by a Constellation-wide development plan, three integrated technology demonstrations, and three focused projects for a task order follow-on.

Proceedings for the Advance Planning Briefing for Industry

DTIC Science & Technology

1990-01-24

Liaison Office TOD - Technical Objective Documents TSR - Tactical Source Region UAV - Unmanned Aerial Vehicle UGT - UnderGround nuclear Test A G.EN D635I...tests in AURORA and underground nuclear tests ( UGT ) and will help develop tactical source region hardening requirements and lead to approaches for TSR...X-Ray theory , lasers, electronic controllers, computers, robotics, etc. Contracting for scientific studies and one-of-a-kind machines will emphasize

Reliability of an interactive computer program for advance care planning.

PubMed

Schubart, Jane R; Levi, Benjamin H; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

2012-06-01

Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83-0.95, and 0.86-0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time.

Reliability of an Interactive Computer Program for Advance Care Planning

PubMed Central

Levi, Benjamin H.; Camacho, Fabian; Whitehead, Megan; Farace, Elana; Green, Michael J

2012-01-01

Abstract Despite widespread efforts to promote advance directives (ADs), completion rates remain low. Making Your Wishes Known: Planning Your Medical Future (MYWK) is an interactive computer program that guides individuals through the process of advance care planning, explaining health conditions and interventions that commonly involve life or death decisions, helps them articulate their values/goals, and translates users' preferences into a detailed AD document. The purpose of this study was to demonstrate that (in the absence of major life changes) the AD generated by MYWK reliably reflects an individual's values/preferences. English speakers ≥30 years old completed MYWK twice, 4 to 6 weeks apart. Reliability indices were assessed for three AD components: General Wishes; Specific Wishes for treatment; and Quality-of-Life values (QoL). Twenty-four participants completed the study. Both the Specific Wishes and QoL scales had high internal consistency in both time periods (Knuder Richardson formula 20 [KR-20]=0.83–0.95, and 0.86–0.89). Test-retest reliability was perfect for General Wishes (κ=1), high for QoL (Pearson's correlation coefficient=0.83), but lower for Specific Wishes (Pearson's correlation coefficient=0.57). MYWK generates an AD where General Wishes and QoL (but not Specific Wishes) statements remain consistent over time. PMID:22512830

Willingness to complete advance directives among low-income older adults living in the USA.

PubMed

Ko, Eunjeong; Lee, Jaehoon; Hong, Youngjoon

2016-11-01

This study explored low-income older adults' willingness to (i) complete advance directives, legal documents, whereby an individual designates decision-makers in the event that they cannot make their own decisions about end-of-life treatment preferences, and (ii) the role of social support and other predictors that impact their willingness. This study was conducted as part of a larger study exploring behaviours of advance care planning among low-income older adults. Out of a total of 255 participants from the original study, this study included 204 participants who did not complete an advance directive for data analysis. A cross-sectional study using probability random sampling stratified by ethnicity was used. Older adults residing in two supportive housing facilities or who were members of a senior centre in San Diego, California, USA, were interviewed in person between December 2010 and April 2011. Hierarchical logistic regression analysis revealed that the majority of participants (72.1%) were willing to complete advance directives and the factors significantly predicting willingness to complete included self-rated health, attitudes towards advance decision-making and social support. Participants with a poorer health status (OR = 1.43, 95% CI = 1.07-1.90) were more willing to complete advance directives. Conversely, participants with higher positive attitudes (OR = 1.18, 95% CI = 1.00-1.39) and greater social support (OR = 1.07, 95% CI = 1.00-1.15) were also more willing to complete advance directives. The findings suggest the importance of ongoing support from healthcare professionals in end-of-life care planning. Healthcare professionals can be a source of support assisting older adults in planning end-of-life care. Initiating ongoing communication regarding personal value and preference for end-of-life care, providing relevant information and evaluating willingness to complete as well as assisting in the actual completion of advance directives will be necessary. © 2015 John Wiley & Sons Ltd.

Designing the Horizons of Your Small Business.

ERIC Educational Resources Information Center

Helgemo, Robert R.

This manual outlines the planning process for developing a feasibility study for a small business. The material is composed of three parts: the planning documents filled out for an imaginary campground; a business plan summarized from the planning documents; and blank planning documents with introductions and instructions. The documents can be…

Social Work Involvement in Advance Care Planning: Findings from a Large Survey of Social Workers in Hospice and Palliative Care Settings.

PubMed

Stein, Gary L; Cagle, John G; Christ, Grace H

2017-03-01

Few data are available describing the involvement and activities of social workers in advance care planning (ACP). We sought to provide data about (1) social worker involvement and leadership in ACP conversations with patients and families; and (2) the extent of functions and activities when these discussions occur. We conducted a large web-based survey of social workers employed in hospice, palliative care, and related settings to explore their role, participation, and self-rated competency in facilitating ACP discussions. Respondents were recruited through the Social Work Hospice and Palliative Care Network and the National Hospice and Palliative Care Organization. Descriptive analyses were conducted on the full sample of respondents (N = 641) and a subsample of clinical social workers (N = 456). Responses were analyzed to explore differences in ACP involvement by practice setting. Most clinical social workers (96%) reported that social workers in their department are conducting ACP discussions with patients/families. Majorities also participate in, and lead, ACP discussions (69% and 60%, respectively). Most respondents report that social workers are responsible for educating patients/families about ACP options (80%) and are the team members responsible for documenting ACP (68%). Compared with other settings, oncology and inpatient palliative care social workers were less likely to be responsible for ensuring that patients/families are informed of ACP options and documenting ACP preferences. Social workers are prominently involved in facilitating, leading, and documenting ACP discussions. Policy-makers, administrators, and providers should incorporate the vital contributions of social work professionals in policies and programs supporting ACP.

Advanced flight deck/crew station simulator functional requirements

NASA Technical Reports Server (NTRS)

Wall, R. L.; Tate, J. L.; Moss, M. J.

1980-01-01

This report documents a study of flight deck/crew system research facility requirements for investigating issues involved with developing systems, and procedures for interfacing transport aircraft with air traffic control systems planned for 1985 to 2000. Crew system needs of NASA, the U.S. Air Force, and industry were investigated and reported. A matrix of these is included, as are recommended functional requirements and design criteria for simulation facilities in which to conduct this research. Methods of exploiting the commonality and similarity in facilities are identified, and plans for exploiting this in order to reduce implementation costs and allow efficient transfer of experiments from one facility to another are presented.

[Advance directives. Representatives' opinions].

PubMed

Busquets I Font, J M; Hernando Robles, P; Font I Canals, R; Diestre Ortin, G; Quintana, S

The use and usefulness of Advance Directives has led to a lot of controversy about their validity and effectiveness. Those areas are unexplored in our country from the perspective of representatives. To determine the opinion of the representatives appointed in a registered Statement of Advance Directives (SAD) on the use of this document. Telephone survey of representatives of 146 already dead people and who, since February 2012, had registered a SAD document. More the two-thirds (98) of respondents recalled that the SAD was consulted, with 86 (58.9%) saying that their opinion as representative was consulted, and 120 (82.1%) believe that the patient's will was respected. Of those interviewed, 102 (69.9%) believe that patients who had previously planned their care using a SAD had a good death, with 33 (22.4%) saying it could have been better, and 10 (6.9%) believe they suffered greatly. The SAD were mostly respected and consulted, and possibly this is related to the fact that most of the representatives declare that the death of those they represented was perceived as comfortable. It would be desirable to conduct further studies addressed at health personnel in order to know their perceptions regarding the use of Advance Directives in the process of dying. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

System Engineering Analysis For Improved Scout Business Information Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Slyke, D. A.

The project uses system engineering principles to address the need of Boy Scout leaders for an integrated system to facilitate advancement and awards records, leader training and planning for meetings and activities. Existing products to address needs of Scout leaders and relevant stakeholders function to support record keeping and some communication functions but opportunity exists for a better system to fully integrate these functions with training delivery and recording, activity planning along with feedback and information gathering from stakeholders. Key stakeholders for the sytem include Scouts and their families, leaders, training providers, sellers of supplies and awards, content generators andmore » facilities that serve Scout activities. Key performance parameters for the system are protection of personal information, availability of current information, information accuracy and information content that has depth. Implementation concepts considered for the system include (1) owned and operated by Boy Scouts of America, (2) Contracted out to a vendor (3) distributed system that functions with BSA managed interfaces. The selected concept is to contract out to a vendor to maximize the likelihood of successful integration and take advantage of the best technology. Development of requirements considers three key use cases (1) System facilitates planning a hike with training needed satisfied in advance and advancement recording real time (2) Scheduling and documenting in-person training, (3) Family interested in Scouting receives information and can request follow-up. Non-functional requirements are analyzed with the Quality Function Deployment tool. Requirement addressing frequency of backup, compatibility with legacy and new technology, language support, software update are developed to address system reliability and intuitive interface. System functions analyzed include update of activity database, maintenance of advancement status, archive of documents, and monitoring of content that is accessible. The study examines risks associated with information security, technological change and continued popularity of Scouting. Mitigation is based on system functions that are defined. The approach to developing an improved system for facilitating Boy Scout leader functions was iterative with insights into capabilities coming in the course of working through the used cases and sequence diagrams.« less

Wellness in Sickness and Health (The W.I.S.H. Project): Advance Care Planning Preferences and Experiences Among Elderly Latino Patients.

PubMed

Maldonado, Lauren Y; Goodson, Ruth B; Mulroy, Matthew C; Johnson, Emily M; Reilly, Jo M; Homeier, Diana C

2017-10-25

To assess advance care planning (ACP) preferences, experiences, and comfort in discussing end-of-life (EOL) care among elderly Latinos. Patients aged 60 and older from the Los Angeles County and University of Southern California (LAC+USC) Medical Center Geriatrics Clinic (n = 41) participated in this intervention. Trained staff conducted ACP counseling with participants in their preferred language, which included: (a) pre-counseling survey about demographics and EOL care attitudes, (b) discussion of ACP and optional completion of an advance directive (AD), and (c) post-session survey. Patients were primarily Spanish speaking with an average of 2.7 chronic medical conditions. Most had not previously documented (95%) or discussed (76%) EOL wishes. Most were unaware they had control over their EOL treatment (61%), but valued learning about EOL options (83%). Post-counseling, 85% reported comfort discussing EOL goals compared to 66% pre-session, and 88% elected to complete an AD. Nearly half of patients reported a desire to discuss EOL wishes sooner. Elderly Latino patients are interested in ACP, given individualized, culturally competent counseling in their preferred language. Patients should be offered the opportunity to discuss and document EOL wishes at all primary care appointments, regardless of health status. Counseling should be completed in the patient's preferred language, using culturally competent materials, and with family members present if this is the patient's preference. Cultural-competency training for providers could enhance the impact of EOL discussions and improve ACP completion rates for Latino patients.

3D Seismic Experimentation and Advanced Processing/Inversion Development for Investigations of the Shallow Subsurface

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levander, Alan Richard; Zelt, Colin A.

2015-03-17

The work plan for this project was to develop and apply advanced seismic reflection and wide-angle processing and inversion techniques to high resolution seismic data for the shallow subsurface to seismically characterize the shallow subsurface at hazardous waste sites as an aid to containment and cleanup activities. We proposed to continue work on seismic data that we had already acquired under a previous DoE grant, as well as to acquire additional new datasets for analysis. The project successfully developed and/or implemented the use of 3D reflection seismology algorithms, waveform tomography and finite-frequency tomography using compressional and shear waves for highmore » resolution characterization of the shallow subsurface at two waste sites. These two sites have markedly different near-surface structures, groundwater flow patterns, and hazardous waste problems. This is documented in the list of refereed documents, conference proceedings, and Rice graduate theses, listed below.« less

Quality Assurance Program Plan for SFR Metallic Fuel Data Qualification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benoit, Timothy; Hlotke, John Daniel; Yacout, Abdellatif

2017-07-05

This document contains an evaluation of the applicability of the current Quality Assurance Standards from the American Society of Mechanical Engineers Standard NQA-1 (NQA-1) criteria and identifies and describes the quality assurance process(es) by which attributes of historical, analytical, and other data associated with sodium-cooled fast reactor [SFR] metallic fuel and/or related reactor fuel designs and constituency will be evaluated. This process is being instituted to facilitate validation of data to the extent that such data may be used to support future licensing efforts associated with advanced reactor designs. The initial data to be evaluated under this program were generatedmore » during the US Integral Fast Reactor program between 1984-1994, where the data includes, but is not limited to, research and development data and associated documents, test plans and associated protocols, operations and test data, technical reports, and information associated with past United States Nuclear Regulatory Commission reviews of SFR designs.« less

Development of a conceptual policy framework for advanced practice nursing: an ethnographic study.

PubMed

Schober, Madrean M; Gerrish, Kate; McDonnell, Ann

2016-06-01

To report on a study examining policy development for advanced practice nursing from intent of policy to realization in practice. Inclusion of advanced practice nursing roles in the healthcare workforce is a worldwide trend. Optimal advanced nursing practice requires supportive policies. Little is known about how policy is developed and implemented. Ethnography using an instrumental case study approach was selected to give an in-depth understanding of the experiences of one country (Singapore) to contribute to insight into development elsewhere. The four-phase study was conducted from 2008-2012 and included document analysis (n = 47), interviews with key policy decision makers (n = 12), interviews with nursing managers and medical directors (n = 11), interviews and participant observation with advanced practice nurses (n = 15). Key policymakers in positions of authority were able to promote policy development. However, this was characterized by lack of strategic planning for implementation. A vague understanding by nursing managers and medical directors of policies, the role and its position in the healthcare workforce led to indecision and uncertainty in execution. Advanced practice nurses developed their role based on theory acquired in their academic programme but were unsure what role to assume in practice. Lack of clear guidelines led to unanticipated difficulties for institutions and healthcare systems. Strategic planning could facilitate integration of advanced practice nurses into the healthcare workforce. A Conceptual Policy Framework is proposed as a guide for a coordinated approach to policy development and implementation for advanced practice nursing. © 2016 John Wiley & Sons Ltd.

GridAPPS-D

DOE Office of Scientific and Technical Information (OSTI.GOV)

2017-03-28

GridAPPS-D is an open-source, open architecture, standards based platform for development of advanced electric power system planning and operations applications. GridAPPS-D provides a documented data abstraction for the application developer enabling creation of applications that can be run in any compliant system or platform. This enables development of applications that are platform vendor independent applications and applications that take advantage of the possibility of data rich and data driven applications based on deployment of smart grid devices and systems.

Software engineering project management - A state-of-the-art report

NASA Technical Reports Server (NTRS)

Thayer, R. H.; Lehman, J. H.

1977-01-01

The management of software engineering projects in the aerospace industry was investigated. The survey assessed such features as contract type, specification preparation techniques, software documentation required by customers, planning and cost-estimating, quality control, the use of advanced program practices, software tools and test procedures, the education levels of project managers, programmers and analysts, work assignment, automatic software monitoring capabilities, design and coding reviews, production times, success rates, and organizational structure of the projects.

Complex decision making in patients with dementia in an internal medicine department.

PubMed

Kabelka, Ladislav

2017-10-01

With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai'i.

PubMed

Volandes, Angelo E; Paasche-Orlow, Michael K; Davis, Aretha Delight; Eubanks, Robert; El-Jawahri, Areej; Seitz, Rae

2016-09-01

Advance care planning (ACP) seeks to promote care delivery that is concordant with patients' informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. The city of Hilo in Hawai'i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) (P < 0.001). Primary care providers in the intervention had an ACP completion rate for patients over 75 years of 37.0 % (1,437/3,888) compared to control providers, who had an average of 25.6 % (10,760/42,099) (P < 0.001). The rate of discharge from hospital to hospice for patients with late-stage disease was 5.7 % prior to the intervention and 13.8 % after the intervention (P < 0.001). The average total insurance cost for the last month of life among Hilo patients was $3,458 (95 % CI $3,051 to 3,865) lower per patient after the intervention when compared to the control region. Implementing ACP video decision aids was associated with improved ACP documentation, greater use of hospice, and decreased costs. Decision aids that promote ACP offer a scalable and cost-efficient medium to place patients at the center of their care.

A Knowledge-Based System For Analysis, Intervention Planning and Prevention of Defects in Immovable Cultural Heritage Objects and Monuments

NASA Astrophysics Data System (ADS)

Valach, J.; Cacciotti, R.; Kuneš, P.; ČerÅanský, M.; Bláha, J.

2012-04-01

The paper presents a project aiming to develop a knowledge-based system for documentation and analysis of defects of cultural heritage objects and monuments. The MONDIS information system concentrates knowledge on damage of immovable structures due to various causes, and preventive/remedial actions performed to protect/repair them, where possible. The currently built system is to provide for understanding of causal relationships between a defect, materials, external load, and environment of built object. Foundation for the knowledge-based system will be the systemized and formalized knowledge on defects and their mitigation acquired in the process of analysis of a representative set of cases documented in the past. On the basis of design comparability, used technologies, materials and the nature of the external forces and surroundings, the developed software system has the capacity to indicate the most likely risks of new defect occurrence or the extension of the existing ones. The system will also allow for a comparison of the actual failure with similar cases documented and will propose a suitable technical intervention plan. The system will provide conservationists, administrators and owners of historical objects with a toolkit for defect documentation for their objects. Also, advanced artificial intelligence methods will offer accumulated knowledge to users and will also enable them to get oriented in relevant techniques of preventive interventions and reconstructions based on similarity with their case.

Shuttle/ISS EMU Failure History and the Impact on Advanced EMU Portable Life Support System (PLSS) Design

NASA Technical Reports Server (NTRS)

Campbell, Colin

2015-01-01

As the Shuttle/ISS EMU Program exceeds 35 years in duration and is still supporting the needs of the International Space Station (ISS), a critical benefit of such a long running program with thorough documentation of system and component failures is the ability to study and learn from those failures when considering the design of the next generation space suit. Study of the subject failure history leads to changes in the Advanced EMU Portable Life Support System (PLSS) schematic, selected component technologies, as well as the planned manner of ground testing. This paper reviews the Shuttle/ISS EMU failure history and discusses the implications to the AEMU PLSS.

Advanced construction management for lunar base construction - Surface operations planner

NASA Technical Reports Server (NTRS)

Kehoe, Robert P.

1992-01-01

The study proposes a conceptual solution and lays the framework for developing a new, sophisticated and intelligent tool for a lunar base construction crew to use. This concept integrates expert systems for critical decision making, virtual reality for training, logistics and laydown optimization, automated productivity measurements, and an advanced scheduling tool to form a unique new planning tool. The concept features extensive use of computers and expert systems software to support the actual work, while allowing the crew to control the project from the lunar surface. Consideration is given to a logistics data base, laydown area management, flexible critical progress scheduler, video simulation of assembly tasks, and assembly information and tracking documentation.

Shuttle/ISS EMU Failure History and the Impact on Advanced EMU PLSS Design

NASA Technical Reports Server (NTRS)

Campbell, Colin

2011-01-01

As the Shuttle/ISS EMU Program exceeds 30 years in duration and is still successfully supporting the needs of the International Space Station (ISS), a critical benefit of such a long running program with thorough documentation of system and component failures is the ability to study and learn from those failures when considering the design of the next generation space suit. Study of the subject failure history leads to changes in the Advanced EMU Portable Life Support System (PLSS) schematic, selected component technologies, as well as the planned manner of ground testing. This paper reviews the Shuttle/ISS EMU failure history and discusses the implications to the AEMU PLSS.

Shuttle/ISS EMU Failure History and the Impact on Advanced EMU PLSS Design

NASA Technical Reports Server (NTRS)

Campbell, Colin

2015-01-01

As the Shuttle/ISS EMU Program exceeds 30 years in duration and is still supporting the needs of the International Space Station (ISS), a critical benefit of such a long running program with thorough documentation of system and component failures is the ability to study and learn from those failures when considering the design of the next generation space suit. Study of the subject failure history leads to changes in the Advanced EMU Portable Life Support System (PLSS) schematic, selected component technologies, as well as the planned manner of ground testing. This paper reviews the Shuttle/ISS EMU failure history and discusses the implications to the AEMU PLSS.

Development of Level 2 Calibration and Validation Plans for GOES-R; What is a RIMP?

NASA Technical Reports Server (NTRS)

Kopp, Thomas J.; Belsma, Leslie O.; Mollner, Andrew K.; Sun, Ziping; Deluccia, Frank

2017-01-01

Calibration and Validation (CalVal) plans for Geostationary Operational Environmental Satellite version R (GOES-R) Level 2 (L2) products were documented via Resource, Implementation, and Management Plans (RIMPs) for all of the official L2 products required from the GOES-R Advanced Baseline Imager (ABI). In 2015 the GOES-R program decided to replace the typical CalVal plans with RIMPs that covered, for a given L2 product, what was required from that product, how it would be validated, and what tools would be used to do so. Similar to Level 1b products, the intent was to cover the full spectrum of planning required for the CalVal of L2 ABI products. Instead of focusing on step-by-step procedures, the RIMPs concentrated on the criteria for each stage of the validation process (Beta, Provisional, and Full Validation) and the many elements required to prove when each stage was reached.

Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond.

PubMed

Jones, Christopher A; Acevedo, Jean; Bull, Janet; Kamal, Arif H

2016-12-01

Although recommended for all persons with serious illness, advance care planning (ACP) has historically been a charitable clinical service. Inadequate or unreliable provisions for reimbursement, among other barriers, have spurred a gap between the evidence demonstrating the importance of timely ACP and recognition by payers for its delivery. 1 For the first time, healthcare is experiencing a dramatic shift in billing codes that support increased care management and care coordination. ACP, chronic care management, and transitional care management codes are examples of this newer recognition of the value of these types of services. ACP discussions are an integral component of comprehensive, high-quality palliative care delivery. The advent of reimbursement mechanisms to recognize these services has an enormous potential to impact palliative care program sustainability and growth. In this article, we highlight 10 tips to effectively using the new ACP codes reimbursable under Medicare. The importance of documentation, proper billing, and nuances regarding coding is addressed.

Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond

PubMed Central

Acevedo, Jean; Bull, Janet; Kamal, Arif H.

2016-01-01

Abstract Although recommended for all persons with serious illness, advance care planning (ACP) has historically been a charitable clinical service. Inadequate or unreliable provisions for reimbursement, among other barriers, have spurred a gap between the evidence demonstrating the importance of timely ACP and recognition by payers for its delivery.1 For the first time, healthcare is experiencing a dramatic shift in billing codes that support increased care management and care coordination. ACP, chronic care management, and transitional care management codes are examples of this newer recognition of the value of these types of services. ACP discussions are an integral component of comprehensive, high-quality palliative care delivery. The advent of reimbursement mechanisms to recognize these services has an enormous potential to impact palliative care program sustainability and growth. In this article, we highlight 10 tips to effectively using the new ACP codes reimbursable under Medicare. The importance of documentation, proper billing, and nuances regarding coding is addressed. PMID:27682147

Histologic evaluation of autogenous connective tissue and acellular dermal matrix grafts in humans.

PubMed

Cummings, Lewis C; Kaldahl, Wayne B; Allen, Edward P

2005-02-01

The clinical success of root coverage with autogenous connective tissue (CT) or acellular dermal matrix (ADM) has been well documented. However, limited histological results of CT grafts have been reported, and a case report of a human block section has been published documenting an ADM graft. The purpose of this study is to document the histological results of CT grafts, ADM grafts, and coronally advanced flaps to cover denuded roots in humans. This study included four patients previously treatment planned for extractions of three or more anterior teeth. Three teeth in each patient were selected and randomly designated to receive either a CT or ADM graft beneath a coronally advanced flap (tests) or coronally advanced flap alone (control). Six months postoperatively block section extractions were performed and the teeth processed for histologic evaluation with hematoxylin-eosin and Verhoeff's stains. Histologically, both the CT and ADM were well incorporated within the recipient tissues. New fibroblasts, vascular elements, and collagen were present throughout the ADM, while retention of the transplanted elastic fibers was apparent. No effect on the keratinization or connective tissue organization of the overlying alveolar mucosa was evident with either graft. For both materials, areas of cemental deposition were present within the root notches, the alveolar bone was essentially unaffected, and the attachments to the root surfaces were similar. Although CT and ADM have a slightly different histological appearance, both can successfully be used to cover denuded roots with similar attachments and no adverse healing.

[The SIAARTI consensus document on the management of patients with end-stage chronic organ failure. From evidence-based medicine to knowledge-based medicine].

PubMed

Bertolini, Guido

2014-01-01

The management of patients with end-stage chronic organ failure is an increasingly important topic, since the extraordinary medical and technological advances have significantly reduced mortality and improved quality of life with prolonged survival of end-stage diseases. What should be the plan of care for these patients? Who should bear the responsibility for care? With what targets? These are crucial questions, to which modern medicine should provide convincing answers. The authors of the document explicitly resisted the temptation to draw up guidelines, showing that it is possible to customize medical intervention on the individual patient, keeping it tightly linked to the available knowledge. This is the most relevant aspect of the document: it goes beyond the classical concept of evidence-based medicine choosing to refer to the most dynamic knowledge-based medicine approach.

Re-evaluating ethical concerns in planned emergency research involving critically ill patients: an interpretation of the guidance document from the United States Food and Drug Administration.

PubMed

Smischney, Nathan J; Onigkeit, James A; Hinds, Richard F; Nicholson, Wayne T

2015-01-01

U.S. federal regulations require that certain ethical elements be followed to protect human research subjects. The location and clinical circumstances of a proposed research study can differ substantially and can have significant implications for these ethical considerations. Both the location and clinical circumstances are particularly relevant for research in intensive care units (ICUs), where patients are often unable to provide informed consent to participate in a proposed research intervention. Our goal is to elaborate on the updated 2013 U.S. Food and Drug Administration (FDA) guidance document regarding an exemption from the requirement of obtaining informed consent from patients or their surrogates and to address certain elements within that document, thereby assisting clinicians in developing a framework for emergency research in accordance with the regulatory bodies at their own institutions and in the United States. Review of the 2011 and updated FDA guidance document on exemption from informed consent. The current process of obtaining informed consent within ICUs needs to be revisited, especially for research in which timely informed consent is not likely. In particular, the process of obtaining informed consent may not be appropriate or even ethical for critically ill patients in extremis who require an intervention for which there is no current acceptable standard of care and clinical equipoise exists. We provide clinicians with a viewpoint that further elaborates on the FDA guidance document. The viewpoints provided herein are those of the authors and are therefore inherently limited by the personal views of a selected few. Other clinicians or researchers may not interpret the FDA guidelines in a similar manner. Moreover, the discussion of a guideline document is a limitation in and of itself. The guidelines set forth by the FDA are precisely that-guidelines. Therefore, they may not be followed as outlined in the guidance document within one's own institution. Our goal is that, by elaborating on the guidelines for planned research involving human subjects in the ICU, institutional regulatory bodies may gain a better understanding in drafting their own document when faced with a clinician or a researcher who wishes to conduct planned research in an ICU. We believe that the interpretations provided will allow clinicians to safely undertake planned research in ICUs without endangering the main tenets of ethical research involving human participants. This research is needed for the advancement of care in the critically ill. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

20 CFR 668.710 - What planning documents must an INA grantee submit?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What planning documents must an INA grantee... Planning/Funding Process § 668.710 What planning documents must an INA grantee submit? Each grantee... participant services and expenditures covering the two-year planning cycle. We will, in consultation with the...

Strategic targeting of advance care planning interventions: the Goldilocks phenomenon.

PubMed

Billings, J Andrew; Bernacki, Rachelle

2014-04-01

Strategically selecting patients for discussions and documentation about limiting life-sustaining treatments-choosing the right time along the end-of-life trajectory for such an intervention and identifying patients at high risk of facing end-of-life decisions-can have a profound impact on the value of advance care planning (ACP) efforts. Timing is important because the completion of an advance directive (AD) too far from or too close to the time of death can lead to end-of-life decisions that do not optimally reflect the patient's values, goals, and preferences: a poorly chosen target patient population that is unlikely to need an AD in the near future may lead to patients making unrealistic, hypothetical choices, while assessing preferences in the emergency department or hospital in the face of a calamity is notoriously inadequate. Because much of the currently studied ACP efforts have led to a disappointingly small proportion of patients eventually benefitting from an AD, careful targeting of the intervention should also improve the efficacy of such projects. A key to optimal timing and strategic selection of target patients for an ACP program is prognostication, and we briefly highlight prognostication tools and studies that may point us toward high-value AD interventions.

BROOKHAVEN NATIONAL LABORATORY INSTITUTIONAL PLAN FY2003-2007.

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This document presents the vision for Brookhaven National Laboratory (BNL) for the next five years, and a roadmap for implementing that vision. Brookhaven is a multidisciplinary science-based laboratory operated for the U.S. Department of Energy (DOE), supported primarily by programs sponsored by the DOE's Office of Science. As the third-largest funding agency for science in the U.S., one of the DOE's goals is ''to advance basic research and the instruments of science that are the foundations for DOE's applied missions, a base for U.S. technology innovation, and a source of remarkable insights into our physical and biological world, and themore » nature of matter and energy'' (DOE Office of Science Strategic Plan, 2000 http://www.osti.gov/portfolio/science.htm). BNL shapes its vision according to this plan.« less

Advanced technology for America's future in space

NASA Technical Reports Server (NTRS)

1990-01-01

In response to Recommendation 8 of the Augustine Committee Report, NASA's Office of Aeronautics, Exploration and Technology (OAET) developed a proposed 'Integrated Technology Plan for the Civil Space Program' that entails substantial changes in the processes, structure and the content of NASA's space research and technology program. The Space Systems and Technology Advisory Committee (SSTAC, a subcommittee of the NASA Advisory Committee) and several other senior, expert, informed advisory groups conducted a review of NASA's proposed Integrated Technology Plan (ITP). This review was in response to the specific request in Recommendation 8 that 'NASA utilize an expert, outside review process, managed from headquarters, to assist in the allocation of technology funds'. This document, the final report from that review, addresses: (1) summary recommendations; (2) mission needs; (3) the integrated technology plan; (4) summary reports of the technical panels; and (5) conclusions and observations.

Advanced manufacturing development of a composite empennage component for L-1011 aircraft

NASA Technical Reports Server (NTRS)

Alva, T.; Henkel, J.; Johnson, R.; Carll, B.; Jackson, A.; Mosesian, B.; Brozovic, R.; Obrien, R.; Eudaily, R.

1982-01-01

This is the final report of technical work conducted during the fourth phase of a multiphase program having the objective of the design, development and flight evaluation of an advanced composite empennage component manufactured in a production environment at a cost competitive with those of its metal counterpart, and at a weight savings of at least 20 percent. The empennage component selected for this program is the vertical fin box of the L-1011 aircraft. The box structure extends from the fuselage production joint to the tip rib and includes front and rear spars. During Phase 4 of the program, production quality tooling was designed and manufactured to produce three sets of covers, ribs, spars, miscellaneous parts, and subassemblies to assemble three complete ACVF units. Recurring and nonrecurring cost data were compiled and documented in the updated producibility/design to cost plan. Nondestruct inspections, quality control tests, and quality acceptance tests were performed in accordance with the quality assurance plan and the structural integrity control plan. Records were maintained to provide traceability of material and parts throughout the manufacturing development phase. It was also determined that additional tooling would not be required to support the current and projected L-1011 production rate.

Individualised advance care planning in children with life-limiting conditions.

PubMed

Loeffen, Erik A H; Tissing, Wim J E; Schuiling-Otten, Meggi A; de Kruiff, Chris C; Kremer, Leontien C M; Verhagen, A A Eduard

2018-05-01

In 2013, the Pediatric Association of the Netherlands launched an evidence-based guideline 'Palliative care for children'. To promote implementation in daily practice and hereby improve quality of paediatric palliative care, we aimed to develop a functional individualised paediatric palliative care plan (IPPCP) that covers physical, psychological, spiritual and social functioning, with great emphasis on the guideline's recommendations, advance care planning and patients' and parents' preferences and desires. A Dutch working group (28 individuals) with a strong multidisciplinary character developed a draft IPPCP, which was piloted retrospectively and prospectively. In the pilots we completed, the IPPCPs for patients who were recently diagnosed with a life-threatening or life-limiting condition and evaluated completeness, usability and user-friendliness. The final IPPCP comprised five domains: (1) IPPCP data, (2) basics, (3) social, (4) psychosocial and spiritual and (5) physical care. Each domain covered various components. In both pilots, the IPPCP was considered a comprehensive document that covered all areas of paediatric palliative care and was experienced as an improvement to the present situation. However, the current form was regarded to lack user-friendliness. We propose a set of essential components of a comprehensive IPPCP for paediatric palliative care with extra attention for advance care planning and anticipatory action. Patients' and parents' preferences and desires are included next to the recommendations of the evidence-based guideline 'Palliative care for children'. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A survey of older peoples' attitudes towards advance care planning.

PubMed

Musa, Irfana; Seymour, Jane; Narayanasamy, Melanie Jay; Wada, Taizo; Conroy, Simon

2015-05-01

advance care planning (ACP) is a process to establish an individual's preference for care in the future; few UK studies have been conducted to ascertain public attitudes towards ACP. the aim of this study was to assess the attitudes of older people in East Midlands through the development and administration of a survey. the survey questionnaire was developed on the basis of a literature review, exploratory focus groups with older adults and expert advisor input. The final questions were then re-tested with lay volunteers. thirteen general practices were enrolled to send out surveys to potential participants aged 65 or older. There were no additional inclusion or exclusion criteria for participants. simple descriptive statistics were used to describe the responses and regression analyses were used to evaluate which items predicted responses to key outcomes. of the 5,375 (34%) community-dwelling older peoples, 1,823 returned questionnaires. Seventeen per cent of respondents had prepared an ACP document; of whom, 4% had completed an Advance Decision to Refuse Treatment (ADRT). Five per cent of respondents stated that they had been offered an opportunity to talk about ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Levels of trust were higher for families than for professionals. One-third of the respondents would be interested in talking about ACP if sessions were available. although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority (17%) had actively engaged. Preferences were for informal discussions with family rather than professionals. © The Author 2015. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Relapse Analysis of Irradiated Patients Within the HD15 Trial of the German Hodgkin Study Group

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kriz, Jan; Reinartz, Gabriele; Dietlein, Markus

2015-05-01

Purpose: To determine, in the setting of advanced-stage of Hodgkin lymphoma (HL), whether relapses occur in the irradiated planning target volume and whether the definition of local radiation therapy (RT) used by the German Hodgkin Study Group (GHSG) is adequate, because there is no harmonization of field and volume definitions among the large cooperative groups in the treatment of advanced-stage HL. Methods and Materials: All patients with residual disease of ≥2.5 cm after multiagent chemotherapy (CTX) were evaluated using additional positron emission tomography (PET), and those with a PET-positive result were irradiated with 30 Gy to the site of residual disease. We re-evaluatedmore » all sites of disease before and after CTX, as well as the PET-positive residual tumor that was treated in all relapsed patients. Documentation of radiation therapy (RT), treatment planning procedures, and portal images were carefully analyzed and compared with the centrally recommended RT prescription. The irradiated sites were compared with sites of relapse using follow-up computed tomography scans. Results: A total of 2126 patients were enrolled, and 225 patients (11%) received RT. Radiation therapy documents of 152 irradiated patients (68%) were analyzed, with 28 irradiated patients (11%) relapsing subsequently. Eleven patients (39%) had an in-field relapse, 7 patients (25%) relapsed outside the irradiated volume, and an additional 10 patients (36%) showed mixed in- and out-field relapses. Of 123 patients, 20 (16%) with adequately performed RT relapsed, compared with 7 of 29 patients (24%) with inadequate RT. Conclusions: The frequency and pattern of relapses suggest that local RT to PET-positive residual disease is sufficient for patients in advanced-stage HL. Insufficient safety margins of local RT may contribute to in-field relapses.« less

Advanced Simulation and Computing: A Summary Report to the Director's Review

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCoy, M G; Peck, T

2003-06-01

It has now been three years since the Advanced Simulation and Computing Program (ASCI), as managed by Defense and Nuclear Technologies (DNT) Directorate, has been reviewed by this Director's Review Committee (DRC). Since that time, there has been considerable progress for all components of the ASCI Program, and these developments will be highlighted in this document and in the presentations planned for June 9 and 10, 2003. There have also been some name changes. Today, the Program is called ''Advanced Simulation and Computing,'' Although it retains the familiar acronym ASCI, the initiative nature of the effort has given way tomore » sustained services as an integral part of the Stockpile Stewardship Program (SSP). All computing efforts at LLNL and the other two Defense Program (DP) laboratories are funded and managed under ASCI. This includes the so-called legacy codes, which remain essential tools in stockpile stewardship. The contract between the Department of Energy (DOE) and the University of California (UC) specifies an independent appraisal of Directorate technical work and programmatic management. Such represents the work of this DNT Review Committee. Beginning this year, the Laboratory is implementing a new review system. This process was negotiated between UC, the National Nuclear Security Administration (NNSA), and the Laboratory Directors. Central to this approach are eight performance objectives that focus on key programmatic and administrative goals. Associated with each of these objectives are a number of performance measures to more clearly characterize the attainment of the objectives. Each performance measure has a lead directorate and one or more contributing directorates. Each measure has an evaluation plan and has identified expected documentation to be included in the ''Assessment File''.« less

NATOs Relevance to United States Enduring National Interests Time to Remove the Training Wheels but Continue to Hold the Handle Bars

DTIC Science & Technology

2016-06-10

shift in the United States’ view of its role within the alliance in the future. Additional research of published documentation on the current and...the Joint Advanced Warfighting School in partial satisfaction of the requirements of a Master of Science Degree in Joint Campaign Planning and...resources so I could conduct the detailed research required for this thesis. Lastly, a special thanks to the “Bulldogs” of Seminar 3, your thoughts

Transportation technology program: Strategic plan

NASA Astrophysics Data System (ADS)

1991-09-01

The purpose of this report is to define the technology program required to meet the transportation technology needs for current and future civil space missions. It is a part of an integrated plan, prepared by NASA in part in response to the Augustine Committee recommendations, to describe and advocate expanded and more aggressive efforts in the development of advanced space technologies. This expanded program will provide a technology basis for future space missions to which the U.S. aspires, and will help to regain technology leadership for the U.S. on a broader front. The six aspects of this integrated program/plan deal with focused technologies to support space sciences, exploration, transportation, platforms, and operations as well as provide a Research and Technology Base Program. This volume describes the technologies needed to support transportation systems, e.g., technologies needed for upgrades to current transportation systems and to provide reliable and efficient transportation for future space missions. The Office of Aeronautics, Exploration, and Technology (OAET) solicited technology needs from the major agency technology users and the aerospace industry community and formed a transportation technology team (appendix A) to develop a technology program to respond to those needs related to transportation technologies. This report addresses the results of that team activity. It is a strategic plan intended for use as a planning document rather than as a project management tool. It is anticipated that this document will be primarily utilized by research & technology (R&T) management at the various NASA Centers as well as by officials at NASA Headquarters and by industry in planning their corporate Independent Research and Development (IR&D) investments.

Transportation technology program: Strategic plan

NASA Technical Reports Server (NTRS)

1991-01-01

The purpose of this report is to define the technology program required to meet the transportation technology needs for current and future civil space missions. It is a part of an integrated plan, prepared by NASA in part in response to the Augustine Committee recommendations, to describe and advocate expanded and more aggressive efforts in the development of advanced space technologies. This expanded program will provide a technology basis for future space missions to which the U.S. aspires, and will help to regain technology leadership for the U.S. on a broader front. The six aspects of this integrated program/plan deal with focused technologies to support space sciences, exploration, transportation, platforms, and operations as well as provide a Research and Technology Base Program. This volume describes the technologies needed to support transportation systems, e.g., technologies needed for upgrades to current transportation systems and to provide reliable and efficient transportation for future space missions. The Office of Aeronautics, Exploration, and Technology (OAET) solicited technology needs from the major agency technology users and the aerospace industry community and formed a transportation technology team (appendix A) to develop a technology program to respond to those needs related to transportation technologies. This report addresses the results of that team activity. It is a strategic plan intended for use as a planning document rather than as a project management tool. It is anticipated that this document will be primarily utilized by research & technology (R&T) management at the various NASA Centers as well as by officials at NASA Headquarters and by industry in planning their corporate Independent Research and Development (IR&D) investments.

Semantic Metadata for Heterogeneous Spatial Planning Documents

NASA Astrophysics Data System (ADS)

Iwaniak, A.; Kaczmarek, I.; Łukowicz, J.; Strzelecki, M.; Coetzee, S.; Paluszyński, W.

2016-09-01

Spatial planning documents contain information about the principles and rights of land use in different zones of a local authority. They are the basis for administrative decision making in support of sustainable development. In Poland these documents are published on the Web according to a prescribed non-extendable XML schema, designed for optimum presentation to humans in HTML web pages. There is no document standard, and limited functionality exists for adding references to external resources. The text in these documents is discoverable and searchable by general-purpose web search engines, but the semantics of the content cannot be discovered or queried. The spatial information in these documents is geographically referenced but not machine-readable. Major manual efforts are required to integrate such heterogeneous spatial planning documents from various local authorities for analysis, scenario planning and decision support. This article presents results of an implementation using machine-readable semantic metadata to identify relationships among regulations in the text, spatial objects in the drawings and links to external resources. A spatial planning ontology was used to annotate different sections of spatial planning documents with semantic metadata in the Resource Description Framework in Attributes (RDFa). The semantic interpretation of the content, links between document elements and links to external resources were embedded in XHTML pages. An example and use case from the spatial planning domain in Poland is presented to evaluate its efficiency and applicability. The solution enables the automated integration of spatial planning documents from multiple local authorities to assist decision makers with understanding and interpreting spatial planning information. The approach is equally applicable to legal documents from other countries and domains, such as cultural heritage and environmental management.

The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial.

PubMed

Sudore, Rebecca; Le, Gem M; McMahan, Ryan; McMahon, Ryan; Feuz, Mariko; Katen, Mary; Barnes, Deborah E

2015-12-12

Advance care planning (ACP) is a process whereby patients prepare for medical decision-making. The traditional objective of ACP has focused on the completion of advance directives. We have developed a new paradigm of ACP focused on preparing patients and their loved ones for communication and informed medical decision-making. To operationalize this new paradigm of ACP, we created an interactive, patient-centered website called PREPARE ( www.prepareforyourcare.org ) designed for diverse older adults. This randomized controlled trial with blinded outcome assessment is designed to determine the efficacy of PREPARE to engage older Veterans in the ACP process. Veterans who are ≥ 60 years of age, have ≥ two medical conditions, and have seen a primary care physician ≥ two times in the last year are being randomized to one of two study arms. The PREPARE study arm reviews the PREPARE website and an easy-to-read advance directive. The control arm only reviews the advance directive. The primary outcome is documentation of an advance directive and ACP discussions. Other clinically important outcomes using validated surveys include ACP behavior change process measures (knowledge, contemplation, self-efficacy, and readiness) and a full range of ACP action measures (identifying a surrogate, identifying values and goals, choosing leeway or flexibility for the surrogate, communicating with clinicians and surrogates, and documenting one's wishes). We will also assess satisfaction with decision-making and Veteran activation within primary care visits by direct audio recording. To examine the outcomes at 1 week, 3 months, and 6 months between the two study arms, we will use mixed effects linear, Poisson, or negative binomial regression and mixed effects logistic regression. This study will determine whether PREPARE increases advance directive completion rates and engagement with the ACP process. If PREPARE is efficacious, it could prove to be an easy and effective intervention to help older adults engage in the ACP process within or outside of the medical environment. PREPARE may also help older adults communicate their medical wishes and goals to their loved ones and clinicians, improve medical decision-making, and ensure their wishes are honored over the life course. ClinicalTrials.gov NCT01550731 . Registered on 8 December 2011.

FY 1987 current fiscal year work plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

This Current Year Work Plan presents a detailed description of the activities to be performed by the Joint Integration Office during FY87. It breaks down the activities into two major work areas: Program Management and Program Analysis. Program Management is performed by the JIO by providing technical planning and guidance for the development of advanced TRU waste management capabilities. This includes equipment/facility design, engineering, construction, and operations. These functions are integrated to allow transition from interim storage to final disposition. JIO tasks include program requirements identification, long-range technical planning, budget development, program planning document preparation, task guidance, task monitoring, informationmore » gathering and task reporting to DOE, interfacing with other agencies and DOE lead programs, integrating public involvement with program efforts, and preparation of program status reports for DOE. Program Analysis is performed by the JIO to support identification and assessment of alternatives, and development of long-term TRU waste program capabilities. This work plan includes: system analyses, requirements analyses, interim and procedure development, legislative and regulatory analyses, dispatch and traffic analyses, and data bases.« less

20 CFR 669.510 - What planning documents must an NFJP grantee submit?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false What planning documents must an NFJP grantee submit? 669.510 Section 669.510 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF... Performance Accountability, Planning and Waiver Provision § 669.510 What planning documents must an NFJP...

32 CFR 813.6 - Planning and requesting combat documentation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Joint Operation Planning and Execution System, that in turn, requests support from HQ AMC. HQ USAF can... 32 National Defense 6 2010-07-01 2010-07-01 false Planning and requesting combat documentation... SALES AND SERVICES VISUAL INFORMATION DOCUMENTATION PROGRAM § 813.6 Planning and requesting combat...

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

Human Factors Engineering Program Review Model (NUREG-0711)Revision 3: Update Methodology and Key Revisions

DOE Office of Scientific and Technical Information (OSTI.GOV)

OHara J. M.; Higgins, J.; Fleger, S.

The U.S. Nuclear Regulatory Commission (NRC) reviews the human factors engineering (HFE) programs of applicants for nuclear power plant construction permits, operating licenses, standard design certifications, and combined operating licenses. The purpose of these safety reviews is to help ensure that personnel performance and reliability are appropriately supported. Detailed design review procedures and guidance for the evaluations is provided in three key documents: the Standard Review Plan (NUREG-0800), the HFE Program Review Model (NUREG-0711), and the Human-System Interface Design Review Guidelines (NUREG-0700). These documents were last revised in 2007, 2004 and 2002, respectively. The NRC is committed to the periodicmore » update and improvement of the guidance to ensure that it remains a state-of-the-art design evaluation tool. To this end, the NRC is updating its guidance to stay current with recent research on human performance, advances in HFE methods and tools, and new technology being employed in plant and control room design. NUREG-0711 is the first document to be addressed. We present the methodology used to update NUREG-0711 and summarize the main changes made. Finally, we discuss the current status of the update program and the future plans.« less

Preliminary environmental assessment for the Satellite Power System (SPS). Volume 2: Detailed assessment

NASA Technical Reports Server (NTRS)

1978-01-01

Volume 2 provides a preliminary assessment of the impact of the Satellite Power System (SPS) on the environment in a technically detailed format more suitable for peer review than the executive summary of Vol. 1. It serves to integrate and assimilate information that has appeared in documents referenced herein and to focus on issues that are purely environmental. It discloses the state-of-knowledge as perceived from recently completed DOE-sponsored studies and defines prospective research and study programs that can advance the state-of-knowledge and provide an expanded data base for use in an assessment planned for 1980. Alternatives for research that may be implemented in order to achieve this advancement are also discussed.

Final Report for the Advanced Concept Studies for Supersonic Commercial Transports Entering Service in the 2030 to 2035 Period, N+3 Supersonic Program

NASA Technical Reports Server (NTRS)

Morgenstern, John; Norstrud, Nicole; Stelmack, Marc; Skoch, Craig

2010-01-01

The N+3 Final Report documents the work and progress made by Lockheed Martin Aeronautics in response to the NASA sponsored program "N+3 NRA Advanced Concept Studies for Supersonic Commercial Transports Entering Service in the 2030 to 2035 Period." The key technical objective of this effort was to generate promising supersonic concepts for the 2030 to 2035 timeframe and to develop plans for maturing the technologies required to make those concepts a reality. The N+3 program is aligned with NASA's Supersonic Project and is focused on providing alternative system-level solutions capable of overcoming the efficiency, environmental, and performance barriers to practical supersonic flight

Promoting advance care planning among community-based older adults: A randomized controlled trial.

PubMed

Bravo, Gina; Trottier, Lise; Arcand, Marcel; Boire-Lavigne, Anne-Marie; Blanchette, Danièle; Dubois, Marie-France; Guay, Maryse; Lane, Julie; Hottin, Paule; Bellemare, Suzanne

2016-11-01

To test an intervention designed to motivate older adults in documenting their healthcare preferences in advance, and to guide proxies in making hypothetical decisions that match those of the older adult. The trial involved 235 older adults, of which half were assisted in communicating their wishes to their proxy. Hypothetical vignettes were used at baseline and twice after the intervention to elicit older adults' preferences and assess their proxy's ability to predict them. By the end of the trial, 80% of older adults allocated to the experimental group had documented their wishes. Changes over time in mean accuracy scores did not differ between groups for any hypothetical situations, except when limiting the sample to dyads that were highly discordant at baseline. The intervention motivated a large proportion of older adults to express their preferences but had little effect on proxies' ability to predict them. Educational tools developed for this study will assist healthcare providers in helping older adults to record their wishes in advance. Clients must be informed of the challenge of making substitute decisions and of the need to discuss the amount of leeway the proxy should have in interpreting expressed wishes. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

20 CFR 669.510 - What planning documents must an NFJP grantee submit?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What planning documents must an NFJP grantee submit? 669.510 Section 669.510 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF... Accountability, Planning and Waiver Provision § 669.510 What planning documents must an NFJP grantee submit? Each...

Treatment planning and smile design using composite resin.

PubMed

Marus, Robert

2006-05-01

Recent advances in dental materials and adhesive protocols have expanded the restorative procedures available to today's clinicians. Used in combination with proper treatment planning, these innovations enable dental professionals to provide enhanced aesthetic care that achieves the increasing expectations of their patients. Using a case presentation, this article will document the steps required to harmoniously integrate smile design, material selection, and patient communication that are involved in the provisional of aesthetic dental care. This article discusses the utilization of composite resin as a tool to enhance the patient's smile. Upon reading this article, the reader should: Become familiar with a smile-enhancing technique which can be completed in one office visit. Realize the benefits that intraoral composite mockups offer in terms of prototyping and confirming patient satisfaction.

The Nuclear Energy Advanced Modeling and Simulation Enabling Computational Technologies FY09 Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Diachin, L F; Garaizar, F X; Henson, V E

2009-10-12

In this document we report on the status of the Nuclear Energy Advanced Modeling and Simulation (NEAMS) Enabling Computational Technologies (ECT) effort. In particular, we provide the context for ECT In the broader NEAMS program and describe the three pillars of the ECT effort, namely, (1) tools and libraries, (2) software quality assurance, and (3) computational facility (computers, storage, etc) needs. We report on our FY09 deliverables to determine the needs of the integrated performance and safety codes (IPSCs) in these three areas and lay out the general plan for software quality assurance to meet the requirements of DOE andmore » the DOE Advanced Fuel Cycle Initiative (AFCI). We conclude with a brief description of our interactions with the Idaho National Laboratory computer center to determine what is needed to expand their role as a NEAMS user facility.« less

Recovery Act. Development and Validation of an Advanced Stimulation Prediction Model for Enhanced Geothermal System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gutierrez, Marte

The research project aims to develop and validate an advanced computer model that can be used in the planning and design of stimulation techniques to create engineered reservoirs for Enhanced Geothermal Systems. The specific objectives of the proposal are to: 1) Develop a true three-dimensional hydro-thermal fracturing simulator that is particularly suited for EGS reservoir creation. 2) Perform laboratory scale model tests of hydraulic fracturing and proppant flow/transport using a polyaxial loading device, and use the laboratory results to test and validate the 3D simulator. 3) Perform discrete element/particulate modeling of proppant transport in hydraulic fractures, and use the resultsmore » to improve understand of proppant flow and transport. 4) Test and validate the 3D hydro-thermal fracturing simulator against case histories of EGS energy production. 5) Develop a plan to commercialize the 3D fracturing and proppant flow/transport simulator. The project is expected to yield several specific results and benefits. Major technical products from the proposal include: 1) A true-3D hydro-thermal fracturing computer code that is particularly suited to EGS, 2) Documented results of scale model tests on hydro-thermal fracturing and fracture propping in an analogue crystalline rock, 3) Documented procedures and results of discrete element/particulate modeling of flow and transport of proppants for EGS applications, and 4) Database of monitoring data, with focus of Acoustic Emissions (AE) from lab scale modeling and field case histories of EGS reservoir creation.« less

Recovery Act. Development and Validation of an Advanced Stimulation Prediction Model for Enhanced Geothermal Systems

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gutierrez, Marte

2013-12-31

This research project aims to develop and validate an advanced computer model that can be used in the planning and design of stimulation techniques to create engineered reservoirs for Enhanced Geothermal Systems. The specific objectives of the proposal are to; Develop a true three-dimensional hydro-thermal fracturing simulator that is particularly suited for EGS reservoir creation; Perform laboratory scale model tests of hydraulic fracturing and proppant flow/transport using a polyaxial loading device, and use the laboratory results to test and validate the 3D simulator; Perform discrete element/particulate modeling of proppant transport in hydraulic fractures, and use the results to improve understandmore » of proppant flow and transport; Test and validate the 3D hydro-thermal fracturing simulator against case histories of EGS energy production; and Develop a plan to commercialize the 3D fracturing and proppant flow/transport simulator. The project is expected to yield several specific results and benefits. Major technical products from the proposal include; A true-3D hydro-thermal fracturing computer code that is particularly suited to EGS; Documented results of scale model tests on hydro-thermal fracturing and fracture propping in an analogue crystalline rock; Documented procedures and results of discrete element/particulate modeling of flow and transport of proppants for EGS applications; and Database of monitoring data, with focus of Acoustic Emissions (AE) from lab scale modeling and field case histories of EGS reservoir creation.« less

Advanced Simulation and Computing Business Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rummel, E.

To maintain a credible nuclear weapons program, the National Nuclear Security Administration’s (NNSA’s) Office of Defense Programs (DP) needs to make certain that the capabilities, tools, and expert staff are in place and are able to deliver validated assessments. This requires a complete and robust simulation environment backed by an experimental program to test ASC Program models. This ASC Business Plan document encapsulates a complex set of elements, each of which is essential to the success of the simulation component of the Nuclear Security Enterprise. The ASC Business Plan addresses the hiring, mentoring, and retaining of programmatic technical staff responsiblemore » for building the simulation tools of the nuclear security complex. The ASC Business Plan describes how the ASC Program engages with industry partners—partners upon whom the ASC Program relies on for today’s and tomorrow’s high performance architectures. Each piece in this chain is essential to assure policymakers, who must make decisions based on the results of simulations, that they are receiving all the actionable information they need.« less

Disease control operations

USGS Publications Warehouse

Friend, M.; Franson, J.C.

1999-01-01

Individual disease outbreaks have killed many thousands of animals on numerous occasions. Tens of thousands of migratory birds have died in single die-offs with as many as 1,000 birds succumbing in 1 day. The ability to successfully combat such explosive situations is highly dependent on the readiness of field personnel to deal with them. Because many disease agents can spread through wildlife populations very quickly, advance preparation is essential for preventing infected animals from spreading disease to additional species and locations. Carefully thought-out disease contingency plans should be developed as practical working documents for field personnel and updated as necessary. Well-designed plans can prove invaluable in minimizing wildlife losses and the costs associated with disease control activities.Although requirements for disease control operations vary and must be tailored to each situation, all disease contingency planning involves general concepts and basic biological information. This chapter, which is intended to be a practical guide, identifies the major activities and needs of disease control operations, and relates them to disease contingency planning.

RELAP-7 Software Verification and Validation Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Curtis L.; Choi, Yong-Joon; Zou, Ling

This INL plan comprehensively describes the software for RELAP-7 and documents the software, interface, and software design requirements for the application. The plan also describes the testing-based software verification and validation (SV&V) process—a set of specially designed software models used to test RELAP-7. The RELAP-7 (Reactor Excursion and Leak Analysis Program) code is a nuclear reactor system safety analysis code being developed at Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework – MOOSE (Multi-Physics Object-Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty yearsmore » of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s capability and extends the analysis capability for all reactor system simulation scenarios.« less

Improvised Nuclear Device Case Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buddemeier, Brooke; Suski, Nancy

2011-07-12

Reducing the casualties of catastrophic terrorist attacks requires an understanding of weapons of mass destruction (WMD) effects, infrastructure damage, atmospheric dispersion, and health effects. The Federal Planning Guidance for Response to a Nuclear Detonation provides the strategy for response to an improvised nuclear device (IND) detonation. The supporting science developed by national laboratories and other technical organizations for this document significantly improves our understanding of the hazards posed by such an event. Detailed fallout predictions from the advanced suite of three-dimensional meteorology and plume/fallout models developed at Lawrence Livermore National Laboratory, including extensive global geographical and real-time meteorological databases tomore » support model calculations, are a key part of response planning. This presentation describes the methodology and results to date, including visualization aids developed for response organizations. These products have greatly enhanced the community planning process through first-person points of view and description of the dynamic nature of the event.« less

Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians.

PubMed

Yap, Sok Shin; Chen, Karren; Detering, Karen M; Fraser, Scott A

2017-05-23

To identify factors that influence the engagement of Chinese Australians with advance care planning. Despite the benefits of advance care planning, there is a low prevalence of advance care planning in the Chinese Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death; however, other logistical factors may also be important. This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in advance care planning. Semistructured interviews were conducted in-language (Mandarin or Cantonese) exploring the views of a purposive sample of 30 community-dwelling older Chinese Australians within Victoria, Australia. Three key themes were identified: knowledge of, attitudes towards and needs for undertaking advance care planning amongst the Chinese Australians. There was a low awareness of advance care planning amongst the participants and some confusion regarding the concept. Most participants reported positive attitudes towards advance care planning but acknowledged that others may be uncomfortable discussing death-related topics. Participants would want to know the true status of their health and plan ahead in consultation with family members to reduce the burden on the family and suffering for themselves. Language was identified as the largest barrier to overcome to increase advance care planning awareness. In-language materials and key support networks including GPs, family and Chinese community groups were identified as ideal forums for the promotion of advance care planning. The participants of this study were open to conversations regarding future medical planning and end-of-life care, suggesting the low uptake of advance care planning amongst Chinese Australians is not culturally motivated but may be due a lack of knowledge relating to advance care planning. The results highlight the need to provide access to appropriate in-language advance care planning resources and promotion of advance care planning across the Chinese community. © 2017 John Wiley & Sons Ltd.

Care planning for aggression management in a specialist secure mental health service: An audit of user involvement.

PubMed

Hallett, Nutmeg; Huber, Jörg W; Sixsmith, Judith; Dickens, Geoffrey L

2016-12-01

This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation. © 2016 Australian College of Mental Health Nurses Inc.

14 CFR 77.2 - Definition of terms.

Code of Federal Regulations, 2011 CFR

2011-01-01

... approach system is planned and is so indicated by an FAA approved airport layout plan; a military service approved military airport layout plan; any other FAA planning document, or military service military... layout plan, a military service approved military airport layout plan, or by any planning document...

Documenting Living Monuments in Indonesia: Methodology for Sustainable Utility

NASA Astrophysics Data System (ADS)

Suryaningsih, F.; Purwestri, N.

2013-07-01

The systematic documentation of cultural heritage in Indonesia has been developed after the establishment of Bataviaasch Genootschap van Kunsten en Wetenschappen (1778) and De Oudheidkundige Dienst (1913) by the Netherlands Indies government. After Indonesian independent, the tasks of cultural heritage documentation take over by The Ministry of Culture (now become The Ministry of Education of Culture) with focus on the ancient and classical heritage, so called dead monument. The needed of comprehensive documentation data regarding cultural heritage become significant issues since the government and private sector pay attention to the preservation of heritage building in the urban site, so called living monument. The archives of original drawing plan many times do not fit with the existing condition, while the conservation plan demands a document such as built drawing plan to work on. The technology, methodology and system to provide such comprehensive document of heritage building and site become important, to produce good conservation plan and heritage building regular maintenance. It means the products will have a sustainable and various utility values. Since 1994, Documentation Centre for Architecture - Indonesia (PDA), has established to meet the needs of a comprehensive data of heritage building (living monuments), to utilized as basic document for conservation planning. Not only provide document of the digital drawing such site plan, plan, elevation, section and details of architecture elements, but also document of historic research, material analysis and completed with diagnosis and mapping of building damages. This manuscript is about PDA field experience, working in this subject issue

Contractors Road Heavy Equipment Area SWMU 055 Corrective Measures Implementation Progress Report Kennedy Space Center, Florida

NASA Technical Reports Server (NTRS)

Johnson, Jill W. (Compiler)

2015-01-01

This Corrective Measures Implementation (CMI) Progress Report documents: (i) activities conducted as part of supplemental assessment activities completed from June 2009 through November 2014; (ii) Engineering Evaluation (EE) Advanced Data Packages (ADPs); and (iii) recommendations for future activities related to corrective measures at the Site. Applicable meeting minutes are provided as Appendix A. The following EE ADPs for CRHE are included with this CMI Progress Report: center dot Supplemental Site Characterization ADP (Step 1 EE) (Appendix B) center dot Site Characterization ADP (Step 1 EE) for Hot Spot 1 (HS1) (Appendix C) center dot Remedial Alternatives Evaluation (Step 2 EE) ADP for HS1 (Appendix D) center dot Interim Measures Work Plan (Step 3 EE) ADP for HS1 (Appendix E) center dot Site Characterization ADP (Step 1 EE) ADP for Hot Spot 2 (HS2), High Concentration Plume (HCP), and Low Concentration Plume (LCP) (Appendix F) A summary of direct-push technology (DPT) and groundwater monitoring well sampling results are provided in Appendices G and H, respectively. The Interim Land Use Control Implementation Plan (LUCIP) is provided as Appendix I. Monitoring well completion reports, other applicable field forms, survey data, and analytical laboratory reports are provided as Appendices J through M, respectively, in the electronic copy of this document. Selected Site photographs are provided in Appendix N. The interim groundwater monitoring plan and document revision log are included as Appendices O and P, respectively. KSC Electronic Data Deliverable (KEDD) files are provided on the attached compact disk.

Knowledge About and Perceptions of Advance Care Planning and Communication of Chinese-American Older Adults.

PubMed

Yonashiro-Cho, Jeanine; Cote, Sarah; Enguidanos, Susan

2016-09-01

Although advance care planning (ACP) is associated with better care at the end of life, better quality of death, and less psychological distress in survivors, ethnic disparities in ACP completion rates have been documented and may be attributable to lack of knowledge about ACP or differences in cultural values and preferences. Despite rapid increases in the size of the Asian-American population, little is known about ACP preferences of Chinese Americans. The purpose of this study is to explore the knowledge, attitudes, and preferences of older Chinese Americans toward ACP. Focus groups with Chinese older adults (n = 34) were conducted in Mandarin, Cantonese, and English, and transcripts were analyzed using a grounded theory approach. Identified themes included knowledge and experience with ACP and end-of-life care options, health as a factor in timing of ACP and communication, and communication of end-of-life care preferences. Knowledge of and experience with ACP and end-of-life decision-making varied according to focus group, although few participants had an advance directive. Findings suggest that Chinese older adults prefer to use indirect communication strategies, such as commenting on the circumstances of others rather than directly stating their wishes, and informal contexts, such as during a family dinner rather than formal meeting, to convey their care preferences to loved ones and may employ similar tactics when communicating with clinicians. This is particularly important given the recent decision by the Centers for Medicare and Medicaid Services to provide reimbursement to physicians for engaging in advance care planning conversations. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Attitudes, experiences, and beliefs affecting end-of-life decision-making among homeless individuals.

PubMed

Tarzian, Anita J; Neal, Maggie T; O'Neil, J Anne

2005-02-01

Individuals who are homeless may encounter various barriers to obtaining quality end-of-life (EOL) care, including access barriers, multiple sources of discrimination, and lack of knowledge among health care providers (HCPs) of their preferences and decision-making practices. Planning for death with individuals who have spent so much energy surviving requires an understanding of their experiences and preferences. This study sought to increase HCPs' awareness and understanding of homeless or similarly marginalized individuals' EOL experiences and treatment preferences. Focus groups were conducted with homeless individuals using a semi-structured interview guide to elicit participants' EOL experiences, decision-making practices, and personal treatment preferences. Five focus groups were conducted with 20 inner-city homeless individuals (4 per group) at a free urban health care clinic for homeless individuals in the United States. Sixteen of the 20 participants were African American; 4 were Caucasian. None were actively psychotic. All had experienced multiple losses and drug addiction. Five main themes emerged: valuing an individual's wishes; acknowledging emotions; the primacy of religious beliefs and spiritual experience; seeking relationship-centered care; and reframing advance care planning. The narrative process of this qualitative study uncovered an approach to EOL decision-making in which participants' reasoning was influenced by emotions, religious beliefs, and spiritual experience. Relationship-centered care, characterized by compassion and respectful, two-way communication, was obvious by its described absence--reasons for this are discussed. Recommendations for reframing advance care planning include ways for HCPs to transform advance care planning from that of a legal document to a process of goal-setting that is grounded in human connection, respect, and understanding.

14 CFR 151.117 - Advance planning proposals: Procedures; application.

Code of Federal Regulations, 2011 CFR

2011-01-01

... desiring to obtain Federal aid for the purpose of advance planning and engineering must submit a completed... existence, must accompany the advance planning proposal. If the advance planning proposal includes...

14 CFR 151.117 - Advance planning proposals: Procedures; application.

Code of Federal Regulations, 2010 CFR

2010-01-01

... desiring to obtain Federal aid for the purpose of advance planning and engineering must submit a completed... existence, must accompany the advance planning proposal. If the advance planning proposal includes...

20 CFR 669.660 - What planning documents and information are required in the application for MSFW youth grants and...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What planning documents and information are... PROGRAM UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT The MSFW Youth Program § 669.660 What planning...? The required planning documents and other required information and the submission dates for filing are...

Allison PD 370-42 advanced turboprop engine. Final report, October 1978-February 1979

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stolp, P.

1979-02-01

This study developed data on Detroit Diesel Allison (DDA) common core derivative engines for use in Maritime Patrol Aircraft (MPA) concept formulation studies. The study included the screening of potential DDA turboprop/turboshaft engines and the preparation of technical and planning information on three of the most promising engine candidates plus an all new engine. Screening of DDA Derivative candidates was performed utilizing an analytical MPA model using synthesized mission profiles to rank the candidates in terms of fuel consumption, weight, cost and complexity. The three turboprop engines selected for further study were as follows: a derivative of the unity sizemore » T701-AD-700 shaft power engine with rematched turbine (PD 370-37), an advanced T701 turboprop derivative with 25:1 overall pressure ratio and a scaled ATEGG demonstrated compressor (PD 370-40), an advanced T701 turboprop derivative with 17.7:1 overall pressure ratio and a scaled ATEGG demonstrated compressor (PD 370-4D al and experimental results attests to the accuracy of the assembled mechanism in its description of the homogenrt documents program highlights and research results for CY 1979 along with plans for the completion of program investigations. Postirradiation test data are presented for plateen chemical s.« less

[Truth telling and advance care planning at the end of life].

PubMed

Hu, Wen-Yu; Yang, Chia-Ling

2009-02-01

One of the core values in terminal care the respect of patient 'autonomy'. This essay begins with a discussion of medical ethics principles and the Natural Death Act in Taiwan and then summarizes two medical ethical dilemmas, truth telling and advance care planning (ACP), faced in the development of hospice and palliative care in Taiwan. The terminal truth telling process incorporates the four basic principles of Assessment and preparation, Communication with family, Truth-telling process, and Support and follow up (the so-called "ACTs"). Many experts suggest practicing ACP by abiding by the following five steps: (1) presenting and illustrating topics; (2) facilitating a structured discussion; (3) completing documents with advanced directives (ADs); (4) reviewing and updating ADs; and (5) applying ADs in clinical circumstances. Finally, the myths and challenges in truth telling and ADs include the influence of healthcare system procedures and priorities, inadequate communication skills, and the psychological barriers of medical staffs. Good communication skills are critical to truth telling and ACP. Significant discussion about ACP should help engender mutual trust between patients and the medical staffs who take the time to establish such relationships. Promoting patient autonomy by providing the opportunity of a good death is an important goal of truth telling and ACP in which patients have opportunities to choose their terminal treatment.

Challenges and opportunities in patient-specific, motion-managed and PET/CT-guided radiation therapy of lung cancer: review and perspective

PubMed Central

2012-01-01

The increasing interest in combined positron emission tomography (PET) and computed tomography (CT) to guide lung cancer radiation therapy planning has been well documented. Motion management strategies during treatment simulation PET/CT imaging and treatment delivery have been proposed to improve the precision and accuracy of radiotherapy. In light of these research advances, why has translation of motion-managed PET/CT to clinical radiotherapy been slow and infrequent? Solutions to this problem are as complex as they are numerous, driven by large inter-patient variability in tumor motion trajectories across a highly heterogeneous population. Such variation dictates a comprehensive and patient-specific incorporation of motion management strategies into PET/CT-guided radiotherapy rather than a one-size-fits-all tactic. This review summarizes challenges and opportunities for clinical translation of advances in PET/CT-guided radiotherapy, as well as in respiratory motion-managed radiotherapy of lung cancer. These two concepts are then integrated into proposed patient-specific workflows that span classification schemes, PET/CT image formation, treatment planning, and adaptive image-guided radiotherapy delivery techniques. PMID:23369522

Integrated Electronic Warfare System Advanced Development Model (ADM); Appendix 1 - Functional Requirement Specification.

DTIC Science & Technology

1977-10-01

APPROVED DATE FUNCTION APPROVED jDATE WRITER J . K-olanek 2/6/76 REVISIONS CHK DESCRIPTION REV CHK DESCRIPTION IREV REVISION jJ ~ ~ ~~~ _ II SHEET NO...DOCUMENT (CDBDD) 45 5.5 COMPUTER PROGRAM PACKAGE (CPP)- j 45 5.6 COMPUTER PROGRAM OPERATOR’S MANUAL (CPOM) 45 5.7 COMPUTER PROGRAM TEST PLAN (CPTPL) 45...I LIST OF FIGURES Number Page 1 JEWS Simplified Block Diagram 4 2 System Controller Architecture 5 SIZE CODE IDENT NO DRAWING NO. A 49956 SCALE REV J

MAPGEN: Mixed-Initiative Activity Planning for the Mars Exploration Rover Mission

NASA Technical Reports Server (NTRS)

Ai-Chang, Mitchell; Bresina, John; Hsu, Jennifer; Jonsson, Ari; Kanefsky, Bob; McCurdy, Michael; Morris, Paul; Rajan, Kanna; Vera, Alonso; Yglesias, Jeffrey

2004-01-01

This document describes the Mixed initiative Activity Plan Generation system MAPGEN. This system is one of the critical tools in the Mars Exploration Rover mission surface operations, where it is used to build activity plans for each of the rovers, each Martian day. The MAPGEN system combines an existing tool for activity plan editing and resource modeling, with an advanced constraint-based reasoning and planning framework. The constraint-based planning component provides active constraint and rule enforcement, automated planning capabilities, and a variety of tools and functions that are useful for building activity plans in an interactive fashion. In this demonstration, we will show the capabilities of the system and demonstrate how the system has been used in actual Mars rover operations. In contrast to the demonstration given at ICAPS 03, significant improvement have been made to the system. These include various additional capabilities that are based on automated reasoning and planning techniques, as well as a new Constraint Editor support tool. The Constraint Editor (CE) as part of the process for generating these command loads, the MAPGEN tool provides engineers and scientists an intelligent activity planning tool that allows them to more effectively generate complex plans that maximize the science return each day. The key to the effectiveness of the MAPGEN tool is an underlying constraint-based planning and reasoning engine.

20 CFR 668.720 - What information must these planning documents contain?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What information must these planning... 166 Planning/Funding Process § 668.720 What information must these planning documents contain? (a) The... planning instructions issued by the Department, the comprehensive services plan must describe in narrative...

26 CFR 301.6104(a)-3 - Public inspection of Internal Revenue Service letters and documents relating to pension and other...

Code of Federal Regulations, 2010 CFR

2010-04-01

... letters and documents relating to pension and other plans. 301.6104(a)-3 Section 301.6104(a)-3 Internal... of Internal Revenue Service letters and documents relating to pension and other plans. (a) In general... qualification of a pension, profit-sharing or stock bonus plan under section 401(a), an annuity plan under...

Implementation of green infrastructure concept in Citarum Watershed

NASA Astrophysics Data System (ADS)

Maryati, Sri; Humaira, An Nisaa'Siti

2017-03-01

Green infrastructure has several benefits compared to grey infrastructure in term of environmental services and sustainability, such as reducing energy consumption, improving air quality, providing carbon sequestration, and increasing property values. Nevertheless in practice, the implementation of the concept in Indonesia is still limited. Implementation of the certain concept has to be guided in planning document. In this paper, green infrastructure concept in the current spatial plan and other planning documents is assessed. The purpose of this research is to figure out how far the green infrastructure concept is integrated into planning system, based on the analysis of planning documents in Citarum Watershed and expert interviews with local stakeholders. Content analysis method is used to analyze the documents and result of interview. The result shows that green infrastructure concept has not been accommodated in spatial plan or other planning documents widely. There are some challenges in implementing the concept including reward and punishment system (incentive and disincentive), coordination, and lack of human resources.

Planning, Conducting, and Documenting Data Analysis for Program Improvement

ERIC Educational Resources Information Center

Winer, Abby; Taylor, Cornelia; Derrington, Taletha; Lucas, Anne

2015-01-01

This 2015 document was developed to help technical assistance (TA) providers and state staff define and limit the scope of data analysis for program improvement efforts, including the State Systemic Improvement Plan (SSIP); develop a plan for data analysis; document alternative hypotheses and additional analyses as they are generated; and…

Advance Care Planning for Serious Illness

MedlinePlus

ADVANCE CARE PLANNING FOR SERIOUS ILLNESS Making plans for the health care you want during a serious illness is called “advance care planning.” Planning involves learning about your illness, understanding choices ...

Advance care planning for nursing home residents with dementia: policy vs. practice.

PubMed

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2016-03-01

The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.

Mobile Launch Platform Vehicle Assembly Area (SWMU 056) Biosparge Expansion Interim Measures Work Plan

NASA Technical Reports Server (NTRS)

Burcham, Michael S.; Daprato, Rebecca C.

2016-01-01

This document presents the design details for an Interim Measure (IM) Work Plan (IMWP) for the Mobile Launch Platform/Vehicle Assembly Building (MLPV) Area, located at the John F. Kennedy Space Center (KSC), Florida. The MLPV Area has been designated Solid Waste Management Unit Number 056 (SWMU 056) under KSC's Resource Conservation and Recovery Act (RCRA) Corrective Action Program. This report was prepared by Geosyntec Consultants (Geosyntec) for the National Aeronautics and Space Administration (NASA) under contract number NNK09CA02B and NNK12CA13B, project control number ENV1642. The Advanced Data Package (ADP) presentation covering the elements of this IMWP report received KSC Remediation Team (KSCRT) approval at the December 2015 Team Meeting; the meeting minutes are included in Appendix A.

Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

PubMed

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2017-01-01

(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

40 CFR 93.118 - Criteria and procedures: Motor vehicle emissions budget.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PLANS Conformity to State or Federal Implementation Plans of Transportation Plans, Programs, and..., consultation among federal, State, and local agencies occurred; full implementation plan documentation was... response to comments that are required to be submitted with any implementation plan. EPA will document its...

40 CFR 93.118 - Criteria and procedures: Motor vehicle emissions budget.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PLANS Conformity to State or Federal Implementation Plans of Transportation Plans, Programs, and..., consultation among federal, State, and local agencies occurred; full implementation plan documentation was... response to comments that are required to be submitted with any implementation plan. EPA will document its...

Multiyear Program Plan for the High Temperature Materials Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arvid E. Pasto

2000-03-17

Recently, the U.S. Department of Energy's (DOE) Office of Heavy Vehicle Technologies (OHVT) prepared a Technology Roadmap describing the challenges facing development of higher fuel efficiency, less polluting sport utility vehicles, vans, and commercial trucks. Based on this roadmap, a multiyear program plan (MYPP) was also developed, in which approaches to solving the numerous challenges are enumerated. Additional planning has been performed by DOE and national laboratory staff, on approaches to solving the numerous challenges faced by heavy vehicle system improvements. Workshops and planning documents have been developed concerning advanced aerodynamics, frictional and other parasitic losses, and thermal management. Similarly,more » the Heavy Vehicle Propulsion Materials Program has developed its own multiyear program plan. The High Temperature Materials Laboratory, a major user facility sponsored by OHVT, has now developed its program plan, described herein. Information was gathered via participation in the development of OHVT's overall Technology Roadmap and MYPP, through personal contacts within the materials-user community, and from attendance at conferences and expositions. Major materials issues for the heavy vehicle industry currently center on trying to increase efficiency of (diesel) engines while at the same time reducing emissions (particularly NO{sub x} and particulates). These requirements dictate the use of increasingly stronger, higher-temperature capable and more corrosion-resistant materials of construction, as well as advanced catalysts, particulate traps, and other pollution-control devices. Exhaust gas recirculation (EGR) is a technique which will certainly be applied to diesel engines in the near future, and its use represents a formidable challenge, as will be described later. Energy-efficient, low cost materials processing methods and surface treatments to improve wear, fracture, and corrosion resistance are also required.« less

Corridor Planning And Feasibility Analysis Corridor, Master Plan

DOT National Transportation Integrated Search

1996-04-01

THE I-70 RURAL IVHS CORRIDOR MASTER PLAN IS THE GUIDANCE DOCUMENT FOR DEPLOYMENT OF THE INTELLIGENT TRANSPORTATION SYSTEM (ITS) FOR THE INTERSTATE-70 CORRIDOR FROM DENVER TO GLENWOOD SPRINGS, COLORADO. AS A WORKING DOCUMENT, THE PLAN RECOMMENDS STRAT...

A practical guide on DTA model applications for regional planning

DOT National Transportation Integrated Search

2016-06-07

This document is intended as a guide for use by Metropolitan Planning Organizations (MPO) and other planning agencies that are interested in applying Dynamic Traffic Assignment (DTA) models for planning applications. The objective of this document is...

30 CFR 254.4 - May I reference other documents in my response plan?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false May I reference other documents in my response plan? 254.4 Section 254.4 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR... May I reference other documents in my response plan? You may reference information contained in other...

NOAA Office of Exploration and Research > About OER > Strategic Plan

Science.gov Websites

Organization Guiding Documents Organizational Structure Map of Staff and Affiliate Locations Strategic Plan Media News Room OER Symposium Overview Organization Guiding Documents Organizational Structure Map of Strategic Plan Home About OER Overview Organization Guiding Documents Organizational Structure Map of Staff

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

PubMed Central

Szarka, Jackie; McFarland, Lynne V.; Taylor, Janelle S.; Sudore, Rebecca L.; Trivedi, Ranak; Reinke, Lynn F.; Vig, Elizabeth K.

2016-01-01

Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease. Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. Results The comments of providers interviewed for this study spoke to significant system–level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. Conclusions The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease. PMID:27084877

Provider Perspectives on Advance Care Planning for Patients with Kidney Disease: Whose Job Is It Anyway?

PubMed

O'Hare, Ann M; Szarka, Jackie; McFarland, Lynne V; Taylor, Janelle S; Sudore, Rebecca L; Trivedi, Ranak; Reinke, Lynn F; Vig, Elizabeth K

2016-05-06

There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease. Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease. Copyright © 2016 by the American Society of Nephrology.

Future ATM Concepts Evaluation Tool (FACET) Interface Control Document

NASA Technical Reports Server (NTRS)

Grabbe, Shon R.

2017-01-01

This Interface Control Document (ICD) documents the airspace adaptation and air traffic inputs of NASA's Future ATM Concepts and Evaluation Tool (FACET). Its intended audience is the project manager, project team, development team, and stakeholders interested in interfacing with the system. FACET equips Air Traffic Management (ATM) researchers and service providers with a way to explore, develop and evaluate advanced air transportation concepts before they are field-tested and eventually deployed. FACET is a flexible software tool that is capable of quickly generating and analyzing thousands of aircraft trajectories. It provides researchers with a simulation environment for preliminary testing of advanced ATM concepts. Using aircraft performance profiles, airspace models, weather data, and flight schedules, the tool models trajectories for the climb, cruise, and descent phases of flight for each type of aircraft. An advanced graphical interface displays traffic patterns in two and three dimensions, under various current and projected conditions for specific airspace regions or over the entire continental United States. The system is able to simulate a full day's dynamic national airspace system (NAS) operations, model system uncertainty, measure the impact of different decision-makers in the NAS, and provide analysis of the results in graphical form, including sector, airport, fix, and airway usage statistics. NASA researchers test and analyze the system-wide impact of new traffic flow management algorithms under anticipated air traffic growth projections on the nation's air traffic system. In addition to modeling the airspace system for NASA research, FACET has also successfully transitioned into a valuable tool for operational use. Federal Aviation Administration (FAA) traffic flow managers and commercial airline dispatchers have used FACET technology for real-time operations planning. FACET integrates live air traffic data from FAA radar systems and weather data from the National Weather Service to summarize NAS performance. This information allows system operators to reroute flights around congested airspace and severe weather to maintain safety and minimize delay. FACET also supports the planning and post-operational evaluation of reroute strategies at the national level to maximize system efficiency. For the commercial airline passenger, strategic planning with FACET can result in fewer flight delays and cancellations. The performance capabilities of FACET are largely due to its architecture, which strikes a balance between flexibility and fidelity. FACET is capable of modeling the airspace operations for the continental United States, processing thousands of aircraft on a single computer. FACET was written in Java and C, enabling the portability of its software to a variety of operating systems. In addition, FACET was designed with a modular software architecture to facilitate rapid prototyping of diverse ATM concepts. Several advanced ATM concepts have already been implemented in FACET, including aircraft self-separation, prediction of aircraft demand and sector congestion, system-wide impact assessment of traffic flow management constraints, and wind-optimal routing.

Technical Needs for Prototypic Prognostic Technique Demonstration for Advanced Small Modular Reactor Passive Components

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meyer, Ryan M.; Coble, Jamie B.; Hirt, Evelyn H.

2013-05-17

This report identifies a number of requirements for prognostics health management of passive systems in AdvSMRs, documents technical gaps in establishing a prototypical prognostic methodology for this purpose, and describes a preliminary research plan for addressing these technical gaps. AdvSMRs span multiple concepts; therefore a technology- and design-neutral approach is taken, with the focus being on characteristics that are likely to be common to all or several AdvSMR concepts. An evaluation of available literature is used to identify proposed concepts for AdvSMRs along with likely operational characteristics. Available operating experience of advanced reactors is used in identifying passive components thatmore » may be subject to degradation, materials likely to be used for these components, and potential modes of degradation of these components. This information helps in assessing measurement needs for PHM systems, as well as defining functional requirements of PHM systems. An assessment of current state-of-the-art approaches to measurements, sensors and instrumentation, diagnostics and prognostics is also documented. This state-of-the-art evaluation, combined with the requirements, may be used to identify technical gaps and research needs in the development, evaluation, and deployment of PHM systems for AdvSMRs. A preliminary research plan to address high-priority research needs for the deployment of PHM systems to AdvSMRs is described, with the objective being the demonstration of prototypic prognostics technology for passive components in AdvSMRs. Greater efficiency in achieving this objective can be gained through judicious selection of materials and degradation modes that are relevant to proposed AdvSMR concepts, and for which significant knowledge already exists. These selections were made based on multiple constraints including the analysis performed in this document, ready access to laboratory-scale facilities for materials testing and measurement, and potential synergies with other national laboratory and university partners.« less

Advance care planning among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis.

PubMed

Carrion, Iraida V; Nedjat-Haiem, Frances R; Martinez-Tyson, Dinorah; Castañeda, Heide

2013-05-01

Limited knowledge exists pertaining to advance care planning (ACP) among Colombian, Mexican, and Puerto Rican women with a cancer diagnosis living in Central Florida, in the USA. The purpose of the study is to identify factors that facilitated the completion of ACP and decisions making patterns among the three groups of Latinas. The research method used was an exploratory qualitative in-depth open-ended semi-structured interview with a grounded theoretical approach and thematic analysis. The interviews were conducted in Spanish with a purposeful sample of 45 Latinas (15 in each group) diagnosed with cancer. A total of ten women (22 %) in the study documented at least one form of ACP. Thirty-five women identified obstacles to accessing information regarding ACP, relating this to insurance and financial factors. Among the Colombian women, one completed a living will, health care surrogate, and power of attorney (all forms of ACP), and three just a living will. Two Puerto Rican women completed all, two a living will, and one both a living will and an enduring power of attorney. Only one Mexican woman completed a living will. This study identifies a knowledge gap regarding ACP among Latina women with cancer diagnosis living in Central Florida, in the USA. Differences between the three groups exist as a result of migration/immigration history, family support, education, English language proficiency, income, knowledge gaps, and information ascertained by medical and health professionals. These differences contribute to their readiness, receptiveness, and willingness to engage in documenting a living will, a health care surrogate, and an enduring power of attorney for health decisions.

42 CFR 137.361 - Does the Secretary have any other opportunities to approve planning or design documents prepared...

Code of Federal Regulations, 2010 CFR

2010-10-01

... approve planning or design documents prepared by the Self-Governance Tribe? 137.361 Section 137.361 Public... OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Roles of the Secretary in... opportunities to approve planning or design documents prepared by the Self-Governance Tribe? Yes, but only if...

Requirement of scientific documentation for the development of Naturopathy.

PubMed

Rastogi, Rajiv

2006-01-01

Past few decades have witnessed explosion of knowledge in almost every field. This has resulted not only in the advancement of the subjects in particular but also have influenced the growth of various allied subjects. The present paper explains about the advancement of science through efforts made in specific areas and also through discoveries in different allied fields having an indirect influence upon the subject in proper. In Naturopathy this seems that though nothing particular is added to the basic thoughts or fundamental principles of the subject yet the entire treatment understanding is revolutionised under the influence of scientific discoveries of past few decades. Advent of information technology has further added to the boom of knowledge and many times this seems impossible to utilize these informations for the good of human being because these are not logically arranged in our minds. In the above background, the author tries to define documentation stating that we have today ocean of information and knowledge about various things- living or dead, plants, animals or human beings; the geographical conditions or changing weather and environment. What required to be done is to extract the relevant knowledge and information required to enrich the subject. The author compares documentation with churning of milk to extract butter. Documentation, in fact, is churning of ocean of information to extract the specific, most appropriate, relevant and defined information and knowledge related to the particular subject . The paper besides discussing the definition of documentation, highlights the areas of Naturopathy requiring an urgent necessity to make proper documentations. Paper also discusses the present status of Naturopathy in India, proposes short-term and long-term goals to be achieved and plans the strategies for achieving them. The most important aspect of the paper is due understanding of the limitations of Naturopathy but a constant effort to improve the same with the growth made in various discipline of science so far.

Legislative Framework for Landscape Planning in Latvia

NASA Astrophysics Data System (ADS)

Nitavska, Natalija; Zigmunde, Daiga

2017-10-01

With the adoption and the ratification of the European Landscape Convention a legally justified need for a clear landscape policy was grounded in the European countries. It includes the elaboration of the new and the improvement of the existing legislative documents on landscape planning, protection and management. The aim of the particular study is to analyse the existing legislative documents in Latvia influencing landscape planning on different scales / and the implementation of the European Landscape Convention. The study emphasizes the complex structure of the Latvian legislative framework affected by the distribution of the normative documents under the various ministries. Therefore, the main problem is unclear responsibility levels and organizational system for solving the issues regarding landscape planning, protection and management. Thus the various discussions between the involved disciplines and responsible institutions are arising. Two groups of the legislative documents influencing the implementation of the landscape policy in Latvia are detected within the study. The first group is strategic documents determining main landscape planning principles and directions at European, national, regional and professional or sectoral level. The second group is operational documents providing a set of actions for the landscape planning, protection and management at the local or the municipality level. The study concludes that operational documents developed by the municipalities are in high importance because of their direct influence on the landscape planning in Latvia. This often leads to the different landscape planning requirements included in the normative documents of the neighbouring municipalities, although the spatial and ecological borders of the visual landscape do not fit with the formal borders of the municipalities. Thus, it is essential to develop the common principles and actions that would be incumbent on all municipalities to provide the landscape integrity and to protect its values according to the main principles defined in the European Landscape Convention.

Northwest Forest Plan research synthesis.

Treesearch

Richard W. Haynes; Gloria E. Perez; [tech. eds.].

2000-01-01

This document synthesizes research accomplishments initiated and funded under the Northwest Forest Plan or the President’s Forest Plan (hereafter referred to as the Forest Plan) since its inception in 1994. Three major parts in this document cover, the context for this effort, eight Forest Plan research accomplishments, and a synthesis. The eight accomplishments...

Base heating methodology improvements, volume 1

NASA Technical Reports Server (NTRS)

Bender, Robert L.; Reardon, John E.; Somers, Richard E.; Fulton, Michael S.; Smith, Sheldon D.; Pergament, Harold

1992-01-01

This document is the final report for NASA MSFC Contract NAS8-38141. The contracted effort had the broad objective of improving the launch vehicles ascent base heating methodology to improve and simplify the determination of that environment for Advanced Launch System (ALS) concepts. It was pursued as an Advanced Development Plan (ADP) for the Joint DoD/NASA ALS program office with project management assigned to NASA/MSFC. The original study was to be completed in 26 months beginning Sep. 1989. Because of several program changes and emphasis on evolving launch vehicle concepts, the period of performance was extended to the current completion date of Nov. 1992. A computer code incorporating the methodology improvements into a quick prediction tool was developed and is operational for basic configuration and propulsion concepts. The code and its users guide are also provided as part of the contract documentation. Background information describing the specific objectives, limitations, and goals of the contract is summarized. A brief chronology of the ALS/NLS program history is also presented to provide the reader with an overview of the many variables influencing the development of the code over the past three years.

Language Documentation in the Americas

ERIC Educational Resources Information Center

Franchetto, Bruna; Rice, Keren

2014-01-01

In the last decades, the documentation of endangered languages has advanced greatly in the Americas. In this paper we survey the role that international funding programs have played in advancing documentation in this part of the world, with a particular focus on the growth of documentation in Brazil, and we examine some of the major opportunities…

System-level planning, coordination, and communication: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

PubMed

Dichter, Jeffrey R; Kanter, Robert K; Dries, David; Luyckx, Valerie; Lim, Matthew L; Wilgis, John; Anderson, Michael R; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V; Christian, Michael D; Kissoon, Niranjan

2014-10-01

System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises.

System-Level Planning, Coordination, and Communication

PubMed Central

Kanter, Robert K.; Dries, David; Luyckx, Valerie; Lim, Matthew L.; Wilgis, John; Anderson, Michael R.; Sarani, Babak; Hupert, Nathaniel; Mutter, Ryan; Devereaux, Asha V.; Christian, Michael D.; Kissoon, Niranjan; Christian, Michael D.; Devereaux, Asha V.; Dichter, Jeffrey R.; Kissoon, Niranjan; Rubinson, Lewis; Amundson, Dennis; Anderson, Michael R.; Balk, Robert; Barfield, Wanda D.; Bartz, Martha; Benditt, Josh; Beninati, William; Berkowitz, Kenneth A.; Daugherty Biddison, Lee; Braner, Dana; Branson, Richard D; Burkle, Frederick M.; Cairns, Bruce A.; Carr, Brendan G.; Courtney, Brooke; DeDecker, Lisa D.; De Jong, Marla J.; Dominguez-Cherit, Guillermo; Dries, David; Einav, Sharon; Erstad, Brian L.; Etienne, Mill; Fagbuyi, Daniel B.; Fang, Ray; Feldman, Henry; Garzon, Hernando; Geiling, James; Gomersall, Charles D.; Grissom, Colin K.; Hanfling, Dan; Hick, John L.; Hodge, James G.; Hupert, Nathaniel; Ingbar, David; Kanter, Robert K.; King, Mary A.; Kuhnley, Robert N.; Lawler, James; Leung, Sharon; Levy, Deborah A.; Lim, Matthew L.; Livinski, Alicia; Luyckx, Valerie; Marcozzi, David; Medina, Justine; Miramontes, David A.; Mutter, Ryan; Niven, Alexander S.; Penn, Matthew S.; Pepe, Paul E.; Powell, Tia; Prezant, David; Reed, Mary Jane; Rich, Preston; Rodriquez, Dario; Roxland, Beth E.; Sarani, Babak; Shah, Umair A.; Skippen, Peter; Sprung, Charles L.; Subbarao, Italo; Talmor, Daniel; Toner, Eric S.; Tosh, Pritish K.; Upperman, Jeffrey S.; Uyeki, Timothy M.; Weireter, Leonard J.; West, T. Eoin; Wilgis, John; Ornelas, Joe; McBride, Deborah; Reid, David; Baez, Amado; Baldisseri, Marie; Blumenstock, James S.; Cooper, Art; Ellender, Tim; Helminiak, Clare; Jimenez, Edgar; Krug, Steve; Lamana, Joe; Masur, Henry; Mathivha, L. Rudo; Osterholm, Michael T.; Reynolds, H. Neal; Sandrock, Christian; Sprecher, Armand; Tillyard, Andrew; White, Douglas; Wise, Robert; Yeskey, Kevin

2014-01-01

BACKGROUND: System-level planning involves uniting hospitals and health systems, local/regional government agencies, emergency medical services, and other health-care entities involved in coordinating and enabling care in a major disaster. We reviewed the literature and sought expert opinions concerning system-level planning and engagement for mass critical care due to disasters or pandemics and offer suggestions for system-planning, coordination, communication, and response. The suggestions in this chapter are important for all of those involved in a pandemic or disaster with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. METHODS: The American College of Chest Physicians (CHEST) consensus statement development process was followed in developing suggestions. Task Force members met in person to develop nine key questions believed to be most relevant for system-planning, coordination, and communication. A systematic literature review was then performed for relevant articles and documents, reports, and other publications reported since 1993. No studies of sufficient quality were identified upon which to make evidence-based recommendations. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. RESULTS: Suggestions were developed and grouped according to the following thematic elements: (1) national government support of health-care coalitions/regional health authorities (HC/RHAs), (2) teamwork within HC/RHAs, (3) system-level communication, (4) system-level surge capacity and capability, (5) pediatric patients and special populations, (6) HC/RHAs and networks, (7) models of advanced regional care systems, and (8) the use of simulation for preparedness and planning. CONCLUSIONS: System-level planning is essential to provide care for large numbers of critically ill patients because of disaster or pandemic. It also entails a departure from the routine, independent system and involves all levels from health-care institutions to regional health authorities. National government support is critical, as are robust communication systems and advanced planning supported by realistic exercises. PMID:25144713

The development and validation of the advance care planning questionnaire in Malaysia.

PubMed

Lai, Pauline Siew Mei; Mohd Mudri, Salinah; Chinna, Karuthan; Othman, Sajaratulnisah

2016-10-18

Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia. The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration. Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947. The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.

Solid waste information and tracking system client-server conversion project management plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

May, D.L.

1998-04-15

This Project Management Plan is the lead planning document governing the proposed conversion of the Solid Waste Information and Tracking System (SWITS) to a client-server architecture. This plan presents the content specified by American National Standards Institute (ANSI)/Institute of Electrical and Electronics Engineers (IEEE) standards for software development, with additional information categories deemed to be necessary to describe the conversion fully. This plan is a living document that will be reviewed on a periodic basis and revised when necessary to reflect changes in baseline design concepts and schedules. This PMP describes the background, planning and management of the SWITS conversion.more » It does not constitute a statement of product requirements. Requirements and specification documentation needed for the SWITS conversion will be released as supporting documents.« less

Transitioning HIV-infected youth into adult health care.

PubMed

2013-07-01

With advances in antiretroviral therapy, most HIV-infected children survive into adulthood. Optimal health care for these youth includes a formal plan for the transition of care from primary and/or subspecialty pediatric/adolescent/family medicine health care providers (medical home) to adult health care provider(s). Successful transition involves the early engagement and participation of the youth and his or her family with the pediatric medical home and adult health care teams in developing a formal plan. Referring providers should have a written policy for the transfer of HIV-infected youth to adult care, which will guide in the development of an individualized plan for each youth. The plan should be introduced to the youth in early adolescence and modified as the youth approaches transition. Assessment of developmental milestones is important to define the readiness of the youth in assuming responsibility for his or her own care before initiating the transfer. Communication among all providers is essential and should include both personal contact and a written medical summary. Progress toward the transition should be tracked and,once completed, should be documented and assessed.

Nursing electives: an innovative and creative learning opportunity.

PubMed

Peate, Ian

Nursing elective can provide the nurse (learner or registered nurse) with a host of new opportunities to experience and observe practice from a variety of different perspectives. The nursing elective should be planned well in advance and much time and thought should be given to preparing for this activity. There are a number of resources (human and material) available to help with the planning of the event and as such careful and thorough planning at an early stage can make the activity much more successful. The funding of the elective event needs to be thought about early on in the planning stage if this is likely to be an issue. Practical considerations, such as insurance cover, honorary contracts, travel and other documents must also be considered carefully. The elective opportunity has the potential to provide the individual with a unique experience, a chance to delve deeper in relation to a particular area of interest as well as potentially experiencing the provision of health care through an alternative lens. The success of the elective largely depends upon the amount of effort the individual puts into it.

Strategic planning in hospitals in two Australian states: an exploratory study of its practice using planning documentation.

PubMed

Jayasuriya, R; Sim, A B

1998-01-01

Hospitals are under pressure to respond to new challenges and competition. Many hospitals have used strategic planning to respond to these environmental changes. This exploratory study examines the extent of strategic planning in hospitals in two Australian States, New South Wales and Victoria, using a sample survey. Based on planning documentation, the study indicated that 47% of the hospitals surveyed did not have a strategic or business plan. A significant difference was found in the comprehensiveness of the plans between the two States. Plans from Victorian hospitals had more documented evidence of external/internal analysis, competitor orientation and customer orientation compared with plans from New South Wales hospitals. The paper discusses the limitations of the study and directions for future research.

End-of-life care of oncology inpatients: Are we getting it right?

PubMed

Batten, Monique; Nguyen, Bella; Burke, Brandon; Harryanto, Hilman; Mitchell, Imogen; Davis, Alison

2018-06-13

To examine the current patterns of end-of-life care of medical oncology patients dying in an Australian tertiary acute hospital setting in order to determine potential areas for improvement. A retrospective observational study was undertaken of 295 consecutive adult medical oncology inpatients dying between 2010 and 2015. Charts were reviewed for evidence of (1) resuscitation plans, (2) acute interventions in the 48-h period prior to death, (3) palliative care involvement and (4) recognition of the dying patient and comfort care plans. At the time of death, 98% of patients had a resuscitation plan, 71% of which were completed by the medical oncology team. Fifty-nine percent of medical emergency team reviews occurred in patients without a documented resuscitation plan. Within 48 h of death, active interventions were still being given to 64% of patients in the total patient population. Comfort care plans were documented in 86% of patients; however, 62% of these were only documented within 48 h of death and 20% of patients with a documented comfort care plan still received noncomfort measures. There was a high level of documented resuscitation plans, comfort care plans and recognition of dying. However, active interventions were common within 48 h of death, and comfort care plans and recognition of dying often occurred late. These data indicate a gap between documenting a resuscitation plan and providing timely and appropriate end-of-life care. Understanding the gaps in delivering appropriate care provides an opportunity for improving end-of-life care. © 2018 John Wiley & Sons Australia, Ltd.

Technical Readiness and Gaps Analysis of Commercial Optical Materials and Measurement Systems for Advanced Small Modular Reactors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anheier, Norman C.; Suter, Jonathan D.; Qiao, Hong

2013-08-06

This report intends to support Department of Energy’s Office of Nuclear Energy (DOE-NE) Nuclear Energy Research and Development Roadmap and industry stakeholders by evaluating optical-based instrumentation and control (I&C) concepts for advanced small modular reactor (AdvSMR) applications. These advanced designs will require innovative thinking in terms of engineering approaches, materials integration, and I&C concepts to realize their eventual viability and deployability. The primary goals of this report include: 1. Establish preliminary I&C needs, performance requirements, and possible gaps for AdvSMR designs based on best available published design data. 2. Document commercial off-the-shelf (COTS) optical sensors, components, and materials in termsmore » of their technical readiness to support essential AdvSMR in-vessel I&C systems. 3. Identify technology gaps by comparing the in-vessel monitoring requirements and environmental constraints to COTS optical sensor and materials performance specifications. 4. Outline a future research, development, and demonstration (RD&D) program plan that addresses these gaps and develops optical-based I&C systems that enhance the viability of future AdvSMR designs. The development of clean, affordable, safe, and proliferation-resistant nuclear power is a key goal that is documented in the Nuclear Energy Research and Development Roadmap. This roadmap outlines RD&D activities intended to overcome technical, economic, and other barriers, which currently limit advances in nuclear energy. These activities will ensure that nuclear energy remains a viable component to this nation’s energy security.« less

Research synergy and drug development: Bright stars in neighboring constellations.

PubMed

Keserci, Samet; Livingston, Eric; Wan, Lingtian; Pico, Alexander R; Chacko, George

2017-11-01

Drug discovery and subsequent availability of a new breakthrough therapeutic or 'cure' is a compelling example of societal benefit from research advances. These advances are invariably collaborative, involving the contributions of many scientists to a discovery network in which theory and experiment are built upon. To document and understand such scientific advances, data mining of public and commercial data sources coupled with network analysis can be used as a digital methodology to assemble and analyze component events in the history of a therapeutic. This methodology is extensible beyond the history of therapeutics and its use more generally supports (i) efficiency in exploring the scientific history of a research advance (ii) documenting and understanding collaboration (iii) portfolio analysis, planning and optimization (iv) communication of the societal value of research. Building upon prior art, we have conducted a case study of five anti-cancer therapeutics to identify the collaborations that resulted in the successful development of these therapeutics both within and across their respective networks. We have linked the work of over 235,000 authors in roughly 106,000 scientific publications that capture the research crucial for the development of these five therapeutics. Applying retrospective citation discovery, we have identified a core set of publications cited in the networks of all five therapeutics and additional intersections in combinations of networks. We have enriched the content of these networks by annotating them with information on research awards from the US National Institutes of Health (NIH). Lastly, we have mapped these awards to their cognate peer review panels, identifying another layer of collaborative scientific activity that influenced the research represented in these networks.

23 CFR 420.111 - What are the documentation requirements for use of FHWA planning and research funds?

Code of Federal Regulations, 2010 CFR

2010-04-01

... and Research Funds § 420.111 What are the documentation requirements for use of FHWA planning and... 23 Highways 1 2010-04-01 2010-04-01 false What are the documentation requirements for use of FHWA planning and research funds? 420.111 Section 420.111 Highways FEDERAL HIGHWAY ADMINISTRATION, DEPARTMENT OF...

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

3 CFR - Unified Command Plan 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unified Command Plan 2011 Presidential Documents Other Presidential Documents Memorandum of April 6, 2011 Unified Command Plan 2011 Memorandum for the... implementation of the revised Unified Command Plan. Consistent with title 10, United States Code, section 161(b...

75 FR 9334 - Multiemployer Pension Plan Information Made Available on Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-02

..., strategies) that, if disclosed by the plan, may cause, or increase a reasonable risk of, financial harm to... certain actuarial and financial documents about the plan to participants, beneficiaries, employee... request, shall furnish copies of certain actuarial and financial documents to any plan participant...

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study

PubMed Central

2014-01-01

Background High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Methods Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Results Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Conclusions Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. PMID:25067908

Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

PubMed

Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

2014-01-01

High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation.

PubMed

Pereira-Salgado, Amanda; Mader, Patrick; O'Callaghan, Clare; Boyd, Leanne

2018-04-16

Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals' solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study. ©Amanda Pereira-Salgado, Patrick Mader, Clare O' Callaghan, Leanne Boyd. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 16.04.2018.

A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation

PubMed Central

Mader, Patrick; O'Callaghan, Clare; Boyd, Leanne

2018-01-01

Background Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. Objective The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. Methods The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. Results Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study. PMID:29661749

Technical aspects of quality assurance in radiation oncology

PubMed Central

Saw, CB; Ferenci, MS; Wanger, H

2008-01-01

The technical aspects of quality assurance (QA) in radiation oncology as practice in the United States will be reviewed and updated in the spirit of offering the experience to the radiation oncology communities in the Asia-Pacific region. The word “technical” is used to express the organisational components or processes and not the materials within the QA program. A comprehensive QA program in radiation oncology will have an official statement declaring the quality plan for effective patient care services it provides in a document. The QA program will include all aspects of patient care: physical, clinical, and medical aspects of the services. The document will describe the organisational structure, responsibilities, checks and procedures, and resources allocated to ensure the successful implementation of the quality of patient management. Regulatory guidelines and guidelines from accreditation agencies should be incorporated in the QA program to ensure compliance. The organisational structure will have a multidisciplinary QA committee that has the authority to evaluate continuously the effectiveness of the QA program to provide prompt corrective recommendations and to request feedback as needed to monitor the response. The continuous monitoring aspects require meetings to be held at regular intervals with the minutes of the meetings officially recorded and documented. To ensure that a QA program is effective, the program itself should be audited for quality at regular intervals at least annually. It has been recognised that the current QA program has not kept abreast with the rapid implementation of new and advanced radiation therapy technologies with the most recent in image-based radiation therapy technology. The societal bodies (ASTRO and AAPM) and federal agency (NCI) acknowledge this inadequacy and have held workshops to address this issue. The challenges for the societal bodies and federal agency are numerous that include (a) the prescriptive methodology used may not be appropriate for currently implemented new technologies, (b) resources are becoming scarce, (c) advanced radiation therapy technologies have been introduced too rapidly, (d) advances in radiation therapy technologies have become too sophisticated and specialised with each therapy modality having its own separate set of equipment, for example its own dose planning software, computer system and dose delivery systems requiring individualised QA procedures. At the present time, industrial engineers are being recruited to assist in devising a methodology that is broad-based and more process-oriented risk-based formulation of QA in radiation oncology. PMID:21611011

"Hope for the best, prepare for the worst": A qualitative interview study on parents' needs and fears in pediatric advance care planning.

PubMed

Lotz, Julia Desiree; Daxer, Marion; Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika

2017-09-01

Pediatric advance care planning is advocated by healthcare providers because it may increase the chance that patient and/or parent wishes are respected and thus improve end-of-life care. However, since end-of-life decisions for children are particularly difficult and charged with emotions, physicians are often afraid of addressing pediatric advance care planning. We aimed to investigate parents' views and needs regarding pediatric advance care planning. We performed a qualitative interview study with parents of children who had died from a severe illness. The interviews were analyzed by descriptive and evaluation coding according to Saldaña. We conducted semi-structured interviews with 11 parents of 9 children. Maximum variation was sought regarding the child's illness, age at death, care setting, and parent gender. Parents find it difficult to engage in pediatric advance care planning but consider it important. They argue for a sensitive, individualized, and gradual approach. Hope and quality of life issues are primary. Parents have many non-medical concerns that they want to discuss. Written advance directives are considered less important, but medical emergency plans are viewed as necessary in particular cases. Continuity of care and information should be improved through regular pediatric advance care planning meetings with the various care providers. Parents emphasize the importance of a continuous contact person to facilitate pediatric advance care planning. Despite a need for pediatric advance care planning, it is perceived as challenging. Needs-adjusted content and process and continuity of communication should be a main focus in pediatric advance care planning. Future research should focus on strategies that facilitate parent engagement in pediatric advance care planning to increase the benefit for the families.

First-of-A-Kind Control Room Modernization Project Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, Kenneth David

This project plan describes a comprehensive approach to the design of an end-state concept for a modernized control room for Palo Verde. It describes the collaboration arrangement between the DOE LWRS Program Control Room Modernization Project and the APS Palo Verde Nuclear Generating Station. It further describes the role of other collaborators, including the Institute for Energy Technology (IFE) and the Electric Power Research Institute (EPRI). It combines advanced tools, methodologies, and facilities to enable a science-based approach to the validation of applicable engineering and human factors principles for nuclear plant control rooms. It addresses the required project results andmore » documentation to demonstrate compliance with regulatory requirements. It describes the project tasks that will be conducted in the project, and the deliverable reports that will be developed through these tasks. This project plan will be updated as new tasks are added and as project milestones are completed. It will serve as an ongoing description on the project both for project participants and for industry stakeholders.« less

The Practice of Health Program Evaluation.

PubMed

Lewis, Sarah R

2017-11-01

The Practice of Health Program Evaluation provides an overview of the evaluation process for public health programs while diving deeper to address select advanced concepts and techniques. The book unfolds evaluation as a three-phased process consisting of identification of evaluation questions, data collection and analysis, and dissemination of results and recommendations. The text covers research design, sampling methods, as well as quantitative and qualitative approaches. Types of evaluation are also discussed, including economic assessment and systems research as relative newcomers. Aspects critical to conducting a successful evaluation regardless of type or research design are emphasized, such as stakeholder engagement, validity and reliability, and adoption of sound recommendations. The book encourages evaluators to document their approach by developing an evaluation plan, a data analysis plan, and a dissemination plan, in order to help build consensus throughout the process. The evaluative text offers a good bird's-eye view of the evaluation process, while offering guidance for evaluation experts on how to navigate political waters and advocate for their findings to help affect change.

Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations

PubMed Central

Lum, Hillary D.; Jones, Jacqueline; Matlock, Daniel D.; Glasgow, Russell E.; Lobo, Ingrid; Levy, Cari R.; Schwartz, Robert S.; Sudore, Rebecca L.; Kutner, Jean S.

2016-01-01

PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care–based group visit model focused on advance care planning. METHODS We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTS Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics. CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. PMID:26951587

Quality-assurance plan for the analysis of suspended sediment by the U.S. Geological Survey in Montana

USGS Publications Warehouse

Dodge, Kent A.; Lambing, John H.

2006-01-01

A quality-assurance plan has been developed for use by the sediment laboratory of the U.S. Geological Survey Montana Water Science Center in conducting activities related to the analysis of suspended sediment. The plan documents quality-assurance policies for sediment-laboratory certification, personnel responsibilities and training, documentation requirements, and laboratory safety. The plan also documents quality-assurance procedures related to laboratory equipment and supplies, sample management, sample analysis, analytical quality control, and data management.

222-S Laboratory Quality Assurance Plan. Revision 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meznarich, H.K.

1995-07-31

This Quality Assurance Plan provides,quality assurance (QA) guidance, regulatory QA requirements (e.g., 10 CFR 830.120), and quality control (QC) specifications for analytical service. This document follows the U.S Department of Energy (DOE) issued Hanford Analytical Services Quality Assurance Plan (HASQAP). In addition, this document meets the objectives of the Quality Assurance Program provided in the WHC-CM-4-2, Section 2.1. Quality assurance elements required in the Guidelines and Specifications for Preparing Quality Assurance Program Plans (QAMS-004) and Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans (QAMS-005) from the US Environmental Protection Agency (EPA) are covered throughout this document. A qualitymore » assurance index is provided in the Appendix A. This document also provides and/or identifies the procedural information that governs laboratory operations. The personnel of the 222-S Laboratory and the Standards Laboratory including managers, analysts, QA/QC staff, auditors, and support staff shall use this document as guidance and instructions for their operational and quality assurance activities. Other organizations that conduct activities described in this document for the 222-S Laboratory shall follow this QA/QC document.« less

Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies.

PubMed

Ke, Li-Shan; Huang, Xiaoyan; O'Connor, Margaret; Lee, Susan

2015-08-01

To explore nurses' views regarding implementing advance care planning for older people. Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review. Qualitative meta-synthesis. Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted. This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning. The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted. © 2015 John Wiley & Sons Ltd.

Evidence still insufficient that advance care documentation leads to engagement of healthcare professionals in end-of-life discussions: A systematic review.

PubMed

Lewis, Ebony; Cardona-Morrell, Magnolia; Ong, Kok Y; Trankle, Steven A; Hillman, Ken

2016-10-01

Administration of non-beneficial life-sustaining treatments in terminal elderly patients still occurs due to lack of knowledge of patient's wishes or delayed physician-family communications on preference. To determine whether advance care documentation encourages healthcare professional's timely engagement in end-of-life discussions. Systematic review of the English language articles published from January 2000 to April 2015. EMBASE, MEDLINE, EBM REVIEWS, PsycINFO, CINAHL and Cochrane Library and manual searches of reference lists. A total of 24 eligible articles from 10 countries including 23,914 subjects met the inclusion criteria, mostly using qualitative or mixed methods, with the exception of two cohort studies. The influence of advance care documentation on initiation of end-of-life discussions was predominantly based on perceptions, attitudes, beliefs and personal experience rather than on standard replicable measures of effectiveness in triggering the discussion. While health professionals reported positive perceptions of the use of advance care documentations (18/24 studies), actual evidence of their engagement in end-of-life discussions or confidence gained from accessing previously formulated wishes in advance care documentations was not generally available. Perceived effectiveness of advance care documentation in encouraging end-of-life discussions appears to be high but is mostly derived from low-level evidence studies. This may indicate a willingness and openness of patients, surrogates and staff to perceive advance directives as an instrument to improve communication, rather than actual evidence of timeliness or effectiveness from suitably designed studies. The assumption that advance care documentations will lead to higher physicians' confidence or engagement in communicating with patients/families could not be objectively demonstrated in this review. © The Author(s) 2016.

The ecological future of cities.

PubMed

McDonnell, Mark J; MacGregor-Fors, Ian

2016-05-20

The discipline of urban ecology arose in the 1990s, primarily motivated by a widespread interest in documenting the distribution and abundance of animals and plants in cities. Today, urban ecologists have greatly expanded their scope of study to include ecological and socioeconomic processes, urban management, planning, and design, with the goal of addressing issues of sustainability, environmental quality, and human well-being within cities and towns. As the global pace of urbanization continues to intensify, urban ecology provides the ecological and social data, as well as the principles, concepts and tools, to create livable cities. Copyright © 2016, American Association for the Advancement of Science.

Connected Vehicle Impacts on Transportation Planning—Outreach to Planning Community.

DOT National Transportation Integrated Search

2016-06-01

This document presents outreach memos on 11 case studies analyzing the impacts of connected and automated vehicles (C/AV) on transportation planning products. These 11 case studies are documented indepth in the associated project document entitled Co...

U.S. Coast Guard Telecommunications Plan (TCP) - Development Document

DOT National Transportation Integrated Search

1997-04-28

The Coast Guard Telecommunications Plan (TCP) describes the near to mid-term telecommunications goals and objectives for Command, Control, and Communications (C3) support. It is intended to document internal telecommunications planning and to provide...

Advance Care Planning and the Quality of End-of-Life Care among Older Adults

PubMed Central

Bischoff, Kara E.; Sudore, Rebecca; Miao, Yinghui; Boscardin, W. John; Smith, Alexander K.

2013-01-01

Background Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Design Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative Health and Retirement Study. Participants 4394 decedent subjects (mean age 82.6 years at death, 55% women). Measurements Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (p<0.01 for all). Conclusion Advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning. PMID:23350921

Risk Quantification of Systems Engineering Documents Improves Probability of DOD Project Success

DTIC Science & Technology

2009-09-01

comprehensive risk model for DoD milestone review documentation as well as recommended changes to the Capability Maturity Model Integration ( CMMI ) Project...Milestone Documentation, Project Planning, Rational Frame, Political Frame, CMMI Project Planning Process Area, CMMI Risk Management Process Area...well as recommended changes to the Capability Maturity Model Integration ( CMMI ) Project Planning and Risk Management process areas. The intent is to

Decoupling the use and meaning of strategic plans in public healthcare

PubMed Central

2013-01-01

Background The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs? Methods An analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents. Results The analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible. Conclusions The evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different stakeholders, although they use different language to answer to the different expectations of each stakeholder. Therefore, strategic planning and plans seem to be driven by neo-institutional approaches, as they are means to build consensus and negotiate ground for strategic actions, rather than means to identify strategic choices and priorities. PMID:23289527

Decoupling the use and meaning of strategic plans in public healthcare.

PubMed

Lega, Federico; Longo, Francesco; Rotolo, Andrea

2013-01-04

The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs? An analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents. The analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible. The evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different stakeholders, although they use different language to answer to the different expectations of each stakeholder. Therefore, strategic planning and plans seem to be driven by neo-institutional approaches, as they are means to build consensus and negotiate ground for strategic actions, rather than means to identify strategic choices and priorities.

High satisfaction and low decisional conflict with advance care planning among chronically ill patients with advanced chronic obstructive pulmonary disease or heart failure using an online decision aid: A pilot study.

PubMed

Van Scoy, Lauren J; Green, Michael J; Dimmock, Anne Ef; Bascom, Rebecca; Boehmer, John P; Hensel, Jessica K; Hozella, Joshua B; Lehman, Erik B; Schubart, Jane R; Farace, Elana; Stewart, Renee R; Levi, Benjamin H

2016-09-01

Many patients with chronic illnesses report a desire for increased involvement in medical decision-making. This pilot study aimed to explore how patients with exacerbation-prone disease trajectories such as advanced heart failure or chronic obstructive pulmonary disease experience advance care planning using an online decision aid and to compare whether patients with different types of exacerbation-prone illnesses had varied experiences using the tool. Pre-intervention questionnaires measured advance care planning knowledge. Post-intervention questionnaires measured: (1) advance care planning knowledge; (2) satisfaction with tool; (3) decisional conflict; and (4) accuracy of the resultant advance directive. Comparisons were made between patients with heart failure and chronic obstructive pulmonary disease. Over 90% of the patients with heart failure (n = 24) or chronic obstructive pulmonary disease (n = 25) reported being "satisfied" or "highly satisfied" with the tool across all satisfaction domains; over 90% of participants rated the resultant advance directive as "very accurate." Participants reported low decisional conflict. Advance care planning knowledge scores rose by 18% (p < 0.001) post-intervention. There were no significant differences between participants with heart failure and chronic obstructive pulmonary disease. Patients with advanced heart failure and chronic obstructive pulmonary disease were highly satisfied after using an online advance care planning decision aid and had increased knowledge of advance care planning. This tool can be a useful resource for time-constrained clinicians whose patients wish to engage in advance care planning. © The Author(s) 2016.

Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

PubMed

Zhou, Guiyun; Stoltzfus, Jill C; Houldin, Arlene D; Parks, Susan M; Swan, Beth Ann

2010-11-01

To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Descriptive, cross-sectional, pilot survey study. The eastern United States. 300 oncology APNs. Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.

25 CFR 1000.52 - What criteria will the Director use to award advance planning grants?

Code of Federal Regulations, 2010 CFR

2010-04-01

... planning grants? 1000.52 Section 1000.52 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS... INDIAN SELF-DETERMINATION AND EDUCATION ACT Section 402(d) Planning and Negotiation Grants Advance Planning Grant Funding § 1000.52 What criteria will the Director use to award advance planning grants...

An Inventory of Documents on Educational Planning and Management in Asia and the Pacific.

ERIC Educational Resources Information Center

Mellor, Warren L., Ed.

This document comprises a UNESCO-sponsored inventory of documents on educational planning and management in Asia and the Pacific. The database consists of 714 documents from participating countries, divided into 10 subsections by country and indexed according to author and subject. The main entries are grouped alphabetically by country, as…

Advancing palliative care in the Uganda health system: an evidence-based policy brief.

PubMed

Nabudere, Harriet; Obuku, Ekwaro; Lamorde, Mohammed

2014-12-01

This paper describes the development and findings for a policy brief on "Advancing the Integration of Palliative Care into the National Health System" and the subsequent use of this report. Key stakeholders involved with palliative care helped identify the problem and potential policy solutions to scale up these services within the health system. A working group of national stakeholder representatives and external reviewers commented on and contributed to successive drafts of the report. Research describing the problem, policy options and implementation considerations was identified by reviewing government documents, routinely collected data, electronic literature searches, contact with key informants, and reviewing the reference lists of relevant documents that were retrieved. The palliative burden is not only high but increasing due to the rise in population and life expectancy. A few options for holistic, supportive care include: Home-based care increases chances of a peaceful death for the terminally ill surrounded by their loved ones; supporting informal caregivers improves their quality of life and discharge planning reduces unscheduled admissions and has the potential to free up capacity for acute care services. A combination of strategies is needed to effectively implement the proposed options as discussed further in this article. The policy brief report was used as a background document for two stakeholder dialogues whose main outcome was that a comprehensive national palliative care policy should be instituted to include all the options, which need to be integrated within the public health system. A draft policy is now in process.

Laboratory Directed Research and Development Program FY98

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hansen, T.; Chartock, M.

1999-02-05

The Ernest Orlando Lawrence Berkeley National Laboratory (LBNL or Berkeley Lab) Laboratory Directed Research and Development Program FY 1998 report is compiled from annual reports submitted by principal investigators following the close of the fiscal year. This report describes the supported projects and summarizes their accomplishments. It constitutes a part of the Laboratory Directed Research and Development (LDRD) program planning and documentation process that includes an annual planning cycle, projection selection, implementation, and review. The LBNL LDRD program is a critical tool for directing the Laboratory's forefront scientific research capabilities toward vital, excellent, and emerging scientific challenges. The program providesmore » the resources for LBNL scientists to make rapid and significant contributions to critical national science and technology problems. The LDRD program also advances LBNL's core competencies, foundations, and scientific capability, and permits exploration of exciting new opportunities. All projects are work in forefront areas of science and technology. Areas eligible for support include the following: Advanced study of hypotheses, concepts, or innovative approaches to scientific or technical problems; Experiments and analyses directed toward ''proof of principle'' or early determination of the utility of new scientific ideas, technical concepts, or devices; and Conception and preliminary technical analyses of experimental facilities or devices.« less

[Who should decide at the end of life? International practice of advance care planning and possibilities for adaptation in Hungary].

PubMed

Busa, Csilla; Zeller, Judit; Csikós, Ágnes

2018-01-01

At the advanced stage of serious illness, end-of-life decisions need to be made. Advance care planning offers patients the right to decide on their own future care when independent decision-making is no longer possible. The most complex and effective advance care plans include patients' preferred or refused medical treatments, care-related wishes, and individual values as well. Advance care planning can improve end-of-life care and contribute to higher satisfaction. It can also reduce distress in relatives and the costs of care. Patients' preferences provide a guidance for professional care. A number of studies have identified the benefits of advance care planning, and it has been included in guidelines. Potential barriers to advance care planning could be as follows: taboo of talking about dying, negative attitudes of patients and relatives, poor knowledge of professional caregivers, lack of necessary circumstances to have the conversation. Advance care planning is almost unknown in Hungary, although it is possible to refuse certain types of treatments. Cooperation of professionals, development of gradual and postgraduate trainings, and improvement of social awareness are also needed so that advance care planning can be adapted in Hungary. Orv Hetil. 2018; 159(4): 131-140.

Three-dimensional surgical simulation.

PubMed

Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

2010-09-01

In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

3D Surgical Simulation

PubMed Central

Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

2009-01-01

This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

Santa Barbara City College: 1999-02 College Plan.

ERIC Educational Resources Information Center

Santa Barbara City Coll., CA.

This document presents Santa Barbara City College's 1999-2002 College Plan. It is intended to be used as the central organizing document for decision making, planning, and budgeting throughout the College during the 1999-2002 period. This plan is the result of thoughtful and substantive dialogue involving individuals and groups throughout the…

El Camino College Master Plan.

ERIC Educational Resources Information Center

El Camino Coll., Torrance, CA.

This document is the educational Master Plan for El Camino Community College District. The purpose of the plan is to develop a research-based document that will be used as a foundation for decisions regarding instructional programs, support services, staffing and facilities. It is intended to serve as the basic foundation for all other plans of…

HFE Process Guidance and Standards for potential application to updating NRC guidance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jacques Hugo; J. J. Persensky

2012-07-01

The U.S. Nuclear Regulatory Commission (NRC) reviews and evaluates the human factors engineering (HFE) programs of applicants for nuclear power plant construction permits, operating licenses, standard design certifications, and combined operating licenses. The purpose of these safety reviews is to help ensure that personnel performance and reliability are appropriately supported. Detailed design review procedures and guidance for the evaluations is provided in three key documents: the Standard Review Plan (NUREG-0800), the HFE Program Review Model (NUREG-0711), and the Human-System Interface Design Review Guidelines (NUREG-0700). These documents were last revised in 2007, 2004 and 2002, respectively. The NRC is committed tomore » the periodic update and improvement of these guidance documents to ensure that they remain state-of-the-art design evaluation tools. Thus, the NRC has initiated a project with BNL to update the NRC guidance to remain current with recent research on human performance, advances in HFE methods and tools, and new technology. INL supported Brookhaven National Lab (BNL) to update the detailed HFE review criteria contained in NUREG-0711 and NUREG-0700 based on (1) feedback obtained from end users, (2) the results of NRC research and development efforts supporting the NRC staff’s HFE safety reviews, and (3) other material the project staff identify as applicable to the update effort. INL submitted comments on development plans and sections of NUREGs 0800, 0711, and 0700. The contractor prepared the report attached here as the deliverable for this work.« less

ANMCO/SIC Consensus Document: cardiology networks for outpatient heart failure care

PubMed Central

Gulizia, Michele Massimo; Di Lenarda, Andrea; Mortara, Andrea; Battistoni, Ilaria; De Maria, Renata; Gabriele, Michele; Iacoviello, Massimo; Navazio, Alessandro; Pini, Daniela; Di Tano, Giuseppe; Marini, Marco; Ricci, Renato Pietro; Alunni, Gianfranco; Radini, Donatella; Metra, Marco; Romeo, Francesco

2017-01-01

Abstract Changing demographics and an increasing burden of multiple chronic comorbidities in Western countries dictate refocusing of heart failure (HF) services from acute in-hospital care to better support the long inter-critical out-of- hospital phases of HF. In Italy, as well as in other countries, needs of the HF population are not adequately addressed by current HF outpatient services, as documented by differences in age, gender, comorbidities and recommended therapies between patients discharged for acute hospitalized HF and those followed-up at HF clinics. The Italian Working Group on Heart Failure has drafted a guidance document for the organisation of a national HF care network. Aims of the document are to describe tasks and requirements of the different health system points of contact for HF patients, and to define how diagnosis, management and care processes should be documented and shared among health-care professionals. The document classifies HF outpatient clinics in three groups: (i) community HF clinics, devoted to management of stable patients in strict liaison with primary care, periodic re-evaluation of emerging clinical needs and prompt treatment of impending destabilizations, (ii) hospital HF clinics, that target both new onset and chronic HF patients for diagnostic assessment, treatment planning and early post-discharge follow-up. They act as main referral for general internal medicine units and community clinics, and (iii) advanced HF clinics, directed at patients with severe disease or persistent clinical instability, candidates to advanced treatment options such as heart transplant or mechanical circulatory support. Those different types of HF clinics are integrated in a dedicated network for management of HF patients on a regional basis, according to geographic features. By sharing predefined protocols and communication systems, these HF networks integrate multi-professional providers to ensure continuity of care and patient empowerment. In conclusion, This guidance document details roles and interactions of cardiology specialists, so as to best exploit the added value of their input in the care of HF patients and is intended to promote a more efficient and effective organization of HF services. PMID:28751837

A Review of Advanced Sewer System Design Technologies (WERF Report INFR4SG09d)

EPA Science Inventory

Abstract: This document seeks to collect into one place current and new technologies about sewerage system design. The document organizes the information found in the 295 documents that were reviewed into six subject areas: Advanced Onsite Technologies; Alternative Wastewater C...

Impact of advance care planning on the care of patients with heart failure: study protocol for a randomized controlled trial.

PubMed

Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A

2016-06-10

Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives are to compare differences in health care expenditures, quality of life, anxiety and depression, understanding of own illness, participation in decision-making and concordance with their caregiver's preferences for end-of-life care, between patients with advanced heart failure receiving advance care planning and usual care. This is a two-arm randomized controlled trial of advance care planning versus usual care (control) conducted at two institutions in Singapore. Two hundred and eighty-two patients with advanced heart failure (n = 94 in the advance care planning arm; n = 188 in the control arm receiving usual care) will be recruited from these centers and followed for 1 year or until they die, whichever is earlier. Additionally, the study will include up to one caregiver per patient enrolled. If advance care planning is proven to be effective, the results will help to promote its uptake among health care providers and patients both within Singapore and in other countries. NCT02299180 . Registered on 18 November 2014.

Thurston Region public transportation system architecture and strategic deployment plan. Technical memorandum #3

DOT National Transportation Integrated Search

2001-10-01

This document is the third in a series of five that present the sequential results of the Thurston Regional Planning Council (TRPC) Regional Intelligent Transportation Systems (ITS) : Planning Project. This document presents an ITS Strategic Depl...

Airport Surface Traffic Control Visual Ground Aids Engineering and Development Plan

DOT National Transportation Integrated Search

1977-01-01

The plan described in this document supports the overall program at the Transportation Systems Center to define, design, develop, and evaluate systems that meet the requirements of airport surface traffic control. This plan is part of documentation s...

Work Package 5: Contingency Management. Mission Planning Requirements Document: Preliminary Version. Revision A

NASA Technical Reports Server (NTRS)

2005-01-01

The purpose of this document is to identify the general flight/mission planning requirements for same-day file-and-fly access to the NAS for both civil and military High-Altitude Long Endurance (HALE) Unmanned Aircraft System (UAS). Currently the scope of this document is limited to Step 1, operations above flight level 43,000 feet (FL430). This document describes the current applicable mission planning requirements and procedures for both manned and unmanned aircraft and addresses HALE UAS flight planning considerations in the future National Airspace System (NAS). It also discusses the unique performance and operational capabilities of HALE UAS associated with the Access 5 Project, presents some of the projected performance characteristics and conceptual missions for future systems, and provides detailed analysis of the recommended mission planning elements for operating HALE UAS in the NAS.

Risk of 12-month mortality among hospital inpatients using the surprise question and SPICT criteria: a prospective study.

PubMed

Mudge, Alison M; Douglas, Carol; Sansome, Xanthe; Tresillian, Michael; Murray, Stephen; Finnigan, Simon; Blaber, Cheryl Ruth

2018-06-01

People with serious life-limiting disease benefit from advance care planning, but require active identification. This study applied the Gold Standards Framework Proactive Identification Guidance (GSF-PIG) to a general hospital population to describe high-risk patients and explore prognostic performance for 12-month mortality. Prospective cohort study conducted in a metropolitan teaching hospital in Australia. Hospital inpatients on a single day aged 18 years and older were eligible, excluding maternity and neonatal, mental health and day treatment patients. Data sources included medical record and structured questions for medical and nursing staff. High-risk was predefined as positive response to the surprise question (SQ) plus two or more SPICT indicators of general deterioration. Descriptive variables included demographics, frailty and functional measures, treating team, advance care planning documentation and hospital utilisation. Primary outcome for prognostic performance was 12-month mortality. We identified 540 eligible inpatients on the study day and 513 had complete data (mean age 60, 54% male, 30% living alone, 19% elective admissions). Of these, 191 (37%) were high-risk; they were older, frailer, more dependent and had been in hospital longer than low-risk participants. Within 12 months, 92 participants (18%) died (72/191(38%) high-risk versus 20/322(6%) low-risk, P<0.001), providing sensitivity 78%, specificity 72%, positive predictive value 38% and negative predictive value 94%. SQ alone provided higher sensitivity, adding advanced disease indicators improved specificity. The GSF-PIG approach identified a large minority of hospital inpatients who might benefit from advance care planning. Future studies are needed to investigate the feasibility, cost and impact of screening in hospitals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Where There's a Will: The Link Between Estate Planning and Disparities in Advance Care Planning by White and Black Older Adults.

PubMed

Koss, Catheryn S; Baker, Tamara A

2018-03-01

Data from the Health and Retirement Study ( n = 6,946) were used to test whether differences in estate planning accounted for disparities in advance care planning between White and Black older adults. White participants were more likely to have advance directives after controlling for demographic, health, and financial variables. When estate planning was also controlled, the odds of having an advance directive were equal for White and Black participants. In contrast, Whites remained more likely to discuss end-of-life preferences after controlling for demographic, health, financial, and estate planning variables. White participants were almost four times as likely to have wills or trusts. Wealth, income, and home ownership were predictive of estate planning. Financial disparities contributed to lower rates of estate planning which in turn explained in large part why Black older adults were less likely to have advance directives but did not account for race disparities in advance care discussion.

ShakeMap manual: technical manual, user's guide, and software guide

USGS Publications Warehouse

Wald, David J.; Worden, Bruce C.; Quitoriano, Vincent; Pankow, Kris L.

2005-01-01

ShakeMap (http://earthquake.usgs.gov/shakemap) --rapidly, automatically generated shaking and intensity maps--combines instrumental measurements of shaking with information about local geology and earthquake location and magnitude to estimate shaking variations throughout a geographic area. The results are rapidly available via the Web through a variety of map formats, including Geographic Information System (GIS) coverages. These maps have become a valuable tool for emergency response, public information, loss estimation, earthquake planning, and post-earthquake engineering and scientific analyses. With the adoption of ShakeMap as a standard tool for a wide array of users and uses came an impressive demand for up-to-date technical documentation and more general guidelines for users and software developers. This manual is meant to address this need. ShakeMap, and associated Web and data products, are rapidly evolving as new advances in communications, earthquake science, and user needs drive improvements. As such, this documentation is organic in nature. We will make every effort to keep it current, but undoubtedly necessary changes in operational systems take precedence over producing and making documentation publishable.

Cultural and religious beliefs and values, and their impact on preferences for end-of-life care among four ethnic groups of community-dwelling older persons.

PubMed

Ohr, Seok; Jeong, Sarah; Saul, Peter

2017-06-01

To explore specific cultural and religious beliefs and values concerning death and dying, truth telling, and advance care planning, and the preferences for end-of-life care among older persons from culturally and linguistically diverse backgrounds. Whilst literature indicates that culture impacts on end-of-life decision-making significantly, there is limited evidence on the topic. A cross-sectional survey. A total of 171 community older persons who make regular visits to 17 day care centres expressed in a questionnaire their; (1) beliefs about death and dying, truth telling, and advance care planning, and (2) preferences for end-of-life care. More than 92% of respondents believed that dying is a normal part of life, and more than 70% felt comfortable talking about death. Whilst respondents accepted dying as a normal part of life, 64% of Eastern Europeans and 53% of Asia/Pacific groups believed that death should be avoided at all costs. People from the Asia/Pacific group reported the most consensual view against all of the life-prolonging measures. Cultural and religious beliefs and values may have an impact on preferences for treatment at end-of-life. The study offers nurses empirical data to help shape conversations about end-of-life care, and thus to enhance their commitment to help people 'die well'. Information acquisition to extend understanding of each individual before proceeding with documentation of advance care planning is essential and should include retrieval of individuals' cultural and religious beliefs and values, and preferences for care. An institutional system and/or protocol that promote conversations about these among nurses and other healthcare professionals are warranted. © 2016 John Wiley & Sons Ltd.

Optimization of Deep Drilling Performance--Development and Benchmark Testing of Advanced Diamond Product Drill Bits & HP/HT Fluids to Significantly Improve Rates of Penetration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alan Black; Arnis Judzis

2003-10-01

This document details the progress to date on the OPTIMIZATION OF DEEP DRILLING PERFORMANCE--DEVELOPMENT AND BENCHMARK TESTING OF ADVANCED DIAMOND PRODUCT DRILL BITS AND HP/HT FLUIDS TO SIGNIFICANTLY IMPROVE RATES OF PENETRATION contract for the year starting October 2002 through September 2002. The industry cost shared program aims to benchmark drilling rates of penetration in selected simulated deep formations and to significantly improve ROP through a team development of aggressive diamond product drill bit--fluid system technologies. Overall the objectives are as follows: Phase 1--Benchmark ''best in class'' diamond and other product drilling bits and fluids and develop concepts for amore » next level of deep drilling performance; Phase 2--Develop advanced smart bit--fluid prototypes and test at large scale; and Phase 3--Field trial smart bit--fluid concepts, modify as necessary and commercialize products. Accomplishments to date include the following: 4Q 2002--Project started; Industry Team was assembled; Kick-off meeting was held at DOE Morgantown; 1Q 2003--Engineering meeting was held at Hughes Christensen, The Woodlands Texas to prepare preliminary plans for development and testing and review equipment needs; Operators started sending information regarding their needs for deep drilling challenges and priorities for large-scale testing experimental matrix; Aramco joined the Industry Team as DEA 148 objectives paralleled the DOE project; 2Q 2003--Engineering and planning for high pressure drilling at TerraTek commenced; 3Q 2003--Continuation of engineering and design work for high pressure drilling at TerraTek; Baker Hughes INTEQ drilling Fluids and Hughes Christensen commence planning for Phase 1 testing--recommendations for bits and fluids.« less

25 CFR 1001.9 - Selection criteria for tribes/consortia seeking advance planning grant funding.

Code of Federal Regulations, 2010 CFR

2010-04-01

... planning grant funding. 1001.9 Section 1001.9 Indians OFFICE OF THE ASSISTANT SECRETARY, INDIAN AFFAIRS... advance planning grant funding. (a) Who is eligible to apply for a planning grant that will be awarded...-governance tribe and needs advance funding in order to complete the planning phase requirement may apply...

Planning for the semiconductor manufacturer of the future

NASA Technical Reports Server (NTRS)

Fargher, Hugh E.; Smith, Richard A.

1992-01-01

Texas Instruments (TI) is currently contracted by the Air Force Wright Laboratory and the Defense Advanced Research Projects Agency (DARPA) to develop the next generation flexible semiconductor wafer fabrication system called Microelectronics Manufacturing Science & Technology (MMST). Several revolutionary concepts are being pioneered on MMST, including the following: new single-wafer rapid thermal processes, in-situ sensors, cluster equipment, and advanced Computer Integrated Manufacturing (CIM) software. The objective of the project is to develop a manufacturing system capable of achieving an order of magnitude improvement in almost all aspects of wafer fabrication. TI was awarded the contract in Oct., 1988, and will complete development with a fabrication facility demonstration in April, 1993. An important part of MMST is development of the CIM environment responsible for coordinating all parts of the system. The CIM architecture being developed is based on a distributed object oriented framework made of several cooperating subsystems. The software subsystems include the following: process control for dynamic control of factory processes; modular processing system for controlling the processing equipment; generic equipment model which provides an interface between processing equipment and the rest of the factory; specification system which maintains factory documents and product specifications; simulator for modelling the factory for analysis purposes; scheduler for scheduling work on the factory floor; and the planner for planning and monitoring of orders within the factory. This paper first outlines the division of responsibility between the planner, scheduler, and simulator subsystems. It then describes the approach to incremental planning and the way in which uncertainty is modelled within the plan representation. Finally, current status and initial results are described.

A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study.

PubMed

Luckett, Tim; Chenoweth, Lynnette; Phillips, Jane; Brooks, Deborah; Cook, Janet; Mitchell, Geoffrey; Pond, Dimity; Davidson, Patricia M; Beattie, Elizabeth; Luscombe, Georgina; Goodall, Stephen; Fischer, Thomas; Agar, Meera

2017-10-01

Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation. Semi-structured interviews were conducted with the RNs in the PCPC role, other members of nursing home staff, and physicians who participated in case conferences. Analysis was conducted by two researchers using a thematic framework approach. Interviews were conducted with 11 PCPCs, 18 other nurses, eight allied health workers, and three physicians. Perceived benefits of facilitated case conferencing included better communication between staff and families, greater multi-disciplinary involvement in case conferences and care planning, and improved staff attitudes and capabilities for dementia palliative care. Key factors influencing implementation included: staffing levels and time; support from management, staff and physicians; and positive family feedback. The facilitated approach explored in this study addressed known barriers to case conferencing. However, current business models in the sector make it difficult for case conferencing to receive the required levels of nursing qualification, training, and time. A collaborative nursing home culture and ongoing relationships with health professionals are also prerequisites for success. Further studies should document resident and family perceptions to harness consumer advocacy.

Advanced High-Level Waste Glass Research and Development Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peeler, David K.; Vienna, John D.; Schweiger, Michael J.

2015-07-01

The U.S. Department of Energy Office of River Protection (ORP) has implemented an integrated program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product quality requirements. The integrated ORP program is focused on providing a technical, science-based foundation from which key decisions can be made regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities. The fundamental data stemming from this program will support development of advanced glass formulations, key process control models, and tactical processing strategies to ensure safe and successful operations formore » both the low-activity waste (LAW) and high-level waste (HLW) vitrification facilities with an appreciation toward reducing overall mission life. The purpose of this advanced HLW glass research and development plan is to identify the near-, mid-, and longer-term research and development activities required to develop and validate advanced HLW glasses and their associated models to support facility operations at WTP, including both direct feed and full pretreatment flowsheets. This plan also integrates technical support of facility operations and waste qualification activities to show the interdependence of these activities with the advanced waste glass (AWG) program to support the full WTP mission. Figure ES-1 shows these key ORP programmatic activities and their interfaces with both WTP facility operations and qualification needs. The plan is a living document that will be updated to reflect key advancements and mission strategy changes. The research outlined here is motivated by the potential for substantial economic benefits (e.g., significant increases in waste throughput and reductions in glass volumes) that will be realized when advancements in glass formulation continue and models supporting facility operations are implemented. Developing and applying advanced glass formulations will reduce the cost of Hanford tank waste management by reducing the schedule for tank waste treatment and reducing the amount of HLW glass for storage, transportation, and disposal. Additional benefits will be realized if advanced glasses are developed that demonstrate more tolerance for key components in the waste (such as Al 2O 3, Cr 2O 3, SO 3 and Na 2O) above the currently defined WTP constraints. Tolerating these higher concentrations of key waste loading limiters may reduce the burden on (or even eliminate the need for) leaching to remove Cr and Al and washing to remove excess S and Na from the HLW fraction. Advanced glass formulations may also make direct vitrification of the HLW fraction without significant pretreatment more cost effective. Finally, the advanced glass formulation efforts seek not only to increase waste loading in glass, but also to increase glass production rate. When coupled with higher waste loading, ensuring that all of the advanced glass formulations are processable at or above the current contract processing rate leads to significant improvements in waste throughput (the amount of waste being processed per unit time),which could significantly reduce the overall WTP mission life. The integration of increased waste loading, reduced leaching/washing requirements, and improved melting rates provides a system-wide approach to improve the effectiveness of the WTP process.« less

Advance care planning in patients with incurable cancer: study protocol for a randomised controlled trial

PubMed Central

Clayton, Josephine; Butow, Phyllis N; Silvester, William; Detering, Karen; Hall, Jane; Kiely, Belinda E; Cebon, Jonathon; Clarke, Stephen; Bell, Melanie L; Stockler, Martin; Beale, Phillip; Tattersall, Martin H N

2016-01-01

Introduction There is limited evidence documenting the effectiveness of Advance Care Planning (ACP) in cancer care. The present randomised trial is designed to evaluate whether the administration of formal ACP improves compliance with patients' end-of-life (EOL) wishes and patient and family satisfaction with care. Methods and analysis A randomised control trial in eight oncology centres across New South Wales and Victoria, Australia, is designed to assess the efficacy of a formal ACP intervention for patients with cancer. Patients with incurable cancer and an expected survival of 3–12 months, plus a nominated family member or friend will be randomised to receive either standard care or standard care plus a formal ACP intervention. The project sample size is 210 patient–family/friend dyads. The primary outcome measure is family/friend-reported: (1) discussion with the patient about their EOL wishes and (2) perception that the patient's EOL wishes were met. Secondary outcome measures include: documentation of and compliance with patient preferences for medical intervention at the EOL; the family/friend's perception of the quality of the patient's EOL care; the impact of death on surviving family; patient–family and patient–healthcare provider communication about EOL care; patient and family/friend satisfaction with care; quality of life of patient and family/friend subsequent to trial entry, the patient's strength of preferences for quality of life and length of life; the costs of care subsequent to trial entry and place of death. Ethics and dissemination Ethical approval was received from the Sydney Local Health District (RPA Zone) Human Research Ethical Committee, Australia (Protocol number X13-0064). Study results will be submitted for publication in peer-reviewed journals and presented at national and international conferences. Trial registration number Pre-results; ACTRN12613001288718. PMID:27909034

Computer-aided dispatch--traffic management center field operational test final evaluation plan : WSDOT deployment

DOT National Transportation Integrated Search

2003-09-22

This document presents the Evaluation Teams plan for conducting the evaluation of the FOT in Washington State. A companion document exists for the evaluation of the Utah deployment. This plan includes the experimental design for testing hypotheses...

Creating a University for the 21st Century: Strategic Plan

ERIC Educational Resources Information Center

North Dakota University System, 2005

2005-01-01

This document presents the strategic plan of the North Dakota University System, revised in November 2005, to develop a common vision and clear set of expectations for higher education in North Dakota. The strategic plan for the University System is directly linked to the Roundtable on Higher Education plan. This document presents the ten sections…

Defense.gov Special Report: Government Shutdown - What You Need to Know

Science.gov Websites

Department is taking to plan for a possible government shutdown. Document Plan for Agency Operations During agencies should plan for a potential shutdown. Document Guidance for Continuation of Operations in The Contingency Plan Guidance for Continuation of Essential Operations in the Absence of Available Appropriations

Solid waste information and tracking system server conversion project management plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

MAY, D.L.

1999-04-12

The Project Management Plan governing the conversion of Solid Waste Information and Tracking System (SWITS) to a client-server architecture. The Solid Waste Information and Tracking System Project Management Plan (PMP) describes the background, planning and management of the SWITS conversion. Requirements and specification documentation needed for the SWITS conversion will be released as supporting documents.

Pharmacist care plans and documentation of follow-up before the Iowa Pharmaceutical Case Management program.

PubMed

Becker, CoraLynn; Bjornson, Darrel C; Kuhle, Julie W

2004-01-01

To document drug therapy problems and their causes and assess pharmacist follow-up of patients with identified drug therapy problems. Cross-sectional analysis. Iowa. 160 pharmacists who submitted 754 pharmaceutical care plans in an effort to qualify for participation in the Iowa Pharmaceutical Case Management program. Care plans were assessed for drug therapy problems and causes and for documentation of pharmacist follow-up (actual, none, or intent to follow up). Pharmacists documented a wide variety of drug therapy problems and causes, including adverse drug reactions (20.1% of care plans), need for additional drug therapy (18.9%), lack of patient adherence to therapy (16.3%), incorrect medication being prescribed (14.1%), and drug dose too high (10.0%). Pharmacist follow-up with patients was not optimal, with 31% of care plans providing documentation of actual follow-up. Another 42.2% of plans indicated that the pharmacist intended to contact the patient for follow-up but either did not do so or did not record the intervention. No actual follow-up or intent to follow up was recorded in 26.8% of care plans. Pharmacists practicing in independent pharmacies followed up with patients more frequently than those in other settings (36.4% of care plans, compared with 22.7%, 23.2%, and 28.4% for chain, clinic, and franchise pharmacies). Pharmacists were more likely to follow up when the identified problem involved drug safety rather than effectiveness (36.2% versus 28.3% of care plans). Documentation of pharmacist follow-up with patients was less than optimal. In addition to identifying drug therapy problems and causes, pharmacists must complete the care continuum through documentation of patient monitoring and follow-up to transform the philosophy and vision of the pharmaceutical care concept into a practice of pharmacy recognized and rewarded by patients and payers.

End of life care: The experiences of advance care planning amongst family caregivers of people with advanced dementia - A qualitative study.

PubMed

Ashton, Susan Elizabeth; Roe, Brenda; Jack, Barbara; McClelland, Bob

2016-09-01

End of life decisions for people with advanced dementia are reported as often being difficult for families as they attempt to make appropriate and justified decisions. To explore the experiences of advance care planning amongst family caregivers of people with advanced dementia. Qualitative research including a series of single cases (close family relatives). A purposive sample of 12 family caregivers within a specialist dementia unit was interviewed about their experiences of advance care planning between August 2009 and February 2010. Family caregivers need encouragement to ask the right questions during advance care planning to discuss the appropriateness of nursing and medical interventions at the end of life. Advance care planning can be facilitated with the family caregiver in the context of everyday practice within the nursing home environment for older people with dementia. © The Author(s) 2014.

Advanced Education and Technology Business Plan, 2008-11

ERIC Educational Resources Information Center

Alberta Advanced Education and Technology, 2008

2008-01-01

The Ministry of Advanced Education and Technology's 2008-11 business plan identifies how it plans to work over the next three years to enhance advanced learning opportunities and innovation for all Albertans. Alberta's advanced learning system is composed of public board-governed institutions, the apprenticeship and industry training system,…

Teaching Spatial Thinking with the National Atlas of Korea in U.S. Secondary Level Education

NASA Astrophysics Data System (ADS)

Chu, Gregory H.; Hwang, Chul Sue; Choi, Jongnam

2018-05-01

This paper is predicated on the body of literature that supports a theoretical concept that middle and high school age children possess the cognitive ability to understand thematic maps and achieve some degree of cartographic literacy. In 2006, the US National Research Council (NRC) of the National Academies published a landmark book on Learning to Think Spatially. This book documented essential secondary education components and various aspects of teaching spatial thinking. The NRC defines spatial thinking as "a form of thinking based on a constructive amalgam of three elements: concepts of space, tools of representation, and processes of reasoning" (NRC, 2006, ix). This paper is an attempt to document and understand some of the attributes associated with these three elements. Specifically, it aims to find ways that can effectively contribute to the teaching of these elements associated with spatial thinking. The National Atlas of Korea is chosen for lesson plan development because it is well-designed and provides a range of contents and comprehensiveness that are ideal; in addition, it is freely accessible online and downloadable (http://nationalatlas.ngii.go.kr/). Four master geography teachers were invited to examine the Atlas to conceive and develop Advanced Placement Human Geography (APHG) lesson plans. Four lesson plans were written and have continually been implemented in classrooms to over 800 students in the States of Utah, Georgia, Minnesota, and Tennessee since the 2015 Fall semester. Results are presented in this paper.

Restoration Planning: Guidance Document for Natural Resource Damage Assessment Under the Oil Pollution Act of 1990

DOT National Transportation Integrated Search

1996-08-01

The purpose of this document is to provide trustees with general guidance to develop restoration plans under OPA that comply with NEPA's procedural requirements. The focus of this document is to more fully describe the processes and products required...

Initial Efficacy Testing of an Autobiographical Memory Intervention on Advance Care Planning for Patients With Terminal Cancer.

PubMed

Brohard, Cheryl

2017-11-01

To test the efficacy of a novel intervention to facilitate advance care planning.
. Exploratory, quasiexperimental pilot study with two independent groups.
. A large hospice located in the southwestern United States. 
. A convenience sample of 50 participants with terminal cancer enrolled in hospice.
. An autobiographical memory (ABM) intervention used the participants' experiences with cancer and end of life for the purpose of directing advance care planning.
. Two domains of advance care planning, decision making and communication, were measured in relation to 11 variables. The ABM intervention was nonthreatening, short in duration, and easily completed with participants as they recalled, without hesitation, specific personal memories of family and friends who had died and their advance care plans. The Mann-Whitney nonparametric test revealed that participants in the experimental group had a higher average rank than those in the control group for communicating the decision about antibiotics, as well as exhibited a trend toward significance for five other advance care planning variables.
. Findings showed that directive ABMs may be effective in influencing the decision making and communication of advance care planning for terminally ill patients with cancer.
. The current level of understanding about using the ABM intervention suggests that nurses can initiate an advance care planning conversation using this approach.

Data management and processing plan, Department of Applied Geodesy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1992-08-01

This plan outlines Data Management and Data Processing requirements of the Department of Applied Geodesy (DAG) and presents the plan to meet these requirements (These requirements are derived from the functional needs of the Department to meet the SSCL alignment tolerances and schedules). In addition, this document presents a schedule for the implementation of this plan. This document is an integral part of the Alignment Plan of the SSCL.

Some guidance on preparing validation plans for the DART Full System Models.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gray, Genetha Anne; Hough, Patricia Diane; Hills, Richard Guy

2009-03-01

Planning is an important part of computational model verification and validation (V&V) and the requisite planning document is vital for effectively executing the plan. The document provides a means of communicating intent to the typically large group of people, from program management to analysts to test engineers, who must work together to complete the validation activities. This report provides guidelines for writing a validation plan. It describes the components of such a plan and includes important references and resources. While the initial target audience is the DART Full System Model teams in the nuclear weapons program, the guidelines are generallymore » applicable to other modeling efforts. Our goal in writing this document is to provide a framework for consistency in validation plans across weapon systems, different types of models, and different scenarios. Specific details contained in any given validation plan will vary according to application requirements and available resources.« less

Nursing home manager's knowledge, attitudes and beliefs about advance care planning for people with dementia in long-term care settings: a cross-sectional survey.

PubMed

Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry

2017-09-01

To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. Nursing home managers in a region in the UK (n = 178). A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. Increased cognisance of the context in which advance care planning takes place is vital for improved implementation in this context. In addition strong nursing leadership is imperative to facilitate initiation, engagement and re-evaluation of the process of advance care planning. © 2016 John Wiley & Sons Ltd.

Preschool Teachers' Perspectives on Planning and Documentation in Preschool

ERIC Educational Resources Information Center

Alvestad, Torgeir; Sheridan, Sonja

2015-01-01

This article is based on a research project focusing on Norwegian teachers' planning and documentation of children's learning in preschool. Norwegian preschools follow a national curriculum and teachers are obliged to document both professional practice and learning outcomes. The aim of the article is to investigate teachers' experiences of…

Comment and response document for the long-term surveillance plan for the Bodo Canyon Disposal Site, Durango. Colorado

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1996-07-01

This document contains comments made by the US Nuclear Regulatory Commission upon their review of the Long-Term Surveillance Plan for the Bodo Canyon Disposal Site, Durango, Colorado. Responses to the comments are also included in the document.

Erste Erkenntnisse zur Prospektion und Charakterisierung des Aquifers der Aroser Dolomiten, Schweiz

NASA Astrophysics Data System (ADS)

Regli, Christian; Kleboth, Peter; Eichenberger, Urs; Schmassmann, Silvia; Nyfeler, Peter; Bolay, Stephan

2014-03-01

In urban areas of the Swiss Alps the use of geothermal energy from several hundred meters depth becomes increasingly important. For this mainly open systems have priority. This work presents the first insights in the prospection and characterisation of the so far unexplored, utilizable, and abundant Aquifer of the Arosa Dolomites. Besides the use of established methods and techniques, such as seismic measurements, an exploration drilling, borehole geophysical measurements, and pumping tests, the application of the KARSYS-approach for geological and conceptual hydrogeological 3D-modelling of the aquifer is illustrated. In addition, the development of a viewer for 3D-visualization of drillings is documented. The hydrogeological and metrological approaches allow a lithological facies differentiation of the Arosa Dolomites, and a differentiation of the fractured and karstified areas within the aquifer. The results represent the basis for advanced findings optimizing and risks minimising exploration and drilling planning, and for sustainable utilization planning.

A Comparison of State Advance Directive Documents

ERIC Educational Resources Information Center

Gunter-Hunt, Gail; Mahoney, Jane E.; Sieger, Carol E.

2002-01-01

Purpose: Advance directive (AD) documents are based on state-specific statutes and vary in terms of content. These differences can create confusion and inconsistencies resulting in a possible failure to honor the health care wishes of people who execute health care documents for one state and receive health care in another state. The purpose of…

Draft Updates to the Planning for Natural Disaster Debris Guidance and to Related Documents

EPA Pesticide Factsheets

EPA is requesting comment on the draft update of the Planning for Natural Disaster Debris Guidance, along with two other documents. This Guidance is an update of the Planning for Natural Disaster Debris guidance that EPA published in March 2008.

48 CFR 252.211-7001 - Availability of Specifications, Standards, and Data Item Descriptions Not Listed in the...

Code of Federal Regulations, 2010 CFR

2010-10-01

... Standardization Information System (ASSIST), and Plans, Drawings, and Other Pertinent Documents. Availability of... Information System (ASSIST), and Plans, Drawings, and Other Pertinent Documents. Availability of... Streamlining and Standardization Information System (ASSIST), and Plans, Drawings, and Other Pertinent...

14 CFR 151.111 - Advance planning proposals: General.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Engineering Proposals § 151.111 Advance planning proposals: General. (a) Each advance planning and engineering... application, under §§ 151.21(c) and 151.27, or both. (c) Each proposal must relate to planning and engineering... “Airport Activity Statistics of Certificated Route Air Carriers” (published jointly by FAA and the Civil...

Advance Directives and Powers of Attorney in Intensive Care Patients.

PubMed

de Heer, Geraldine; Saugel, Bernd; Sensen, Barbara; Rübsteck, Charlotte; Pinnschmidt, Hans O; Kluge, Stefan

2017-06-05

Advance directives and powers of attorney are increasingly common, yet data on their use in clinical situations remain sparse. In this single center cross-sectional study, we collected data by questionnaire from 1004 intensive care patients in a university hospital. The frequencies of advance directives and powers of attorney were determined, and the factors affecting them were studied with multivariate logistic regression analysis. Usable data were obtained from 998 patients. 51.3% stated that they had prepared a document of at least one of these two kinds. Among them, 39.6% stated that they had given the relevant document(s) to the hospital, yet such documents were present in the patient's hospital record for only 23%. 508 patients stated their reasons for preparing an advance directive or a power of attorney: the most common reason (48%) was the fear of being at other people's mercy, of the lack of self-determination, or of medical overtreatment. The most important factors associated with a patient's statement that he/she had prepared such a document were advanced age (advance directive: 1.022 [1.009; 1.036], p = 0.001; power of attorney: 1.027 [1.014; 1.040], p<0.001) and elective admission to the hospital (advance directive: 1.622 [1.138; 2.311], p<0.007; power of attorney: 1.459 [1.049; 2.030], p = 0.025). 39.8% of the advance directives and 44.1% of the powers of attorney that were present in the hospital records were poorly interpretable because of the incomplete filling-out of preprinted forms. Half of the patients who did not have such a document had already thought of preparing one, but had not yet done so. For patients hospitalized in intensive care units, there should be early discussion about the presence or absence of documents of these kinds and early evaluation of the patient's concrete wishes in critical situations. Future studies are needed to determine how best to assure that these documents will be correctly prepared and then given over to hospital staff so that they can take their place in the patient's record.

The Environmental Control and Life Support System (ECLSS) advanced automation project

NASA Technical Reports Server (NTRS)

Dewberry, Brandon S.; Carnes, Ray

1990-01-01

The objective of the environmental control and life support system (ECLSS) Advanced Automation Project is to influence the design of the initial and evolutionary Space Station Freedom Program (SSFP) ECLSS toward a man-made closed environment in which minimal flight and ground manpower is needed. Another objective includes capturing ECLSS design and development knowledge future missions. Our approach has been to (1) analyze the SSFP ECLSS, (2) envision as our goal a fully automated evolutionary environmental control system - an augmentation of the baseline, and (3) document the advanced software systems, hooks, and scars which will be necessary to achieve this goal. From this analysis, prototype software is being developed, and will be tested using air and water recovery simulations and hardware subsystems. In addition, the advanced software is being designed, developed, and tested using automation software management plan and lifecycle tools. Automated knowledge acquisition, engineering, verification and testing tools are being used to develop the software. In this way, we can capture ECLSS development knowledge for future use develop more robust and complex software, provide feedback to the knowledge based system tool community, and ensure proper visibility of our efforts.

Advanced information processing system: The Army Fault-Tolerant Architecture detailed design overview

NASA Technical Reports Server (NTRS)

Harper, Richard E.; Babikyan, Carol A.; Butler, Bryan P.; Clasen, Robert J.; Harris, Chris H.; Lala, Jaynarayan H.; Masotto, Thomas K.; Nagle, Gail A.; Prizant, Mark J.; Treadwell, Steven

1994-01-01

The Army Avionics Research and Development Activity (AVRADA) is pursuing programs that would enable effective and efficient management of large amounts of situational data that occurs during tactical rotorcraft missions. The Computer Aided Low Altitude Night Helicopter Flight Program has identified automated Terrain Following/Terrain Avoidance, Nap of the Earth (TF/TA, NOE) operation as key enabling technology for advanced tactical rotorcraft to enhance mission survivability and mission effectiveness. The processing of critical information at low altitudes with short reaction times is life-critical and mission-critical necessitating an ultra-reliable/high throughput computing platform for dependable service for flight control, fusion of sensor data, route planning, near-field/far-field navigation, and obstacle avoidance operations. To address these needs the Army Fault Tolerant Architecture (AFTA) is being designed and developed. This computer system is based upon the Fault Tolerant Parallel Processor (FTPP) developed by Charles Stark Draper Labs (CSDL). AFTA is hard real-time, Byzantine, fault-tolerant parallel processor which is programmed in the ADA language. This document describes the results of the Detailed Design (Phase 2 and 3 of a 3-year project) of the AFTA development. This document contains detailed descriptions of the program objectives, the TF/TA NOE application requirements, architecture, hardware design, operating systems design, systems performance measurements and analytical models.

Feasibility and acceptability of advance care planning in elderly Italian and Greek speaking patients as compared to English-speaking patients: an Australian cross-sectional study.

PubMed

Detering, Karen; Sutton, Elizabeth; Fraser, Scott; Wallis, Kasey; Silvester, William; Mawren, Daveena; Whiteside, Kathryn

2015-08-28

To assess the feasibility and acceptability of facilitated advance care planning (ACP) discussions in elderly Italian and Greek-speaking inpatients compared to English-speaking inpatients. This cross-sectional study with convenience sampling was conducted in Melbourne, Australia, and recruited hospital inpatients with medical decision-making capacity, aged 65 years or above, who spoke Greek (25 patients), Italian (24 patients) or English (63 patients). Facilitated ACP was offered, aiming to assists patients to consider and discuss their goals, values, beliefs and future treatment wishes with their family and doctor; to help them consider how they would like healthcare decisions made in the future if they become unable to do this for themselves; and to complete advance care directives. The completion of ACP discussions, their duration, advance care directive completion and utilisation of interpreters. Of 112 patients, 109 (97%) had at least one discussion, 63 (54%) completed advance care directives, either nominating a substitute decision-maker, documenting their wishes or both, and 76 (68%) included family in discussions. The median duration of discussions for all patients was slightly more than 1 h, over two visits. There were no differences between the Greek-speaking and the Italian-speaking patients, or between the Non-English speaking and the English-speaking patients in any of these measures. Only 14 non-English speaking patients, (30%) utilised interpreters, but when utilised, patients were much more likely (p<0.005) to complete advance care directives. Facilitated ACP in elderly Italian and Greek-speaking patients is feasible, acceptable and is similar to that for English-speaking patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Repository-based software engineering program: Concept document

NASA Technical Reports Server (NTRS)

1992-01-01

This document provides the context for Repository-Based Software Engineering's (RBSE's) evolving functional and operational product requirements, and it is the parent document for development of detailed technical and management plans. When furnished, requirements documents will serve as the governing RBSE product specification. The RBSE Program Management Plan will define resources, schedules, and technical and organizational approaches to fulfilling the goals and objectives of this concept. The purpose of this document is to provide a concise overview of RBSE, describe the rationale for the RBSE Program, and define a clear, common vision for RBSE team members and customers. The document also provides the foundation for developing RBSE user and system requirements and a corresponding Program Management Plan. The concept is used to express the program mission to RBSE users and managers and to provide an exhibit for community review.

Cancer Nanotechnology Plan

Cancer.gov

The Cancer Nanotechnology Plan serves as a strategic document to the NCI Alliance for Nanotechnology in Cancer as well as a guiding document to the cancer nanotechnology and oncology fields, as a whole.

Development of a tethered personal health record framework for early end-of-life discussions.

PubMed

Bose-Brill, Seuli; Kretovics, Matthew; Ballenger, Taylor; Modan, Gabriella; Lai, Albert; Belanger, Lindsay; Koesters, Stephen; Pressler-Vydra, Taylor; Wills, Celia

2016-06-01

End-of-life planning, known as advance care planning (ACP), is associated with numerous positive outcomes, such as improved patient satisfaction with care and improved patient quality of life in terminal illness. However, patient-provider ACP conversations are rarely performed or documented due to a number of barriers, including time required, perceived lack of skill, and a limited number of resources. Use of tethered personal health records (PHRs) may help streamline ACP conversations and documentations for outpatient workflows. Our objective was to develop an ACP-PHR framework that would be for use in a primary care, outpatient setting. Qualitative content analysis of focus groups and cognitive interviews (participatory design). A novel PHR-ACP tool was developed and tested using data and feedback collected from 4 patient focus groups (n = 13), 1 provider focus group (n = 4), and cognitive interviews (n = 22). Patient focus groups helped develop a focused, 4-question PHR communication tool. Cognitive interviews revealed that, while patients felt framework content and workflow were generally intuitive, minor changes to content and workflow would optimize the framework. A focused framework for electronic ACP communication using a patient portal tethered to the PHR was developed. This framework may provide an efficient way to have ACP conversations in busy outpatient settings.

Missouri Comprehensive Outdoor Recreation Plan: Executive Summary.

ERIC Educational Resources Information Center

Missouri State Inter-Agency for Outdoor Recreation, Jefferson.

The document is a summary of the Missouri State Comprehensive Outdoor Recreation Plan, which was designed to provide guidelines for allocation of resources for needed recreation facilities. The plan identifies the present and future needs for outdoor recreation and recommends ways of meeting these needs. This 1967 document provides a brief history…

Public Comment Period Open for the Draft Update to the Planning for Natural Disaster Debris Guidance and to Related Documents

EPA Pesticide Factsheets

EPA is requesting comment on the draft Planning for Natural Disaster Debris Guidance, and two other documents. The Guidance is an update of the Planning for Natural Disaster Debris guidance that EPA published in March 2008.

Impact of postgraduate education on advanced practice nurse activity - a national survey.

PubMed

Wilkinson, J; Carryer, J; Budge, C

2018-03-22

There is a wealth of international evidence concerning the contribution post-registration master's level education makes to advancing the discipline of nursing. There are approximately 277 nurse practitioners registered in NZ, but they account for only a small portion of nurses who have undertaken master's level education. The additional contribution these nurses make to the work environment through advanced practice activities has not, hitherto, been documented. To report the extent of advanced practice nurse activity associated with various levels of nursing education in a sample of nurses working in clinical practice in New Zealand. A replication of recent Australian research was done via a national cross-sectional survey of 3255 registered nurses and nurse practitioners in New Zealand using an online questionnaire to collect responses to the amended Advanced Practice Delineation survey tool. In addition, demographic data were collected including position titles and levels of postgraduate education. A positive association was found between postgraduate education at any level and more time spent in advanced practice activities. Independent of level of postgraduate education, the role a nurse holds also effects the extent of involvement in advanced practice activities. There is an additional contribution made to the work environment by nurses with master's level education which occurs even when they are not employed in an advanced practice role. These findings are of significance to workforce policy and planning across the globe as countries work to sustain health services by increasing nursing capacity effectively within available resources. © 2018 International Council of Nurses.

Disease control operations

USGS Publications Warehouse

Friend, Milton; Franson, J. Christian

1987-01-01

Individual disease outbreaks have killed many thousands of animals on numerous occasions. Tens of thousands of migratory birds have died in single die-offs with as many as 1,000 birds succumbing in 1 day. In mammals, individual disease outbreaks have killed hundreds to thousands of animals with, for example, hemorrhagic disease in white-tailed deer, distemper in raccoon, Errington's disease in muskrat, and sylvatic plague in wild rodents. The ability to successfully combat such explosive situations is highly dependent n the readiness of field personnel to deal with them. Because many disease agents can spread though wildlife populations very fast, advance preparation is essential in preventing infected animals from spreading disease to additional species and locations. Carefully though-out disease contingency plans should be developed as practical working documents for field personnel and updated as necessary. Such well-designed plans can prove invaluable in minimizing wildlife losses and costs associated with disease control activities. Although requirements for disease control operations vary and must be tailored to each situation, all disease contingency planning involved general concepts and basic biological information. This chapter, intended as a practical guide, identifies the major activities and needs of disease control operations, and relates them to disease contingency planning.

Advanced Air Transportation Technologies Project, Final Document Collection

NASA Technical Reports Server (NTRS)

Mogford, Richard H.; Wold, Sheryl (Editor)

2008-01-01

This CD ROM contains a compilation of the final documents of the Advanced Air Transportation Technologies (AAIT) project, which was an eight-year (1996 to 2004), $400M project managed by the Airspace Systems Program office, which was part of the Aeronautics Research Mission Directorate at NASA Headquarters. AAIT focused on developing advanced automation tools and air traffic management concepts that would help improve the efficiency of the National Airspace System, while maintaining or enhancing safety. The documents contained in the CD are final reports on AAIT tasks that serve to document the project's accomplishments over its eight-year term. Documents include information on: Advanced Air Transportation Technologies, Autonomous Operations Planner, Collaborative Arrival Planner, Distributed Air/Ground Traffic Management Concept Elements 5, 6, & 11, Direct-To, Direct-To Technology Transfer, Expedite Departure Path, En Route Data Exchange, Final Approach Spacing Tool - (Active and Passive), Multi-Center Traffic Management Advisor, Multi Center Traffic Management Advisor Technology Transfer, Surface Movement Advisor, Surface Management System, Surface Management System Technology Transfer and Traffic Flow Management Research & Development.

Evaluation and management of the elderly patient presenting with cognitive complaints.

PubMed

Hildreth, Kerry L; Church, Skotti

2015-03-01

Cognitive complaints are common in the geriatric population. Older adults should routinely be asked about any concerns about their memory or thinking, and any cognitive complaint from the patient or an informant should be evaluated rather than be attributed to aging. Several screening instruments are available to document objective impairments and guide further evaluation. Management goals for patients with cognitive impairment are focused on maintaining function and independence, providing caregiver support, and advance care planning. There are currently no treatments to effectively prevent or treat dementia. Increasing appreciation of the heterogeneity of Alzheimer disease may lead to novel treatment approaches. Copyright © 2015 Elsevier Inc. All rights reserved.

Habitability issues in long duration undersea and space missions

NASA Technical Reports Server (NTRS)

Parker, J. F., Jr.; Every, M. G.

1972-01-01

The report reviews a number of studies in the area of habitability. Emphasis was placed on extracting from these studies that information most relevant to any long-term mission in confinement. It is concluded that, whereas the basic laws of habitability are known, there is much yet to be learned concerning development of social structures in small groups in relative isolation, planning for necessary hygiene needs, development of proper work spaces, and construction of internal and external communications systems. With respect to testing for habitability and the documentation of habitability principles, the space program was found to be considerably more advanced than was the program for undersea missions.

Work Breakdown Structure (WBS) and WBS dictionary. [advanced x ray astrophysics facility (AXAF)

NASA Technical Reports Server (NTRS)

Cocuzzo, F.

1994-01-01

This document is intended to provide the framework for defining all work to be accomplished under the proposed contract for the mission support program as defined by Section J-1 Statement of Work (SOW) of the RFP No.8-1-3-TA-50030 dated 11/2/93. The time period of performance of this contract will be from 3/1/94 through to the end of fiscal 1999. In addition to providing the framework for the integration of the cost, schedule, and manpower planning necessary to accomplish this work it establishes the association among the WBS elements, the SOW, and the Technical Proposal.

Advance care planning in a multi-cultural family-centric community: A qualitative study of healthcare professionals', patients' and caregivers' perspectives.

PubMed

Menon, Sumytra; Kars, Marijke; Malhotra, Chetna; Campbell, Alastair V; van Delden, J J M

2018-05-15

Advance care planning has been shown to improve end-of-life care but it was developed in the USA and most research has been conducted in western communities. We aimed to study the attitudes and perceptions of patients with life-limiting illnesses, informal caregivers, doctors, nurses and medical social workers regarding advance care planning in a multi-cultural family-centric community. We conducted an explorative qualitative study, using focus groups and individual in-depth interviews. We used purposive sampling techniques to recruit 61 adults (15 doctors, 13 nurses, 5 medical social workers, 15 patients and 13 caregivers) from multiple healthcare settings across the country. The participants are genuinely anxious about the implementation of advance care planning. They had positive and negative expectations of advance care planning. Many were confused about the legal framework for healthcare decision-making and expected advance care planning to be of limited value because family members, rather than the patient, were usually the key decision-makers. A nuanced approach to advance care planning which considers the family network is required in multi-cultural family centric communities. Policies should be reconciled to create a more consistent message that respects patients, the family, and is legally coherent. Further research could focus on adaptations of advance care planning to promote its acceptance in such communities. Copyright © 2018. Published by Elsevier Inc.

Guidance and Control Software Project Data - Volume 1: Planning Documents

NASA Technical Reports Server (NTRS)

Hayhurst, Kelly J. (Editor)

2008-01-01

The Guidance and Control Software (GCS) project was the last in a series of software reliability studies conducted at Langley Research Center between 1977 and 1994. The technical results of the GCS project were recorded after the experiment was completed. Some of the support documentation produced as part of the experiment, however, is serving an unexpected role far beyond its original project context. Some of the software used as part of the GCS project was developed to conform to the RTCA/DO-178B software standard, "Software Considerations in Airborne Systems and Equipment Certification," used in the civil aviation industry. That standard requires extensive documentation throughout the software development life cycle, including plans, software requirements, design and source code, verification cases and results, and configuration management and quality control data. The project documentation that includes this information is open for public scrutiny without the legal or safety implications associated with comparable data from an avionics manufacturer. This public availability has afforded an opportunity to use the GCS project documents for DO-178B training. This report provides a brief overview of the GCS project, describes the 4-volume set of documents and the role they are playing in training, and includes the planning documents from the GCS project. Volume 1 contains five appendices: A. Plan for Software Aspects of Certification for the Guidance and Control Software Project; B. Software Development Standards for the Guidance and Control Software Project; C. Software Verification Plan for the Guidance and Control Software Project; D. Software Configuration Management Plan for the Guidance and Control Software Project; and E. Software Quality Assurance Activities.

Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer.

PubMed

Clark, C H; Miles, E A; Urbano, M T Guerrero; Bhide, S A; Bidmead, A M; Harrington, K J; Nutting, C M

2009-07-01

The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. The pre-trial quality assurance (QA) programme and results are described. Each centre undertook exercises in target volume definition and treatment planning, completed a resource questionnaire and produced a process document. Additionally, the QA team visited each participating centre. Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.

Smart Grid Demonstration Project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, Craig; Carroll, Paul; Bell, Abigail

The National Rural Electric Cooperative Association (NRECA) organized the NRECA-U.S. Department of Energy (DOE) Smart Grid Demonstration Project (DE-OE0000222) to install and study a broad range of advanced smart grid technologies in a demonstration that spanned 23 electric cooperatives in 12 states. More than 205,444 pieces of electronic equipment and more than 100,000 minor items (bracket, labels, mounting hardware, fiber optic cable, etc.) were installed to upgrade and enhance the efficiency, reliability, and resiliency of the power networks at the participating co-ops. The objective of this project was to build a path for other electric utilities, and particularly electrical cooperatives,more » to adopt emerging smart grid technology when it can improve utility operations, thus advancing the co-ops’ familiarity and comfort with such technology. Specifically, the project executed multiple subprojects employing a range of emerging smart grid technologies to test their cost-effectiveness and, where the technology demonstrated value, provided case studies that will enable other electric utilities—particularly electric cooperatives— to use these technologies. NRECA structured the project according to the following three areas: Demonstration of smart grid technology; Advancement of standards to enable the interoperability of components; and Improvement of grid cyber security. We termed these three areas Technology Deployment Study, Interoperability, and Cyber Security. Although the deployment of technology and studying the demonstration projects at coops accounted for the largest portion of the project budget by far, we see our accomplishments in each of the areas as critical to advancing the smart grid. All project deliverables have been published. Technology Deployment Study: The deliverable was a set of 11 single-topic technical reports in areas related to the listed technologies. Each of these reports has already been submitted to DOE, distributed to co-ops, and posted for universal access at www.nreca.coop/smartgrid. This research is available for widespread distribution to both cooperative members and non-members. These reports are listed in Table 1.2. Interoperability: The deliverable in this area was the advancement of the MultiSpeak™ interoperability standard from version 4.0 to version 5.0, and improvement in the MultiSpeak™ documentation to include more than 100 use cases. This deliverable substantially expanded the scope and usability of MultiSpeak, ™ the most widely deployed utility interoperability standard, now in use by more than 900 utilities. MultiSpeak™ documentation can be accessed only at www.multispeak.org. Cyber Security: NRECA’s starting point was to develop cyber security tools that incorporated succinct guidance on best practices. The deliverables were: cyber security extensions to MultiSpeak,™ which allow more security message exchanges; a Guide to Developing a Cyber Security and Risk Mitigation Plan; a Cyber Security Risk Mitigation Checklist; a Cyber Security Plan Template that co-ops can use to create their own cyber security plans; and Security Questions for Smart Grid Vendors.« less

Pulsed Power Science and Technology: A Strategic Outlook for the National Nuclear Security Administration (Summary)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sinars, Daniel; Scott, Kimberly Carole; Edwards, M. John

Major advances in pulsed power technology and applications over the last twenty years have expanded the mission areas for pulsed power and created compelling new opportunities for the Stockpile Stewardship Program (SSP). This summary document is a forward look at the development of pulsed power science and technology (PPS&T) capabilities in support of the next 20 years of the SSP. This outlook was developed during a three-month-long tri-lab study on the future of PPS&T research and capabilities in support of applications to: (1) Dynamic Materials, (2) Thermonuclear Burn Physics and Inertial Confinement Fusion (ICF), and (3) Radiation Effects and Nuclearmore » Survivability. It also considers necessary associated developments in next-generation codes and pulsed power technology as well as opportunities for academic, industry, and international engagement. The document identifies both imperatives and opportunities to address future SSP mission needs. This study was commissioned by the National Nuclear Security Administration (NNSA). A copy of the memo request is contained in the Appendix. NNSA guidance received during this study explicitly directed that it not be constrained by resource limitations and not attempt to prioritize its findings against plans and priorities in other areas of the national weapons program. That prioritization, including the relative balance amongst the three focus areas themselves, must of course occur before any action is taken on the observations presented herein. This unclassified summary document presents the principal imperatives and opportunities identified in each mission and supporting area during this study. Preceding this area-specific outlook, we discuss a cross-cutting opportunity to increase the shot capacity on the Z pulsed power facility as a near-term, cost-effective way to broadly impact PPS&T for SSP as well as advancing the science and technology to inform future SSMP milestones over the next 5-10 years. The final page of the summary presents two timelines that couch the opportunities discussed here in terms of the broader strategic timelines encapsulated in the fiscal year 2017 Stockpile Stewardship Management Plan (SSMP).« less

Facilitated Psychiatric Advance Directives: A Randomized Trial of an Intervention to Foster Advance Treatment Planning Among Persons with Severe Mental Illness

PubMed Central

Swanson, Jeffrey W.; Swartz, Marvin S.; Elbogen, Eric B.; Van Dorn, Richard A.; Ferron, Joelle; Wagner, H. Ryan; McCauley, Barbara J.; Kim, Mimi

2013-01-01

Objective Studies show a high potential demand for psychiatric advance directives but low completion rates. The authors conducted a randomized study of a structured, manualized intervention to facilitate completion of psychiatric advance directives. Method A total of 469 patients with severe mental illness were randomly assigned to a facilitated psychiatric advance directive session or a control group that received written information about psychiatric advance directives and referral to resources in the public mental health system. Completion of an advance directive, its structure and content, and its short-term effects on working alliance and treatment satisfaction were recorded. Results Sixty-one percent of participants in the facilitated session completed an advance directive or authorized a proxy decision maker, compared with only 3% of control group participants. Psychiatrists rated the advance directives as highly consistent with standards of community practice. Most participants used the advance directive to refuse some medications and to express preferences for admission to specific hospitals and not others, although none used an advance directive to refuse all treatment. At 1-month follow-up, participants in the facilitated session had a greater working alliance with their clinicians and were more likely than those in the control group to report receiving the mental health services they believed they needed. Conclusions The facilitation session is an effective method of helping patients complete psychiatric advance directives and ensuring that the documents contain useful information about patients’ treatment preferences. Achieving the promise of psychiatric advance directives may require system-level policies to embed facilitation of these instruments in usual-care care settings. PMID:17074946

Building foundations for the future: the NHS Scotland advanced practice succession planning development pathway.

PubMed

Currie, Kay; Grundy, Maggie

2011-10-01

To highlight implications for managers from the implementation of a national advanced practice succession planning development pathway within Scotland. Internationally, advanced practice posts have often developed in an ad-hoc manner, with little organizational attention to succession planning. Evaluation of a pilot national succession planning development pathway identified mechanisms which facilitate or hamper effective planning for advanced practice roles. A responsive evaluation design incorporating semi-structured questionnaires to pathway participants (n = 15) and semi-structured telephone interviews with case-site pathway participants (n = 7) and their line managers. Managers believed the development pathway was worthwhile; however, there was limited strategic planning to match individuals' development to service need. Practitioners generally perceived managers as interested in their development, although levels of practical support varied. There is concern from both managers and practitioners regarding ongoing funding for advanced practice development. The present evaluation study reiterates the need for organizational commitment to succession planning including robust service needs analysis mechanisms and adequate funding for development processes. Nurse managers are viewed as the 'gatekeepers' to opportunities for developing advanced nurse practitioners; scare resources must be targeted effectively to support succession planning through the development of selected individuals for future advanced practice posts, justified by service need. © 2011 Blackwell Publishing Ltd.

Psychometric Testing of the Self-Efficacy for Interdisciplinary Plans of Care Scale.

PubMed

Molle, Elizabeth; Froman, Robin

2017-01-01

Computerized interdisciplinary plans of care have revitalized nurse-centric care plans into dynamic and meaningful electronic documents. To maximize the benefits of these documents, it is important to understand healthcare professionals' attitudes, specifically their confidence, for making computerized interdisciplinary care plans useful and meaningful documents. The purpose of the study was to test the psychometric properties of the Self-Efficacy for Interdisciplinary Plans of Care instrument intended to measure healthcare professionals' self-efficacy for using such documents. Content validity was assessed by an expert review panel. Content validity indices ranged from 0.75 to 1.00, with a scale CVI of 0.94. A sample of 389 healthcare providers completed the 14-item instrument. Principal axis factoring was used to assess factor structure. The exploratory factor analysis yielded a single-factor structure accounting for 71.76% of covariance. Cronbach internal consistency coefficient for the single factor solution was .97. The corrected item-total correlations ranged from 0.71 to 0.90. The coefficient of stability, during a 2-week period, with a subset of the sample (n = 38), was estimated at 0.82. The results of this study suggest that the Self-Efficacy for Interdisciplinary Plans of Care has sturdy reliability and validity for measuring the self-efficacy of healthcare providers to make computerized interdisciplinary plans of care meaningful and useful documents.

Probabilistic Flood Maps to support decision-making: Mapping the Value of Information

NASA Astrophysics Data System (ADS)

Alfonso, L.; Mukolwe, M. M.; Di Baldassarre, G.

2016-02-01

Floods are one of the most frequent and disruptive natural hazards that affect man. Annually, significant flood damage is documented worldwide. Flood mapping is a common preimpact flood hazard mitigation measure, for which advanced methods and tools (such as flood inundation models) are used to estimate potential flood extent maps that are used in spatial planning. However, these tools are affected, largely to an unknown degree, by both epistemic and aleatory uncertainty. Over the past few years, advances in uncertainty analysis with respect to flood inundation modeling show that it is appropriate to adopt Probabilistic Flood Maps (PFM) to account for uncertainty. However, the following question arises; how can probabilistic flood hazard information be incorporated into spatial planning? Thus, a consistent framework to incorporate PFMs into the decision-making is required. In this paper, a novel methodology based on Decision-Making under Uncertainty theories, in particular Value of Information (VOI) is proposed. Specifically, the methodology entails the use of a PFM to generate a VOI map, which highlights floodplain locations where additional information is valuable with respect to available floodplain management actions and their potential consequences. The methodology is illustrated with a simplified example and also applied to a real case study in the South of France, where a VOI map is analyzed on the basis of historical land use change decisions over a period of 26 years. Results show that uncertain flood hazard information encapsulated in PFMs can aid decision-making in floodplain planning.

Science and Observation Recommendations for Future NASA Carbon Cycle Research

NASA Technical Reports Server (NTRS)

McClain, Charles R.; Collatz, G. J.; Kawa, S. R.; Gregg, W. W.; Gervin, J. C.; Abshire, J. B.; Andrews, A. E.; Behrenfeld, M. J.; Demaio, L. D.; Knox, R. G.

2002-01-01

Between October 2000 and June 2001, an Agency-wide planning, effort was organized by elements of NASA Goddard Space Flight Center (GSFC) to define future research and technology development activities. This planning effort was conducted at the request of the Associate Administrator of the Office of Earth Science (Code Y), Dr. Ghassem Asrar, at NASA Headquarters (HQ). The primary points of contact were Dr. Mary Cleave, Deputy Associate Administrator for Advanced Planning at NASA HQ (Headquarters) and Dr. Charles McClain of the Office of Global Carbon Studies (Code 970.2) at GSFC. During this period, GSFC hosted three workshops to define the science requirements and objectives, the observational and modeling requirements to meet the science objectives, the technology development requirements, and a cost plan for both the science program and new flight projects that will be needed for new observations beyond the present or currently planned. The plan definition process was very intensive as HQ required the final presentation package by mid-June 2001. This deadline was met and the recommendations were ultimately refined and folded into a broader program plan, which also included climate modeling, aerosol observations, and science computing technology development, for contributing to the President's Climate Change Research Initiative. This technical memorandum outlines the process and recommendations made for cross-cutting carbon cycle research as presented in June. A separate NASA document outlines the budget profiles or cost analyses conducted as part of the planning effort.

RTU Comparison Calculator Enhancement Plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miller, James D.; Wang, Weimin; Katipamula, Srinivas

Over the past two years, Department of Energy’s Building Technologies Office (BTO) has been investigating ways to increase the operating efficiency of the packaged rooftop units (RTUs) in the field. First, by issuing a challenge to the RTU manufactures to increase the integrated energy efficiency ratio (IEER) by 60% over the existing ASHRAE 90.1-2010 standard. Second, by evaluating the performance of an advanced RTU controller that reduces the energy consumption by over 40%. BTO has previously also funded development of a RTU comparison calculator (RTUCC). RTUCC is a web-based tool that provides the user a way to compare energy andmore » cost savings for two units with different efficiencies. However, the RTUCC currently cannot compare savings associated with either the RTU Challenge unit or the advanced RTU controls retrofit. Therefore, BTO has asked PNNL to enhance the tool so building owners can compare energy and savings associated with this new class of products. This document provides the details of the enhancements that are required to support estimating energy savings from use of RTU challenge units or advanced controls on existing RTUs.« less

Optimization of Deep Drilling Performance - Development and Benchmark Testing of Advanced Diamond Product Drill Bits & HP/HT Fluids to Significantly Improve Rates of Penetration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alan Black; Arnis Judzis

2005-09-30

This document details the progress to date on the OPTIMIZATION OF DEEP DRILLING PERFORMANCE--DEVELOPMENT AND BENCHMARK TESTING OF ADVANCED DIAMOND PRODUCT DRILL BITS AND HP/HT FLUIDS TO SIGNIFICANTLY IMPROVE RATES OF PENETRATION contract for the year starting October 2004 through September 2005. The industry cost shared program aims to benchmark drilling rates of penetration in selected simulated deep formations and to significantly improve ROP through a team development of aggressive diamond product drill bit--fluid system technologies. Overall the objectives are as follows: Phase 1--Benchmark ''best in class'' diamond and other product drilling bits and fluids and develop concepts for amore » next level of deep drilling performance; Phase 2--Develop advanced smart bit-fluid prototypes and test at large scale; and Phase 3--Field trial smart bit--fluid concepts, modify as necessary and commercialize products. As of report date, TerraTek has concluded all Phase 1 testing and is planning Phase 2 development.« less

Planning documents: a business planning strategy.

PubMed

Kaehrle, P A

2000-06-01

Strategic planning and business plan development are essential nursing management skills in today's competitive, fast paced, continually changing health care environment. Even in times of great uncertainty, nurse managers need to plan and forecast for the future. A well-written business plan allows nurse managers to communicate their expertise and proactively contribute to the programmatic decisions and changes occurring within their patient population or service area. This article presents the use of planning documents as a practical, strategic business planning strategy. Although the model addresses orthopedic services specifically, nurse managers can gain an understanding and working knowledge of planning concepts that can be applied to all patient populations.

Connected commercial vehicles-integrated truck project : data acquisition system (DAS) documentation.

DOT National Transportation Integrated Search

1996-08-01

The report documents work performed under the FTA Advanced Public Transportation Systems (APTS) Program, a program structured to undertake research and development of innovative applications of advanced navigation, information, and communication tech...

Energy Efficiency/Renewable Energy Programs in State Implementation Plans - Guidance Documents

EPA Pesticide Factsheets

final document that provides guidance to States and local areas on quantifying and including emission reductions from energy efficiency and renewable energy measures in State Implementation Plans (SIPS).

Policy Document on Earth Observation for Urban Planning and Management: State of the Art and Recommendations for Application of Earth Observation in Urban Planning

NASA Technical Reports Server (NTRS)

Nichol, Janet; King, Bruce; Xiaoli, Ding; Dowman, Ian; Quattrochi, Dale; Ehlers, Manfred

2007-01-01

A policy document on earth observation for urban planning and management resulting from a workshop held in Hong Kong in November 2006 is presented. The aim of the workshop was to provide a forum for researchers and scientists specializing in earth observation to interact with practitioners working in different aspects of city planning, in a complex and dynamic city, Hong Kong. A summary of the current state of the art, limitations, and recommendations for the use of earth observation in urban areas is presented here as a policy document.

Identifying the Factors That Facilitate or Hinder Advance Planning by Persons With Dementia

PubMed Central

Hirschman, Karen B.; Kapo, Jennifer M.; Karlawish, Jason H. T.

2009-01-01

We performed semistructured interviews with 30 family members of patients with advanced dementia to identify the factors that facilitate or hinder advance planning by persons with dementia. All interviews were analyzed using qualitative data analysis techniques. The majority (77%) of family members reported that their relative had some form of written advance directive, and at least half reported previous discussions about health care preferences (57%), living situation or placement issues (50%), and finances or estate planning (60%) with the patient. Family members reported some themes that prompted planning and others that were barriers to planning. Events that most often triggered planning were medical, living situation, or financial issues associated with a friend or family member of the patient (57%). Barriers to planning included both passive and active avoidance. The most common form of passive avoidance was not realizing the importance of planning until it was too late to have the discussion (63%). The most common form of active avoidance was avoiding the discussion (53%). These data suggest potentially remediable strategies to address barriers to advance planning discussions. PMID:18580595

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations.

PubMed

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2016-05-01

While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.

Distribution of a Generic Mission Planning and Scheduling Toolkit for Astronomical Spacecraft

NASA Technical Reports Server (NTRS)

Kleiner, Steven C.

1996-01-01

Work is progressing as outlined in the proposal for this contract. A working planning and scheduling system has been documented and packaged and made available to the WIRE Small Explorer group at JPL, the FUSE group at JHU, the NASA/GSFC Laboratory for Astronomy and Solar Physics and the Advanced Planning and Scheduling Branch at STScI. The package is running successfully on the WIRE computer system. It is expected that the WIRE will reuse significant portions of the SWAS code in its system. This scheduling system itself was tested successfully against the spacecraft hardware in December 1995. A fully automatic scheduling module has been developed and is being added to the toolkit. In order to maximize reuse, the code is being reorganized during the current build into object-oriented class libraries. A paper describing the toolkit has been written and is included in the software distribution. We have experienced interference between the export and production versions of the toolkit. We will be requesting permission to reprogram funds in order to purchase a standalone PC onto which to offload the export version.

Advancing the state of the art in healthcare strategic planning.

PubMed

Zuckerman, Alan M

2006-01-01

A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.

17 CFR 230.428 - Documents constituting a section 10(a) prospectus for Form S-8 registration statement...

Code of Federal Regulations, 2010 CFR

2010-04-01

... employee benefit plan information required by Item 1 of the Form; (ii) The statement of availability of registrant information, employee benefit plan annual reports and other information required by Item 2; and (iii) The documents containing registrant information and employee benefit plan annual reports that are...

A Plan for: A Consumer Conference for Older Adults.

ERIC Educational Resources Information Center

Zarakov, Selma

This document provides a step-by-step description of the planning and implementation of a two day consumer concerns conference for older adults held at Palomar Community College (California). The bulk of the document is made up of practical discussions of such planning phases as facility selection and decoration, conference publicity, snack and…

30 CFR 746.13 - Decision document and recommendation on mining plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Decision document and recommendation on mining plan. 746.13 Section 746.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR FEDERAL LANDS PROGRAM REVIEW AND APPROVAL OF MINING PLANS § 746.13 Decision...

Information security management system planning for CBRN facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lenaeu, Joseph D.; O'Neil, Lori Ross; Leitch, Rosalyn M.

The focus of this document is to provide guidance for the development of information security management system planning documents at chemical, biological, radiological, or nuclear (CBRN) facilities. It describes a risk-based approach for planning information security programs based on the sensitivity of the data developed, processed, communicated, and stored on facility information systems.

Advance directives in nursing homes: prevalence, validity, significance, and nursing staff adherence.

PubMed

Sommer, Sarah; Marckmann, Georg; Pentzek, Michael; Wegscheider, Karl; Abholz, Heinz-Harald; in der Schmitten, Jürgen

2012-09-01

The German Advance Directives Act of 2009 confirms that advance directives (ADs) are binding. Little is known, however, about their prevalence in nursing homes, their quality, and whether they are honored. In 2007, we carried out a cross-sectional survey in all 11 nursing homes of a German city in the state of North Rhine-Westphalia (total nursing home population, 1089 residents). The ADs were formally analyzed and assessed by 3 raters with respect to 5 clinical decision-making scenarios. The specifications of the ADs were compared with what the nurses reported that they would do in each scenario. 11% of the nursing home residents had a personal AD, and a further 1.4% an AD by proxy. 52% of the 119 ADs that we analyzed contained no documentation of the patient's decision-making capacity and/or voluntariness, and only 3% contained documentation of a medical consultation. Most ADs failed to state what should be done in case the patient acutely became incapable of consenting to treatment (inter-rater agreement [IRA] >83%). For the case of permanent decisional incapacity, many ADs contained ambiguous information (IRA<43%). 23 directives stated that the patient should not have cardiopulmonary resuscitation in case an arrest occurred in the patient's current clinical condition, but the nurses reported a corresponding do-not-resuscitate agreement for only 9 of these 23 patients. In 2007, ADs were rare in these German nursing homes, and most of the existing ones were invalid, of little meaning, and/or disregarded by the nursing staff. There is little reason to believe that the Advance Directives Act of 2009 will bring about any major change in this miserable status quo. Advance care planning, a system-oriented concept still uncommon in Germany, could give new impulses to promote a cultural change in this respect.

43 CFR 46.315 - How to format an environmental assessment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... planning, decision-making, and appropriate public participation. (b) An environmental assessment may be accompanied by any other planning or decision-making document. The portion of the document that analyzes the...

14 CFR 151.119 - Advance planning proposals: Procedures; funding.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and...

14 CFR 151.117 - Advance planning proposals: Procedures; application.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Advance planning proposals: Procedures; application. 151.117 Section 151.117 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and...

14 CFR 151.117 - Advance planning proposals: Procedures; application.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Advance planning proposals: Procedures; application. 151.117 Section 151.117 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and...

14 CFR 151.117 - Advance planning proposals: Procedures; application.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Advance planning proposals: Procedures; application. 151.117 Section 151.117 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIRPORTS FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and...

14 CFR 151.129 - Payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FEDERAL AID TO AIRPORTS Rules and Procedures for Advance Planning and Engineering Proposals § 151.129 Payments. (a) The United States' share of advance planning costs is paid in two installments unless the advance planning grant agreement provides otherwise. Upon request by sponsor, the first payment may be...

NASA software documentation standard software engineering program

NASA Technical Reports Server (NTRS)

1991-01-01

The NASA Software Documentation Standard (hereinafter referred to as Standard) can be applied to the documentation of all NASA software. This Standard is limited to documentation format and content requirements. It does not mandate specific management, engineering, or assurance standards or techniques. This Standard defines the format and content of documentation for software acquisition, development, and sustaining engineering. Format requirements address where information shall be recorded and content requirements address what information shall be recorded. This Standard provides a framework to allow consistency of documentation across NASA and visibility into the completeness of project documentation. This basic framework consists of four major sections (or volumes). The Management Plan contains all planning and business aspects of a software project, including engineering and assurance planning. The Product Specification contains all technical engineering information, including software requirements and design. The Assurance and Test Procedures contains all technical assurance information, including Test, Quality Assurance (QA), and Verification and Validation (V&V). The Management, Engineering, and Assurance Reports is the library and/or listing of all project reports.

Advance Care Planning Beyond Advance Directives: Perspectives from Patients and Surrogates

PubMed Central

McMahan, Ryan; Knight, Sara J.; Fried, Terri R.; Sudore, Rebecca L.

2014-01-01

Context Advance care planning (ACP) has focused on documenting life-sustaining treatment preferences in advance directives (ADs). ADs alone may be insufficient to prepare diverse patients and surrogates for complex medical decisions. Objectives To understand what steps best prepare patients and surrogates for decision making. Methods We conducted 13 English/Spanish focus groups with participants from a Veterans Affairs and county hospital and the community. Seven groups included patients (n=38) aged ≥65 years, who reported making serious medical decisions. Six separate groups included surrogates (n=31), aged ≥18 years, who made decisions for others. Semi-structured focus groups asked what activities best prepared participants for decision making. Two investigators independently coded data and performed thematic content analysis. Disputes were resolved by consensus. Results Mean±SD patient age was 78±8 years and 61% were non-white. Mean±SD surrogate age was 57±10 years and 91% were non-white. Qualitative analysis identified four overarching themes about how to best prepare for decision making: 1) identify values based on past experiences and quality of life, 2) choose surrogates wisely and verify they understand their role, 3) decide whether to grant leeway in surrogate decision making, and 4) inform other family and friends of one's wishes to prevent conflict. Conclusion Beyond ADs, patients and surrogates recommend several additional steps to prepare for medical decision making including using past experiences to identify values, verifying the surrogate understands their role, deciding whether to grant surrogates leeway, and informing other family and friends of one's wishes. Future ACP interventions should consider incorporating these additional ACP activities. PMID:23200188

Advance Care Planning and Health Care Preferences of Community-Dwelling Elders: The Framingham Heart Study

PubMed Central

McCarthy, Ellen P.; Pencina, Michael J.; Kelly-Hayes, Margaret; Evans, Jane C.; Oberacker, Elizabeth J.; D’Agostino, Ralph B.; Burns, Risa B.; Murabito, Joanne M.

2009-01-01

Objectives To describe self-reported advance care planning, health care preferences, use of advance directives, and health perceptions in a very elderly community-dwelling sample. Methods Surviving participants of the original cohort of the Framingham Heart Study who were cognitively intact and attended a routine research exam between February 2004 and October 2005. Participants were queried about discussions about end of life care, preferences for care, documentation of advance directives, and health perceptions. Results Among 220 community-dwelling respondents, 67% were women with a mean age of 88 years (range 84-100). Overall 69% discussed their wishes for medical care at the end of life with someone, but only 17% discussed their wishes with a physician or health care provider. Two-thirds had a health care proxy, 55% had a living will, and 41% had both. Most (80%) respondents preferred comfort care over life-extending care, and 71% preferred to die at home; however, substantially fewer respondents said they would rather die than receive specific life-prolonging interventions [chronic ventilator (63%) or feeding tube (64%)]. Many were willing to endure distressing health states, with less than half indicating that they would rather die than live out their life in a great deal of pain (46%) or be confused/forgetful (45%) all of the time. Conclusions Although the vast majority of very elderly community-dwellers in this sample appear to prefer comfort measures at the end of life, many said they were willing to endure specific life-prolonging interventions and distressing health states to avoid death. Our results highlight the need for physicians better understand patients’ preferences and goals of care to help them make informed decisions at the end of life. PMID:18840800

Public Opinion Regarding Financial Incentives to Engage in Advance Care Planning and Complete Advance Directives.

PubMed

Auriemma, Catherine L; Chen, Lucy; Olorunnisola, Michael; Delman, Aaron; Nguyen, Christina A; Cooney, Elizabeth; Gabler, Nicole B; Halpern, Scott D

2017-09-01

The Centers for Medicare & Medicaid Services (CMS) recently instituted physician reimbursements for advance care planning (ACP) discussions with patients. To measure public support for similar programs. Cross-sectional online and in-person surveys. English-speaking adults recruited at public parks in Philadelphia, Pennsylvania, from July to August 2013 and online through survey sampling international Web-based recruitment platform in July 2015. Participants indicated support for 6 programs designed to increase advance directive (AD) completion or ACP discussion using 5-point Likert scales. Participants also indicated how much money (US$0-US$1000) was appropriate to incentivize such behaviors, compared to smoking cessation or colonoscopy screening. We recruited 883 participants: 503 online and 380 in-person. The status quo of no systematic approach to motivate AD completion was supported by 67.0% of participants (63.9%-70.1%). The most popular programs were paying patients to complete ADs (58.0%; 54.5%-61.2%) and requiring patients to complete ADs or declination forms for health insurance (54.1%; 50.8%-57.4%). Participants more commonly supported paying patients to complete ADs than paying physicians whose patients complete ADs (22.6%; 19.8%-25.4%) or paying physicians who document ACP discussions (19.1%; 16.5%-21.7%; both P < .001). Participants supported smaller payments for AD completion and ACP than for obtaining screening colonoscopies or stopping smoking. Americans view payments for AD completion or ACP more skeptically than for other health behaviors and prefer that such payments go to patients rather than physicians. The current CMS policy of reimbursing physicians for ACP conversations with patients was the least preferred of the programs evaluated.

Implementing an advance care planning program in German nursing homes: results of an inter-regionally controlled intervention trial.

PubMed

In der Schmitten, Jürgen; Lex, Katharina; Mellert, Christine; Rothärmel, Sonja; Wegscheider, Karl; Marckmann, Georg

2014-01-24

Advance Care Planning (ACP) is a systematic approach to ensure that effective advance directives (ADs) are developed and respected. We studied the effects of implementing a regional ACP program in Germany. In a prospective, inter-regionally controlled trial focusing on nursing homes (n/hs), we compared the number, relevance and validity of new ADs completed in the intervention region versus the control region. Intervention n/h residents and their families were offered professional facilitation including standardized documentation. Data from 136 residents of three intervention n/hs were compared with data from 439 residents of 10 control n/hs over a study period of 16.5 months. In the intervention region, 49 (36.0%) participating residents completed a new AD over the period of the study, compared to 18 (4.1%) in the control region; these ADs included 30 ADs by proxy in the intervention region versus 10 in the control region. Proxies were designated in 94.7% versus 50.0% of cases, the AD was signed by a physician in 93.9% versus 16.7%, and an emergency order was included in 98.0% versus 44.4%. Resuscitation status was addressed in 95.9% versus 38.9% of cases (p<0.01 for all of the differences mentioned above). In the intervention region, new ADs were preceded by an average of 2.5 facilitated conversations (range, 2–5) with a mean total duration of 100 minutes (range, 60–240 minutes). The implementation of an ACP program in German nursing homes led, much more frequently than previously reported, to the creation of advance directives with potential relevance to medical decision-making. Future research should assess the effect of such programs on clinical and structural outcomes.

Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies.

PubMed

Ke, Li-Shan; Huang, Xiaoyan; Hu, Wen-Yu; O'Connor, Margaret; Lee, Susan

2017-05-01

Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

Management plan documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 2

NASA Technical Reports Server (NTRS)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the second of five volumes of the Information System Life-Cycle and Documentation Standards. This volume provides a well-organized, easily used standard for management plans used in acquiring, assuring, and developing information systems and software, hardware, and operational procedures components, and related processes.

An International Coordinated Effort to Further the Documentation & Development of Quality Assurance, Quality Control, and Best Practices for Oceanographic Observations

NASA Astrophysics Data System (ADS)

Bushnell, M.; Waldmann, C.; Hermes, J.; Tamburri, M.

2017-12-01

Many oceanographic observation groups create and maintain QA, QC, and best practices (BP) to ensure efficient and accurate data collection and quantify quality. Several entities - IOOS® QARTOD, AtlantOS, ACT, WMO/IOC JCOMM OCG - have joined forces to document existing practices, identify gaps, and support development of emerging techniques. While each group has a slightly different focus, many underlying QA/QC/BP needs can be quite common. QARTOD focuses upon real-time data QC, and has produced manuals that address QC tests for eleven ocean variables. AtlantOS is a research and innovation project working towards the integration of ocean-observing activities across all disciplines in the Atlantic Basin. ACT brings together research institutions, resource managers, and private companies to foster the development and adoption of effective and reliable sensors for coastal, freshwater, and ocean environments. JCOMM promotes broad international coordination of oceanographic and marine meteorological observations and data management and services. Leveraging existing efforts of these organizations is an efficient way to consolidate available information, develop new practices, and evaluate the use of ISO standards to judge the quality of measurements. ISO standards may offer accepted support for a framework for an ocean data quality management system, similar to the meteorological standards defined by WMO (https://www.wmo.int/pages/prog/arep/gaw/qassurance.html). We will first cooperatively develop a plan to create a QA/QC/BP manual. The resulting plan will describe the need for such a manual, the extent of the manual, the process used to engage the community in creating it, the maintenance of the resultant document, and how these things will be done. It will also investigate standards for metadata. The plan will subsequently be used to develop the QA/QC/BP manual, providing guidance which advances the standards adopted by IOOS, AtlantOS, JCOMM, and others.

Credentialing of radiotherapy centres in Australasia for TROG 09.02 (Chisel), a Phase III clinical trial on stereotactic ablative body radiotherapy of early stage lung cancer.

PubMed

Kron, Tomas; Chesson, Brent; Hardcastle, Nicholas; Crain, Melissa; Clements, Natalie; Burns, Mark; Ball, David

2018-05-01

A randomised clinical trial comparing stereotactic ablative body radiotherapy (SABR) with conventional radiotherapy for early stage lung cancer has been conducted in Australia and New Zealand under the auspices of the TransTasman Radiation Oncology Group (NCT01014130). We report on the technical credentialing program as prerequisite for centres joining the trial. Participating centres were asked to develop treatment plans for two test cases to assess their ability to create plans according to protocol. Dose delivery in the presence of inhomogeneity and motion was assessed during a site visit using a phantom with moving inserts. Site visits for the trial were conducted in 16 Australian and 3 New Zealand radiotherapy facilities. The tests with low density inhomogeneities confirmed shortcomings of the AAA algorithm for dose calculation. Dose was assessed for a typical treatment delivery including at least one non-coplanar beam in a stationary and moving phantom. This end-to-end test confirmed that all participating centres were able to deliver stereotactic ablative body radiotherapy with the required accuracy while the planning study demonstrated that they were able to produce acceptable plans for both test cases. The credentialing process documented that participating centres were able to deliver dose as required in the trial protocol. It also gave an opportunity to provide education about the trial and discuss technical issues such as four-dimensional CT, small field dosimetry and patient immobilisation with staff in participating centres. Advances in knowledge: Credentialing is an important quality assurance tool for radiotherapy trials using advanced technology. In addition to confirming technical competence, it provides an opportunity for education and discussion about the trial.

A Randomized Controlled Trial of a CPR and Intubation Video Decision Support Tool for Hospitalized Patients.

PubMed

El-Jawahri, Areej; Mitchell, Susan L; Paasche-Orlow, Michael K; Temel, Jennifer S; Jackson, Vicki A; Rutledge, Renee R; Parikh, Mihir; Davis, Aretha D; Gillick, Muriel R; Barry, Michael J; Lopez, Lenny; Walker-Corkery, Elizabeth S; Chang, Yuchiao; Finn, Kathleen; Coley, Christopher; Volandes, Angelo E

2015-08-01

Decisions about cardiopulmonary resuscitation (CPR) and intubation are a core part of advance care planning, particularly for seriously ill hospitalized patients. However, these discussions are often avoided. We aimed to examine the impact of a video decision tool for CPR and intubation on patients' choices, knowledge, medical orders, and discussions with providers. This was a prospective randomized trial conducted between 9 March 2011 and 1 June 2013 on the internal medicine services at two hospitals in Boston. One hundred and fifty seriously ill hospitalized patients over the age of 60 with an advanced illness and a prognosis of 1 year or less were included. Mean age was 76 and 51% were women. Three-minute video describing CPR and intubation plus verbal communication of participants' preferences to their physicians (intervention) (N = 75) or control arm (usual care) (N = 75). The primary outcome was participants' preferences for CPR and intubation (immediately after viewing the video in the intervention arm). Secondary outcomes included: orders to withhold CPR/intubation, documented discussions with providers during hospitalization, and participants' knowledge of CPR/ intubation (five-item test, range 0-5, higher scores indicate greater knowledge). Intervention participants (vs. controls) were more likely not to want CPR (64% vs. 32%, p <0.0001) and intubation (72% vs. 43%, p < 0.0001). Intervention participants (vs. controls) were also more likely to have orders to withhold CPR (57% vs. 19%, p < 0.0001) and intubation (64% vs.19%, p < 0.0001) by hospital discharge, documented discussions about their preferences (81% vs. 43%, p < 0.0001), and higher mean knowledge scores (4.11 vs. 2.45; p < 0.0001). Seriously ill patients who viewed a video about CPR and intubation were more likely not to want these treatments, be better informed about their options, have orders to forgo CPR/ intubation, and discuss preferences with providers. Clinicaltrials.gov NCT01325519 Registry Name: A prospective randomized trial using video images in advance care planning in seriously ill hospitalized patients.

A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving.

PubMed

Dolan, R; Broadbent, P

2016-02-01

Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care.

Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

PubMed

Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

2015-08-01

This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

'Not yet' and 'Just ask': barriers and facilitators to advance care planning--a qualitative descriptive study of the perspectives of seriously ill, older patients and their families.

PubMed

Simon, Jessica; Porterfield, Pat; Bouchal, Shelley Raffin; Heyland, Daren

2015-03-01

To explore seriously ill, older hospitalised patients' and their family members' perspectives on the barriers and facilitators of advance care planning (ACP). We used qualitative descriptive study methodology to analyse data from an interviewer administered, questionnaire-based, Canadian multicentre, prospective study of this population. Three main categories described these barriers and facilitators: (1) person (beliefs, attitudes, experiences, health status), (2) access (to doctors and healthcare providers, information, tools and infrastructure to communicate ACP preferences) and (3) the interaction with the doctor (who and how initiated, location, timing, quality of communication, relationship with doctor). Based on the findings, we suggest strategies for both healthcare systems and individual healthcare providers to improve the quality and quantity of ACP with this population. These include assessing readiness for participation in ACP and personalising relevance of ACP to each individual, routinely offering scheduled family meetings for exploring a person's own goals and sharing information, ensuring systems and policies are in place to access previous ACP documentation and ensuring doctors' education includes ACP communication skills. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Coordinating Council. Third Meeting: STI Strategic Plans

NASA Technical Reports Server (NTRS)

1990-01-01

The NASA Scientific and Technical Information Program Coordinating Council conducts meetings after which both modified transcripts of presentations and interactive discussions are published. The theme for the November 1990 meeting was 'STI Strategic Plans'. This theme was the focus of recorded discussions by members of the council. The last section of the report presents visuals on strategic goals for the STI Information Division. NASA's vision is to be at the forefront of advancements in aeronautics, space science, and exploration. More specific NASA goals are listed followed by the STI Division mission statement. The Strategic Goals for the STI Division are outlined as follows: Implement effective management strategies, Accomplish rapid deployment of the NASA STI Network, Seek out and develop cooperative partnerships, Establish the STI Program as an integral part of the NASA R&D effort, Enhance the quality of our products and services through a focus on the customer, Build an attitude of quality throughout the enterprise, Expand the existing participant community, Assert a NASA leadership role for STI policy, and Develop a program for information science R&D. The STI division mission statement appears on the document cover as follows 'The mission of the NASA STI Program is to advance aerospace knowledge, contribute to U.S. competitiveness, and become an integral partner in NASA R&D programs to support NASA goals.'

Laboratory directed research and development program, FY 1996

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-02-01

The Ernest Orlando Lawrence Berkeley National Laboratory (Berkeley Lab) Laboratory Directed Research and Development Program FY 1996 report is compiled from annual reports submitted by principal investigators following the close of the fiscal year. This report describes the projects supported and summarizes their accomplishments. It constitutes a part of the Laboratory Directed Research and Development (LDRD) program planning and documentation process that includes an annual planning cycle, projection selection, implementation, and review. The Berkeley Lab LDRD program is a critical tool for directing the Laboratory`s forefront scientific research capabilities toward vital, excellent, and emerging scientific challenges. The program provides themore » resources for Berkeley Lab scientists to make rapid and significant contributions to critical national science and technology problems. The LDRD program also advances the Laboratory`s core competencies, foundations, and scientific capability, and permits exploration of exciting new opportunities. Areas eligible for support include: (1) Work in forefront areas of science and technology that enrich Laboratory research and development capability; (2) Advanced study of new hypotheses, new experiments, and innovative approaches to develop new concepts or knowledge; (3) Experiments directed toward proof of principle for initial hypothesis testing or verification; and (4) Conception and preliminary technical analysis to explore possible instrumentation, experimental facilities, or new devices.« less

Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning.

PubMed

Van Scoy, Lauren J; Reading, Jean M; Hopkins, Margaret; Smith, Brandi; Dillon, Judy; Green, Michael J; Levi, Benjamin H

2017-11-01

Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments. This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients with chronic illness and/or their caregivers when deployed in a community setting. Twenty-two games (n = 93 participants) were held in community settings surrounding Hershey, PA in 2016. Participants were recruited using random sampling from patient databases and also convenience sampling (i.e., flyers). Quantitative questionnaires and qualitative focus group interviews were administered to assess the game experience and subsequent performance of ACP behaviors. Both quantitative and qualitative data found that Community Game Day was a well-received, positive experience for participants and 75% of participants performed ACP within three months post-intervention. These findings suggest that using a conversation game during community outreach is a useful approach for engaging patients and caregivers in ACP. The convergence of quantitative and qualitative data strongly supports the continued investigation of the game in randomized controlled trials. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

EPA Guidance for Geospatially Related Quality Assurance Project Plans

EPA Pesticide Factsheets

This March 2003 document discusses EPA's Quality Assurance (QA) Project Plan as a tool for project managers and planners to document the type and quality of data and information needed for making environmental decisions

Content of Advance Directives for Individuals with Advanced Dementia

PubMed Central

Black, Betty S.; Phillips, Hilary; Fahrendorf, Sarah Richardson; Schwartz, Jack; Angelino, Andrew F.; Anderson, Danielle; Rabins, Peter V.

2010-01-01

Objectives To examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives. Methods The documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed. Results More years of education and White race were significantly associated with having an advance directive. With the exceptions of comfort care and pain treatment, advance directives were used primarily to restrict, not request, many forms of care at the end-of-life. Decisions about care for end-stage conditions such as Alzheimer's dementia are less often addressed in these documents than for terminal conditions and persistent vegetative state. Discussion In order for advance directives to better reflect a person's wishes, discussions with individuals and families about advance directives should include a range of care issues in the settings of terminal illness, persistent vegetative state or end-stage illness. These documents should be reviewed periodically to make certain they convey accurately the person's treatment preferences. PMID:18625761

Adversaries at the Bedside: Advance Care Plans and Future Welfare.

PubMed

Kestigian, Aidan; London, Alex John

2016-10-01

Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans. © 2016 John Wiley & Sons Ltd.

Advanced planetary studies

NASA Technical Reports Server (NTRS)

1977-01-01

Results of planetary advanced studies and planning support are summarized. The scope of analyses includes cost estimation research, planetary mission performance, penetrator advanced studies, Mercury mission transport requirements, definition of super solar electric propulsion/solar sail mission discriminators, and advanced planning activities.

Concept for a Satellite-Based Advanced Air Traffic Management System : Volume 6. Development and Transition Plans.

DOT National Transportation Integrated Search

1974-02-01

The volume presents the plans for implementing the Satellite-Based Advanced Air Traffic Management System (SAATMS) described in Volumes II, III, and IV. Two plans are presented: an RDT&E plan and a transition plan. The RDT&E plan is presented as a se...

Advance care treatment plan (ACT-Plan) for African American family caregivers: a pilot study.

PubMed

Bonner, Gloria J; Wang, Edward; Wilkie, Diana J; Ferrans, Carol E; Dancy, Barbara; Watkins, Yashika

2014-01-01

Research is limited on end-of-life treatment decisions made by African American family caregivers. In a pilot study, we examined the feasibility of implementing an advance care treatment plan (ACT-Plan), a group-based education intervention, with African American dementia caregivers. Theoretically based, the ACT-Plan included strategies to enhance knowledge, self-efficacy, and behavioral skills to make end-of-life treatment plans in advance. Cardiopulmonary resuscitation, mechanical ventilation, and tube feeding were end-of-life treatments discussed in the ACT-Plan. In a four-week pre/posttest two-group design at urban adult day care centers, 68 caregivers were assigned to the ACT-Plan or attention-control health promotion conditions. Findings strongly suggest that the ACT-Plan intervention is feasible and appropriate for African American caregivers. Self-efficacy and knowledge about dementia, cardiopulmonary resuscitation, mechanical ventilation, and tube feeding increased for ACT-Plan participants but not for the attention-control. More ACT-Plan than attention-control participants developed advance care plans for demented relatives. Findings warrant a randomized efficacy trial.

Timing of Advance Directive Completion and Relationship to Care Preferences.

PubMed

Enguidanos, Susan; Ailshire, Jennifer

2017-01-01

Given recent Medicare rules reimbursing clinicians for engaging in advance care planning, there is heightened need to understand factors associated with the timing of advance directive (AD) completion before death and how the timing impacts care decisions. The purpose of this study was to investigate patterns in timing of AD completion and the relationship between timing and documented care preferences. We hypothesize that ADs completed late in the course of illness or very early in the disease trajectory will reflect higher preferences for aggressive care. We conducted a retrospective study using logistic regressions to analyze data from the Health and Retirement Study, a nationally representative longitudinal survey of older adults. The analytic sample included exit interviews conducted from 2000 to 2012 among 2904 proxy reporters of deceased participants who had an AD. Nearly three-quarters (71%) of ADs were completed a year or more before death. Being younger or a racial/ethnic minority, and having lower education, a diagnosis of cancer or lung disease, and an expected death were associated with completing an AD within the three months before death, while having the lowest quartile of assets and memory problems were inversely associated with AD completion. Minorities, those with lower education, expected death, and timing of AD completion were associated with electing aggressive care. Early documentation of care wishes may not be associated with an increased likelihood of electing aggressive care; however, ADs completed in the last months of life have higher rates of election of aggressive care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Curriculum Planning and Some Current Health Problems. Educational Studies and Documents, No. 13.

ERIC Educational Resources Information Center

Southworth, Warren H.

This document is a supplement to the UNESCO Source Book "Planning for Health Education in Schools" by C. E. Turner. It is intended for those directly concerned with curriculum planning in relation to health--school administrators, health education supervisors, curriculum specialists, individual teachers--but it is also thought to be of interest to…

75 FR 11105 - Kootenai (KNF) and Idaho Panhandle National Forests (IPNF); Montana, Idaho and Washington...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-10

... plan revision. The Comprehensive Evaluation Report (CER) provided for public review and comment in 2006, built upon the AMS and documents the evaluation of the 1987 Forest Plans and proposed changes. The CER.... The CER, under the 2005 and 2008 Planning Rules, served as the principle document that supported the...

23 CFR 420.111 - What are the documentation requirements for use of FHWA planning and research funds?

Code of Federal Regulations, 2011 CFR

2011-04-01

... and subrecipients in a work program, or other document that describes the work to be accomplished... various combinations, or brought together as a single work program. The expenditure of PL funds for transportation planning outside of metropolitan planning areas under § 420.109(d) may be included in the work...

Child Care and Education: The Critical Connection. Action Plan [and] Policy Statement.

ERIC Educational Resources Information Center

Child Care Action Campaign, New York, NY.

This document presents the action plan of the Child Care Action Campaign (CCAC) for improving the quantity and quality of child care services. The document also provides a policy statement on linking education and child care efforts. The action plan describes CCAC's vision of a streamlined system providing child care to infants and toddlers,…

Planning guidance for the Chemical Stockpile Emergency Preparedness Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shumpert, B.L.; Watson, A.P.; Sorensen, J.H.

1995-02-01

This planning guide was developed under the direction of the U.S. Army and the Federal Emergency Management Agency (FEMA) which jointly coordinate and direct the development of the Chemical Stockpile Emergency Preparedness Program (CSEPP). It was produced to assist state, local, and Army installation planners in formulating and coordinating plans for chemical events that may occur at the chemical agent stockpile storage locations in the continental United States. This document provides broad planning guidance for use by both on-post and off-post agencies and organizations in the development of a coordinated plan for responding to chemical events. It contains checklists tomore » assist in assuring that all important aspects are included in the plans and procedures developed at each Chemical Stockpile Disposal Program (CSDP) location. The checklists are supplemented by planning guidelines in the appendices which provide more detailed guidance regarding some issues. The planning guidance contained in this document will help ensure that adequate coordination between on-post and off-post planners occurs during the planning process. This planning guide broadly describes an adequate emergency planning base that assures that critical planning decisions will be made consistently at every chemical agent stockpile location. This planning guide includes material drawn from other documents developed by the FEMA, the Army, and other federal agencies with emergency preparedness program responsibilities. Some of this material has been developed specifically to meet the unique requirements of the CSEPP. In addition to this guidance, other location-specific documents, technical studies, and support studies should be used as needed to assist in the planning at each of the chemical agent stockpile locations to address the specific hazards and conditions at each location.« less

Advance care planning for haemodialysis patients.

PubMed

Lim, Chi Eung Danforn; Ng, Rachel W C; Cheng, Nga Chong Lisa; Cigolini, Maria; Kwok, Cannas; Brennan, Frank

2016-07-26

End-stage kidney disease (ESKD) is a chronic, debilitative and progressive illness that may need interventions such as dialysis, transplantation, dietary and fluid restrictions. Most patients with ESKD will require renal replacement therapy, such as kidney transplantation or maintenance dialysis. Advance care planning traditionally encompass instructions via living wills, and concern patient preferences about interventions such as cardiopulmonary resuscitation and feeding tubes, or circumstances around assigning surrogate decision makers. Most people undergoing haemodialysis are not aware of advance care planning and few patients formalise their wishes as advance directives and of those who do, many do not discuss their decisions with a physician. Advance care planning involves planning for future healthcare decisions and preferences of the patient in advance while comprehension is intact. It is an essential part of good palliative care that likely improves the lives and deaths of haemodialysis patients. The objective of this review was to determine whether advance care planning in haemodialysis patients, compared with no or less structured forms of advance care planning, can result in fewer hospital admissions or less use of treatments with life-prolonging or curative intent, and if patient's wishes were followed at end-of-life. We searched the Cochrane Kidney and Transplant Specialised Register to 27 June 2016 through contact with the Information Specialist using search terms relevant to this review. We also searched the Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Social Work Abstracts (OvidSP). All randomised controlled trials (RCTs) and quasi-RCTs (RCTs in which allocation to treatment was obtained by alternation, use of alternate medical records, date of birth or other predictable methods) looking at advance care planning versus no form of advance care planning in haemodialysis patients was considered for inclusion without language restriction. Data extraction was carried out independently by two authors using standard data extraction forms. Studies reported in non-English language journals were translated before assessment. Where more than one publication of one study exists, reports were grouped together and the publication with the most complete data was used in the analyses. Where relevant outcomes are only published in earlier versions these data were used. Any discrepancies between published versions were highlighted. Non-randomised controlled studies were excluded. We included two studies (three reports) that involved 337 participants which investigated advance care planning for people with ESKD. Neither of the included studies reported outcomes relevant to this review. Study quality was assessed as suboptimal. We found sparse data that were assessed at suboptimal quality and therefore we were unable to formulate conclusions about whether advance care planning can influence numbers of hospital admissions and treatment required by people with ESKD, or if patients' advance care directives were followed at end-of-life. Further well designed and adequately powered RCTs are needed to better inform patient and clinical decision-making about advance care planning and advance directives among people with ESKD who are undergoing dialysis.

Documents and Symbols of American Freedom. Elementary Grade Activity. Schools of California Online Resources for Education (SCORE): Connecting California's Classrooms to the World.

ERIC Educational Resources Information Center

Hutchens, Dorothy

This lesson plan for elementary-age children studies some of the primary source documents and symbols of freedom which were and are important for the nation. The lesson plan uses the following documents: "The Mayflower Compact"; "The Declaration of Independence"; "The Constitution"; and the "Bill of Rights."…

EPA Concurrence/Approval of Federal Facility Proposed Plans and Records of Decision and other Documents

EPA Pesticide Factsheets

The purpose of this memorandum is to ensure that EPA Regions scrutinize all proposed plans, draft and final RODs, and post-ROD documents that address institutional controls (ICs) in order to verify that they adequately document the objectives of the ICs and clearly identify who has responsibility for implementation, monitoring, reporting, and enforcement of the IC.

Comparisons of ANS, ASME, AWS, and NFPA standards cited in the NRC standard review plan, NUREG-0800, and related documents

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ankrum, A.R.; Bohlander, K.L.; Gilbert, E.R.

This report provides the results of comparisons of the cited and latest versions of ANS, ASME, AWS and NFPA standards cited in the NRC Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants (NUREG 0800) and related documents. The comparisons were performed by Battelle Pacific Northwest Laboratories in support of the NRC`s Standard Review Plan Update and Development Program. Significant changes to the standards, from the cited version to the latest version, are described and discussed in a tabular format for each standard. Recommendations for updating each citation in the Standard Review Plan are presented.more » Technical considerations and suggested changes are included for related regulatory documents (i.e., Regulatory Guides and the Code of Federal Regulations) citing the standard. The results and recommendations presented in this document have not been subjected to NRC staff review.« less

300 Area waste acid treatment system closure plan

DOE Office of Scientific and Technical Information (OSTI.GOV)

LUKE, S.N.

1999-05-17

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to themore » General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.« less

Methods for Estimating Environmental Effects and Constraints on NexGen: High Density Case Study

NASA Technical Reports Server (NTRS)

Augustine, S.; Ermatinger, C.; Graham, M.; Thompson, T.

2010-01-01

This document provides a summary of the current methods developed by Metron Aviation for the estimate of environmental effects and constraints on the Next Generation Air Transportation System (NextGen). This body of work incorporates many of the key elements necessary to achieve such an estimate. Each section contains the background and motivation for the technical elements of the work, a description of the methods used, and possible next steps. The current methods described in this document were selected in an attempt to provide a good balance between accuracy and fairly rapid turn around times to best advance Joint Planning and Development Office (JPDO) System Modeling and Analysis Division (SMAD) objectives while also supporting the needs of the JPDO Environmental Working Group (EWG). In particular this document describes methods applied to support the High Density (HD) Case Study performed during the spring of 2008. A reference day (in 2006) is modeled to describe current system capabilities while the future demand is applied to multiple alternatives to analyze system performance. The major variables in the alternatives are operational/procedural capabilities for airport, terminal, and en route airspace along with projected improvements to airframe, engine and navigational equipment.

Advanced Education and Technology Business Plan, 2010-13

ERIC Educational Resources Information Center

Alberta Advanced Education and Technology, 2010

2010-01-01

This paper presents the business plan of the Ministry of Advanced Education and Technology for 2010 to 2013. Advanced Education and Technology supports the advanced learning system by providing funding for advanced learning providers, coordinating and approving programs of study at public institutions, licensing and approving programs at private…

Teaching Advance Care Planning to Medical Students with a Computer-Based Decision Aid

PubMed Central

Levi, Benjamin H.

2013-01-01

Discussing end-of-life decisions with cancer patients is a crucial skill for physicians. This article reports findings from a pilot study evaluating the effectiveness of a computer-based decision aid for teaching medical students about advance care planning. Second-year medical students at a single medical school were randomized to use a standard advance directive or a computer-based decision aid to help patients with advance care planning. Students' knowledge, skills, and satisfaction were measured by self-report; their performance was rated by patients. 121/133 (91%) of students participated. The Decision-Aid Group (n=60) outperformed the Standard Group (n=61) in terms of students´ knowledge (p<0.01), confidence in helping patients with advance care planning (p<0.01), knowledge of what matters to patients (p=0.05), and satisfaction with their learning experience (p<0.01). Likewise, patients in the Decision Aid Group were more satisfied with the advance care planning method (p<0.01) and with several aspects of student performance. Use of a computer-based decision aid may be an effective way to teach medical students how to discuss advance care planning with cancer patients. PMID:20632222

5 CFR 720.304 - Agency plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

...) AFFIRMATIVE EMPLOYMENT PROGRAMS Disabled Veterans Affirmative Action Program § 720.304 Agency plan. (a) Plan... advancement of disabled veterans. (1) Each agency must review its plan on an annual basis, together with its... advancement of disabled veterans. OPM must be informed when headquarters offices require plans at the field or...

Mainstreaming gender equality in the sustainable development process: 1992-1996.

PubMed

1997-01-01

One of the major contributions of Economic Commission for Africa (ECA) in the mainstreaming of gender equality into a sustainable development process was organizing the 5th African Regional Conference on Women in November 1994, in which a comprehensive policy document was formulated and adopted by all African governments. The policy contained in a document entitled the African Platform for Action (APA), which promotes the advancement of women through sustainable development. Its recommendations are being implemented together with the Global Platform for Action (GPA). To ensure the implementation of APA and GPA, ECA has set up various monitoring and implementation-coordinating groups such as the African Regional Coordinating Committee and the African Women's Communications and Development Network. In addition, ECA also facilitated the creation of the African Women Committee for Peace in November 1996, which will ensure the participation of women in the peace process at the highest level. All work programs of the ECA are expected to mainstream gender in their plans and activities.

Study protocol for 'we DECide': implementation of advance care planning for nursing home residents with dementia.

PubMed

Ampe, Sophie; Sevenants, Aline; Coppens, Evelien; Spruytte, Nele; Smets, Tinne; Declercq, Anja; van Audenhove, Chantal

2015-05-01

To evaluate the effects of 'we DECide', an educational intervention for nursing home staff on shared decision-making in the context of advance care planning for residents with dementia. Advance care planning (preparing care choices for when persons no longer have decision-making capacity) is of utmost importance for nursing home residents with dementia, but is mostly not realized for this group. Advance care planning consists of discussing care choices and making decisions and corresponds to shared decision-making (the involvement of persons and their families in care and treatment decisions). This quasi-experimental pre-test-post-test study is conducted in 19 nursing homes (Belgium). Participants are nursing home staff. 'We DECide' focuses on three crucial moments for discussing advance care planning: the time of admission, crisis situations and everyday conversations. The 'ACP-audit' assesses participants' views on the organization of advance care planning (organizational level), the 'OPTION scale' evaluates the degree of shared decision-making in individual conversations (clinical level) and the 'IFC-SDM Questionnaire' assesses participants' views on Importance, Frequency and Competence of realizing shared decision-making (clinical level). (Project funded: July 2010). The study hypothesis is that 'we DECide' results in a higher realization of shared decision-making in individual conversations on advance care planning. A better implementation of advance care planning will lead to a higher quality of end-of-life care and more person-centred care. We believe our study will be of interest to researchers and to professional nursing home caregivers and policy-makers. © 2014 John Wiley & Sons Ltd.

76 FR 69172 - Determination of Governmental Plan Status

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

...The Treasury Department and IRS anticipate issuing regulations under section 414(d) of the Internal Revenue Code (Code) to define the term ``governmental plan.'' This document describes the rules that the Treasury Department and IRS are considering proposing relating to the determination of whether a plan is a governmental plan within the meaning of section 414(d) and contains an appendix that includes a draft notice of proposed rulemaking on which the Treasury Department and IRS invite comments from the public. This document applies to sponsors of, and participants and beneficiaries in, employee benefit plans that are determined to be governmental plans.

Web-based training course for evaluating radiological dose assessment in NRC's license termination process.

PubMed

Lepoire, D; Richmond, P; Cheng, J-J; Kamboj, S; Arnish, J; Chen, S Y; Barr, C; McKenney, C

2008-08-01

As part of the requirement for terminating the licenses of nuclear power plants or other nuclear facilities, license termination plans or decommissioning plans are submitted by the licensee to the U.S. Nuclear Regulatory Commission (NRC) for review and approval. Decommissioning plans generally refer to the decommissioning of nonreactor facilities, while license termination plans specifically refer to the decommissioning of nuclear reactor facilities. To provide a uniform and consistent review of dose modeling aspects of these plans and to address NRC-wide knowledge management issues, the NRC, in 2006, commissioned Argonne National Laboratory to develop a Web-based training course on reviewing radiological dose assessments for license termination. The course, which had first been developed in 2005 to target specific aspects of the review processes for license termination plans and decommissioning plans, evolved from a live classroom course into a Web-based training course in 2006. The objective of the Web-based training course is to train NRC staff members (who have various relevant job functions and are located at headquarters, regional offices, and site locations) to conduct an effective review of dose modeling in accordance with the latest NRC guidance, including NUREG-1757, Volumes 1 and 2. The exact size of the staff population who will receive the training has not yet been accurately determined but will depend on various factors such as the decommissioning activities at the NRC. This Web-based training course is designed to give NRC staff members modern, flexible access to training. To this end, the course is divided into 16 modules: 9 core modules that deal with basic topics, and 7 advanced modules that deal with complex issues or job-specific topics. The core and advanced modules are tailored to various NRC staff members with different job functions. The Web-based system uses the commercially available software Articulate, which incorporates audio, video, and animation in slide presentations and has glossary, document search, and Internet connectivity features. The training course has been implemented on an NRC system that allows staff members to register, select courses, track records, and self-administer quizzes.

Advanced rural transportation systems (ARTS) : rural intelligent transportation systems (ITS) : program plan

DOT National Transportation Integrated Search

1996-08-01

This Program Plan for the Advanced Rural Transportation Systems (ARTS) implements the goals and objectives established in the U.S. Department of Transportations (USDOTs) Strategic Plan for the ARTS. This Program Plan proposes five years (FY 97...

Salvage plan & information sheet

DOT National Transportation Integrated Search

1997-11-05

This document allows the On Scene Coordinator (OSC) or Captain of the Port (COTP) to formulate and evaluate the impact of a Salvage Plan. Specifically, this document allows the OSC or COTP to: 1. Quickly gather all information needed during the respo...

FY 1998 Proposed Rail Improvement Program

DOT National Transportation Integrated Search

1997-01-01

The Illinois Department of Transportation has, in the past, published its Rail program yearly, and its Rail plan as needs dictate. The department has combined : both documents into one. This new document, as with those Programs and Plans : that have ...

14 CFR 151.113 - Advance planning proposals: Sponsor eligibility.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Engineering Proposals § 151.113 Advance planning proposals: Sponsor eligibility. The sponsor of an advance planning and engineering proposal must be a public agency, as defined in § 151.37(a), and must be legally... agreement; (c) Provide enough funds to pay all estimated proposal costs not borne by the United States; and...

14 CFR 151.113 - Advance planning proposals: Sponsor eligibility.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Engineering Proposals § 151.113 Advance planning proposals: Sponsor eligibility. The sponsor of an advance planning and engineering proposal must be a public agency, as defined in § 151.37(a), and must be legally... agreement; (c) Provide enough funds to pay all estimated proposal costs not borne by the United States; and...

Advance care planning and physician orders in nursing home residents with dementia: a nationwide retrospective study among professional caregivers and relatives.

PubMed

Vandervoort, An; Houttekier, Dirk; Van den Block, Lieve; van der Steen, Jenny T; Vander Stichele, Robert; Deliens, Luc

2014-02-01

Advance care planning (ACP) is key to good palliative care for nursing home (NH) residents with dementia. We examined the extent to which the family physicians (FPs), nurses, and the relative most involved in the resident's care are informed about ACP, written advance directives, and FP treatment orders (FP-orders) for NH residents dying with dementia. We also examined the congruence among FP, nurse, and relative regarding the content of ACP. This was a representative nationwide post-mortem study (2010) in Flanders, Belgium, using random cluster sampling. In selected NHs, all deaths of residents with dementia in a three month period were reported. A structured questionnaire was completed by the FP, the nurse, and the patient's relative. We identified 205 deceased residents with dementia in 69 NHs. Residents expressed their wishes regarding end-of-life care in 11.8% of cases according to the FP. The FP and nurse spoke with the resident in 22.0% and 9.7% of cases, respectively, and with the relative in 70.6% and 59.5%, respectively. An advance directive was present in 9.0%, 13.6%, and 18.4% of the cases according to the FP, nurse, and the relative, respectively. The FP-orders were present in 77.3% according to the FP, and discussed with the resident in 13.0% and with the relative in 79.3%. Congruence was fair (FP-nurse) on the documentation of FP-orders (k=0.26), and poor to slight on the presence of an advance directive (FP-relative, k=0.03; nurse-relative, k=-0.05; FP-nurse k=0.12). Communication regarding care is rarely patient driven and more often professional caregiver or family driven. The level of congruence between professional caregivers and relatives is low. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The Village Green Project: Lesson Plans for K-8 Educators ...

EPA Pesticide Factsheets

This document contains lesson plans spanning kindergarten through 8th grade, that are written to connect next-generation science standards (USA) to the Village Green Project and related air quality topics. This document contains a series of classroom lesson plans to support connections between the Village Green Project and the USA National Science Standards at various education levels.

17 CFR 240.17a-6 - Right of national securities exchange, national securities association, registered clearing...

Code of Federal Regulations, 2010 CFR

2010-04-01

... plan may provide that any such document may be transferred to microfilm or other recording medium after... years or at such earlier date as is specified in a plan for the destruction or disposition of any such documents if such plan has been filed with the Commission by such exchange, association, clearing agency or...

Advance care planning for adolescent patients with life-threatening neurological conditions: a survey of Japanese paediatric neurologists.

PubMed

Yotani, Nobuyuki; Kizawa, Yoshiyuki; Shintaku, Haruo

2017-01-01

To evaluate current attitudes and barriers to advance care planning for adolescent patients with life-threatening conditions among paediatric neurologists. Cross-sectional study. A self-reported questionnaire was administered to assess the practice of advance care planning, advance directives and barriers to advance care planning for adolescent patients with life-threatening conditions. All board-certified paediatric neurologists in Japan were surveyed and those who had experience in taking care of adolescent patients with decision-making capacity were analysed. We compared the results with those of paediatric haematologists reported previously. In total, 186 paediatric neurologists were analysed. If the patient's prognosis was <3 months, only about 30% of paediatric neurologists reported having discussions with patients, such as 'do not attempt resuscitation' orders (28%) and ventilator use (32%), whereas more than 70% did discuss these topics with patients' families. About half of the paediatric neurologists did not discuss advance directives at the end of life with their patients, whereas over 75% did discuss advance directives with patients' families. Compared with paediatric haematologists, paediatric neurologists had more end-of-life discussions with patients, such as where treatment and care will take place, do not attempt resuscitation orders, and the use of a ventilator, if the patient's prognosis was >1 year. About half or less of the paediatric neurologists discussed advance care planning and advance directives with their adolescent patients who had life-threatening conditions, even if the patient's prognosis was <3 months. They tended to discuss advance care planning and advance directives more with families than with patients themselves.

FDA plan for statutory compliance. Notice of availability.

PubMed

1998-11-24

The Food and Drug Administration (FDA) is announcing the availability of a document entitled "FDA Plan for Statutory Compliance" (the plan). This document is the agency's response to section 406(b) of the Food and Drug Administration Modernization Act of 1997 (FDAMA), which requires the Secretary of the Department of Health and Human Services (the Secretary) to develop a plan bringing the agency into compliance with the requirements of the Federal Food, Drug, and Cosmetic Act (the act).

Hypersonic Vehicle Propulsion System Simplified Model Development

NASA Technical Reports Server (NTRS)

Stueber, Thomas J.; Raitano, Paul; Le, Dzu K.; Ouzts, Peter

2007-01-01

This document addresses the modeling task plan for the hypersonic GN&C GRC team members. The overall propulsion system modeling task plan is a multi-step process and the task plan identified in this document addresses the first steps (short term modeling goals). The procedures and tools produced from this effort will be useful for creating simplified dynamic models applicable to a hypersonic vehicle propulsion system. The document continues with the GRC short term modeling goal. Next, a general description of the desired simplified model is presented along with simulations that are available to varying degrees. The simulations may be available in electronic form (FORTRAN, CFD, MatLab,...) or in paper form in published documents. Finally, roadmaps outlining possible avenues towards realizing simplified model are presented.

Standardised care plans for in hospital stroke care improve documentation of health care assessments.

PubMed

Pöder, Ulrika; Dahm, Marie Fogelberg; Karlsson, Nina; Wadensten, Barbro

2015-10-01

To compare stroke unit staff members' documentation of care in line with evidence-based guidelines pre- and postimplementation of a multi-professional, evidence-based standardised care plan for stroke care in the electronic health record. Rapid and effective measures for patients with stroke or suspected stroke can limit the extent of damage; it is imperative that patients be observed, assessed and treated in accordance with evidence-based practice in hospital. Quantitative, comparative. Structured retrospective health record reviews were made prior to (n 60) and one and a half years after implementation (n 60) of a multi-professional evidence-based standardised care plan with a quality standard for stroke care in the electronic health record. Significant improvements were found in documentation of assessed vital signs, except for body temperature, Day 1 post compared with preimplementation. Documentation frequency regarding body temperature Day 1 and blood pressure and pulse Day 2 decreased post compared with preimplementation. Improvements were also detected in documented observations of patients' micturition capacity, swallowing capacity and mouth status and the proportion of physiotherapist-documented aid assessments. Observations of blood glucose, mobilisation ability and speech and communication ability were unchanged. An evidence-based standardised care plan in an electronic health record assists staff in improving documentation of health status assessments during the first days after a stroke diagnosis. Use of a standardised care plan seems to have the potential to help staff adhere to evidence-based patient care and, thereby, to increase patient safety. © 2015 John Wiley & Sons Ltd.

Rural applications of advanced traveler information systems : user needs and technology assessment

DOT National Transportation Integrated Search

1997-07-01

The User Needs and Technology Assessment Report is one in a series of interim documents for the Rural Applications of Advanced Traveler Information Systems (ATIS) project. The document describes the research design and findings from rural traveler su...

Autonomy, liberalism and advance care planning.

PubMed Central

Ikonomidis, S; Singer, P A

1999-01-01

The justification for advance directives is grounded in the notion that they extend patient autonomy into future states of incompetency through patient participation in decision making about end-of-life care. Four objections challenge the necessity and sufficiency of individual autonomy, perceived to be a defining feature of liberal philosophical theory, as a basis of advance care planning. These objections are that the liberal concept of autonomy (i) implies a misconception of the individual self, (ii) entails the denial of values of social justice, (iii) does not account for justifiable acts of paternalism, and (iv) does not account for the importance of personal relationships in the advance care planning process. The last objection is especially pertinent in light of recent empirical research highlighting the importance of personal relationships in advance care planning. This article examines these four objections to autonomy, and the liberal theoretical framework with which it is associated, in order to re-evaluate the philosophical basis of advance care planning. We argue that liberal autonomy (i) is not a misconceived concept as critics assume, (ii) does not entail the denial of values of social justice, (iii) can account for justifiable acts of paternalism, though it (iv) is not the best account of the value of personal relationships that arise in advance care planning. In conclusion, we suggest that liberalism is a necessary component of a theoretical framework for advance care planning but that it needs to be supplemented with theories that focus explicitly on the significance of personal relationships. PMID:10635509

Does facilitated Advance Care Planning reduce the costs of care near the end of life? Systematic review and ethical considerations

PubMed Central

Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg

2015-01-01

Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218

Too Soon to Give Up? Re-examining the Value of Advance Directives

PubMed Central

Levi, Benjamin H.; Green, Michael J.

2013-01-01

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future, translates an individual’s values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by 1) educating users about advance care planning; 2) helping individuals identify, clarify, and prioritize factors that influence their decision-making about future medical conditions; 3) explaining common end-of-life medical conditions and life-sustaining treatment; 4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and 5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and healthcare providers in discussions about advance care planning. PMID:20379910

National Rocket Propulsion Materials Plan: A NASA, Department of Defense, and Industry Partnership

NASA Technical Reports Server (NTRS)

Clinton, Raymond G., Jr.; Munafo, Paul M. (Technical Monitor)

2001-01-01

NASA, Department of Defense, and rocket propulsion industry representatives are working together to create a national rocket propulsion materials development roadmap. This "living document" will facilitate collaboration among the partners, leveraging of resources, and will be a highly effective tool for technology development planning. The structuring of the roadmap, and development plan, which will combine the significant efforts of the Integrated High Payoff Rocket Propulsion Technology (IHPRPT) Program, and NASA's Integrated Space Transportation Plan (ISTP), is being lead by the IHPRPT Materials Working Group (IMWG). The IHPRPT Program is a joint DoD, NASA, and industry effort to dramatically improve the nation's rocket propulsion capabilities. This phased program is structured with increasingly challenging goals focused on performance, reliability, and cost to effectively double rocket propulsion capabilities by 2010. The IHPRPT program is focused on three propulsion application areas: Boost and Orbit Transfer (both liquid rocket engines and solid rocket motors), Tactical, and Spacecraft. Critical to the success of this initiative is the development and application of advanced materials, processes, and manufacturing technologies. NASA's ISTP is a comprehensive strategy focusing on the aggressive safety, reliability, and affordability goals for future space transportation systems established by the agency. Key elements of this plan are the 2 nd and 3 d Generation Reusable Launch Vehicles (RLV). The affordability and safety goals of these generational systems are, respectively, 10X cheaper and 100X safer by 2010, and 100X cheaper and 10,000X safer by 2025. Accomplishment of these goals requires dramatic and sustained breakthroughs, particularly in the development and the application of advanced material systems. The presentation will provide an overview of the IHPRPT materials initiatives, NASA's 2nd and 3 rd Generation RLV propulsion materials projects, and the approach for the development of the national rocket propulsion materials roadmap.

Human Exploration of Mars: The Reference Mission of the NASA Mars Exploration Study Team

NASA Astrophysics Data System (ADS)

Hoffman, Stephen J.; Kaplan, David I.

1997-07-01

Personnel representing several NASA field centers have formulated a "Reference Mission" addressing human exploration of Mars. This report summarizes their work and describes a plan for the first human missions to Mars, using approaches that are technically feasible, have reasonable risks, and have relatively low costs. The architecture for the Mars Reference Mission builds on previous work of the Synthesis Group (1991) and Zubrin's (1991) concepts for the use of propellants derived from the Martian Atmosphere. In defining the Reference Mission, choices have been made. In this report, the rationale for each choice is documented; however, unanticipated technology advances or political decisions might change the choices in the future.

Human Exploration of Mars: The Reference Mission of the NASA Mars Exploration Study Team

NASA Technical Reports Server (NTRS)

Hoffman, Stephen J. (Editor); Kaplan, David I. (Editor)

1997-01-01

Personnel representing several NASA field centers have formulated a "Reference Mission" addressing human exploration of Mars. This report summarizes their work and describes a plan for the first human missions to Mars, using approaches that are technically feasible, have reasonable risks, and have relatively low costs. The architecture for the Mars Reference Mission builds on previous work of the Synthesis Group (1991) and Zubrin's (1991) concepts for the use of propellants derived from the Martian Atmosphere. In defining the Reference Mission, choices have been made. In this report, the rationale for each choice is documented; however, unanticipated technology advances or political decisions might change the choices in the future.

Evaluation of the trade-offs encountered in planning and treating locally advanced head and neck cancer: intensity-modulated radiation therapy vs dual-arc volumetric-modulated arc therapy

PubMed Central

Oliver, M; McConnell, D; Romani, M; McAllister, A; Pearce, A; Andronowski, A; Wang, X; Leszczynski, K

2012-01-01

Objective The primary purpose of this study was to assess the practical trade-offs between intensity-modulated radiation therapy (IMRT) and dual-arc volumetric-modulated arc therapy (DA-VMAT) for locally advanced head and neck cancer (HNC). Methods For 15 locally advanced HNC data sets, nine-field step-and-shoot IMRT plans and two full-rotation DA-VMAT treatment plans were created in the Pinnacle3 v. 9.0 (Philips Medical Systems, Fitchburg, WI) treatment planning environment and then delivered on a Clinac iX (Varian Medical Systems, Palo Alto, CA) to a cylindrical detector array. The treatment planning goals were organised into four groups based on their importance: (1) spinal cord, brainstem, optical structures; (2) planning target volumes; (3) parotids, mandible, larynx and brachial plexus; and (4) normal tissues. Results Compared with IMRT, DA-VMAT plans were of equal plan quality (p>0.05 for each group), able to be delivered in a shorter time (3.1 min vs 8.3 min, p<0.0001), delivered fewer monitor units (on average 28% fewer, p<0.0001) and produced similar delivery accuracy (p>0.05 at γ2%/2mm and γ3%/3mm). However, the VMAT plans took more planning time (28.9 min vs 7.7 min per cycle, p<0.0001) and required more data for a three-dimensional dose (20 times more, p<0.0001). Conclusions Nine-field step-and-shoot IMRT and DA-VMAT are both capable of meeting the majority of planning goals for locally advanced HNC. The main trade-offs between the techniques are shorter treatment time for DA-VMAT but longer planning time and the additional resources required for implementation of a new technology. Based on this study, our clinic has incorporated DA-VMAT for locally advanced HNC. Advances in knowledge DA-VMAT is a suitable alternative to IMRT for locally advanced HNC. PMID:22806619