Sample records for advance planning documents

  1. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 45 Public Welfare 4 2010-10-01 2010-10-01 false Submittal of advance planning documents. 1355.54 Section 1355.54 Public Welfare Regulations Relating to Public Welfare (Continued) OFFICE OF HUMAN... § 1355.54 Submittal of advance planning documents. The State title IV-E agency must submit an APD for a...

  2. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  3. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  4. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  5. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  6. 42 CFR 495.336 - Health information technology planning advance planning document requirements (HIT PAPD).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Health information technology planning advance... STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.336 Health information technology planning advance planning document requirements...

  7. 45 CFR 1355.54 - Submittal of advance planning documents.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 45 Public Welfare 4 2014-10-01 2014-10-01 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...

  8. 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...

  9. 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...

  10. 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.

  11. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 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...

  12. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 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...

  13. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 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...

  14. 42 CFR 495.338 - Health information technology implementation advance planning document requirements (HIT IAPD).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 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...

  15. 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...

  16. 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...

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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.

  3. Development and evaluation of an aged care specific Advance Care Plan.

    PubMed

    Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie

    2013-06-01

    To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention. 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans. Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.

  4. 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. ACTRN

  5. 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

  6. 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

  7. Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

    PubMed

    Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

    2018-06-26

    Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39

  8. Does implementation matter if comprehension is lacking? A qualitative investigation into perceptions of advance care planning in people with cancer.

    PubMed

    Ugalde, Anna; O'Callaghan, Clare; Byard, Clem; Brean, Samantha; MacKay, Jenelle; Boltong, Anna; Davoren, Sondra; Lawson, Deborah; Parente, Phillip; Michael, Natasha; Livingston, Patricia

    2018-05-11

    While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended advance care plans and examine how accurately advance care planning documentation represented patient wishes. This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants' existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate, Statement of Choices, and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91), and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: incomplete advance care planning understanding and confidence, limited congruence for attitude and documentation, advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants' attitudes and their written document congruence were limited, but advance care planning was seen as helpful. This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation.

  9. 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.

  10. 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.) .

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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

  2. 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...

  3. 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...

  4. 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...

  5. 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.

  6. 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.

  7. 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…

  8. 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 ...

  9. 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.

  10. 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).

  11. 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.

  12. 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…

  13. 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.

  14. 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.

  15. 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.

  16. 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...

  17. 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...

  18. 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...

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. Knowledge enabled plan of care and documentation prototype.

    PubMed

    DaDamio, Rebecca; Gugerty, Brian; Kennedy, Rosemary

    2006-01-01

    There exist significant challenges in integrating the plan of care into documentation and point of care operational processes. A plan of care is often a static artifact that meets regulatory standards with limited influence on supporting goal-directed care delivery processes. Although this prototype is applicable to many clinical disciplines, we will highlight nursing processes in demonstrating a knowledge-driven computerized solution that fully integrates the plan of care within documentation. The knowledge-driven solution reflects evidenced-based practice; is an effective tool for managing problems, orders/interventions, and the patient's progress towards expected outcomes; meets regulatory standards; and drives quality and process improvement. The knowledge infrastructure consists of fully represented terminology, structured clinical expressions utilizing the controlled terminology and clinical knowledge representing evidence-based practice.

  4. 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

  5. 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

  6. 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

  7. 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...

  8. "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.

  9. Environmental Scan: A Strategic Planning Document.

    ERIC Educational Resources Information Center

    Osborn, Frances

    Information, perceptions, and predictions from a variety of sources are brought together in this document to help guide planning and decision making at Monroe Community College (MCC). The first section examines national events and trends with implications for the future of MCC, including employment projections; educational norms; data on community…

  10. 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.

  11. 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...

  12. 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...

  13. 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...

  14. 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.

  15. 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

  16. 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...

  17. 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...

  18. 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

  19. [Advance directives and advance care planning].

    PubMed

    Vayne-Bossert, Petra; Vailloud, Christiane; Ducloux, Dominique; Matis, Caroline; Déramé, Laurence

    2017-02-01

    Advance directives (AD) and Advance Care Planning (ACP) are two measures a person may undertake to assure that their treatment preferences will be respected until the end of his / her life. Anticipation is based on an open and honest communication between the patient, the durable medical power of attorney and the health care professionals. ADs and ACPs are based on a person's values and beliefs that are important to his quality of life. ACP is a continuing process, initiated by health care professionals and integrated into the health care plan of a person. It should be adjusted all along the disease trajectory and favors communication and anticipation in the health care network. ADs are often a personal initiative to ensure one's wishes in relation to health issues. In Switzerland, they are based on a legal framework and their application is therefore mandatory for health care professionals.

  20. 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…

  1. 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.

  2. 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...

  3. 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.

  4. '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

  5. Advanced 3-dimensional planning in neurosurgery.

    PubMed

    Ferroli, Paolo; Tringali, Giovanni; Acerbi, Francesco; Schiariti, Marco; Broggi, Morgan; Aquino, Domenico; Broggi, Giovanni

    2013-01-01

    During the past decades, medical applications of virtual reality technology have been developing rapidly, ranging from a research curiosity to a commercially and clinically important area of medical informatics and technology. With the aid of new technologies, the user is able to process large amounts of data sets to create accurate and almost realistic reconstructions of anatomic structures and related pathologies. As a result, a 3-diensional (3-D) representation is obtained, and surgeons can explore the brain for planning or training. Further improvement such as a feedback system increases the interaction between users and models by creating a virtual environment. Its use for advanced 3-D planning in neurosurgery is described. Different systems of medical image volume rendering have been used and analyzed for advanced 3-D planning: 1 is a commercial "ready-to-go" system (Dextroscope, Bracco, Volume Interaction, Singapore), whereas the others are open-source-based software (3-D Slicer, FSL, and FreesSurfer). Different neurosurgeons at our institution experienced how advanced 3-D planning before surgery allowed them to facilitate and increase their understanding of the complex anatomic and pathological relationships of the lesion. They all agreed that the preoperative experience of virtually planning the approach was helpful during the operative procedure. Virtual reality for advanced 3-D planning in neurosurgery has achieved considerable realism as a result of the available processing power of modern computers. Although it has been found useful to facilitate the understanding of complex anatomic relationships, further effort is needed to increase the quality of the interaction between the user and the model.

  6. 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,…

  7. 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...

  8. 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

  9. 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.

  10. 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.

  11. Supporting Active Living Through Community Plans: The Association of Planning Documents With Design Standards and Features.

    PubMed

    Peterson, Erin L; Carlson, Susan A; Schmid, Thomas L; Brown, David R; Galuska, Deborah A

    2018-01-01

    The purpose of this study was to examine the association between the presence of supportive community planning documents in US municipalities with design standards and requirements supportive of active living. Cross-sectional study using data from the 2014 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. Nationally representative sample of US municipalities. Respondents are 2005 local officials. Assessed: (1) The presence of design standards and feature requirements and (2) the association between planning documents and design standards and feature requirements supportive of active living in policies for development. Using logistic regression, significant trends were identified in the presence of design standards and feature requirements by plan and number of supportive objectives present. Prevalence of design standards ranged from 19% (developer dedicated right-of-way for bicycle infrastructure development) to 50% (traffic-calming features in areas with high pedestrian and bicycle volume). Features required in policies for development ranged from 14% (short/medium pedestrian-scale block sizes) to 44% (minimum sidewalk widths of 5 feet) of municipalities. As the number of objectives in municipal plans increased, there was a significant and positive trend ( P < .05) in the prevalence of each design standard and requirement. Municipal planning documents containing objectives supportive of physical activity are associated with design standards and feature requirements supportive of activity-friendly communities.

  12. 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...

  13. Legal Briefing: Medicare Coverage of Advance Care Planning.

    PubMed

    Pope, Thaddeus Mason

    2015-01-01

    This issue's "Legal Briefing" column covers the recent decision by the Centers for Medicare and Medicaid Services (CMS) to expand Medicare coverage of advance care planning, beginning 1 January 2016. Since 2009, most "Legal Briefings" in this journal have covered a wide gamut of judicial, legislative, and regulatory developments concerning a particular topic in clinical ethics. In contrast, this "Legal Briefing" is more narrowly focused on one single legal development. This concentration on Medicare coverage of advance care planning seems warranted. Advance care planning is a frequent subject of articles in JCE. After all, it has long been seen as an important, albeit only partial, solution to a significant range of big problems in clinical ethics. These problems range from medical futility disputes to decision making for incapacitated patients who have no available legally authorized surrogate. Consequently, expanded Medicare coverage of advance care planning is a potentially seismic development. It may materially reduce both the frequency and severity of key problems in clinical ethics. Since the sociological, medical, and ethical literature on advance care planning is voluminous, I will not even summarize it here. Instead, I focus on Medicare coverage. I proceed, chronologically, in six stages: 1. Prior Medicare Coverage of Advance Care Planning 2. Proposed Expanded Medicare Coverage in 2015 3. Proposed Expanded Medicare Coverage in 2016 4. The Final Rule Expanding Medicare Coverage in 2016 5. Remaining Issues for CMS to Address in 2017 6. Pending Federal Legislation. Copyright 2015 The Journal of Clinical Ethics. All rights reserved.

  14. 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.

  15. Consolidated Cab Display (CCD) System, Project Planning Document (PPD),

    DTIC Science & Technology

    1981-02-01

    1980 1981 I 2 3 4 5 6 7 8 9 10 1112 1 2 3 4 5 6 7 8 9 1011112 1 2 31 12. Software Documentation a. Overall Computer Program Description ( OCPD ) b...Approve OCPD c. Computer Program Functional Specifications (CPFS) d. Data Base Table Design Specification (DBTDS) e. Software Interface Control Document...Parts List Master Pattern and Plan View Reproducible Drawings Instruction Book Training Aids/Materials b. Software: OCPD CPFS SI CD PDS DBTDS SDD

  16. 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

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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).

  2. Advanced planetary analyses. [for planetary mission planning

    NASA Technical Reports Server (NTRS)

    1974-01-01

    The results are summarized of research accomplished during this period concerning planetary mission planning are summarized. The tasks reported include the cost estimations research, planetary missions handbook, and advanced planning activities.

  3. No Further Remedial Action Planned Decision Document for Site 3.

    DTIC Science & Technology

    1998-04-01

    INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 3 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland &nc QUALITY IMSmm«^ 19980519 204 XA REPORT...Document for Site 3 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Montgomery

  4. 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...

  5. 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.

  6. 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.

  7. 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.

  8. 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...

  9. 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.

  10. 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.

  11. 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

  12. Advanced rural transportation systems (ARTS) : strategic plan

    DOT National Transportation Integrated Search

    1997-08-01

    This Strategic Plan has been developed for the Advanced Rural Transportation Systems (ARTS) portion of the ITS Program. The plan focuses on the Federal Government's role in developing rural ITS options and prudently managing emerging ITS technologies...

  13. 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

  14. 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…

  15. 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.

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. 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.

  1. Medicare and Advance Planning: The Importance of Context.

    PubMed

    Dresser, Rebecca

    2016-05-01

    In January 2016, a long-delayed Medicare change took effect. The Medicare program will now reimburse doctors for time they spend talking with patients about end-of-life care. This is the move that Sarah Palin and other Affordable Care Act critics said would authorize government "death panels" to decide whether older Americans should live or die. Today virtually no one buys into Palin's death panel rhetoric. But many people do think the Medicare change is a big deal. Representative Earl Blumenauer, a Democrat from Oregon who sponsored the original ACA reimbursement proposal, lauded the Medicare provision as "a turning point in end-of-life care." Others are not so sure about that. After all, laws promoting advance care planning have existed for decades. The federal Patient Self-Determination Act of 1990 and the many court decisions and state laws supporting advance care planning have had relatively little impact. Similarly, legal recognition of physician orders for life-sustaining treatment as advance planning instruments have not produced the improvements that were predicted. And from a broad perspective, advance care planning is a small piece of the puzzle. The effort to improve end-of-life care must take into account the limitations of advance decision-making, as well as the overriding importance of the general standard of care for terminally ill patients. © 2016 The Hastings Center.

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. SU-E-T-201: Safety-Focused Customization of Treatment Plan Documentation.

    PubMed

    Schubert, L; Westerly, D; Stuhr, K; Miften, M

    2012-06-01

    Plan report documentation contains numerous details about the treatment plan, but critical information for patient safety is often presented without special emphasis. This can make it difficult to detect errors from treatment planning and data transfer during the initial chart review. The objective of this work is to improve safety measures in radiation therapy practice by customizing the treatment plan report to emphasize safety-critical information. Commands within the template file from a commercial planning system (Eclipse, Varian Medical Systems) that automatically generates the treatment plan report were reviewed and modified. Safety-critical plan parameters were identified from published risks known to be inherent in the treatment planning process. Risks having medium to high potential impact on patient safety included incorrect patient identifiers, erroneous use of the treatment prescription, and incorrect transfer of beam parameters or consideration of accessories. Specific examples of critical information in the treatment plan report that can be overlooked during a chart review included prescribed dose per fraction and number of fractions, wedge and open field monitor units, presence of beam accessories, and table shifts for patient setup. Critical information was streamlined and concentrated. Patient and plan identification, dose prescription details, and patient positioning couch shift instructions were placed on the first page. Plan information to verify the correct data transfer to the record and verify system was re-organized in an easy to review tabular format and placed in the second page of the customized printout. Placeholders were introduced to indicate both the presence and absence of beam modifiers. Font sizes and spacing were adjusted for clarity, and departmental standards and terminology were introduced to streamline data communication among staff members. Plan reporting documentation has been customized to concentrate and emphasize safety

  7. 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...

  8. 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...

  9. 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).

  10. 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

  11. 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.

  12. 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

  13. The Evolution of Health Care Advance Planning Law and Policy

    PubMed Central

    Sabatino, Charles P

    2010-01-01

    Context: The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. Methods: This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. Findings: While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a “legal transactional approach” to a “communications approach,” the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients’ goals into visible and portable medical orders. Conclusions: States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients’ wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice. PMID:20579283

  14. The evolution of health care advance planning law and policy.

    PubMed

    Sabatino, Charles P

    2010-06-01

    The legal tools of health care advance planning have substantially changed since their emergence in the mid-1970s. Thirty years of policy development, primarily at the state legislative level addressing surrogate decision making and advance directives, have resulted in a disjointed policy landscape, yet with important points of convergence evolving over time. An understanding of the evolution of advance care planning policy has important implications for policy at both the state and federal levels. This article is a longitudinal statutory and literature review of health care advance planning from its origins to the present. While considerable variability across the states still remains, changes in law and policy over time suggest a gradual paradigm shift from what is described as a "legal transactional approach" to a "communications approach," the most recent extension of which is the emergence of Physician Orders for Life-Sustaining Treatment, or POLST. The communications approach helps translate patients' goals into visible and portable medical orders. States are likely to continue gradually moving away from a legal transactional mode of advance planning toward a communications model, albeit with challenges to authentic and reliable communication that accurately translates patients' wishes into the care they receive. In the meantime, the states and their health care institutions will continue to serve as the primary laboratory for advance care planning policy and practice.

  15. Advanced Education and Technology Business Plan, 2007-10

    ERIC Educational Resources Information Center

    Alberta Enterprise and Advanced Education, 2007

    2007-01-01

    The Government of Alberta Strategic Business Plan addresses significant opportunities and challenges facing Alberta over the next three years and positions Alberta to make the most of its economic, social and natural advantages. It is a plan to strategically manage growth and plan for a sustainable and secure future. Advanced Education and…

  16. 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

  17. Advanced Launch System advanced development oxidizer turbopump program: Technical implementation plan

    NASA Technical Reports Server (NTRS)

    Ferlita, F.

    1989-01-01

    The Advanced Launch Systems (ALS) Advanced Development Oxidizer Turbopump Program has designed, fabricated and demonstrated a low cost, highly reliable oxidizer turbopump for the Space Transportation Engine that minimizes the recurring cost for the ALS engines. Pratt and Whitney's (P and W's) plan for integrating the analyses, testing, fabrication, and other program efforts is addressed. This plan offers a comprehensive description of the total effort required to design, fabricate, and test the ALS oxidizer turbopump. The proposed ALS oxidizer turbopump reduces turbopump costs over current designs by taking advantage of design simplicity and state-of-the-art materials and producibility features without compromising system reliability. This is accomplished by selecting turbopump operating conditions that are within known successful operating regions and by using proven manufacturing techniques.

  18. 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…

  19. 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

  20. 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.

  1. The economic evidence for advance care planning: Systematic review of evidence.

    PubMed

    Dixon, Josie; Matosevic, Tihana; Knapp, Martin

    2015-12-01

    Advance care planning is a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of making better use of healthcare resources at the end of life. To review and summarise economic evidence on advance care planning. A systematic review of the academic literature. We searched for English language, peer-reviewed journal articles, 1990-2014, using relevant research databases: PubMed, ProQuest, CINAHL Plus with Full Text; EconLit, PsycINFO, SocINDEX with Full Text and International Bibliography of the Social Sciences. Empirical studies using statistical methods in which advance care planning and costs are variables were included. There are no published cost-effectiveness studies. Included studies focus on healthcare savings, usually associated with reduced demand for hospital care. Advance care planning appears to be associated with healthcare savings for some people in some circumstances, such as people living with dementia in the community, people in nursing homes or in areas with high end-of-life care spending. There is no evidence that advance care planning is likely to be more expensive. There is need for clearer articulation of the likely mechanisms by which advance care planning can lead to reduced care costs or improved cost-effectiveness, particularly for people who retain capacity. There is also a need to consider wider costs, including the costs of advance care planning facilitation or interventions and the costs of substitute health, social and informal care. Economic outcomes need to be considered in the context of quality benefits. © The Author(s) 2015.

  2. Numerical Correlation of Levator Advancement in Preoperative Planning.

    PubMed

    Makeeva, Valeria; Collawn, Sherry S; Pierce, Evelina N; Mousa, Mina S; Yang, Jennifer H; Davison, Peter N; Jospitre, Elodie C

    2017-06-01

    Several procedures have been proposed for the treatment of eyelid ptosis, and both levator advancement and levator plication are widely used to shorten the levator palpebrae superioris. The purpose of this study was to quantify perioperative lid measurements in patients undergoing bilateral levator aponeurosis advancements to aid in preoperative planning. Between July 2014 and June 2016, the authors performed a retrospective analysis of all bilateral upper eyelid levator advancement procedures for ptosis performed by the senior surgeon. There are a total of 21 patients (6 men and 15 women) with a mean age of 63 years (range, 48-79 years). The average time at follow-up was 5.3 months, with a range of 1 to 26 months. In this retrospective study, we collected data on presurgical measurements including marginal reflex distance 1 (MRD1), surgical technique used (symmetrical/asymmetrical levator advancement) with millimeters of advancement used, and postsurgical measurements. We found that on average, an advancement of 4 mm led to an improvement in MRD1 of 2.26 mm (n = 14), and advancement of 5 mm led to an improvement in MRD1 of 2.74 mm (n = 15). Patients also reported improvements in their quality of life. Our results may be used to guide clinicians in preoperative planning.

  3. 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

  4. Design and analysis of advanced flight planning concepts

    NASA Technical Reports Server (NTRS)

    Sorensen, John A.

    1987-01-01

    The objectives of this continuing effort are to develop and evaluate new algorithms and advanced concepts for flight management and flight planning. This includes the minimization of fuel or direct operating costs, the integration of the airborne flight management and ground-based flight planning processes, and the enhancement of future traffic management systems design. Flight management (FMS) concepts are for on-board profile computation and steering of transport aircraft in the vertical plane between a city pair and along a given horizontal path. Flight planning (FPS) concepts are for the pre-flight ground based computation of the three-dimensional reference trajectory that connects the city pair and specifies the horizontal path, fuel load, and weather profiles for initializing the FMS. As part of these objectives, a new computer program called EFPLAN has been developed and utilized to study advanced flight planning concepts. EFPLAN represents an experimental version of an FPS. It has been developed to generate reference flight plans compatible as input to an FMS and to provide various options for flight planning research. This report describes EFPLAN and the associated research conducted in its development.

  5. 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.

  6. 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.

  7. 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

  8. 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.

  9. 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.

  10. 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…

  11. 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

  12. Design of an advanced flight planning system

    NASA Technical Reports Server (NTRS)

    Sorensen, J. A.; Goka, T.

    1985-01-01

    The demand for both fuel conservation and four-dimensional traffic management require that the preflight planning process be designed to account for advances in airborne flight management and weather forecasting. The steps and issues in designing such an advanced flight planning system are presented. Focus is placed on the different optimization options for generating the three-dimensional reference path. For the cruise phase, one can use predefined jet routes, direct routes based on a network of evenly spaced grid points, or a network where the grid points are existing navaid locations. Each choice has its own problem in determining an optimum solution. Finding the reference path is further complicated by choice of cruise altitude levels, use of a time-varying weather field, and requiring a fixed time-of-arrival (four-dimensional problem).

  13. 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.

  14. 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...

  15. 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

  16. [3-dimensional imaging systems: first experience in planning and documentation of plastic surgery procedures].

    PubMed

    Spanholtz, T A; Leitsch, S; Holzbach, T; Volkmer, E; Engelhardt, T; Giunta, R E

    2012-08-01

    A reproducible 3-dimensional photographic system enables plastic surgeons to perform preoperative planning and helps them to understand the patient's expectations. There are a few systems available that allow a reproducible 3-dimensional scans of the patient with direct simulation of the planned procedure. The Vectra Volumetric 3D Surface Imaging® by Canfield® provides such an option and helps the surgeons to document and compare postoperative changes at different time points. Since January 2011 we are digitally documenting all patients receiving form-modulating procedures in our plastic surgery unit. We present the spectrum of clinical implications and discuss advantages and disadvantages of the system. Furthermore, we have studied the accuracy of the system in comparison to direct measurement in 15 volunteers. The system is especially suited for planning and evaluation of breast augmentation, facial aesthetic and reconstructive surgery as well as volumetric measurements before and after liposuction and lipofilling. Computer-assisted measurements correlate with a median deviation of 2.3% with manually measured distances in the face. We found the user-friendly Vectra® system to be a reliable and reproducible device for planning plastic surgery therapies and for documenting postoperative results. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Phonological Advance Planning in Sentence Production

    ERIC Educational Resources Information Center

    Oppermann, Frank; Jescheniak, Jorg D.; Schriefers, Herbert

    2010-01-01

    Our study addresses the scope of phonological advance planning during sentence production using a novel experimental procedure. The production of German sentences in various syntactic formats (SVO, SOV, and VSO) was cued by presenting pictures of the agents of previously memorized agent-action-patient scenes. To tap the phonological activation of…

  18. Challenges in implementing an advance care planning programme in long-term care.

    PubMed

    McGlade, Ciara; Daly, Edel; McCarthy, Joan; Cornally, Nicola; Weathers, Elizabeth; O'Caoimh, Rónán; Molloy, D William

    2017-02-01

    A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the 'Let Me Decide' advance care planning programme in long-term-care. This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. The challenges encountered were largely concerned with preserving resident's autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Although it may be too late for many long-term-care residents to complete their own advance care directive, the ' Let Me Decide' programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of

  19. 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.

  20. 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...

  1. 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.

  2. 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.

  3. 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

  4. 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.

  5. 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...

  6. 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

  7. 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.

  8. 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

  9. 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.

  10. 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...

  11. Summary Document: Restoration Plan for Major Airports after a Bioterrorist Attack

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

    Raber, E

    2007-01-11

    This document provides general guidelines for developing a Restoration Plan for a major airport following release of a biological warfare agent. San Francisco International Airport was selected as the example airport during development of the Plan to illustrate specific details. The spore forming bacterium Bacillus anthracis was selected as the biological agent of primary concern because it is the most difficult of known bioterrorism agents to inactivate and is considered to be one of the agents most likely to be used as a biological weapon. The focus of the Plan is on activities associated with the Characterization, Remediation, and Clearancemore » Phases that are defined herein. Activities associated with the Notification and First-Response Phases are briefly discussed in Appendixes A and B, respectively. In addition to the main text of this Plan and associated appendixes, a data supplement was developed specifically for San Francisco International Airport. Requests for the data supplement must be made directly to the Emergency Planning Operations Division of San Francisco International Airport.« less

  12. 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

  13. Comprehensive Planning Resource Document, 1990-91, for the Kern Community College District.

    ERIC Educational Resources Information Center

    Cook, Lauraine

    This compilation of resources for district planning in 1990-91 provides an overview of demographic, personnel, financial, facilities, and curriculum issues for the Kern Community College District (California) and its member institutions, Bakersfield, Cerro Coso, and Porterville colleges. The 10 sections of the document cover: (1) General…

  14. 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...

  15. Advanced Nuclear Technology: Advanced Light Water Reactors Utility Requirements Document Small Modular Reactors Inclusion Summary

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

    Loflin, Leonard; McRimmon, Beth

    2014-12-18

    This report summarizes a project by EPRI to include requirements for small modular light water reactors (smLWR) into the EPRI Utility Requirements Document (URD) for Advanced Light Water Reactors. The project was jointly funded by EPRI and the U.S. Department of Energy (DOE). The report covers the scope and content of the URD, the process used to revise the URD to include smLWR requirements, a summary of the major changes to the URD to include smLWR, and how to use the URD as revised to achieve value on new plant projects.

  16. [Advance care planning and severe chronic diseases].

    PubMed

    Diestre Ortín, Germán; González Sequero, Vanessa; Collell Domènech, Núria; Pérez López, Francisca; Hernando Robles, Pablo

    2013-01-01

    Advanced care planning (ACP) helps in make decisions on the health problems of people who have lost the capacity for informed consent. It has proven particularly useful in addressing the end of life. The aim of this study was to determine the prevalence of ACP in patients with severe chronic diseases. Review of medical records of patients with dementia, amyotrophic lateral sclerosis, Parkinson's disease, chronic obstructive pulmonary disease or interstitial lung disease, heart failure, chronic kidney disease on dialysis and cancer, all in advanced stages. We collected data on living wills or registered prior decisions by the physician according to clinical planned. A total of 135 patients were studied. There was a record of ACP in 22 patients (16.3%). In most of them it was planned not to start any vital treatment in the event of high risk of imminent death and lacking the ability to make decisions. Only two patients were had a legal living will. The registration of ACP is relatively low, and this can affect decision-making in accordance with the personal values of patients when they do not have the capacity to exercise informed consent. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. 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

  3. 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...

  4. 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.

  5. 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.

  6. The potential for advanced computerized aids for comprehensible writing of technical documents

    NASA Astrophysics Data System (ADS)

    Kieras, D. E.

    1985-01-01

    It is widely agreed that technical documents for equipment are poorly written and hard to comprehend. This has been a long-standing problem because the information-processing demands of editing and revision are so high that many comprehensibility problems go undetected. However, many of these problems can be detected by computerized systems that scan a document and point out where the writing can be improved. Existing systems of this type are based on conventional writing customs, rather than on the research literature on comprehension, and give poor advice or miss important problems. They also do not process the input document to any depth. An approach to advanced writing aids is described; such a system would base its criticisms on what is known about the cognition psychology of comprehension, and would make use of techniques from artificial intelligence for processing the language. Some examples of the relevant research results are presented, and a demonstration system of this type is briefly described.

  7. 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...

  8. 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.

  9. 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...

  10. Candidate functions for advanced technology implementation in the Columbus mission planning environment

    NASA Technical Reports Server (NTRS)

    Loomis, Audrey; Kellner, Albrecht

    1988-01-01

    The Columbus Project is the European Space Agency's contribution to the International Space Station program. Columbus is planned to consist of three elements (a laboratory module attached to the Space Station base, a man-tended freeflyer orbiting with the Space Station base, and a platform in polar orbit). System definition and requirements analysis for Columbus are underway, scheduled for completion in mid-1990. An overview of the Columbus mission planning environment and operations concept as currently defined is given, and some of the challenges presented to software maintainers and ground segment personnel during mission operators are identified. The use of advanced technologies in system implementation is being explored. Both advantages of such solutions and potential problems they present are discussed, and the next steps to be taken by Columbus before targeting any functions for advanced technology implementation are summarized. Several functions in the mission planning process were identified as candidates for advanced technology implementation. These range from expert interaction with Columbus' data bases through activity scheduling and near-real-time response to departures from the planned timeline. Each function is described, and its potential for advanced technology implementation briefly assessed.

  11. 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.

  12. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary engineering...

  13. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary engineering...

  14. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary engineering...

  15. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary engineering...

  16. 14 CFR 151.125 - Allowable advance planning costs.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Allowable advance planning costs. 151.125 Section 151.125 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION... as preliminary topographic and soil exploration; (2) Site evaluation; (3) Preliminary engineering...

  17. Advance Care Planning Does Not Adversely Affect Hope or Anxiety Among Patients With Advanced Cancer.

    PubMed

    Green, Michael J; Schubart, Jane R; Whitehead, Megan M; Farace, Elana; Lehman, Erik; Levi, Benjamin H

    2015-06-01

    Many physicians avoid advance care planning (ACP) discussions because they worry such conversations will lead to psychological distress. To investigate whether engaging in ACP using online planning tools adversely affects hope, hopelessness, or anxiety among patients with advanced cancer. Patients with advanced cancer and an estimated survival of two years or less (Intervention group) and a Control group were recruited at a tertiary care academic medical center (2007-2012) to engage in ACP using an online decision aid ("Making Your Wishes Known"). Pre/post and between-group comparisons were made, including hope (Herth Hope Index), hopelessness (Beck Hopelessness Scale), and anxiety (State Trait Anxiety Inventory). Secondary outcomes included ACP knowledge, self-determination, and satisfaction. A total of 200 individuals completed the study. After engaging in ACP, there was no decline in hope or increase in hopelessness in either the Control or Intervention group. Anxiety was likewise unchanged in the Control group but decreased slightly in the Intervention group. Knowledge of ACP (% correct answers) increased in both the groups, but more so in the Intervention group (13% increase vs. 4%; P<0.01). Self-determination increased slightly in both groups, and satisfaction with the ACP process was greater (P<0.01) in the Intervention than Control group. Engaging in ACP with online planning tools increases knowledge without diminishing hope, increasing hopelessness, or inducing anxiety in patients with advanced cancer. Physicians need not avoid ACP out of concern for adversely affecting patients' psychological well-being. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  18. [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.

  19. 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

  20. Physicians' Views on Advance Care Planning and End-of-Life Care Conversations.

    PubMed

    Fulmer, Terry; Escobedo, Marcus; Berman, Amy; Koren, Mary Jane; Hernández, Sandra; Hult, Angela

    2018-05-23

    To evaluate physicians' views on advance care planning, goals of care, and end-of-life conversations. Random sample telephone survey. United States. Physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) actively practicing medicine and regularly seeing patients aged 65 and older (N=736; 81% male, 75% white, 66% aged ≥50. A 37-item telephone survey constructed by a professional polling group with national expert oversight measured attitudes and perceptions of barriers and facilitators to advance care planning. Summative data are presented here. Ninety-nine percent of participants agreed that it is important to have end-of-life conversations, yet only 29% reported that they have formal training for such conversations. Those most likely to have training included younger physicians and those caring for a racially and ethnically diverse population. Patient values and preferences were the strongest motivating factors in having advance care planning conversations, with 92% of participants rating it extremely important. Ninety-five percent of participants reported that they supported a new Medicare fee-for-service benefit reimbursing advance care planning. The biggest barrier mentioned was time availability. Other barriers included not wanting a patient to give up hope and feeling uncomfortable. With more than half of physicians reporting that they feel educationally unprepared, there medical school curricula need to be strengthened to ensure readiness for end-of-life conversations. Clinician barriers need to be addressed to meet the needs of older adults and families. Policies that focus on payment for quality should be evaluated at regular intervals to monitor their effect on advance care planning. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

  1. WHAT INFLUENCES INDIVIDUALS TO ENGAGE IN ADVANCE CARE PLANNING?

    PubMed Central

    Dellasega, Cheryl; Whitehead, Megan; Green, Michael J.

    2013-01-01

    Background Advance care planning (ACP) is an under-utilized process that involves thinking about what kind of life-prolonging medical care one would want should the need arise, identifying a spokesperson, and then communicating these wishes. Objective To better understand what influences individuals to engage in ACP. Design Three focus groups using semi-structured interactive interviews were conducted with 23 older individuals from three diverse populations in central Pennsylvania. Results Four categories of influences for engaging in ACP were identified: 1) Concern for Self; 2) Concern for Others; 3) Expectations About the Impact of Advance Care Planning; and 4) Anecdotes, Stories, & Experiences. Conclusions The motivations for undertaking ACP that we have identified offer healthcare providers insight into effective strategies for facilitating the process of ACP with their patients. PMID:20103783

  2. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    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; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... donated labor, materials, or equipment. ...

  3. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    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; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... donated labor, materials, or equipment. ...

  4. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    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; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... donated labor, materials, or equipment. ...

  5. 14 CFR 151.119 - Advance planning proposals: Procedures; funding.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Advance planning proposals: Procedures; funding. 151.119 Section 151.119 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF... donated labor, materials, or equipment. ...

  6. 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

  7. 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

  8. Advanced Materials Laboratory User Test Planning Guide

    NASA Technical Reports Server (NTRS)

    Orndoff, Evelyne

    2012-01-01

    Test process, milestones and inputs are unknowns to first-time users of the Advanced Materials Laboratory. The User Test Planning Guide aids in establishing expectations for both NASA and non-NASA facility customers. The potential audience for this guide includes both internal and commercial spaceflight hardware/software developers. It is intended to assist their test engineering personnel in test planning and execution. Material covered includes a roadmap of the test process, roles and responsibilities of facility and user, major milestones, facility capabilities, and inputs required by the facility. Samples of deliverables, test article interfaces, and inputs necessary to define test scope, cost, and schedule are included as an appendix to the guide.

  9. ICESat (GLAS) Science Processing Software Document Series. Volume 2; Science Data Management Plan; 4.0

    NASA Technical Reports Server (NTRS)

    Jester, Peggy L.; Hancock, David W., III

    1999-01-01

    This document provides the Data Management Plan for the GLAS Standard Data Software (SDS) supporting the GLAS instrument of the EOS ICESat Spacecraft. The SDS encompasses the ICESat Science Investigator-led Processing System (I-SIPS) Software and the Instrument Support Facility (ISF) Software. This Plan addresses the identification, authority, and description of the interface nodes associated with the GLAS Standard Data Products and the GLAS Ancillary Data.

  10. 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.

  11. Test Protocols for Advanced Inverter Interoperability Functions – Main Document

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

    Johnson, Jay Dean; Gonzalez, Sigifredo; Ralph, Mark E.

    2013-11-01

    Distributed energy resources (DER) such as photovoltaic (PV) systems, when deployed in a large scale, are capable of influencing significantly the operation of power systems. Looking to the future, stakeholders are working on standards to make it possible to manage the potentially complex interactions between DER and the power system. In 2009, the Electric Power Research Institute (EPRI), Sandia National Laboratories (SNL) with the U.S. Department of Energy (DOE), and the Solar Electric Power Association (SEPA) initiated a large industry collaborative to identify and standardize definitions for a set of DER grid support functions. While the initial effort concentrated onmore » grid-tied PV inverters and energy storage systems, the concepts have applicability to all DER. A partial product of this on-going effort is a reference definitions document (IEC TR 61850-90-7, Object models for power converters in distributed energy resources (DER) systems) that has become a basis for expansion of related International Electrotechnical Commission (IEC) standards, and is supported by US National Institute of Standards and Technology (NIST) Smart Grid Interoperability Panel (SGIP). Some industry-led organizations advancing communications protocols have also embraced this work. As standards continue to evolve, it is necessary to develop test protocols to independently verify that the inverters are properly executing the advanced functions. Interoperability is assured by establishing common definitions for the functions and a method to test compliance with operational requirements. This document describes test protocols developed by SNL to evaluate the electrical performance and operational capabilities of PV inverters and energy storage, as described in IEC TR 61850-90-7. While many of these functions are not currently required by existing grid codes or may not be widely available commercially, the industry is rapidly moving in that direction. Interoperability issues are

  12. 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.

  13. 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.

  14. 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.

  15. 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.

  16. 40 CFR 60.4355 - How do I establish and document a proper parameter monitoring plan?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Standards of Performance for Stationary Combustion Turbines Monitoring § 60.4355 How do I establish and document a proper parameter monitoring plan? (a) The steam or water to fuel ratio or other parameters that...

  17. 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

  18. 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.

  19. 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

  20. Three Methods of Assessing Values for Advance Care Planning

    PubMed Central

    Karel, Michele J.; Moye, Jennifer; Bank, Adam; Azar, Armin R.

    2016-01-01

    Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools—open-ended, forced-choice, and rating scale questions—and named a preferred surrogate decision maker. Responses to forced-choice items were examined at 9-month retest. Adults with and without dementia appeared equally able to respond meaningfully to questions about values regarding quality of life and health care decisions. People with dementia were generally as able as controls to respond consistently after 9 months. Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able. PMID:17215205

  1. 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...

  2. 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 ...

  3. 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…

  4. Contribution of FDOPA PET to radiotherapy planning for advanced glioma

    NASA Astrophysics Data System (ADS)

    Dowson, Nicholas; Fay, Michael; Thomas, Paul; Jeffree, Rosalind; McDowall, Robert; Winter, Craig; Coulthard, Alan; Smith, Jye; Gal, Yaniv; Bourgeat, Pierrick; Salvado, Olivier; Crozier, Stuart; Rose, Stephen

    2014-03-01

    Despite radical treatment with surgery, radiotherapy and chemotherapy, advanced gliomas recur within months. Geographic misses in radiotherapy planning may play a role in this seemingly ineluctable recurrence. Planning is typically performed on post-contrast MRIs, which are known to underreport tumour volume relative to FDOPA PET scans. FDOPA PET fused with contrast enhanced MRI has demonstrated greater sensitivity and specificity than MRI alone. One sign of potential misses would be differences between gross target volumes (GTVs) defined using MRI alone and when fused with PET. This work examined whether such a discrepancy may occur. Materials and Methods: For six patients, a 75 minute PET scan using 3,4-dihydroxy-6-18F-fluoro-L-phynel-alanine (18F-FDOPA) was taken within 2 days of gadolinium enhanced MRI scans. In addition to standard radiotherapy planning by an experienced radiotherapy oncologist, a second gross target volume (GTV) was defined by an experienced nuclear medicine specialist for fused PET and MRI, while blinded to the radiotherapy plans. The volumes from standard radiotherapy planning were compared to the PET defined GTV. Results: The comparison indicated radiotherapy planning would change in several cases if FDOPA PET data was available. PET-defined contours were external to 95% prescribed dose for several patients. However, due to the radiotherapy margins, the discrepancies were relatively small in size and all received a dose of 50 Gray or more. Conclusions: Given the limited size of the discrepancies it is uncertain that geographic misses played a major role in patient outcome. Even so, the existence of discrepancies indicates that FDOPA PET could assist in better defining margins when planning radiotherapy for advanced glioma, which could be important for highly conformal radiotherapy plans.

  5. 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

  6. 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...

  7. Advance care planning for cancer patients in primary care: a feasibility study

    PubMed Central

    Boyd, Kirsty; Mason, Bruce; Kendall, Marilyn; Barclay, Stephen; Chinn, David; Thomas, Keri; Sheikh, Aziz; Murray, Scott A

    2010-01-01

    Background Advance care planning is being promoted as a central component of end-of-life policies in many developed countries, but there is concern that professionals find its implementation challenging. Aim To assess the feasibility of implementing advance care planning in UK primary care. Design of study Mixed methods evaluation of a pilot educational intervention. Setting Four general practices in south-east Scotland. Method Interviews with 20 GPs and eight community nurses before and after a practice-based workshop; this was followed by telephone interviews with nine other GPs with a special interest in palliative care from across the UK. Results End-of-life care planning for patients typically starts as an urgent response to clear evidence of a short prognosis, and aims to achieve a ‘good death’. Findings suggest that there were multiple barriers to earlier planning: prognostic uncertainty; limited collaboration with secondary care; a desire to maintain hope; and resistance to any kind of ‘tick-box’ approach. Following the workshop, participants' knowledge and skills were enhanced but there was little evidence of more proactive planning. GPs from other parts of the UK described confusion over terminology and were concerned about the difficulties of implementing inflexible, policy-driven care. Conclusion A clear divide was found between UK policy directives and delivery of end-of-life care in the community that educational interventions targeting primary care professionals are unlikely to address. Advance care planning has the potential to promote autonomy and shared decision making about end-of-life care, but this will require a significant shift in attitudes. PMID:21144189

  8. 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.

  9. Knowledge regarding advance care planning: A systematic review.

    PubMed

    Kermel-Schiffman, Ile; Werner, Perla

    2017-11-01

    Lack of knowledge is one of the main reasons for the low rates of completion of Advance Care Planning (ACP). The purpose of this study was to systematically review the existing literature on knowledge regarding Advance Care Planning. A systematic search of the literature was made in CINHAL, AgeLine, PubMed, PsyINFO and SocINDEX, from 1994 till May 2016. We identified 37 articles that satisfied the inclusion criteria: 35 were quantitative, one was qualitative and one used mixed methods. Most of the studies (n=23) were conducted in the United States and participants in most of the studies (n=22) were professionals. A variety of aspects of ACP were examined, regarding subjective and objective knowledge. Seventeen studies found that participants knew some aspects of ACP, but didn't know others. Inconsistencies were found in the types of instruments and the number of items used to assess knowledge. More effort should be invested in increasing knowledge regarding ACP among professionals and lay people. Developing validated tools to measure objective and subjective knowledge in both populations might be a first step in this direction. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Advanced Platform Systems Technology study. Volume 4: Technology advancement program plan

    NASA Technical Reports Server (NTRS)

    1983-01-01

    An overview study of the major technology definition tasks and subtasks along with their interfaces and interrelationships is presented. Although not specifically indicated in the diagram, iterations were required at many steps to finalize the results. The development of the integrated technology advancement plan was initiated by using the results of the previous two tasks, i.e., the trade studies and the preliminary cost and schedule estimates for the selected technologies. Descriptions for the development of each viable technology advancement was drawn from the trade studies. Additionally, a logic flow diagram depicting the steps in developing each technology element was developed along with descriptions for each of the major elements. Next, major elements of the logic flow diagrams were time phased, and that allowed the definition of a technology development schedule that was consistent with the space station program schedule when possible. Schedules show the major milestone including tests required as described in the logic flow diagrams.

  11. Advance care planning with individuals experiencing homelessness: Literature review and recommendations for public health practice.

    PubMed

    Hubbell, Sarah A

    2017-09-01

    Vulnerable populations in the United States experience disparities in access to advance care planning and may have significant unmet health care needs at the end of life, including unrelieved suffering. People who are homeless have increased morbidity and mortality risks, yet lack opportunities to communicate end-of-life preferences. This paper includes a narrative literature review of advance care planning interventions and qualitative investigations into end-of-life concerns among people experiencing homelessness. Trials of clinician-guided interventions with homeless individuals demonstrated effectiveness in achieving advance directive completion and surrogate decision-maker designation. End-of-life concerns among homeless persons included fears of dying alone, dying unnoticed, or remaining unidentified after death. Research participants also reported concerns regarding burial and notification of family members. Public health practitioners should facilitate advance care planning for people who are homeless by providing opportunities for education and discussion on care options and advance directives. © 2017 Wiley Periodicals, Inc.

  12. Development and Validation of a Questionnaire to Detect Behavior Change in Multiple Advance Care Planning Behaviors

    PubMed Central

    Sudore, Rebecca L.; Stewart, Anita L.; Knight, Sara J.; McMahan, Ryan D.; Feuz, Mariko; Miao, Yinghui; Barnes, Deborah E.

    2013-01-01

    Introduction Advance directives have traditionally been considered the gold standard for advance care planning. However, recent evidence suggests that advance care planning involves a series of multiple discrete behaviors for which people are in varying stages of behavior change. The goal of our study was to develop and validate a survey to measure the full advance care planning process. Methods The Advance Care Planning Engagement Survey assesses “Process Measures” of factors known from Behavior Change Theory to affect behavior (knowledge, contemplation, self-efficacy, and readiness, using 5-point Likert scales) and “Action Measures” (yes/no) of multiple behaviors related to surrogate decision makers, values and quality of life, flexibility for surrogate decision making, and informed decision making. We administered surveys at baseline and 1 week later to 50 diverse, older adults from San Francisco hospitals. Internal consistency reliability of Process Measures was assessed using Cronbach's alpha (only continuous variables) and test-retest reliability of Process and Action Measures was examined using intraclass correlations. For discriminant validity, we compared Process and Action Measure scores between this cohort and 20 healthy college students (mean age 23.2 years, SD 2.7). Results Mean age was 69.3 (SD 10.5) and 42% were non-White. The survey took a mean of 21.4 minutes (±6.2) to administer. The survey had good internal consistency (Process Measures Cronbach's alpha, 0.94) and test-retest reliability (Process Measures intraclass correlation, 0.70; Action Measures, 0.87). Both Process and Action Measure scores were higher in the older than younger group, p<.001. Conclusion A new Advance Care Planning Engagement Survey that measures behavior change (knowledge, contemplation, self-efficacy, and readiness) and multiple advance care planning actions demonstrates good reliability and validity. Further research is needed to assess whether survey scores

  13. 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...

  14. Advanced Education and Technology Business Plan, 2009-12. Highlights

    ERIC Educational Resources Information Center

    Alberta Advanced Education and Technology, 2009

    2009-01-01

    Advanced Education and Technology provides strategic leadership for the development of the next generation economy in Alberta through the provision of accessible, affordable and quality learning opportunities for all Albertans and support for a dynamic and integrated innovation system. This paper provides the highlights of the business plan of the…

  15. Advanced Stirling Radioisotope Generator Life Certification Plan

    NASA Technical Reports Server (NTRS)

    Rusick, Jeffrey J.; Zampino, Edward J.

    2013-01-01

    An Advanced Stirling Radioisotope Generator (ASRG) power supply is being developed by the Department of Energy (DOE) in partnership with NASA for potential future deep space science missions. Unlike previous radioisotope power supplies for space exploration, such as the passive MMRTG used recently on the Mars Curiosity rover, the ASRG is an active dynamic power supply with moving Stirling engine mechanical components. Due to the long life requirement of 17 years and the dynamic nature of the Stirling engine, the ASRG project faced some unique challenges trying to establish full confidence that the power supply will function reliably over the mission life. These unique challenges resulted in the development of an overall life certification plan that emphasizes long-term Stirling engine test and inspection when analysis is not practical. The ASRG life certification plan developed is described.

  16. 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.

  17. 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

  18. 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.

  19. 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…

  20. 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

    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.

  1. [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.

  2. Unit Planning Grids for Music: Grade 9-12 Advanced.

    ERIC Educational Resources Information Center

    Delaware State Dept. of Education, Dover.

    This unit planning grid outlines the expectations of Delaware high school students for advanced music studies. The grid identifies nine standards for music: (1) students will sing, independently and with others, a varied repertoire of music; (2) students will perform on instruments, independently and with others, a varied repertoire of music; (3)…

  3. 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

  4. Incidence and Predictors of Advance Care Planning Among Persons with Cognitive Impairment

    PubMed Central

    Garand, Linda; Dew, Mary Amanda; Lingler, Jennifer H.; DeKosky, Steven T.

    2010-01-01

    Objective Persons with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) are at heightened risk for future decisional incapacity. We sought to characterize advance care planning (ACP) rates over time in individuals who had no advance directives (living will or durable power of attorney) in place when they initially presented for a cognitive evaluation. Design Retrospective analysis of data that had been prospectively collected. Setting Alzheimer’s Disease Research Center memory disorders clinic. Participants Persons (N=127) with a diagnosis of MCI or early AD (n = 72) or moderate to severe AD (n = 55) and no advance directives upon initial presentation for a cognitive evaluation. Measurements Extraction of responses to items pertaining to advance care planning assessed during annual semi-structured interviews. Results By 5 years of follow-up, 39% of the sample had initiated ACP, with little difference by baseline diagnosis. Younger subjects (under 65 years old) were significantly more likely to initiate advance directives (43%) than were older subjects (37%). This age effect was more pronounced in men than women as well as in married subjects, those with a family history of dementia, no depressive disorder, and subjects with moderate to severe AD (versus those with MCI or early AD) at baseline. Conclusion Only a minority of subjects initiated ACPs. The findings suggest the need for interventions aimed at enhancing ACP completion rates, particularly among older adults with cognitive impairment since these individuals may have a timed-limited opportunity to plan for future medical, financial, and other major life decisions. PMID:21785291

  5. Academic Self-Perceptions of Ability and Course Planning among Academically Advanced Students

    ERIC Educational Resources Information Center

    Rudasill, Kathleen Moritz; Callahan, Carolyn M.

    2010-01-01

    The purpose of this study is to examine the contribution of gender to the academic self-perceptions of ability and related coursework plans for high school and college across academically advanced students. Participants were academically advanced students (N = 447) from grades 5 to 12. Findings revealed that (a) girls' self-perceptions of ability…

  6. Using Micro-Synchrophasor Data for Advanced Distribution Grid Planning and Operations Analysis

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

    Stewart, Emma; Kiliccote, Sila; McParland, Charles

    2014-07-01

    This report reviews the potential for distribution-grid phase-angle data that will be available from new micro-synchrophasors (µPMUs) to be utilized in existing distribution-grid planning and operations analysis. This data could augment the current diagnostic capabilities of grid analysis software, used in both planning and operations for applications such as fault location, and provide data for more accurate modeling of the distribution system. µPMUs are new distribution-grid sensors that will advance measurement and diagnostic capabilities and provide improved visibility of the distribution grid, enabling analysis of the grid’s increasingly complex loads that include features such as large volumes of distributed generation.more » Large volumes of DG leads to concerns on continued reliable operation of the grid, due to changing power flow characteristics and active generation, with its own protection and control capabilities. Using µPMU data on change in voltage phase angle between two points in conjunction with new and existing distribution-grid planning and operational tools is expected to enable model validation, state estimation, fault location, and renewable resource/load characterization. Our findings include: data measurement is outstripping the processing capabilities of planning and operational tools; not every tool can visualize a voltage phase-angle measurement to the degree of accuracy measured by advanced sensors, and the degree of accuracy in measurement required for the distribution grid is not defined; solving methods cannot handle the high volumes of data generated by modern sensors, so new models and solving methods (such as graph trace analysis) are needed; standardization of sensor-data communications platforms in planning and applications tools would allow integration of different vendors’ sensors and advanced measurement devices. In addition, data from advanced sources such as µPMUs could be used to validate models to improve

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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

  12. 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.

  13. NASA Software Documentation Standard

    NASA Technical Reports Server (NTRS)

    1991-01-01

    The NASA Software Documentation Standard (hereinafter referred to as "Standard") is designed to support the documentation of all software developed for NASA; its goal is to provide a framework and model for recording the essential information needed throughout the development life cycle and maintenance of a software system. The NASA Software Documentation Standard can be applied to the documentation of all NASA software. The 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. The 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.

  14. 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.

  15. 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.

  16. Standardization Documents

    DTIC Science & Technology

    2011-08-01

    Specifications and Standards; Guide Specifications; CIDs; and NGSs . Learn. Perform. Succeed. STANDARDIZATION DOCUMENTS Federal Specifications Commercial...national or international standardization document developed by a private sector association, organization, or technical society that plans ...Maintain lessons learned • Examples: Guidance for application of a technology; Lists of options Learn. Perform. Succeed. DEFENSE HANDBOOK

  17. 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...

  18. 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.

  19. 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.

  20. Advanced Life Support Equivalent System Mass Guidelines Document

    NASA Technical Reports Server (NTRS)

    Levri, Julie; Fisher, John W.; Jones, Harry W.; Drysdale, Alan E.; Ewert, Michael K.; Hanford, Anthony J.; Hogan, John A.; Joshi, Jitendri, A.; Vaccari, David A.

    2003-01-01

    This document is a viewgraph presentation which provides guidelines for performing an Equivalent System Mass (ESM) evaluation for trade study purposes. The document: 1) Defines ESM; 2) Explains how to calculate ESM; 3) Discusses interpretation of ESM results. The document is designed to provide detailed instructive material for researchers who are performing ESM evaluations for the first time.

  1. 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.

  2. General practitioners perceptions on advance care planning for patients living with dementia.

    PubMed

    Brazil, Kevin; Carter, Gillian; Galway, Karen; Watson, Max; van der Steen, Jenny T

    2015-04-23

    Advance care planning (ACP) facilitates communication and understanding of preferences, nevertheless the use of ACPs in primary care is low. The uncertain course of dementia and the inability to communicate with the patient living with dementia are significant challenges for GPs to initiate discussions on goals of care. A cross-sectional survey, using a purposive, cluster sample of GPs across Northern Ireland with registered dementia patients was used. GPs at selected practices received the survey instrument and up to four mail contacts was implemented. One hundred and thirty-three GPs (40.6%) participated in the survey, representing 60.9% of surveyed practices. While most respondents regarded dementia as a terminal disease (96.2%) only 37.6% felt that palliative care applied equally from the time of diagnosis to severe dementia. While most respondents thought that early discussions would facilitate decision-making during advanced dementia (61%), respondents were divided on whether ACP should be initiated at the time of diagnoses. While most respondents felt that GPs should take the initiative to introduce and encourage ACP, most survey participants acknowledged the need for improved knowledge to involve families in caring for patients with dementia at the end of life and that a standard format for ACP documentation was needed. Optimal timing of ACP discussions should be determined by the readiness of the patient and family carer to face end of life. ACP discussions can be enhanced by educational strategies directed towards the patient and family carer that enable shared decision-making with their GP when considering options in future care.

  3. The views of patients with severe chronic obstructive pulmonary disease on advance care planning: a qualitative study.

    PubMed

    MacPherson, Anna; Walshe, Catherine; O'Donnell, Valerie; Vyas, Aashish

    2013-03-01

    Chronic obstructive pulmonary disease (COPD) is a major cause of death worldwide and there are concerns that end-of-life care for these patients is inadequate. Advance care planning is encouraged, with the hope that it will improve communication and avoid unwanted interventions, which have been particular concerns; in practice, these discussions rarely occur. We have little knowledge of the views of patients with COPD on advance care planning. Understanding this could help integrate advance care planning into the routine management of patients with COPD. To explore the views of people with severe COPD about advance care planning. Qualitative design, with data collection incorporating audio recorded semi-structured interviews. Analysis followed a grounded theory approach. Patients with severe COPD (n =10, Gold Standards Framework criteria) were recruited from primary and secondary care settings. Participants felt they had not been given enough information about their diagnosis and prognosis, and were keen for more discussion with healthcare professionals. They wanted more involvement in decisions about their treatment when those decisions were required. Participants were happy to discuss their general views about future care, but felt uncomfortable with the traditional model of binding 'advance directives'. Considering advance care planning as a repeated process of discussion of prognosis, concerns and probable preferences for care would be more useful than encouraging binding advance decisions. Further research should assess the effectiveness of this approach. Local coordination of who is responsible for information provision is needed, and greater involvement of patients with COPD in management decisions as they arise.

  4. An Assessment of Social Diffusion in the Respecting Choices Advance Care Planning Program

    ERIC Educational Resources Information Center

    Moorman, Sara M.; Carr, Deborah; Kirchhoff, Karin T.; Hammes, Bernard J.

    2012-01-01

    This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients'…

  5. 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.

  6. 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.

  7. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 2 CHEMICALS § 713.4 Advance declaration requirements for additionally planned production... additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section 713.4...

  8. 15 CFR 713.4 - Advance declaration requirements for additionally planned production, processing, or consumption...

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 2 CHEMICALS § 713.4 Advance declaration requirements for additionally planned production... additionally planned production, processing, or consumption of Schedule 2 chemicals. 713.4 Section 713.4...

  9. Advance Care Planning in palliative care: a qualitative investigation into the perspective of Paediatric Intensive Care Unit staff.

    PubMed

    Mitchell, Sarah; Dale, Jeremy

    2015-04-01

    The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.

  10. "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.

  11. Randomized, Controlled Trial of an Advance Care Planning Video Decision Support Tool for Patients With Advanced Heart Failure.

    PubMed

    El-Jawahri, Areej; Paasche-Orlow, Michael K; Matlock, Dan; Stevenson, Lynne Warner; Lewis, Eldrin F; Stewart, Garrick; Semigran, Marc; Chang, Yuchiao; Parks, Kimberly; Walker-Corkery, Elizabeth S; Temel, Jennifer S; Bohossian, Hacho; Ooi, Henry; Mann, Eileen; Volandes, Angelo E

    2016-07-05

    Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult. This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure. This was a multisite, randomized, controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of >50% within 2 years. Intervention participants received a verbal description for goals of care (life-prolonging care, limited care, and comfort care) and CPR/intubation plus a 6-minute video depicting the 3 levels of care, CPR/intubation, and an advance care planning checklist. Control subjects received only the verbal description. The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention. Secondary outcomes were CPR/intubation preferences and knowledge (6-item test; range, 0-6) after intervention. In the intervention group, 27 (22%) chose life-prolonging care, 31 (25%) chose limited care, 63 (51%) selected comfort care, and 2 (2%) were uncertain. In the control group, 50 (41%) chose life-prolonging care, 27 (22%) selected limited care, 37 (30%) chose comfort care, and 8 (7%) were uncertain (P<0.001). Intervention participants (compared with control subjects) were more likely to forgo CPR (68% versus 35%; P<0.001) and intubation (77% versus 48%; P<0.001) and had higher mean knowledge scores (4.1 versus 3.0; P<0.001). Patients with heart failure who viewed a video were more informed, more likely to select a focus on comfort, and less likely to desire CPR/intubation compared with patients receiving verbal information only. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01589120. © 2016 American Heart Association, Inc.

  12. 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…

  13. Technical Support Document: Development of the Advanced Energy Design Guide for K-12 Schools--30% Energy Savings

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

    Pless, S.; Torcellini, P.; Long, N.

    2007-09-01

    This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for K-12 School Buildings (K-12 AEDG), a design guidance document intended to provide recommendations for achieving 30% energy savings in K-12 Schools over levels contained in ANSI/ASHRAE/IESNA Standard 90.1-1999, Energy Standard for Buildings Except Low-Rise Residential Buildings. The 30% energy savings target is the first step toward achieving net-zero energy schools; schools that, on an annual basis, draw from outside sources less or equal energy than they generate on site from renewable energy sources.

  14. 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...

  15. 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

  16. Unit Planning Grids for Visual Arts--Grade 9-12 Advanced.

    ERIC Educational Resources Information Center

    Delaware State Dept. of Education, Dover.

    This planning grid for teaching visual arts (advanced) in grades 9-12 in Delaware outlines the following six standards for students to complete: (1) students will select and use form, media, techniques, and processes to create works of art and communicate meaning; (2) students will create ways to use visual, spatial, and temporal concepts in…

  17. 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.

  18. 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

  19. 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 ...

  20. 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.

  1. Technical Support Document: The Development of the Advanced Energy Design Guide for Highway Lodging Buildings

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

    Jiang, Wei; Jarnagin, Ronald E.; Gowri, Krishnan

    2008-09-30

    This Technical Support Document (TSD) describes the process and methodology for development of the Advanced Energy Design Guide for Highway Lodgings (AEDG-HL or the Guide), a design guidance document intended to provide recommendations for achieving 30% energy savings in highway lodging properties over levels contained in ANSI/ASHRAE/IESNA Standard 90.1-1999, Energy Standard for Buildings Except Low-Rise Residential Buildings. The AEDG-HL is the fifth in a series of guides being developed by a partnership of organizations, including the American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE), the American Institute of Architects (AIA), the Illuminating Engineering Society of North America (IESNA),more » the United States Green Buildings Council (USGBC), and the U.S. Department of Energy (DOE).« less

  2. Making the connection: advancing traffic incident management in transportation planning : a primer.

    DOT National Transportation Integrated Search

    2013-07-01

    "The intent of this primer is to inform and guide traffic incident management (TIM) professionals and transportation planners to initiate and develop collaborative relationships and advance TIM programs through the metropolitan planning process. The ...

  3. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    PubMed

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  4. 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

  5. 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.

  6. The Financial Impact of Advanced Kidney Disease on Canada Pension Plan and Private Disability Insurance Costs.

    PubMed

    Manns, Braden; McKenzie, Susan Q; Au, Flora; Gignac, Pamela M; Geller, Lawrence Ian

    2017-01-01

    Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and receive disability payments, either from the Canadian government or from private insurers, but the magnitude of those payments is unknown. The objective of this study was to estimate Canada Pension Plan Disability Benefit and private disability insurance benefits paid to Canadians with advanced kidney failure, and how feasible improvements in prevention, identification, and early treatment of CKD and increased use of kidney transplantation might mitigate those costs. This study used an analytical model combining Canadian data from various sources. This study included all patients with advanced CKD in Canada, including those with estimated glomerular filtration rate (eGFR) <30 mL/min/m 2 and those on dialysis. We combined disability estimates from a provincial kidney care program with the prevalence of advanced CKD and estimated disability payments from the Canada Pension Plan and private insurance plans to estimate overall disability benefit payments for Canadians with advanced CKD. We estimate that Canadians with advanced kidney failure are receiving disability benefit payments of at least Can$217 million annually. These estimates are sensitive to the proportion of individuals with advanced kidney disease who are unable to work, and plausible variation in this estimate could mean patients with advanced kidney disease are receiving up to Can$260 million per year. Feasible strategies to reduce the proportion of individuals with advanced kidney disease, either through prevention, delay or reduction in severity, or increasing the rate of transplantation, could result in reductions in the cost of Canada Pension Plan and private disability insurance payments by Can$13.8 million per year within 5 years. This study does not estimate how CKD prevention or increasing the rate of kidney

  7. Experience Documentation in Assessing Professional Practice or Work Experience: Lessons from Granting Advanced Certification to Health Education Specialists

    ERIC Educational Resources Information Center

    Gambescia, Stephen F.; Lysoby, Linda; Perko, Michael; Sheu, Jiunn-Jye

    2016-01-01

    The purpose of this article is to demonstrate how one profession used an "experience documentation process" to grant advanced certification to qualified certified health education specialists. The competency validation process approved by the certifying organization serves as an example of an additional method, aside from traditional…

  8. An environmental scan of advance care planning decision AIDS for patients undergoing major surgery: a study protocol.

    PubMed

    Aslakson, Rebecca A; Schuster, Anne L R; Miller, Judith; Weiss, Matthew; Volandes, Angelo E; Bridges, John F P

    2014-01-01

    Patients who undergo major surgery are at risk for perioperative morbidity and mortality. It would be appropriate to initiate advance care planning with patients prior to surgery, but surgeons may experience difficulty initiating such conversations. Rather than focus on changing clinician behavior, advance care planning decision aids can be an innovative vehicle to motivate advance care planning among surgical patients and their families. The purpose of this paper is to describe a study protocol for conducting an environmental scan concerning advance care planning decision aids that may be relevant to patients undergoing high-risk surgery. This study will gather information from written or verbal data sources that incorporate professional and lay perspectives: a systematic review, a grey literature review, key informant interviews, and patient and family engagement. It is envisioned that this study will generate three outcomes: a synthesis of current evidence, a summary of gaps in knowledge, and a taxonomy of existing advance care planning decision aids. This environmental scan will demonstrate principles of patient-centered outcomes research, and it will exemplify a pioneering approach for reviewing complex interventions. Anticipated limitations are that information will be gathered from a small sample of patients and families, and that potentially relevant information could also be missing from the environmental scan due to the inclusion/exclusion criteria. Outcomes from the environmental scan will inform future patient-centered research to develop and evaluate a new decision aid.

  9. Document cards: a top trumps visualization for documents.

    PubMed

    Strobelt, Hendrik; Oelke, Daniela; Rohrdantz, Christian; Stoffel, Andreas; Keim, Daniel A; Deussen, Oliver

    2009-01-01

    Finding suitable, less space consuming views for a document's main content is crucial to provide convenient access to large document collections on display devices of different size. We present a novel compact visualization which represents the document's key semantic as a mixture of images and important key terms, similar to cards in a top trumps game. The key terms are extracted using an advanced text mining approach based on a fully automatic document structure extraction. The images and their captions are extracted using a graphical heuristic and the captions are used for a semi-semantic image weighting. Furthermore, we use the image color histogram for classification and show at least one representative from each non-empty image class. The approach is demonstrated for the IEEE InfoVis publications of a complete year. The method can easily be applied to other publication collections and sets of documents which contain images.

  10. 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.

  11. Preliminary analysis of an integrated logistics system for OSSA payloads. Volume 3: OSSA integrated logistics support planning document

    NASA Technical Reports Server (NTRS)

    Palguta, T.; Bradley, W.; Stockton, T.

    1988-01-01

    Guidance in preparing and updating an integrated logistics support plan (ILSP) is given. Clear, concise, and detailed instructions are provided on the preparation and content of an ILSP in order to ensure a quality document that reflects total program requirements.

  12. Automated documentation generator for advanced protein crystal growth

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

    The System Management and Production Laboratory at the Research Institute, the University of Alabama in Huntsville (UAH), was tasked by the Microgravity Experiment Projects (MEP) Office of the Payload Projects Office (PPO) at Marshall Space Flight Center (MSFC) to conduct research in the current methods of written documentation control and retrieval. The goals of this research were to determine the logical interrelationships within selected NASA documentation, and to expand on a previously developed prototype system to deliver a distributable, electronic knowledge-based system. This computer application would then be used to provide a paperless interface between the appropriate parties for the required NASA document.

  13. 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...

  14. 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...

  15. Documenting for Posterity: Advocating the Use of Advanced Recording Techniques for Documentation in the Field of Building Archaeology

    NASA Astrophysics Data System (ADS)

    De Vos, P. J.

    2017-08-01

    Since the new millennium, living in historic cities has become extremely popular in the Netherlands. As a consequence, historic environments are being adapted to meet modern living standards. Houses are constantly subjected to development, restoration and renovation. Although most projects are carried out with great care and strive to preserve and respect as much historic material as possible, nevertheless a significant amount of historical fabric disappears. This puts enormous pressure on building archaeologists that struggle to rapidly and accurately capture in situ authentic material and historical evidence in the midst of construction works. In Leiden, a medieval city that flourished during the seventeenth century and that today counts over 3,000 listed monuments, a solution to the problem has been found with the implementation of advanced recording techniques. Since 2014, building archaeologists of the city council have experienced first-hand that new recording techniques, such as laser scanning and photogrammetry, have dramatically decreased time spent on site with documentation. Time they now use to uncover, analyse and interpret the recovered historical data. Nevertheless, within building archaeology education, a strong case is made for hand drawing as a method for understanding a building, emphasising the importance of close observation and physical contact with the subject. In this paper, the use of advanced recording techniques in building archaeology is being advocated, confronting traditional educational theory with practise, and research tradition with the rapid rise of new recording technologies.

  16. 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

  17. 15 CFR 714.3 - Advance declaration requirements for additionally planned production of Schedule 3 chemicals.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance declaration requirements for additionally planned production of Schedule 3 chemicals. (a) Declaration... additionally planned production of Schedule 3 chemicals. 714.3 Section 714.3 Commerce and Foreign Trade...

  18. Automated VMAT planning for postoperative adjuvant treatment of advanced gastric cancer.

    PubMed

    Sharfo, Abdul Wahab M; Stieler, Florian; Kupfer, Oskar; Heijmen, Ben J M; Dirkx, Maarten L P; Breedveld, Sebastiaan; Wenz, Frederik; Lohr, Frank; Boda-Heggemann, Judit; Buergy, Daniel

    2018-04-23

    Postoperative/adjuvant radiotherapy of advanced gastric cancer involves a large planning target volume (PTV) with multi-concave shapes which presents a challenge for volumetric modulated arc therapy (VMAT) planning. This study investigates the advantages of automated VMAT planning for this site compared to manual VMAT planning by expert planners. For 20 gastric cancer patients in the postoperative/adjuvant setting, dual-arc VMAT plans were generated using fully automated multi-criterial treatment planning (autoVMAT), and compared to manually generated VMAT plans (manVMAT). Both automated and manual plans were created to deliver a median dose of 45 Gy to the PTV using identical planning and segmentation parameters. Plans were evaluated by two expert radiation oncologists for clinical acceptability. AutoVMAT and manVMAT plans were also compared based on dose-volume histogram (DVH) and predicted normal tissue complication probability (NTCP) analysis. Both manVMAT and autoVMAT plans were considered clinically acceptable. Target coverage was similar (manVMAT: 96.6 ± 1.6%, autoVMAT: 97.4 ± 1.0%, p = 0.085). With autoVMAT, median kidney dose was reduced on average by > 25%; (for left kidney from 11.3 ± 2.1 Gy to 8.9 ± 3.5 Gy (p = 0.002); for right kidney from 9.2 ± 2.2 Gy to 6.1 ± 1.3 Gy (p <  0.001)). Median dose to the liver was lower as well (18.8 ± 2.3 Gy vs. 17.1 ± 3.6 Gy, p = 0.048). In addition, Dmax of the spinal cord was significantly reduced (38.3 ± 3.7 Gy vs. 31.6 ± 2.6 Gy, p <  0.001). Substantial improvements in dose conformity and integral dose were achieved with autoVMAT plans (4.2% and 9.1%, respectively; p <  0.001). Due to the better OAR sparing in the autoVMAT plans compared to manVMAT plans, the predicted NTCPs for the left and right kidney and the liver-PTV were significantly reduced by 11.3%, 12.8%, 7%, respectively (p ≤ 0.001). Delivery time and total

  19. The Financial Impact of Advanced Kidney Disease on Canada Pension Plan and Private Disability Insurance Costs

    PubMed Central

    Manns, Braden; McKenzie, Susan Q.; Au, Flora; Gignac, Pamela M.; Geller, Lawrence Ian

    2017-01-01

    Background: Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and receive disability payments, either from the Canadian government or from private insurers, but the magnitude of those payments is unknown. Objective: The objective of this study was to estimate Canada Pension Plan Disability Benefit and private disability insurance benefits paid to Canadians with advanced kidney failure, and how feasible improvements in prevention, identification, and early treatment of CKD and increased use of kidney transplantation might mitigate those costs. Design: This study used an analytical model combining Canadian data from various sources. Setting and Patients: This study included all patients with advanced CKD in Canada, including those with estimated glomerular filtration rate (eGFR) <30 mL/min/m2 and those on dialysis. Measurements: We combined disability estimates from a provincial kidney care program with the prevalence of advanced CKD and estimated disability payments from the Canada Pension Plan and private insurance plans to estimate overall disability benefit payments for Canadians with advanced CKD. Results: We estimate that Canadians with advanced kidney failure are receiving disability benefit payments of at least Can$217 million annually. These estimates are sensitive to the proportion of individuals with advanced kidney disease who are unable to work, and plausible variation in this estimate could mean patients with advanced kidney disease are receiving up to Can$260 million per year. Feasible strategies to reduce the proportion of individuals with advanced kidney disease, either through prevention, delay or reduction in severity, or increasing the rate of transplantation, could result in reductions in the cost of Canada Pension Plan and private disability insurance payments by Can$13.8 million per year within 5 years. Limitations

  20. 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.

  1. 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.

  2. Health behavior change in advance care planning: an agent-based model.

    PubMed

    Ernecoff, Natalie C; Keane, Christopher R; Albert, Steven M

    2016-02-29

    A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables. We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.

  3. Advanced Planning for Tsunamis in California

    NASA Astrophysics Data System (ADS)

    Miller, K.; Wilson, R. I.; Larkin, D.; Reade, S.; Carnathan, D.; Davis, M.; Nicolini, T.; Johnson, L.; Boldt, E.; Tardy, A.

    2013-12-01

    The California Tsunami Program is comprised of the California Governor's Office of Emergency Services (CalOES) and the California Geological Survey (CGS) and funded through the National Tsunami Hazard Mitigation Program (NTHMP) and the Federal Emergency Management Agency (FEMA). The program works closely with the 20 coastal counties in California, as well as academic, and industry experts to improve tsunami preparedness and mitigation in shoreline communities. Inundation maps depicting 'worst case' inundation modeled from plausible sources around the Pacific were released in 2009 and have provided a foundation for public evacuation and emergency response planning in California. Experience during recent tsunamis impacting the state (Japan 2011, Chile 2010, Samoa 2009) has brought to light the desire by emergency managers and decision makers for even more detailed information ahead of future tsunamis. A solution to provide enhanced information has been development of 'playbooks' to plan for a variety of expected tsunami scenarios. Elevation 'playbook' lines can be useful for partial tsunami evacuations when enough information about forecast amplitude and arrival times is available to coastal communities and there is sufficient time to make more educated decisions about who to evacuate for a given scenario or actual event. NOAA-issued Tsunami Alert Bulletins received in advance of a distant event will contain an expected wave height (a number) for each given section of coast. Provision of four elevation lines for possible inundation enables planning for different evacuation scenarios based on the above number potentially alleviating the need for an 'all or nothing' decision with regard to evacuation. Additionally an analytical tool called FASTER is being developed to integrate storm, tides, modeling errors, and local tsunami run-up potential with the forecasted tsunami amplitudes in real-time when a tsunami Alert is sent out. Both of these products will help

  4. 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

  5. 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.

  6. 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

  7. Do older adults with Alzheimer's disease engage in estate planning and advance care planning preparation?

    PubMed

    Choi, Shinae; Kim, Minjung; McDonough, Ian M

    2018-04-18

    This study investigated the estate planning and advance care planning (ACP) of older adults diagnosed with Alzheimer's disease (AD) for the presence of (1) a valid will, (2) a durable power of attorney for health care, and (3) a living will. We analyzed 10,273 adults aged 65 and older from the 2012 Health and Retirement Study (HRS) using multilevel logistic regression. We found that a diagnosis of AD was significantly associated with the ACP variables. Older adults with AD were more likely to assign a durable power of attorney for health care and have a written living will than older adults without an AD diagnosis. However, we found no significant association between a diagnosis of AD and having a valid will. These findings were robust when adjusting for demographic and socioeconomic variables. Other factors decreased engagement in estate planning and ACP, including lower socioeconomic status, being male, and being a minority. Our findings suggest that a diagnosis of AD is associated with more engagement in ACP for individuals and their families, but important barriers exist for people with fewer resources.

  8. 40 CFR 230.94 - Planning and documentation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... waters and uplands; methods for establishing the desired plant community; plans to control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and...

  9. 40 CFR 230.94 - Planning and documentation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... waters and uplands; methods for establishing the desired plant community; plans to control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and...

  10. 40 CFR 230.94 - Planning and documentation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... waters and uplands; methods for establishing the desired plant community; plans to control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and...

  11. 40 CFR 230.94 - Planning and documentation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... waters and uplands; methods for establishing the desired plant community; plans to control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and...

  12. 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

  13. 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.

  14. Development of Methodologic Tools for Planning and Managing Library Services: II. Measuring a Library's Capability for Providing Documents *

    PubMed Central

    Orr, Richard H.; Pings, Vern M.; Pizer, Irwin H.; Olson, Edwin E.; Spencer, Carol C.

    1968-01-01

    A method of measuring a library's capability for providing the documents its users need has been developed. The library is tested with a representative sample of such documents to determine how long would be required for users to obtain these documents. Test results are expressed in terms of a Capability Index, which has a maximal value of 100 only if all the sample documents are found “on shelf.” Specific tests employing samples of 300 documents have been developed that are appropriate for academic and for “reservoir” biomedical libraries. Realistic field trials have demonstrated that these two tests are practical to administer and that test results are adequately reproducible. When strict comparability is not important, a library can test itself. In assessing a reservoir library, test results are supplemented by data on its typical processing time for interlibrary loan requests. Currently these tests are being used in a national survey. The general method is applicable to other types of libraries, provided appropriate test samples are established. If their limitations are clearly understood, these “Document Delivery Tests” can be valuable tools for planning and managing library services. PMID:5665969

  15. Advance care planning, palliative care, and end-of-life care interventions for homeless people: A systematic review.

    PubMed

    Sumalinog, Rafael; Harrington, Katy; Dosani, Naheed; Hwang, Stephen W

    2017-02-01

    Homeless individuals have a high prevalence of multiple chronic comorbidities and early mortality compared to the general population. They also experience significant barriers to access and stigmatization in the healthcare system. Providing advance care planning, palliative care, and end-of-life care for this underserved population is an important health issue. To summarize and evaluate the evidence surrounding advance care planning, palliative care, and end-of-life care interventions for homeless persons. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles from MEDLINE, EMBASE, CINAHL, PsycINFO, Social Work Abstracts, Cochrane Library, Web of Science, and PubMed databases were searched through 13 June 2015. Peer-reviewed studies that implemented advance care planning, palliative care, and end-of-life care interventions for homeless populations were included. Data from studies were independently extracted by two investigators using pre-specified criteria, and quality was assessed using modified Cochrane and Critical Appraisal Skills Programme tools. Six articles met inclusion criteria. Two studies were randomized controlled trials involving advance directive completion. Two cohort studies investigated the costs of a shelter-based palliative care intervention and predictors for completing advance directives. These studies were rated low to fair quality. Two qualitative studies explored the interface between harm-reduction services and end-of-life care and the conditions for providing palliative care for homeless persons in a support home. The effectiveness of advance care planning, palliative care, and end-of-life care interventions for homeless individuals is uncertain. High-quality studies of interventions that reflect the unique and complex circumstances of homeless populations and investigate patient-related outcomes, caregiver burden, and cost-effectiveness are needed.

  16. 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

  17. 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.

  18. A Renewal Plan for the Advanced Photon Source

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

    Fischetti, Robert F.; Fuoss, Paul H.; Gerig, Rodney E.

    2010-06-23

    With coordination from the APS Renewal Steering Committee (the members of which are the co-authors of this paper), staff and users of the U.S. Department of Energy's Advanced Photon Source (APS) at Argonne National Laboratory are in the process of developing a renewal plan for the facility. The renewal is a coordinated upgrade of the accelerator, beamlines, and associated technical structure that will enable users of the APS to address key scientific challenges in the coming decades. The cost of the renewal is estimated to be from $300M to $400M and to take approximately six years from start to finish.

  19. 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.

  20. 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.

  1. Developing a Legal Framework for Advance Healthcare Planning: Comparing England & Wales and Ireland.

    PubMed

    Donnelly, Mary

    2017-03-01

    This article examines the legislative frameworks for advance healthcare planning in England & Wales (the Mental Capacity Act 2005) and in Ireland (the Assisted Decision-Making (Capacity) Act 2015), undertaking a comparative analysis of each measure, with particular focus on the detail of the approaches taken. It is only through this kind of detailed focus that the normative choices made by legislation can fully be understood and evaluated. The article argues that, in several respects, possibly because the drafters were able to reflect lessons learned from other jurisdictions, the Assisted Decision-Making (Capacity) Act 2015 provides a more rounded and complete form of advance healthcare planning than that provided by the Mental Capacity Act. This is on the basis that it provides more protection for patient choice; better potential for delivery on the choices made; and a more appropriate balance between formalities and enforceability.

  2. Defining Advance Care Planning for Adults: A Consensus Definition from a Multidisciplinary Delphi Panel

    PubMed Central

    Sudore, Rebecca L.; Lum, Hillary D.; You, John J.; Hanson, Laura C.; Meier, Diane E.; Pantilat, Steven Z.; Matlock, Daniel D.; Rietjens, Judith A. C.; Korfage, Ida J.; Ritchie, Christine S.; Kutner, Jean S.; Teno, Joan M.; Thomas, Judy; McMahan, Ryan D.; Heyland, Daren K.

    2017-01-01

    Background Despite increasing interest in advance care planning (ACP) and prior ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. Objective To develop a consensus definition of ACP for adults. Design Delphi Panel Setting/Participants Participants included a multidisciplinary panel of international ACP experts consisting of 52 clinicians, researchers, and policy leaders from 4 countries, and a patient/surrogate advisory committee. Measurements We conducted 10 rounds of a modified Delphi method and qualitatively analyzed panelists’ input. Panelists identified several themes lacking consensus, and iteratively discussed and developed a final consensus definition. Results Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients’ values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: “Advance care planning is a process 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 goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness.” The panel also described strategies to best support adults in ACP. Conclusions A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. PMID:28062339

  3. Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.

    PubMed

    Sudore, Rebecca L; Lum, Hillary D; You, John J; Hanson, Laura C; Meier, Diane E; Pantilat, Steven Z; Matlock, Daniel D; Rietjens, Judith A C; Korfage, Ida J; Ritchie, Christine S; Kutner, Jean S; Teno, Joan M; Thomas, Judy; McMahan, Ryan D; Heyland, Daren K

    2017-05-01

    Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives. The aim of this study was to develop a consensus definition of ACP for adults. We convened a Delphi panel of multidisciplinary, international ACP experts consisting of 52 clinicians, researchers, and policy leaders from four countries and a patient/surrogate advisory committee. We conducted 10 rounds using a modified Delphi method and qualitatively analyzed panelists' input. Panelists identified several themes lacking consensus and iteratively discussed and developed a final consensus definition. Panelists identified several tensions concerning ACP concepts such as whether the definition should focus on conversations vs. written advance directives; patients' values vs. treatment preferences; current shared decision making vs. future medical decisions; and who should be included in the process. The panel achieved a final consensus one-sentence definition and accompanying goals statement: "Advance care planning is a process 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 goal of advance care planning is to help ensure that people receive medical care that is consistent with their values, goals and preferences during serious and chronic illness." The panel also described strategies to best support adults in ACP. A multidisciplinary Delphi panel developed a consensus definition for ACP for adults that can be used to inform implementation and measurement of ACP clinical, research, and policy initiatives. Published by Elsevier Inc.

  4. Desire for predictive testing for Alzheimer's disease and impact on advance care planning: a cross-sectional study.

    PubMed

    Sheffrin, Meera; Stijacic Cenzer, Irena; Steinman, Michael A

    2016-12-13

    It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer's disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer's disease, and examined how using such a test may impact advance care planning. A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65 years or older asked questions about a test predictive of Alzheimer's disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer's disease. Then, imagining they knew they would develop Alzheimer's disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer's disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones. Overall, 75% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer's disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be ≤75 years old (odds ratio 0.71 (95% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer's, 81% would be likely to complete an advance directive, although only 15% had done so already. In this nationally representative sample, 75% of older adults would take a free and definitive test predictive of Alzheimer's disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer's disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

  5. Bay Delta Conservation Plan / California WaterFix Documents

    EPA Pesticide Factsheets

    EPA is working with state and federal agencies on development of the Bay Delta Conservation Plan (BDCP), a habitat conservation plan. This page contains correspondence commenting on BDCP planning by state and federal agencies.

  6. Results of an Experimental Exploration of Advanced Automated Geospatial Tools: Agility in Complex Planning

    DTIC Science & Technology

    2009-06-01

    AUTOMATED GEOSPATIAL TOOLS : AGILITY IN COMPLEX PLANNING Primary Topic: Track 5 – Experimentation and Analysis Walter A. Powell [STUDENT] - GMU...TITLE AND SUBTITLE Results of an Experimental Exploration of Advanced Automated Geospatial Tools : Agility in Complex Planning 5a. CONTRACT NUMBER...Std Z39-18 Abstract Typically, the development of tools and systems for the military is requirement driven; systems are developed to meet

  7. 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

  8. [Multimodal document management in radiotherapy].

    PubMed

    Fahrner, H; Kirrmann, S; Röhner, F; Schmucker, M; Hall, M; Heinemann, F

    2013-12-01

    After incorporating treatment planning and the organisational model of treatment planning in the operating schedule system (BAS, "Betriebsablaufsystem"), complete document qualities were embedded in the digital environment. The aim of this project was to integrate all documents independent of their source (paper-bound or digital) and to make content from the BAS available in a structured manner. As many workflow steps as possible should be automated, e.g. assigning a document to a patient in the BAS. Additionally it must be guaranteed that at all times it could be traced who, when, how and from which source documents were imported into the departmental system. Furthermore work procedures should be changed that the documentation conducted either directly in the departmental system or from external systems can be incorporated digitally and paper document can be completely avoided (e.g. documents such as treatment certificate, treatment plans or documentation). It was a further aim, if possible, to automate the removal of paper documents from the departmental work flow, or even to make such paper documents superfluous. In this way patient letters for follow-up appointments should automatically generated from the BAS. Similarly patient record extracts in the form of PDF files should be enabled, e.g. for controlling purposes. The available document qualities were analysed in detail by a multidisciplinary working group (BAS-AG) and after this examination and assessment of the possibility of modelling in our departmental workflow (BAS) they were transcribed into a flow diagram. The gathered specifications were implemented in a test environment by the clinical and administrative IT group of the department of radiation oncology and subsequent to a detailed analysis introduced into clinical routine. The department has succeeded under the conditions of the aforementioned criteria to embed all relevant documents in the departmental workflow via continuous processes. Since the

  9. Advance care planning: the impact of Ceiling of Treatment plans in patients with Coordinate My Care.

    PubMed

    Broadhurst, Helen Lucy; Droney, Joanne; Callender, Tom; Shaw, Amanda; Riley, Julia

    2018-03-22

    The aim of this evaluation is to describe the components and results of urgent care planning in Coordinate My Care (CMC), a digital clinical service for patients with life-limiting illness, for use if a patient is unable to make or express choices. Ceiling of treatment (CoT) plans were created detailing where the patient would like to receive their care and how aggressive medical interventions should be. A retrospective service evaluation was completed of all CMC records created between December 2015 and September 2016 (n=6854). CMC records were divided into two cohorts: those with a CoT plan and those without. The factors associated with these cohorts were reviewed including age, diagnosis, resuscitation status and preferences for place of death (PPD). Analysis of the non-mandatory free text section was carried out. Two-thirds of patients had recorded decisions about CoT. Regardless of which CoT option was chosen, for most patients, PPD was home or care home. Patients with a CoT plan were more likely to have a documented resuscitation status.Patients with a CoT were more likely to die in their PPD (82%vs71%, OR 1.79, p<0.0001). A higher proportion of patients with a CoT decision died outside hospital. This analysis demonstrates that a substantial proportion of patients are willing to engage in urgent care planning. Three facets of urgent care planning identified include PPD, CoT and resuscitation status. © 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.

  10. 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

  11. Measuring Advance Care Planning: Optimizing the Advance Care Planning Engagement Survey.

    PubMed

    Sudore, Rebecca L; Heyland, Daren K; Barnes, Deborah E; Howard, Michelle; Fassbender, Konrad; Robinson, Carole A; Boscardin, John; You, John J

    2017-04-01

    A validated 82-item Advance Care Planning (ACP) Engagement Survey measures a broad range of behaviors. However, concise surveys are needed. The objective of this study was to validate shorter versions of the survey. The survey included 57 process (e.g., readiness) and 25 action items (e.g., discussions). For item reduction, we systematically eliminated questions based on face validity, item nonresponse, redundancy, ceiling effects, and factor analysis. We assessed internal consistency (Cronbach's alpha) and construct validity with cross-sectional correlations and the ability of the progressively shorter survey versions to detect change one week after exposure to an ACP intervention (Pearson correlation coefficients). Five hundred one participants (four Canadian and three US sites) were included in item reduction (mean age 69 years [±10], 41% nonwhite). Because of high correlations between readiness and action items, all action items were removed. Because of high correlations and ceiling effects, two process items were removed. Successive factor analysis then created 55-, 34-, 15-, nine-, and four-item versions; 664 participants (from three US ACP clinical trials) were included in validity analysis (age 65 years [±8], 72% nonwhite, 34% Spanish speaking). Cronbach's alphas were high for all versions (four items 0.84-55 items 0.97). Compared with the original survey, cross-sectional correlations were high (four items 0.85; 55 items 0.97) as were delta correlations (four items 0.68; 55 items 0.93). Shorter versions of the ACP Engagement Survey are valid, internally consistent, and able to detect change across a broad range of ACP behaviors for English and Spanish speakers. Shorter ACP surveys can efficiently measure broad ACP behaviors in research and clinical settings. Published by Elsevier Inc.

  12. 2006 Marine Corps Systems Command Advanced Planning Briefing to Industry

    DTIC Science & Technology

    2006-04-14

    Virginia Beach 34 5 m ile s 34 5 m ile s 2 00 m ile s Philadelphia 9 Video of AAV and EFV 10 Success Story – Amphibious Assault Vehicle Turret...Director Information Systems & InfrastructureProduct Group 10 Overview, Ms. Elizabeth Sedlacek Product Group Director Advanced Planning Briefing to...managers. The slick sheets will contain the names and phone numbers of everyone in the product groups. Corporate – Ms. Gloria Pryor & Ms. Tammy York PG 10

  13. 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.

  14. 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.

  15. A novel classification and online platform for planning and documentation of medical applications of additive manufacturing.

    PubMed

    Tuomi, Jukka; Paloheimo, Kaija-Stiina; Vehviläinen, Juho; Björkstrand, Roy; Salmi, Mika; Huotilainen, Eero; Kontio, Risto; Rouse, Stephen; Gibson, Ian; Mäkitie, Antti A

    2014-12-01

    Additive manufacturing technologies are widely used in industrial settings and now increasingly also in several areas of medicine. Various techniques and numerous types of materials are used for these applications. There is a clear need to unify and harmonize the patterns of their use worldwide. We present a 5-class system to aid planning of these applications and related scientific work as well as communication between various actors involved in this field. An online, matrix-based platform and a database were developed for planning and documentation of various solutions. This platform will help the medical community to structurally develop both research innovations and clinical applications of additive manufacturing. The online platform can be accessed through http://www.medicalam.info. © The Author(s) 2014.

  16. [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.

  17. 42 CFR 137.360 - Does the Secretary approve project planning and design documents prepared by the Self-Governance...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Does the Secretary approve project planning and design documents prepared by the Self-Governance Tribe? 137.360 Section 137.360 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE...

  18. 42 CFR 137.360 - Does the Secretary approve project planning and design documents prepared by the Self-Governance...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Does the Secretary approve project planning and design documents prepared by the Self-Governance Tribe? 137.360 Section 137.360 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE...

  19. End-of-Life Treatment Preferences: A Key to Reducing Ethnic/Racial Disparities in Advance Care Planning?

    PubMed Central

    Garrido, Melissa M.; Harrington, Shannon T.; Prigerson, Holly G.

    2014-01-01

    Background This study sought to identify targets for interventions to reduce end-of-life care disparities among patients with advanced cancer. To do this, we evaluated the degree to which end-of-life care values and preferences are associated with advance care planning within racial/ethnic minority groups. Methods The Coping with Cancer study recruited patients with advanced cancer from outpatient clinics in five states from 2002-2008. We examined rates of one type of advance care planning, do not resuscitate [DNR] orders, reported at baseline interviews by 606 patients. Bivariate tests determined associations among DNR order completion, religious values, and treatment preferences within racial/ethnic groups. Results Non-Latino White patients were significantly more likely to have a DNR order (45%) than Black (25%) and Latino (20%) patients (p <.001). Preferences against specific life-prolonging treatments (e.g. chemotherapy, ventilation) were the only factor significantly associated with higher DNR order likelihood in each group, with non-Latino White patients more likely than Latino or Black patients to express preferences against life-prolonging care (e.g. 26% of non-Latino White, 46% of Black, and 41% of Latino patients wanted a feeding tube if it would extend life for one more day, p<.001). Conclusions Preferences against life-prolonging care differ dramatically by race/ethnicity, but they are uniformly significantly associated with DNR order completion rates across racial/ethnic groups of patients with advanced cancer. Advance care planning interventions that target preferences associated with DNR orders across racial/ethnic groups may reach a broad patient population and reduce end-of-life care disparities. PMID:25145489

  20. Barriers to Advance Care Planning in End-Stage Renal Disease: Who is to Blame, and What Can be Done?

    PubMed

    Kelley, Alan Taylor; Turner, Jeffrey; Doolittle, Benjamin

    2018-07-01

    Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without 'clear and convincing evidence' of a patient's previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for advance care planning in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for advance care planning in daily practice remains unmet.

  1. 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

  2. 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)

  3. 42 CFR 137.361 - Does the Secretary have any other opportunities to approve planning or design documents prepared...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Does the Secretary have any other opportunities to approve planning or design documents prepared by the Self-Governance Tribe? 137.361 Section 137.361 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL...

  4. 42 CFR 137.361 - Does the Secretary have any other opportunities to approve planning or design documents prepared...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Does the Secretary have any other opportunities to approve planning or design documents prepared by the Self-Governance Tribe? 137.361 Section 137.361 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES TRIBAL...

  5. Understanding advance care planning as a process of health behavior change.

    PubMed

    Fried, Terri R; Bullock, Karen; Iannone, Lynne; O'Leary, John R

    2009-09-01

    To explore whether models of health behavior change can help to inform interventions for advance care planning (ACP). Qualitative cross-sectional study. Community. Sixty-three community-dwelling persons aged 65 and older and 30 caregivers with experience as surrogate decision-makers. In focus groups conducted separately with older persons and caregivers, participants were asked to discuss ways they had planned for future declines in health and why they had or had not engaged in such planning. Transcripts were analyzed using grounded theory. Four themes illustrated the potential of applying models of health behavior change to improve ACP. (1) Participants demonstrated variable readiness to engage in ACP and could be in different stages of readiness for different components of ACP, including consideration of treatment goals, completion of advance directives, and communication with families and physicians. (2) Participants identified a wide range of benefits of and barriers to ACP. (3) Participants used a variety of processes of change to progress through stages of readiness, and ACP was only one of a broader set of behaviors that participants engaged in to prepare for declines in their health or for death. (4) Experience with healthcare decision-making for loved ones was a strong influence on perceptions of susceptibility and engagement in ACP. The variability in participants' readiness, barriers and benefits, perceptions of susceptibility, and use of processes to increase readiness for participating in each component of ACP suggests the utility of customized, stage-specific interventions based on individualized assessments to improve ACP.

  6. Recommended HSE-7 documents hierarchy

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

    Klein, R.B.; Jennrich, E.A.; Lund, D.M.

    1990-12-12

    This report recommends a hierarchy of waste management documents at Los Alamos National Laboratory (LANL or Laboratory''). The hierarchy addresses documents that are required to plan, implement, and document waste management programs at Los Alamos. These documents will enable the waste management group and the six sections contained within that group to satisfy requirements that are imposed upon them by the US Department of Energy (DOE), DOE Albuquerque Operations, US Environmental Protection Agency, various State of New Mexico agencies, and Laboratory management.

  7. Recommended HSE-7 documents hierarchy

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

    Klein, R.B.; Jennrich, E.A.; Lund, D.M.

    1990-12-12

    This report recommends a hierarchy of waste management documents at Los Alamos National Laboratory (LANL or ``Laboratory``). The hierarchy addresses documents that are required to plan, implement, and document waste management programs at Los Alamos. These documents will enable the waste management group and the six sections contained within that group to satisfy requirements that are imposed upon them by the US Department of Energy (DOE), DOE Albuquerque Operations, US Environmental Protection Agency, various State of New Mexico agencies, and Laboratory management.

  8. 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...

  9. Earth Observing System (EOS)/Advanced Microwave Sounding Unit-A (AMSU-A): Calibration management plan

    NASA Technical Reports Server (NTRS)

    1994-01-01

    This is the Calibration Management Plan for the Earth Observing System/Advanced Microwave Sounding Unit-A (AMSU-A). The plan defines calibration requirements, calibration equipment, and calibration methods for the AMSU-A, a 15 channel passive microwave radiometer that will be used for measuring global atmospheric temperature profiles from the EOS polar orbiting observatory. The AMSU-A system will also provide data to verify and augment that of the Atmospheric Infrared Sounder.

  10. ICESat (GLAS) Science Processing Software Document Series. Volume 1; Science Software Management Plan; 3.0

    NASA Technical Reports Server (NTRS)

    Hancock, David W., III

    1999-01-01

    This document provides the Software Management Plan for the GLAS Standard Data Software (SDS) supporting the GLAS instrument of the EOS ICESat Spacecraft. The SDS encompasses the ICESat Science Investigator-led Processing System (I-SIPS) Software and the Instrument Support Terminal (IST) Software. For the I-SIPS Software, the SDS will produce Level 0, Level 1, and Level 2 data products as well as the associated product quality assessments and descriptive information. For the IST Software, the SDS will accommodate the GLAS instrument support areas of engineering status, command, performance assessment, and instrument health status.

  11. Electron/proton spectrometer certification documentation analyses

    NASA Technical Reports Server (NTRS)

    Gleeson, P.

    1972-01-01

    A compilation of analyses generated during the development of the electron-proton spectrometer for the Skylab program is presented. The data documents the analyses required by the electron-proton spectrometer verification plan. The verification plan was generated to satisfy the ancillary hardware requirements of the Apollo Applications program. The certification of the spectrometer requires that various tests, inspections, and analyses be documented, approved, and accepted by reliability and quality control personnel of the spectrometer development program.

  12. 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

  13. On the flexibility of grammatical advance planning during sentence production: Effects of cognitive load on multiple lexical access.

    PubMed

    Wagner, Valentin; Jescheniak, Jörg D; Schriefers, Herbert

    2010-03-01

    Three picture-word interference experiments addressed the question of whether the scope of grammatical advance planning in sentence production corresponds to some fixed unit or rather is flexible. Subjects produced sentences of different formats under varying amounts of cognitive load. When speakers described 2-object displays with simple sentences of the form "the frog is next to the mug," the 2 nouns were found to be lexically-semantically activated to similar degrees at speech onset, as indexed by similarly sized interference effects from semantic distractors related to either the first or the second noun. When speakers used more complex sentences (including prenominal color adjectives; e.g., "the blue frog is next to the blue mug") much larger interference effects were observed for the first than the second noun, suggesting that the second noun was lexically-semantically activated before speech onset on only a subset of trials. With increased cognitive load, introduced by an additional conceptual decision task and variable utterance formats, the interference effect for the first noun was increased and the interference effect for second noun disappeared, suggesting that the scope of advance planning had been narrowed. By contrast, if cognitive load was induced by a secondary working memory task to be performed during speech planning, the interference effect for both nouns was increased, suggesting that the scope of advance planning had not been affected. In all, the data suggest that the scope of advance planning during grammatical encoding in sentence production is flexible, rather than structurally fixed.

  14. Learning to Facilitate Advance Care Planning: The Novice Social Worker's Experience

    ERIC Educational Resources Information Center

    Washington, Karla; Bowland, Sharon; Mueggenburg, Kay; Pederson, Margaret; Otten, Sheila; Renn, Tanya

    2014-01-01

    Professional leaders have identified clear roles for social workers involved in advance care planning (ACP), a facilitated process whereby individuals identify their preferences for future medical care; yet information about effective teaching practices in this area is scant. This study reports on the experiences of 14 social workers who…

  15. 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

  16. ADVANCED HEAT TRANSFER TEST FACILITY, TRA666A. ELEVATIONS. ROOF FRAMING PLAN. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    ADVANCED HEAT TRANSFER TEST FACILITY, TRA-666A. ELEVATIONS. ROOF FRAMING PLAN. CONCRETE BLOCK SIDING. SLOPED ROOF. ROLL-UP DOOR. AIR INTAKE ENCLOSURE ON NORTH SIDE. F.C. TORKELSON 842-MTR-666-A5, 8/1966. INL INDEX NO. 531-0666-00-851-152258, REV. 2. - Idaho National Engineering Laboratory, Test Reactor Area, Materials & Engineering Test Reactors, Scoville, Butte County, ID

  17. 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.

  18. Uniform Federal Policy for Quality Assurance Project Plans: Evaluating, Assessing, and Documenting Environmental Data Collection and Use Programs. Part 1. UFP-QAPP Manual

    DTIC Science & Technology

    2004-07-01

    sampler, project manager, data reviewer, statistician , risk assessor, assessment personnel, and laboratory QC manager. In addition, a complete copy of...sample • Corrective actions to be taken if the QC sample fails these criteria • A description of how the QC data and results are to be documented and...Intergovernmental Data Quality Task Force Uniform Federal Policy for Quality Assurance Project Plans Evaluating, Assessing, and Documenting

  19. 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

  20. Comparison of historical documents for writership

    NASA Astrophysics Data System (ADS)

    Ball, Gregory R.; Pu, Danjun; Stritmatter, Roger; Srihari, Sargur N.

    2010-01-01

    Over the last century forensic document science has developed progressively more sophisticated pattern recognition methodologies for ascertaining the authorship of disputed documents. These include advances not only in computer assisted stylometrics, but forensic handwriting analysis. We present a writer verification method and an evaluation of an actual historical document written by an unknown writer. The questioned document is compared against two known handwriting samples of Herman Melville, a 19th century American author who has been hypothesized to be the writer of this document. The comparison led to a high confidence result that the questioned document was written by the same writer as the known documents. Such methodology can be applied to many such questioned documents in historical writing, both in literary and legal fields.

  1. Advance care planning in dementia: recommendations for healthcare professionals.

    PubMed

    Piers, Ruth; Albers, Gwenda; Gilissen, Joni; De Lepeleire, Jan; Steyaert, Jan; Van Mechelen, Wouter; Steeman, Els; Dillen, Let; Vanden Berghe, Paul; Van den Block, Lieve

    2018-06-21

    Advance care planning (ACP) is a continuous, dynamic process of reflection and dialogue between an individual, those close to them and their healthcare professionals, concerning the individual's preferences and values concerning future treatment and care, including end-of-life care. Despite universal recognition of the importance of ACP for people with dementia, who gradually lose their ability to make informed decisions themselves, ACP still only happens infrequently, and evidence-based recommendations on when and how to perform this complex process are lacking. We aimed to develop evidence-based clinical recommendations to guide professionals across settings in the practical application of ACP in dementia care. Following the Belgian Centre for Evidence-Based Medicine's procedures, we 1) performed an extensive literature search to identify international guidelines, articles reporting heterogeneous study designs and grey literature, 2) developed recommendations based on the available evidence and expert opinion of the author group, and 3) performed a validation process using written feedback from experts, a survey for end users (healthcare professionals across settings), and two peer-review groups (with geriatricians and general practitioners). Based on 67 publications and validation from ten experts, 51 end users and two peer-review groups (24 participants) we developed 32 recommendations covering eight domains: initiation of ACP, evaluation of mental capacity, holding ACP conversations, the role and importance of those close to the person with dementia, ACP with people who find it difficult or impossible to communicate verbally, documentation of wishes and preferences, including information transfer, end-of-life decision-making, and preconditions for optimal implementation of ACP. Almost all recommendations received a grading representing low to very low-quality evidence. No high-quality guidelines are available for ACP in dementia care. By combining evidence

  2. First Steps in Government Documents: A Basic Guide.

    ERIC Educational Resources Information Center

    Sears, Jean L.; Moody, Marilyn K.

    Designed to aid users in locating materials in the government documents department at Miami University in Oxford Ohio, this guide contains general information on the documents collection, a floor plan of the documents department, an introduction to U.S. government document finding aids, an introduction to U.S. Congressional and legislative…

  3. An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes.

    PubMed

    Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly

    2015-01-01

    Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs.

  4. NACA documents database project

    NASA Technical Reports Server (NTRS)

    Smith, Ruth S.

    1991-01-01

    The plan to get all the National Advisory Committee on Aeronautics (NACA) collection online, with quality records, led to the NACA Documents Data base Project. The project has a two fold purpose: (1) to develop the definitive bibliography of NACA produced and/or held documents; and (2) to make that bibliography and the associated documents available to the aerospace community. This study supports the first objective by providing an analysis of the NACA collection and its bibliographic records, and supports the second objective by defining the NACA archive and recommending methodologies for meeting the project objectives.

  5. 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

  6. Acceptability of Family-Centered Advanced Care Planning for Adolescents With HIV

    PubMed Central

    Kimmel, Allison; Wilkins, Megan L.; Rana, Sohail; Garcia, Ana; Cheng, Yao I.; Wang, Jichuan; Lyon, Maureen E.

    2016-01-01

    BACKGROUND AND OBJECTIVE: Small pilot studies support the appropriateness of engaging adolescents with chronic or life-limiting illnesses in pediatric advance care planning (pACP). We do not yet know if pACP is acceptable, feasible, and worthwhile, even if emotionally intense, in a fully powered randomized controlled trial. METHODS: We conducted a prospective 2-arm randomized controlled trial at 6 US urban hospitals. Adolescent/family member dyads were randomized to receive the 1-session-a-week 3-session FAmily-CEntered Advance Care Planning (FACE) pACP intervention (1, ACP Survey; 2, Goals of Care Conversation/Treatment Preferences; 3, Completion of Advance Directive) or active comparator (1, Developmental History; 2, Safety Tips; 3, Nutrition/Exercise). The Satisfaction Questionnaire was administered to participants independently after each session by a blinded research assistant. RESULTS: We enrolled 53% of eligible participants and intervened with 97 adolescent/family dyads. Adolescents ranged in age from 14 to 21 years; 54% were male individuals; 93% African American; and 73% perinatally infected. Attendance was 99% for all 3 sessions in each arm. At session 3, FACE adolescents and family dyad members, respectively, found the session useful (98%, 98%) and helpful (98%, 100%), despite feelings of sadness (25%, 17%). FACE adolescents’ improvement in the total subscale A score (useful, helpful, like a load off my mind, satisfied, something I needed to do, courageous, worthwhile) was better than control adolescents at session 3 (β = 1.16, P = .02). There were no adverse events. CONCLUSIONS: FACE enabled worthwhile conversations, while simultaneously eliciting intense emotions. No participants withdrew, 99% of those enrolled completed each session, and there were no adverse events, evidence of pACP’s feasibility, acceptability, and safety. PMID:27940700

  7. End-of-Life Care for Undocumented Immigrants With Advanced Cancer: Documenting the Undocumented.

    PubMed

    Jaramillo, Sylvia; Hui, David

    2016-04-01

    There are approximately 11.1 million undocumented immigrants in the United States, with a majority being Latino. Cancer is now the leading cause of death in Latinos. There is little research guiding providers on how to deliver optimal end-of-life care in this population. We describe a case of an undocumented Latino patient with advanced cancer, and provide a review of the literature on end-of-life care in undocumented immigrants. Our patient encountered many challenges as he navigated through the healthcare system in the last months of life. These included delayed diagnosis, limited social support, financial issues, fear of deportation, and language and cultural barriers, which resulted in significant physical and psychological distress. Within the undocumented patient population, there is often a lack of advance care planning, prognostic understanding, mistrust, religious practices, and cultural beliefs that may affect decision making. Given the growing number of undocumented immigrants in the United States, it is important for clinicians and policy makers to have a better understanding of the issues surrounding end-of-life care for undocumented immigrants, and work together to improve the quality of life and quality of end-of-life care for these disadvantaged individuals. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  8. 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.

  9. 36 CFR 219.30 - Plan documentation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... also contains maps, monitoring and evaluation results, the annual monitoring and evaluation report, and... annual monitoring and evaluation report; and (6) A summary of the projected program of work, updated... years; and a display of the budget trends over at least the past 5 years. (e) Other components. A plan...

  10. 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.

  11. 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.

  12. Advance Planning of Form Properties in the Written Production of Single and Multiple Words

    ERIC Educational Resources Information Center

    Damian, Markus F.; Stadthagen-Gonzalez, Hans

    2009-01-01

    Three experiments investigated the scope of advance planning in written production. Experiment 1 manipulated phonological factors in single word written production, and Experiments 2 and 3 did the same in the production of adjective-noun utterances. In all three experiments, effects on latencies were found which mirrored those previously…

  13. Critical Infrastructure References: Documented Literature Search

    DTIC Science & Technology

    2012-10-01

    the literature search document can be a resource for DRDC and external partners. Future plans: At present, the electronic copies of the reference...Personal Information Protection and Electronic Documents Act (S.C. 2000, c. 5) Title: Personal Information Protection and Electronic Documents Act (S.C...2011 Overview: • "An Act to support and promote electronic commerce by protecting personal information that is collected, used or disclosed in

  14. 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.

  15. Advanced Life Support Project Plan

    NASA Technical Reports Server (NTRS)

    2002-01-01

    Life support systems are an enabling technology and have become integral to the success of living and working in space. As NASA embarks on human exploration and development of space to open the space frontier by exploring, using and enabling the development of space and to expand the human experience into the far reaches of space, it becomes imperative, for considerations of safety, cost, and crew health, to minimize consumables and increase the autonomy of the life support system. Utilizing advanced life support technologies increases this autonomy by reducing mass, power, and volume necessary for human support, thus permitting larger payload allocations for science and exploration. Two basic classes of life support systems must be developed, those directed toward applications on transportation/habitation vehicles (e.g., Space Shuttle, International Space Station (ISS), next generation launch vehicles, crew-tended stations/observatories, planetary transit spacecraft, etc.) and those directed toward applications on the planetary surfaces (e.g., lunar or Martian landing spacecraft, planetary habitats and facilities, etc.). In general, it can be viewed as those systems compatible with microgravity and those compatible with hypogravity environments. Part B of the Appendix defines the technology development 'Roadmap' to be followed in providing the necessary systems for these missions. The purpose of this Project Plan is to define the Project objectives, Project-level requirements, the management organizations responsible for the Project throughout its life cycle, and Project-level resources, schedules and controls.

  16. 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

  17. Advanced Stirling Convertor Durability Testing: Plans and Interim Results

    NASA Technical Reports Server (NTRS)

    Meer, David W.; Oriti, Salvatore M.

    2012-01-01

    The U.S. Department of Energy (DOE), Lockheed Martin Corporation (LM), and NASA Glenn Research Center (GRC) have been developing the Advanced Stirling Radioisotope Generator (ASRG) for use as a power system for space science missions. In support of this program, GRC has been involved in testing Stirling convertors, including the Advanced Stirling Convertor (ASC), for use in the ASRG. This testing includes electromagnetic interference/compatibility (EMI/EMC), structural dynamics, advanced materials, organics, and unattended extended operation. The purpose of the durability tests is to experimentally demonstrate the margins in the ASC design. Due to the high value of the hardware, previous ASC tests focused on establishing baseline performance of the convertors within the nominal operating conditions. The durability tests present the first planned extension of the operating conditions into regions beyond those intended to meet the product spec, where the possibility exists of lateral contact, overstroke, or over-temperature events. These tests are not intended to cause damage that would shorten the life of the convertors, so they can transition into extended operation at the conclusion of the tests. This paper describes the four tests included in the durability test sequence: 1) start/stop cycling, 2) exposure to constant acceleration in the lateral and axial directions, 3) random vibration at increased piston amplitude to induce contact events, and 4) overstroke testing to simulate potential failures during processing or during the mission life where contact events could occur. The paper also summarizes the analysis and simulation used to predict the results of each of these tests.

  18. The do-not-resuscitate order: associations with advance directives, physician specialty and documentation of discussion 15 years after the Patient Self-Determination Act.

    PubMed

    Morrell, E D; Brown, B P; Qi, R; Drabiak, K; Helft, P R

    2008-09-01

    Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate (DNR) order. Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician's specialty and extent of documentation of discussion on end-of-life care. DNR orders were more frequent for patients on a medical service than on a surgical service (77.34% vs 64.20%, p = 0.02) and were made earlier in the hospital stay for medicine than for surgical patients (adjusted mean ratio of time from DNR orders to death versus total length of stay 0.30 for internists vs 0.21 for surgeons, p = 0.04). 22.18% of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death (2.1 days with no or minimal discussion vs 2.8 days with extensive discussion, p<0.01). The physician's specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing.

  19. Digital Documentation: Using Computers to Create Multimedia Reports.

    ERIC Educational Resources Information Center

    Speitel, Tom; And Others

    1996-01-01

    Describes methods for creating integrated multimedia documents using recent advances in print, audio, and video digitization that bring added usefulness to computers as data acquisition, processing, and presentation tools. Discusses advantages of digital documentation. (JRH)

  20. Frequency and Correlates of Advance Planning Among Cognitively Impaired Older Adults

    PubMed Central

    Lingler, Jennifer Hagerty; Hirschman, Karen B.; Garand, Linda; Dew, Mary Amanda; Becker, James T.; Schulz, Richard; DeKosky, Steven T.

    2009-01-01

    Objective To examine the prevalence and sociodemographic correlates of written advance planning among patients with or at risk for dementia-imposed decisional incapacity. Design Retrospective, cross-sectional. Setting University-based memory disorders clinic. Participants Persons with a consensus-based diagnosis of mild cognitive impairment (N = 112), probable or possible Alzheimer disease (AD; N = 549), and nondemented comparison subjects (N = 84). Intervention N/A. Measurements Semistructured interviews to assess durable power of attorney (DPOA) and living will (LW) status upon initial presentation for a dementia evaluation. Results Sixty-five percent of participants had a DPOA and 56% had a LW. Planning rates did not vary by diagnosis. European Americans (adjusted odds ratio = 4.75; 95% CI, 2.40-9.38), older adults (adjusted odds ratio = 1.05; 95% CI, 1.03-1.07) and college graduates (adjusted odds ratio = 2.06; 95% CI, 1.33-3.20) were most likely to have a DPOA. Findings were similar for LW rates. Conclusions Although a majority of persons with and at risk for the sustained and progressive decisional incapacity of AD are formally planning for the future, a substantial minority are not. PMID:18669942

  1. Planning the Transition to End-of-Life Care in Advanced Cancer (PDQ®)—Patient Version

    Cancer.gov

    Planning the transition to end-of-life care in advanced cancer involves talking about patient wishes and preferences. Learn more about common topics and how preparation for transition to end-of-life care can help ease the stress in patients and their families.

  2. Future care planning: a first step to palliative care for all patients with advanced heart disease.

    PubMed

    Denvir, M A; Murray, S A; Boyd, K J

    2015-07-01

    Palliative care is recommended for patients with end-stage heart failure with several recent, randomised trials showing improvements in symptoms and quality of life and more studies underway. Future care planning provides a framework for discussing a range of palliative care problems with patients and their families. This approach can be introduced at any time during the patient's journey of care and ideally well in advance of end-of-life care. Future care planning is applicable to a wide range of patients with advanced heart disease and could be delivered systematically by cardiology teams at the time of an unplanned hospital admission, akin to cardiac rehabilitation for myocardial infarction. Integrating cardiology care and palliative care can benefit many patients with advanced heart disease at increased risk of death or hospitalisation. Larger, randomised trials are needed to assess the impact on patient outcomes and experiences. 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.

  3. 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...

  4. Space Station Freedom advanced photovoltaics and battery technology development planning

    NASA Technical Reports Server (NTRS)

    Brender, Karen D.; Cox, Spruce M.; Gates, Mark T.; Verzwyvelt, Scott A.

    1993-01-01

    Space Station Freedom (SSF) usable electrical power is planned to be built up incrementally during assembly phase to a peak of 75 kW end-of-life (EOL) shortly after Permanently Manned Capability (PMC) is achieved in 1999. This power will be provided by planar silicon (Si) arrays and nickel-hydrogen (NiH2) batteries. The need for power is expected to grow from 75 kW to as much as 150 kW EOL during the evolutionary phase of SSF, with initial increases beginning as early as 2002. Providing this additional power with current technology may not be as cost effective as using advanced technology arrays and batteries expected to develop prior to this evolutionary phase. A six-month study sponsored by NASA Langley Research Center and conducted by Boeing Defense and Space Group was initiated in Aug. 1991. The purpose of the study was to prepare technology development plans for cost effective advanced photovoltaic (PV) and battery technologies with application to SSF growth, SSF upgrade after its arrays and batteries reach the end of their design lives, and other low Earth orbit (LEO) platforms. Study scope was limited to information available in the literature, informal industry contacts, and key representatives from NASA and Boeing involved in PV and battery research and development. Ten battery and 32 PV technologies were examined and their performance estimated for SSF application. Promising technologies were identified based on performance and development risk. Rough order of magnitude cost estimates were prepared for development, fabrication, launch, and operation. Roadmaps were generated describing key issues and development paths for maturing these technologies with focus on SSF application.

  5. Planning and Managing Learning Tasks and Activities. Advances in Research on Teaching. Volume 3.

    ERIC Educational Resources Information Center

    Brophy, Jere, Ed.

    This publication is the third volume in the "Advanced in Research on Teaching" series, which has been established to provide state-of-the-art conceptualization and analysis of the processes involved in functioning as a classroom teacher. This volume focuses on the planning and managing of learning tasks and activities, in particular,…

  6. 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.

  7. Advance Care Planning: Understanding Clinical Routines and Experiences of Interprofessional Team Members in Diverse Health Care Settings.

    PubMed

    Arnett, Kelly; Sudore, Rebecca L; Nowels, David; Feng, Cindy X; Levy, Cari R; Lum, Hillary D

    2017-12-01

    Interprofessional health care team members consider advance care planning (ACP) to be important, yet gaps remain in systematic clinical routines to support ACP. A clearer understanding of the interprofessional team members' perspectives on ACP clinical routines in diverse settings is needed. One hundred eighteen health care team members from community-based clinics, long-term care facilities, academic clinics, federally qualified health centers, and hospitals participated in a 35-question, cross-sectional online survey to assess clinical routines, workflow processes, and policies relating to ACP. Respondents were 53% physicians, 18% advanced practice nurses, 11% nurses, and 18% other interprofessional team members including administrators, chaplains, social workers, and others. Regarding clinical routines, respondents reported that several interprofessional team members play a role in facilitating ACP (ie, physician, social worker, nurse, others). Most (62%) settings did not have, or did not know of, policies related to ACP documentation. Only 14% of settings had a patient education program. Two-thirds of the respondents said that addressing ACP is a high priority and 85% felt that nonphysicians could have ACP conversations with appropriate training. The clinical resources needed to improve clinical routines included training for providers and staff, dedicated staff to facilitate ACP, and availability of patient/family educational materials. Although interprofessional health care team members consider ACP a priority and several team members may be involved, clinical settings lack systematic clinical routines to support ACP. Patient educational materials, interprofessional team training, and policies to support ACP clinical workflows that do not rely solely on physicians could improve ACP across diverse clinical settings.

  8. 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.

  9. Promoting advance planning for health care and research among older adults: A randomized controlled trial

    PubMed Central

    2012-01-01

    Background Family members are often required to act as substitute decision-makers when health care or research participation decisions must be made for an incapacitated relative. Yet most families are unable to accurately predict older adult preferences regarding future health care and willingness to engage in research studies. Discussion and documentation of preferences could improve proxies' abilities to decide for their loved ones. This trial assesses the efficacy of an advance planning intervention in improving the accuracy of substitute decision-making and increasing the frequency of documented preferences for health care and research. It also investigates the financial impact on the healthcare system of improving substitute decision-making. Methods/Design Dyads (n = 240) comprising an older adult and his/her self-selected proxy are randomly allocated to the experimental or control group, after stratification for type of designated proxy and self-report of prior documentation of healthcare preferences. At baseline, clinical and research vignettes are used to elicit older adult preferences and assess the ability of their proxy to predict those preferences. Responses are elicited under four health states, ranging from the subject's current health state to severe dementia. For each state, we estimated the public costs of the healthcare services that would typically be provided to a patient under these scenarios. Experimental dyads are visited at home, twice, by a specially trained facilitator who communicates the dyad-specific results of the concordance assessment, helps older adults convey their wishes to their proxies, and offers assistance in completing a guide entitled My Preferences that we designed specifically for that purpose. In between these meetings, experimental dyads attend a group information session about My Preferences. Control dyads attend three monthly workshops aimed at promoting healthy behaviors. Concordance assessments are repeated at the

  10. 15 CFR 714.3 - Advance declaration requirements for additionally planned production of Schedule 3 chemicals.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... additionally planned production of Schedule 3 chemicals. 714.3 Section 714.3 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE CHEMICAL WEAPONS CONVENTION REGULATIONS ACTIVITIES INVOLVING SCHEDULE 3 CHEMICALS § 714.3 Advance...

  11. 40 CFR 230.94 - Planning and documentation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-sections), watershed size, design discharge, and riparian area plantings. (8) Maintenance plan. A... sustainability of the resource, including long-term financing mechanisms and the party responsible for long-term...

  12. Planning and scheduling the Hubble Space Telescope: Practical application of advanced techniques

    NASA Technical Reports Server (NTRS)

    Miller, Glenn E.

    1994-01-01

    NASA's Hubble Space Telescope (HST) is a major astronomical facility that was launched in April, 1990. In late 1993, the first of several planned servicing missions refurbished the telescope, including corrections for a manufacturing flaw in the primary mirror. Orbiting above the distorting effects of the Earth's atmosphere, the HST provides an unrivaled combination of sensitivity, spectral coverage and angular resolution. The HST is arguably the most complex scientific observatory ever constructed and effective use of this valuable resource required novel approaches to astronomical observation and the development of advanced software systems including techniques to represent scheduling preferences and constraints, a constraint satisfaction problem (CSP) based scheduler and a rule based planning system. This paper presents a discussion of these systems and the lessons learned from operational experience.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. Implementation status and explanatory analysis of early advance care planning for Stage IV non-small cell lung cancer patients.

    PubMed

    Tokito, Takaaki; Murakami, Haruyasu; Mori, Keita; Osaka, Iwao; Takahashi, Toshiaki

    2015-03-01

    The American Society of Clinical Oncology published the goals of individualized care including advance care planning for advanced cancer patients in 2011. However, no data are available on the implementation status of advance care planning. We retrospectively reviewed the electronic medical records and informed consent forms of consecutive Stage IV non-small cell lung cancer patients treated with chemotherapy between January 2010 and December 2012 at our institution. Two outcomes were defined to investigate the advance care planning implementation status: C-D, the duration from the last day of chemotherapy to death and D-D, that from the day of confirmed do-not-attempt-resuscitation order to death. The study included 136 eligible patients. The advance care planning implementation status in participating patients was as follows: 96 (70%) patients received information on 'incurable disease before first-line chemotherapy', 69 (50%) were informed about 'supportive care before first-line chemotherapy', whereas 43 (32%) learned about their prognosis. The do-not-attempt-resuscitation decision was reflected in 29 patients' will (21%). The median C-D was 64 days. Receipt of ≤2 chemotherapy regimens and provision of prognosis information to patients were significantly associated with long C-D in multivariate analysis. The median D-D was 25 days. Provision of information on supportive care before first-line chemotherapy and provision of prognosis information to patients were significantly associated with long D-D in multivariate analysis. Our results suggest that there is possible benefit from providing information on supportive care before first-line chemotherapy and informing patients about their prognosis in prolonging the duration of supportive care. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. 12 CFR 952.7 - Documentation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... INVESTMENT CASH ADVANCE PROGRAMS § 952.7 Documentation. (a) A Bank shall require the borrower to certify to... requirements, and where appropriate, a statistical summary or list of incomes of the borrowers, rents for the...

  19. Semantic Document Library: A Virtual Research Environment for Documents, Data and Workflows Sharing

    NASA Astrophysics Data System (ADS)

    Kotwani, K.; Liu, Y.; Myers, J.; Futrelle, J.

    2008-12-01

    The Semantic Document Library (SDL) was driven by use cases from the environmental observatory communities and is designed to provide conventional document repository features of uploading, downloading, editing and versioning of documents as well as value adding features of tagging, querying, sharing, annotating, ranking, provenance, social networking and geo-spatial mapping services. It allows users to organize a catalogue of watershed observation data, model output, workflows, as well publications and documents related to the same watershed study through the tagging capability. Users can tag all relevant materials using the same watershed name and find all of them easily later using this tag. The underpinning semantic content repository can store materials from other cyberenvironments such as workflow or simulation tools and SDL provides an effective interface to query and organize materials from various sources. Advanced features of the SDL allow users to visualize the provenance of the materials such as the source and how the output data is derived. Other novel features include visualizing all geo-referenced materials on a geospatial map. SDL as a component of a cyberenvironment portal (the NCSA Cybercollaboratory) has goal of efficient management of information and relationships between published artifacts (Validated models, vetted data, workflows, annotations, best practices, reviews and papers) produced from raw research artifacts (data, notes, plans etc.) through agents (people, sensors etc.). Tremendous scientific potential of artifacts is achieved through mechanisms of sharing, reuse and collaboration - empowering scientists to spread their knowledge and protocols and to benefit from the knowledge of others. SDL successfully implements web 2.0 technologies and design patterns along with semantic content management approach that enables use of multiple ontologies and dynamic evolution (e.g. folksonomies) of terminology. Scientific documents involved with

  20. 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…

  1. Comment and response document for the long-term surveillance plan for the Bodo Canyon Disposal Site, Durango, Colorado, Revision 0

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

    NONE

    1995-11-01

    This report contains the comment and response document for the Draft Long-Term Surveillance Plan of the Bodo Canyon Site in Durango, California. This is a part of the Uranium Mill Tailings Remedial Action (UMTRA) Project. Questions and comments regarding specific sections or statements in the report are described and then a response to each review comment or question is provided.

  2. Exploring uncertainty in advance care planning in African Americans: does low health literacy influence decision making preference at end of life.

    PubMed

    Melhado, Lolita; Bushy, Angeline

    2011-11-01

    African Americans over 65 represent 3.5 of the 35.6 million Americans. Morbidity and mortality rates are highest among this group; associated with lack of resources and awareness of health problems. But health needs are the same at end of life, yet care is less than optimal. African Americans are less likely to have advance directives nonetheless desire communication, information, respect, and a trusting doctor-patient relationship. Low health literacy may contribute to this disparity. This scholarly review examines the health literacy in advance care planning and refines concepts of uncertainty in illness theory deriving a model for advance care planning in African Americans.

  3. Document control and Conduct of Operations

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

    Collins, S.K.; Meltzer, F.L.

    1993-01-01

    Department of Energy (DOE) Order 5480.19, Conduct of operations, places stringent requirements on a wide range of activities at DOE facilities. These requirements directly affect personnel at the Advanced Test Reactor (ATR), which is located in the Test Reactor Area of the Idaho National Engineering Laboratory and operated for DOE by EG G Idaho, Inc. In order for the ATR to comply with 5480.19, the very personality of the reactor facility's document control unit has had to undergo a major change. The Facility and Administrative Support Unit (FAS) is charged with nudntenance of ATR's controlled ddcuments-diousands of operating and administrativemore » procedures. Prior to the imposition of 5480.19, FAS was content to operate in a clerical support mode, seldom questioning or seeking to improve. This numer of doing business is inappropriate within the framework of DOE 5480.19 and is also at odds with the approach to Total Quality Management (TQM) promulgated by EG G Idaho.To comply with the requirements of 5480.19, FAS has Actively applied TQM principles. Empowered personnel to unprove operations through the establishment of a teatn approach. Begun an automation process that is already paying large dividends in terms of improved procedure accuracy and compliance. A state-of-the-art text retrival system is already in place. We are vigorously pursuing fully automated document tmcidng and document management. This paper describes in detail the steps taken to date, the improvements and the lessons learned. It aLw discusses plans for the future that will enable FAS to support the ATR in inccreasing its responsiveness to the Conduct of Operations Order.« less

  4. Advancing Medication Safety: Establishing a National Action Plan for Adverse Drug Event Prevention.

    PubMed

    Harris, Yael; Hu, Dale J; Lee, Christine; Mistry, Mishale; York, Andrew; Johnson, Tisha K

    2015-08-01

    Adverse drug events (ADEs) are important contributors to preventable morbidity and mortality, comprising one third of all hospital adverse events. In response to growing evidence detailing the high prevalence of ADEs, particularly among vulnerable older adults, Congress requested that the Secretary of the Department of Health and Human Services (HHS) convene a Federal Interagency Steering Committee to establish a National Action Plan to focus on ADE prevention. In August 2014, the Office of Disease Prevention and Health Promotion released the final version of the National Action Plan for Adverse Drug Event Prevention. The Action Plan directly supports the goals of the HHS Strategic Plan and the Patient Protection and Affordable Care Act by providing guidance on tracking and preventing ADEs, as well as describing evidence-based tools and resources to enhance medication safety. ADE ACTION PLAN CONTENT: The Federal Interagency Steering Committee focused the Action Plan on ADEs that are clinically significant, account for the greatest number of measurable harms as identified by using existing surveillance tools, and are largely preventable. As such, the decision was made to target three medication classes: anticoagulants, diabetes agents (insulin and oral hypoglycemic agents), and opioids. The Action Plan is organized around four key areas: surveillance; evidence-based prevention; payment, policy incentives, and oversight; and research opportunities to advance medication safety. One measure of the ADE Action Plan's success will be the wider dissemination of information and educational resources to providers and patients (or consumers) regarding the risks associated with medications. Future Action Plan iterations are likely to consider other high-priority medication classes and update the recommendations.

  5. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial

    PubMed Central

    Sudore, Rebecca L; Barnes, Deborah E; Le, Gem M; Ramos, Roberto; Osua, Stacy J; Richardson, Sarah A; Boscardin, John; Schillinger, Dean

    2016-01-01

    Introduction Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours. Methods and analysis We include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression. Ethics and dissemination This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will

  6. 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

  7. Coordinating Council. Fourth Meeting: NACA Documents Database Project

    NASA Technical Reports Server (NTRS)

    1991-01-01

    This NASA Scientific and Technical Information Coordination Council meeting dealt with the topic 'NACA Documents Database Project'. The following presentations were made and reported on: NACA documents database project study plan, AIAA study, the Optimal NACA database, Deficiencies in online file, NACA documents: Availability and Preservation, the NARA Collection: What is in it? and What to do about it?, and NACA foreign documents and availability. Visuals are available for most presentations.

  8. 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.

  9. Planning the Transition to End-of-Life Care in Advanced Cancer (PDQ®)—Health Professional Version

    Cancer.gov

    Planning the transition to end-of-life care in advanced cancer involves making decisions that can be challenging and emotionally distressing. Get information about likely topics and strategies to improve patient-oncologist communication and decision making in this clinician summary.

  10. Quality of Dying in Nursing Home Residents Dying with Dementia: Does Advanced Care Planning Matter? A Nationwide Postmortem Study

    PubMed Central

    Vandervoort, An; Houttekier, Dirk; Vander Stichele, Robert; van der Steen, Jenny T.; Van den Block, Lieve

    2014-01-01

    Background Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia. Methods Cross-sectional study of deaths (2010) using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires. Findings We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate). A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety) on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1–11) than for those without either (AOR 2.99; CI,1.1–8.3). We found no association between verbal communication or having a GP order and quality of dying. Conclusion For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as

  11. 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...

  12. Agency behind bars: Advance care planning with aging and dying offenders.

    PubMed

    Sanders, Sara; Stensland, Meredith; Juraco, Kim

    2018-01-01

    Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's agentic perspective, the authors examined 20 aging/dying offenders' EOL preferences and ACP. Findings include 6 themes: decisions in the shadow of the past, what works best for me, feeling blessed, what is really going on, can anyone be trusted, and turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process.

  13. 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.

  14. United States Department of Energy Environmental Restoration and Waste Management: Comment Response Document. Five-Year Plan, Fiscal Years 1993--1997

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

    Not Available

    IN 1989, Secretary of Energy James Watkins called for a fundamental change in the way US Department of Energy (DOE) meets its environmental responsibilities. Whereas DOE had long subordinated environmental concerns to the higher priority of weapons production, the Department`s mission was restructured to place less emphasis on defense-related production and much greater emphasis on sound environmental management and restoration of its weapons complex. To carry out this new mission, the Office of Environmental Restoration and Waste Management (EM) was created. Secretary Watkins further stressed that DOE`s new commitment to environmental values will be carried out under a new DOEmore » culture-one of openness, responsiveness, and accountability. The Environmental Restoration and Waste Management Five-Year Plan is the key planning document that embodies both the new DOE emphasis on environmental management and the Department`s commitment to involving the public in its planning process. Updated annually, the Five-Year Plan guides EM`s efforts to clean up DOE facilities and manage its waste -- its accomplishments, goals, and planned activities -- and reinforces DOE`s commitment to the culture change by involving the general public in its development.« less

  15. 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.

  16. 33 CFR 332.4 - Planning and documentation.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and erosion control measures. For stream compensatory mitigation projects, the... standards and if adaptive management is needed. A schedule for monitoring and reporting on monitoring...

  17. 33 CFR 332.4 - Planning and documentation.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and erosion control measures. For stream compensatory mitigation projects, the... standards and if adaptive management is needed. A schedule for monitoring and reporting on monitoring...

  18. 33 CFR 332.4 - Planning and documentation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and erosion control measures. For stream compensatory mitigation projects, the... standards and if adaptive management is needed. A schedule for monitoring and reporting on monitoring...

  19. 33 CFR 332.4 - Planning and documentation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... control invasive plant species; the proposed grading plan, including elevations and slopes of the substrate; soil management; and erosion control measures. For stream compensatory mitigation projects, the... standards and if adaptive management is needed. A schedule for monitoring and reporting on monitoring...

  20. "I Don't Want to Die like that...": The Impact of Significant Others' Death Quality on Advance Care Planning

    ERIC Educational Resources Information Center

    Carr, Deborah

    2012-01-01

    Purpose of the Study: I examine whether 5 aspects of a significant other's death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others' deaths that respondents say triggered their own planning. Design and…

  1. 78 FR 40745 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-08

    .... Description: The Advance Planning Document (APD) process, established in the rules at 45 CFR part 95, subpart F, is the procedure by which States request and obtain approval for Federal financial participation... Advance Planning Document 34 1.2 120 4,896 Operational Advance Planning Document 20 1 30 600 Estimated...

  2. 78 FR 37819 - Submission for OMB Review; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-24

    .... Description: The Advance Planning Document (APD) process, established in the rules at 45 CFR Part 95, Subpart F, is the procedure by which States request and obtain approval for Federal financial participation... Advance Planning Document 34 1.2 120 4,896 Operational Advance Planning Document 20 1 30 600 [[Page 37820...

  3. 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

  4. 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.

  5. 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

  6. 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.

  7. Inter-subject variability modulates phonological advance planning in the production of adjective-noun phrases.

    PubMed

    Michel Lange, Violaine; Laganaro, Marina

    2014-01-01

    The literature on advance phonological planning in adjective-noun phrases (NPs) presents diverging results: while many experimental studies suggest that the entire NP is encoded before articulation, other results favor a span of encoding limited to the first word. Although cross-linguistic differences in the structure of adjective-NPs may account for some of these contrasting results, divergences have been reported even among similar languages and syntactic structures. Here we examined whether inter-individual differences account for variability in the span of phonological planning in the production of French NPs, where previous results indicated encoding limited to the first word. The span of phonological encoding is tested with the picture-word interference (PWI) paradigm using phonological distractors related to the noun or to the adjective of the NPs. In Experiment 1, phonological priming effects were limited to the first word in adjective NPs whichever the position of the adjective (pre-nominal or post-nominal). Crucially, phonological priming effects on the second word interacted with speakers' production speed suggesting different encoding strategies for participants. In Experiment 2, we tested this hypothesis further with a larger group of participants. Results clearly showed that slow and fast initializing participants presented different phonological priming patterns on the last element of adjective-NPs: while the first word was primed by a distractor for all speakers, only the slow speaker group presented a priming effect on the second element of the NP. These results show that the span of phonological encoding is modulated by inter-individual strategies: in experimental paradigms some speakers plan word by word whereas others encode beyond the initial word. We suggest that the diverging results reported in the literature on advance phonological planning may partly be reconciled in light of the present results.

  8. Tobacco document research reporting

    PubMed Central

    Carter, S

    2005-01-01

    Design: Interpretive analysis of published research. Sample: 173 papers indexed in Medline between 1995 and 2004 that cited tobacco industry documents. Analysis: Information about year published, journal and author, and a set of codes relating to methods reporting, were managed in N*Vivo. This coding formed the basis of an interpretation of tobacco document research reporting. Results: Two types of papers were identified. The first used tobacco documents as the primary data source (A-papers). The second was dedicated to another purpose but cited a small number of documents (B-papers). In B-papers documents were used either to provide a specific example or to support an expansive contention. A-papers contained information about purpose, sources, searching, analysis, and limitations that differed by author and journal and over time. A-papers had no clear methodological context, but used words from three major traditions—interpretive research, positivist research, and history—to describe analysis. Interpretation: A descriptive mainstream form of tobacco document reporting is proposed, initially typical but decreasing, and a continuum of positioning of the researcher, from conduit to constructor. Reporting practices, particularly from experienced researchers, appeared to evolve towards researcher as constructor, with later papers showing more complex purposes, diverse sources, and detail of searching and analysis. Tobacco document research could learn from existing research traditions: a model for planning and evaluating tobacco document research is presented. PMID:16319359

  9. Document Management in Local Government.

    ERIC Educational Resources Information Center

    Williams, Bernard J. S.

    1998-01-01

    The latest in electronic document management in British local government is discussed. Finance, revenues, and benefits systems of leading vendors to local authorities are highlighted. A planning decisions archive management system and other information services are discussed. (AEF)

  10. Iowa in motion : transit system plan : implementing Iowa's state transportation plan

    DOT National Transportation Integrated Search

    1999-09-14

    The Iowa Transit System Plan was developed as a result of the on-going long-range transportation planning process known as Iowa In Motion This planning document, the 1999 Iowa Transit System Plan, is the result of this continuing planning process and...

  11. 48 CFR 11.101 - Order of precedence for requirements documents.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    .... (2) Performance-oriented documents (e.g., a PWS or SOO). (See 2.101.) (3) Detailed design-oriented... requirements documents. 11.101 Section 11.101 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION ACQUISITION PLANNING DESCRIBING AGENCY NEEDS Selecting and Developing Requirements Documents 11...

  12. Doctors, Lawyers and Advance Care Planning: Time for Innovation to Work Together to Meet Client Needs

    PubMed Central

    Douglas, Maureen; Simon, Jessica; Fassbender, Konrad

    2016-01-01

    Health organizations in Canada have invested considerable resources in strategies to improve knowledge and uptake of advance care planning (ACP). Yet barriers persist and many Canadians do not engage in the full range of ACP behaviours, including writing an advance directive and appointing a legally authorized decision-maker. Not engaging effectively in ACP disadvantages patients, their loved ones and their healthcare providers. This article advocates for greater collaboration between health and legal professionals to better support clients in ACP and presents a framework for action to build connections between these typically siloed professions. PMID:28032821

  13. Evaluation of MLC leaf transmission on IMRT treatment plan quality of patients with advanced lung cancer.

    PubMed

    Chen, Jiayun; Fu, Guishan; Li, Minghui; Song, Yixin; Dai, Jianrong; Miao, Junjie; Liu, Zhiqiang; Li, Yexiong

    2017-12-14

    The purpose of this paper was to evaluate the impact of leaf treatment of multileaf collimator (MLC) in plan quality of intensity-modulated radiotherapy (IMRT) of patients with advanced lung cancer. Five MLCs with different leaf transmissions (0.01%, 0.5%, 1.2%, 1.8%, and 3%) were configured for an accelerator in a treatment planning system. Correspondingly, 5 treatment plans with the same optimization setting were created and evaluated quantitatively for each patient (11 patients total) who was diagnosed with advanced lung cancer. All of the 5 plans for each patient met the dose requirement for the planning treatment volumes (PTVs) and had similar target dose homogeneity and conformity. On average, the doses to selected organs were as follows: (1) V 5 , V 20 , and the mean dose of total lung; (2) the maximum and mean dose to spinal cord planning organ-at-risk volume (PRV); and (3) V 30 and V 40 of heart, decreased slightly when MLC transmission was decreased, but with no statistical differences. There is a clear grouping of plans having total quality score (S D ) value, which is used to evaluate plan quality: (1) more than 1 (patient nos. 1 to 3, 5, and 8), and more than 2.5 (patient no. 6); (2) less than 1 (patient nos. 7 and 10); (3) around 1 (patient nos. 4, 9, and 11). As MLC transmission increased, overall S D values increased as well and plan dose requirement was harder to meet. The clinical requirements were violated increasingly as MLC transmission became large. Total S D with and without normal tissue (NT) showed similar results, with no statistically significant differences. Therefore, decrease of MLC transmission did have minimum impact on plan, and it improved target coverage and reduced normal tissue radiation slightly, with no statistical significance. Plan quality could not be significantly improved by MLC transmission reduction. However, lower MLC transmission may have advantages on lung sparing to low- and intermediate-dose exposure. Besides

  14. Public Hearing & Comment Period Document(s) for the Cape Wind Associates, LLC, Horseshoe Shoal, Nantucket Sound (Offshore Renewable Energy Project/OCS Air Permit)

    EPA Pesticide Factsheets

    List of public hearing & comment period document(s) for the Cape Wind Associates, LLC, Horseshoe Shoal, Nantucket Sound (Offshore Renewable Energy Project/OCS Air Permit: Massachusetts Plan Approval including nonattainment NSR Appendix A requirements).

  15. Digital document imaging systems: An overview and guide

    NASA Technical Reports Server (NTRS)

    1990-01-01

    This is an aid to NASA managers in planning the selection of a Digital Document Imaging System (DDIS) as a possible solution for document information processing and storage. Intended to serve as a manager's guide, this document contains basic information on digital imaging systems, technology, equipment standards, issues of interoperability and interconnectivity, and issues related to selecting appropriate imaging equipment based upon well defined needs.

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

    PubMed

    Johnson, Stephanie; 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

    2016-12-01

    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. 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. 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. Pre-results; ACTRN12613001288718. 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/.

  17. DOE planning workshop advanced biomedical technology initiative

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

    Not Available

    1994-06-01

    The Department of Energy has mad major contributions in the biomedical sciences with programs in medical applications and instrumentation development, molecular biology, human genome, and computational sciences. In an effort to help determine DOE`s role in applying these capabilities to the nation`s health care needs, a planning workshop was held on January 11--12, 1994. The workshop was co-sponsored by the Department`s Office of Energy Research and Defense Programs organizations. Participants represented industry, medical research institutions, national laboratories, and several government agencies. They attempted to define the needs of the health care industry. identify DOE laboratory capabilities that address these needs,more » and determine how DOE, in cooperation with other team members, could begin an initiative with the goals of reducing health care costs while improving the quality of health care delivery through the proper application of technology and computational systems. This document is a report of that workshop. Seven major technology development thrust areas were considered. Each involves development of various aspects of imaging, optical, sensor and data processing and storage technologies. The thrust areas as prioritized for DOE are: (1) Minimally Invasive Procedures; (2) Technologies for Individual Self Care; (3) Outcomes Research; (4) Telemedicine; (5) Decision Support Systems; (6) Assistive Technology; (7) Prevention and Education.« less

  18. Parametric Study of Advanced Mixing of Fuel/Oxidant System in High Speed Gaseous Flows and Experimental Validation Planning

    DTIC Science & Technology

    2001-08-30

    Body with Thermo-Chemical destribution of Heat-Protected System . In: Physical and Gasdynamic Phenomena in Supersonic Flows Over Bodies. Edit. By...Final Report on ISTC Contract # 1809p Parametric Study of Advanced Mixing of Fuel/Oxidant System in High Speed Gaseous Flows and Experimental...of Advanced Mixing of Fuel/Oxidant System in High Speed Gaseous Flows and Experimental Validation Planning 5c. PROGRAM ELEMENT NUMBER 5d. PROJECT

  19. Financial effect of instituting Deficit Reduction Act documentation requirements in family planning clinics in Oregon.

    PubMed

    Rodriguez, Maria Isabel; Angus, Lisa; Elman, Emily; Darney, Philip D; Caughey, Aaron B

    2011-06-01

    The study was conducted to estimate the long-term costs for implementing citizenship documentation requirements in a Medicaid expansion program for family planning services in Oregon. A decision-analytic model was developed using two perspectives: the state and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was utilized to capture multiple future pregnancies. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multi-way sensitivity analyses were conducted. A Monte Carlo simulation was performed to simultaneously incorporate uncertainty from all of the model inputs. Screening for citizenship results in a loss of $3119 over 5 years ($39,382 vs. $42,501) for the state and $4209 for society ($63,391 compared to $59,182) for adult women. Among adolescents, requiring proof of identity and citizenship results in a loss of $3123 for the state ($39,378 versus $42,501) and $4214 for society ($63,391 instead of $59,177). Screening for citizenship status in publicly funded family planning clinics leads to financial losses for the state and society. Copyright © 2011 Elsevier Inc. All rights reserved.

  20. Advanced Education Business Plan 2005-2008

    ERIC Educational Resources Information Center

    Alberta Advanced Education, 2005

    2005-01-01

    In collaboration with learning providers, the advanced education system, industry, communities, government agencies and non-governmental organizations, Advanced Education strives to create accessible, affordable and quality learning opportunities that are responsive to the ongoing learning needs of Albertans. The Ministry's 2005-08 Business Plan…

  1. Planned Experiments on the Princeton Advanced Test Stand

    NASA Astrophysics Data System (ADS)

    Stepanov, A.; Gilson, E. P.; Grisham, L.; Kaganovich, I.; Davidson, R. C.

    2010-11-01

    The Princeton Advanced Test Stand (PATS) device is an experimental facility based on the STS-100 high voltage test stand transferred from LBNL. It consists of a multicusp RF ion source, a pulsed extraction system capable of forming high-perveance 100keV ion beams, and a large six-foot-long vacuum with convenient access for beam diagnostics. This results in a flexible system for studying high perveance ion beams relevant to NDCX-I/II, including experiments on beam neutralization by ferroelectric plasma sources (FEPS) being developed at PPPL. Research on PATS will concern the basic physics of beam-plasma interactions, such as the effects of volume neutralization on beam emittance, as well as optimizing technology of the FEPS. PATS combines the advantage of an ion beam source and a large-volume plasma source in a chamber with ample access for diagnostics, resulting in a robust setup for investigating and improving relevant aspects of neutralized drift. There are also plans for running the ion source with strongly electro-negative gases such as chlorine, making it possible to extract positive or negative ion beams.

  2. Advanced planetary studies

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Results of planetary advanced studies and planning support are summarized. The scope of analyses includes cost estimation research, planetary mission performance, penetrator mission concepts for airless planets/satellites, geology orbiter payload adaptability, lunar mission performance, and advanced planning activities. Study reports and related publications are included in a bibliography section.

  3. 'We have to discuss it': cancer patients' advance care planning impressions following educational information about cardiopulmonary resuscitation.

    PubMed

    Epstein, A S; Shuk, E; O'Reilly, E M; Gary, K A; Volandes, A E

    2015-12-01

    Most cancer patients desire information about care options at the end of life, including cardiopulmonary resuscitation (CPR). Communicating such care options can be challenging and is part of advance care planning (ACP). Our prior studies with video educational media produced data on patients' categoric preferences (yes/no/unsure) for CPR; however, the thematic underpinnings of these educated preferences in patients treated for advanced cancer aren't well known. Qualitative thematic content analysis of participants' responses in a randomized trial of an educational video (V) or narrative (N) about CPR in patients with advanced gastrointestinal cancers. Responses were independently coded and categorized for thematic content by two reviewers. Of 54 study participants, 26 total (41% of V arm, 56% of N arm) articulated questions, comments, or both. Reviewer analyses demonstrated thematic consensus and resulted in seven distinct themes listed in decreasing order of prevalence: (a) ACP should be started early; (b) educational information about CPR affirmed participants' existing beliefs/knowledge/values about advanced illness; (c) participants were apprehensive about ACP but wanted to discuss it; (d) gaps in knowledge about ACP emerged; (e) CPR information was helpful/acceptable; (f) physicians should be involved in ACP; and (g) medical questions about critical illness arose. Findings identified that while sometimes difficult to discuss, advance care planning is desired, deemed helpful, and ideally begun early by clinicians, and that video education is an appropriate and affirming initiator of discussions. These themes are incorporated into our ongoing research on cancer patient-specific values and education about care options. Copyright © 2015 John Wiley & Sons, Ltd.

  4. 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…

  5. ModSAF Software Architecture Design and Overview Document

    DTIC Science & Technology

    1993-12-20

    ADVANCED DISTRIBUTED SIMULATIONTECHNOLOGY AD-A282 740 ModSAF SOFTWARE ARCHITECTURE DESIGN AND OVERVIEW DOCUMENT Ver 1.0 - 20 December 1993 D T...AND SUBTITLE 5. FUNDING NUMBERS MOdSAF SOFTWARE ARCHITECTURE DESIGN AND OVERVIEW DOCUMENT C N61339-91-D-O00, Delivery Order (0021), ModSAF (CDRL A004) 6

  6. 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.

  7. Office of River Protection Advanced Low-Activity Waste Glass Research and Development Plan

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

    Peeler, David K.; Kim, Dong-Sang; Vienna, John D.

    2015-11-01

    The U.S. Department of Energy Office of River Protection (ORP) has initiated and leads an integrated Advanced Waste Glass (AWG) program to increase the loading of Hanford tank wastes in glass while meeting melter lifetime expectancies and process, regulatory, and product performance requirements. The integrated ORP program is focused on providing a technical, science-based foundation for making key decisions regarding the successful operation of the Hanford Tank Waste Treatment and Immobilization Plant (WTP) facilities in the context of an optimized River Protection Project (RPP) flowsheet. The fundamental data stemming from this program will support development of advanced glass formulations, keymore » product performance and process control models, and tactical processing strategies to ensure safe and successful operations for both the low-activity waste (LAW) and high-level waste vitrification facilities. These activities will be conducted with the objective of improving the overall RPP mission by enhancing flexibility and reducing cost and schedule. The purpose of this advanced LAW glass research and development plan is to identify the near-term, mid-term, and longer-term research and development activities required to develop and validate advanced LAW glasses, property-composition models and their uncertainties, and an advanced glass algorithm to support WTP facility operations, including both Direct Feed LAW and full pretreatment flowsheets. Data are needed to develop, validate, and implement 1) new glass property-composition models and 2) a new glass formulation algorithm. Hence, this plan integrates specific studies associated with increasing the Na2O and SO3/halide concentrations in glass, because these components will ultimately dictate waste loadings for LAW vitrification. Of equal importance is the development of an efficient and economic strategy for 99Tc management. Specific and detailed studies are being implemented to understand the fate of Tc

  8. Miami Valley ITS : early deployment plan : final user service plan

    DOT National Transportation Integrated Search

    1997-07-01

    This User Service Plan is the first major product of the process to develop an Intelligent Transportation System (ITS) Early Deployment Plan (EDP) for the Miami Valley. This User Service Plan documents the travel environment, growth trends and transp...

  9. Journey to 2030 : transportation plan of the Boston region metropolitan planning organization.

    DOT National Transportation Integrated Search

    2007-06-28

    JOURNEY to 2030, the Transportation Plan of the Boston Region Metropolitan Planning Organization (referred to as the Plan), is the long-range, comprehensive transportation planning document for the Boston region. The region encompasses 101 cities and...

  10. NASTRAN documentation for flutter analysis of advanced turbopropellers

    NASA Technical Reports Server (NTRS)

    Elchuri, V.; Gallo, A. M.; Skalski, S. C.

    1982-01-01

    An existing capability developed to conduct modal flutter analysis of tuned bladed-shrouded discs was modified to facilitate investigation of the subsonic unstalled flutter characteristics of advanced turbopropellers. The modifications pertain to the inclusion of oscillatory modal aerodynamic loads of blades with large (backward and forward) varying sweep.

  11. 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…

  12. Haleakala National Park Air Tour Management Plan: Planning and NEPA Scoping Document

    DOT National Transportation Integrated Search

    2004-03-03

    The Federal Aviation Administration (FAA), in cooperation with the National Park Service (NPS), has initiated the development of Air Tour Management Plans (ATMPs) for Haleakala National Park, Hawaii Volcanoes National Park and Kalaupapa National Hist...

  13. 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...

  14. Prototyping a bedside documentation system.

    PubMed

    Bachand, P; Bobis, K

    1993-01-01

    The implementation of a comprehensive bedside documentation system is a major project that demands careful analysis and planning. Since the cost of a typical bedside system can easily exceed $3 million, a design oversight could have disastrous effects on the benefits of the system.

  15. 29 CFR 4050.6 - Payment and required documentation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... MISSING PARTICIPANTS § 4050.6 Payment and required documentation. (a) Time of payment and filing. The plan... administrator and the plan's enrolled actuary) specified in the missing participant forms and instructions, by the time the post-distribution certification is due. Except as otherwise provided in the missing...

  16. 29 CFR 4050.6 - Payment and required documentation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MISSING PARTICIPANTS § 4050.6 Payment and required documentation. (a) Time of payment and filing. The plan... administrator and the plan's enrolled actuary) specified in the missing participant forms and instructions, by the time the post-distribution certification is due. Except as otherwise provided in the missing...

  17. Improving advance care planning for English-speaking and Spanish-speaking older adults: study protocol for the PREPARE randomised controlled trial.

    PubMed

    Sudore, Rebecca L; Barnes, Deborah E; Le, Gem M; Ramos, Roberto; Osua, Stacy J; Richardson, Sarah A; Boscardin, John; Schillinger, Dean

    2016-07-11

    Advance care planning (ACP) is a process that allows patients to identify their goals for medical care. Traditionally, ACP has focused on completing advance directives; however, we have expanded the ACP paradigm to also prepare patients to communicate their wishes and make informed decisions. To this end, we created an ACP website called PREPARE (http://www.prepareforyourcare.org) to prepare diverse English-speaking and Spanish-speaking older adults for medical decision-making. Here, we describe the study protocol for a randomised controlled efficacy trial of PREPARE in a safety-net setting. The goal is to determine the efficacy of PREPARE to engage diverse English-speaking and Spanish-speaking older adults in a full spectrum of ACP behaviours. We include English-speaking and Spanish-speaking adults from an urban public hospital who are ≥55 years old, have ≥2 chronic medical conditions and have seen a primary care physician ≥2 times in the last year. Participants are randomised to the PREPARE intervention (review PREPARE and an easy-to-read advance directive) or the control arm (only the easy-to-read advance directive). The primary outcome is documentation of an advance directive and/or ACP discussion. Secondary outcomes include ACP behaviour change processes measured with validated surveys (eg, self-efficacy, readiness) and a broad range of ACP actions (eg, choosing a surrogate, identifying goals for care, discussing ACP with clinicians and/or surrogates). Using blinded outcome ascertainment, outcomes will be measured at 1 week and at 3, 6 and 12 months, and compared between study arms using mixed-effects logistic regression and mixed-effects linear, Poisson or negative binomial regression. This study has been approved by the appropriate Institutional Review Boards and is guided by input from patient and clinical advisory boards and a data safety monitoring board. The results of this study will be disseminated to academic and community stakeholders

  18. Mental health, treatment preferences, advance care planning, location, and quality of death in advanced cancer patients with dependent children.

    PubMed

    Nilsson, Matthew E; Maciejewski, Paul K; Zhang, Baohui; Wright, Alexi A; Trice, Elizabeth D; Muriel, Anna C; Friedlander, Robert J; Fasciano, Karen M; Block, Susan D; Prigerson, Holly G

    2009-01-15

    Clinicians observe that advanced cancer patients with dependent children agonize over the impact their death will have on their children. The objective of this study was to determine empirically whether advanced cancer patients with and without dependent children differ in treatment preferences, mental health, and end-of-life (EOL) outcomes. Coping with Cancer is a National Cancer Institute/National Institute of Mental Health-funded, multi-institutional, prospective cohort study of 668 patients with advanced cancer. Patients with and without dependent children were compared on rates of psychiatric disorders, advance care planning (ACP), EOL care, quality of their last week of life, and location of death. In adjusted analyses, patients with advanced cancer who had dependent children were more likely to meet panic disorder criteria (adjusted odds ratio [AOR], 5.41; 95% confidence interval [95% CI], 2.13-13.69), more likely to be worried (mean difference in standard deviations [delta], 0.09; P=.006), and more likely to prefer aggressive treatment over palliative care (AOR, 1.77; 95% CI, 1.07-2.93). Patients with dependent children were less likely to engage in ACP (eg, do not resuscitate orders: AOR, 0.44; 95% CI, 0.26-0.75) and had a worse quality of life in the last week of life (delta, 0.15; P=.007). Among spousal caregivers, those with dependent children were more likely to meet criteria for major depressive disorder (AOR, 4.53; 95% CI, 1.47-14) and generalized anxiety disorder (AOR, 3.95; 95% CI, 1.29-12.16). Patients with dependent children were more anxious, were less likely to engage in ACP, and were more likely to have a worse quality of life in their last week of life. Advanced cancer patients and spousal caregivers with dependent children represent a particularly distressed group that warrants further clinical attention, research, and support. Copyright (c) 2009 American Cancer Society.

  19. An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.

    PubMed

    Lindo, Jascinth; Stennett, Rosain; Stephenson-Wilson, Kayon; Barrett, Kerry Ann; Bunnaman, Donna; Anderson-Johnson, Pauline; Waugh-Brown, Veronica; Wint, Yvonne

    2016-09-01

    Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses

  20. Narrative review: the promotion of gabapentin: an analysis of internal industry documents.

    PubMed

    Steinman, Michael A; Bero, Lisa A; Chren, Mary-Margaret; Landefeld, C Seth

    2006-08-15

    Internal documents from the pharmaceutical industry provide a unique window for understanding the structure and methods of pharmaceutical promotion. Such documents have become available through litigation concerning the promotion of gabapentin (Neurontin, Pfizer, Inc., New York, New York) for off-label uses. To describe how gabapentin was promoted, focusing on the use of medical education, research, and publication. Court documents available to the public from United States ex. rel David Franklin vs. Pfizer, Inc., and Parke-Davis, Division of Warner-Lambert Company, mostly from 1994-1998. All documents were reviewed by 1 author, with selected review by coauthors. Marketing strategies and tactics were identified by using an iterative process of review, discussion, and re-review of selected documents. The promotion of gabapentin was a comprehensive and multifaceted process. Advisory boards, consultants meetings, and accredited continuing medical education events organized by third-party vendors were used to deliver promotional messages. These tactics were augmented by the recruitment of local champions and engagement of thought leaders, who could be used to communicate favorable messages about gabapentin to their physician colleagues. Research and scholarship were also used for marketing by encouraging "key customers" to participate in research, using a large study to advance promotional themes and build market share, paying medical communication companies to develop and publish articles about gabapentin for the medical literature, and planning to suppress unfavorable study results. Most available documents were submitted by the plaintiff and may not represent a complete picture of marketing practices. Activities traditionally considered independent of promotional intent, including continuing medical education and research, were extensively used to promote gabapentin. New strategies are needed to ensure a clear separation between scientific and commercial activity.

  1. 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

  2. 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

  3. Technical Support Document: Development of the Advanced Energy Design Guide for Large Hospitals - 50% Energy Savings

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

    Bonnema, E.; Leach, M.; Pless, S.

    2013-06-01

    This Technical Support Document describes the process and methodology for the development of the Advanced Energy Design Guide for Large Hospitals: Achieving 50% Energy Savings Toward a Net Zero Energy Building (AEDG-LH) ASHRAE et al. (2011b). The AEDG-LH is intended to provide recommendations for achieving 50% whole-building energy savings in large hospitals over levels achieved by following Standard 90.1-2004. The AEDG-LH was created for a 'standard' mid- to large-size hospital, typically at least 100,000 ft2, but the strategies apply to all sizes and classifications of new construction hospital buildings. Its primary focus is new construction, but recommendations may be applicablemore » to facilities undergoing total renovation, and in part to many other hospital renovation, addition, remodeling, and modernization projects (including changes to one or more systems in existing buildings).« less

  4. Digital Architecture Planning Model

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

    Oxstrand, Johanna Helene; Al Rashdan, Ahmad Yahya Mohammad; Bly, Aaron Douglas

    As part of the U.S. Department of Energy’s Light Water Reactor Sustainability Program, the Digital Architecture (DA) Project focuses on providing a model that nuclear utilities can refer to when planning deployment of advanced technologies. The digital architecture planning model (DAPM) is the methodology for mapping power plant operational and support activities into a DA that unifies all data sources needed by the utilities to operate their plants. The DA is defined as a collection of information technology capabilities needed to support and integrate a wide spectrum of real-time digital capabilities for performance improvements of nuclear power plants. DA canmore » be thought of as integration of the separate instrumentation and control and information systems already in place in nuclear power plants, which are brought together for the purpose of creating new levels of automation in plant work activities. A major objective in DAPM development was to survey all key areas that needed to be reviewed in order for a utility to make knowledgeable decisions regarding needs and plans to implement a DA at the plant. The development was done in two steps. First, researchers surveyed the nuclear industry in order to learn their near-term plans for adopting new advanced capabilities and implementing a network (i.e., wireless and wire) infrastructure throughout the plant, including the power block. Secondly, a literature review covering regulatory documents, industry standards, and technical research reports and articles was conducted. The objective of the review was to identify key areas to be covered by the DAPM, which included the following: 1. The need for a DA and its benefits to the plant 2. Resources required to implement the DA 3. Challenges that need to be addressed and resolved to implement the DA 4. Roles and responsibilities of the DA implementation plan. The DAPM was developed based on results from the survey and the literature review. Model development

  5. Role of Advance Care Planning in Proxy Decision Making Among Individuals With Dementia and Their Family Caregivers.

    PubMed

    Kwak, Jung; De Larwelle, Jessica A; Valuch, Katharine O'Connell; Kesler, Toni

    2016-01-01

    Health care proxies make important end-of-life decisions for individuals with dementia. A cross-sectional survey was conducted to examine the role of advance care planning in proxy decision making for 141 individuals with cognitive impairment, Alzheimer's disease, or other types of dementia. Proxies who did not know the preferences of individuals with dementia for life support treatments reported greater understanding of their values. Proxies of individuals with dementia who did not want life support treatments anticipated receiving less support and were more uncertain in decision making. The greater knowledge proxies had about dementia trajectory, family support, and trust of physicians, the more informed, clearer, and less uncertain they were in decision making. In addition to advance care planning, multiple factors influence proxy decision making, which should be considered in developing interventions and future research to support informed decision making for individuals with dementia and their families. Copyright 2016, SLACK Incorporated.

  6. Advance care planning in 21st century Australia: a systematic review and appraisal of online advance care directive templates against national framework criteria.

    PubMed

    Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M

    2015-11-01

    A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.

  7. Five-Year Technology Plan. Educational Planning Center.

    ERIC Educational Resources Information Center

    Virginia Beach City Public Schools, VA.

    This 5-year plan is based on "A Comprehensive Plan for Instructional and Administrative Use of Computers in the Virginia Beach Public Schools" ("The Pogrow Report," completed in December 1984) and the "Task Force Report on Information Systems" (completed in July 1988). These reports document the importance of making…

  8. 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.

  9. Anticipatory Water Management in Phoenix using Advanced Scenario Planning and Analyses: WaterSim 5

    NASA Astrophysics Data System (ADS)

    Sampson, D. A.; Quay, R.; White, D. D.; Gober, P.; Kirkwood, C.

    2013-12-01

    Complexity, uncertainty, and variability are inherent properties of linked social and natural processes; sustainable resource management must somehow consider all three. Typically, a decision support tool (using scenario analyses) is used to examine management alternatives under suspected trajectories in driver variables (i.e., climate forcing's, growth or economic projections, etc.). This traditional planning focuses on a small set of envisioned scenarios whose outputs are compared against one-another in order to evaluate their differing impacts on desired metrics. Human cognition typically limits this to three to five scenarios. However, complex and highly uncertain issues may require more, often much more, than five scenarios. In this case advanced scenario analysis provides quantitative or qualitative methods that can reveal patterns and associations among scenario metrics for a large ensemble of scenarios. From this analysis, then, a smaller set of heuristics that describe the complexity and uncertainty revealed provides a basis to guide planning in an anticipatory fashion. Our water policy and management model, termed WaterSim, permits advanced scenario planning and analysis for the Phoenix Metropolitan Area. In this contribution we examine the concepts of advanced scenario analysis on a large scale ensemble of scenarios using our work with WaterSim as a case study. For this case study we created a range of possible water futures by creating scenarios that encompasses differences in water supplies (our surrogates for climate change, drought, and inherent variability in riverine flows), population growth, and per capital water consumption. We used IPCC estimates of plausible, future, alterations in riverine runoff, locally produced and vetted estimates of population growth projections, and empirical trends in per capita water consumption for metropolitan cities. This ensemble consisted of ~ 30, 700 scenarios (~575 k observations). We compared and contrasted

  10. College Graduate Retention: An Initiative Planning Document for Medina, Portage, Summit, Stark and Wayne Counties. Ohio Department of Job and Family Services and Ohio Department of Development Graduate Retention Initiative

    ERIC Educational Resources Information Center

    Stark Education Partnership, 2011

    2011-01-01

    This document represents the findings of the Greater Akron and Canton Regional Chambers of Commerce under an Ohio Department of Job and Family Services and Ohio Department of Development Graduate Retention Initiative (GRI) Planning Grant. The document also includes a proposal for the implementation phase of the initiative with a geographic scope…

  11. Advances in Language Planning.

    ERIC Educational Resources Information Center

    Fishman, Joshua A.

    This volume is an attempt to provide the sociology of language with the basic teaching-learning tools needed in order to facilitate its academic growth and consolidation. It provides the students and specialist in language planning with a comprehensive anthology of articles dealing with this area of research in the sociology of language. The…

  12. Planning for Impact: A Guide to Planning Effective Family Program.

    ERIC Educational Resources Information Center

    Hardy, James M.

    A document intended to provide program planning guidelines for Young Men's Christian Associations (YMCAs) desirous of working with families, recommends adherence to eight principles and following of five steps. The principles involve planning before action, fact finding and analysis, clear delineation of operational objectives, planning at all…

  13. Document recognition serving people with disabilities

    NASA Astrophysics Data System (ADS)

    Fruchterman, James R.

    2007-01-01

    Document recognition advances have improved the lives of people with print disabilities, by providing accessible documents. This invited paper provides perspectives on the author's career progression from document recognition professional to social entrepreneur applying this technology to help people with disabilities. Starting with initial thoughts about optical character recognition in college, it continues with the creation of accurate omnifont character recognition that did not require training. It was difficult to make a reading machine for the blind in a commercial setting, which led to the creation of a nonprofit social enterprise to deliver these devices around the world. This network of people with disabilities scanning books drove the creation of Bookshare.org, an online library of scanned books. Looking forward, the needs for improved document recognition technology to further lower the barriers to reading are discussed. Document recognition professionals should be proud of the positive impact their work has had on some of society's most disadvantaged communities.

  14. "I'm Still Here": Exploring What Matters to People with Intellectual Disability during Advance Care Planning

    ERIC Educational Resources Information Center

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

    2017-01-01

    Background: 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. Methods: This in depth qualitative study explored the experiences of four people with intellectual disability and life limiting conditions,…

  15. 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

  16. Contingency Management Requirements Document: Preliminary Version. Revision F

    NASA Technical Reports Server (NTRS)

    2005-01-01

    This is the High Altitude, Long Endurance (HALE) Remotely Operated Aircraft (ROA) Contingency Management (CM) Functional Requirements document. This document applies to HALE ROA operating within the National Airspace System (NAS) limited at this time to enroute operations above 43,000 feet (defined as Step 1 of the Access 5 project, sponsored by the National Aeronautics and Space Administration). A contingency is an unforeseen event requiring a response. The unforeseen event may be an emergency, an incident, a deviation, or an observation. Contingency Management (CM) is the process of evaluating the event, deciding on the proper course of action (a plan), and successfully executing the plan.

  17. 78 FR 14556 - Proposed Information Collection Activity; Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-06

    ... for ACF. OMB No.: 0992-0005. Description: The Advance Planning Document (APD) process, established in... Biennial Reports 54 1 1.50 81 Advance Planning Document 34 1.2 120 4,896 Operational Advance Planning... for the proper performance of the functions of the agency, including whether the information shall...

  18. Thinking ahead--the need for early Advance Care Planning for people on haemodialysis: A qualitative interview study.

    PubMed

    Bristowe, Katherine; Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O'Donoghue, Donal; Vinen, Katie; Murtagh, Felicity E M

    2015-05-01

    There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the 'conveyor belt' culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential - one size does not fit all. © The Author(s) 2014.

  19. From plans to actions in patient and public involvement: qualitative study of documented plans and the accounts of researchers and patients sampled from a cohort of clinical trials

    PubMed Central

    Buck, Deborah; Gamble, Carrol; Dudley, Louise; Preston, Jennifer; Hanley, Bec; Williamson, Paula R; Young, Bridget

    2014-01-01

    Patient and public involvement (PPI) in research is increasingly required, although evidence to inform its implementation is limited. Objective Inform the evidence base by describing how plans for PPI were implemented within clinical trials and identifying the challenges and lessons learnt by research teams. Methods We compared PPI plans extracted from clinical trial grant applications (funded by the National Institute for Health Research Health Technology Assessment Programme between 2006 and 2010) with researchers’ and PPI contributors’ interview accounts of PPI implementation. Analysis of PPI plans and transcribed qualitative interviews drew on the Framework technique. Results Of 28 trials, 25 documented plans for PPI in funding applications and half described implementing PPI before applying for funding. Plans varied from minimal to extensive, although almost all anticipated multiple modes of PPI. Interview accounts indicated that PPI plans had been fully implemented in 20/25 trials and even expanded in some. Nevertheless, some researchers described PPI within their trials as tokenistic. Researchers and contributors noted that late or minimal PPI engagement diminished its value. Both groups perceived uncertainty about roles in relation to PPI, and noted contributors’ lack of confidence and difficulties attending meetings. PPI contributors experienced problems in interacting with researchers and understanding technical language. Researchers reported difficulties finding ‘the right’ PPI contributors, and advised caution when involving investigators’ current patients. Conclusions Engaging PPI contributors early and ensuring ongoing clarity about their activities, roles and goals, is crucial to PPI's success. Funders, reviewers and regulators should recognise the value of preapplication PPI and allocate further resources to it. They should also consider whether PPI plans in grant applications match a trial's distinct needs. Monitoring and reporting PPI

  20. 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...

  1. 40 CFR 310.16 - What kind of cost documentation is necessary?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS REIMBURSEMENT TO LOCAL GOVERNMENTS FOR... cost documentation is necessary? Cost documentation must be adequate for an audit. At a minimum, you...

  2. 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.

  3. Preparing GMAT for Operational Maneuver Planning of the Advanced Composition Explorer (ACE)

    NASA Technical Reports Server (NTRS)

    Qureshi, Rizwan Hamid; Hughes, Steven P.

    2014-01-01

    The General Mission Analysis Tool (GMAT) is an open-source space mission design, analysis and trajectory optimization tool. GMAT is developed by a team of NASA, private industry, public and private contributors. GMAT is designed to model, optimize and estimate spacecraft trajectories in flight regimes ranging from low Earth orbit to lunar applications, interplanetary trajectories and other deep space missions. GMAT has also been flight qualified to support operational maneuver planning for the Advanced Composition Explorer (ACE) mission. ACE was launched in August, 1997 and is orbiting the Sun-Earth L1 libration point. The primary science objective of ACE is to study the composition of both the solar wind and the galactic cosmic rays. Operational orbit determination, maneuver operations and product generation for ACE are conducted by NASA Goddard Space Flight Center (GSFC) Flight Dynamics Facility (FDF). This paper discusses the entire engineering lifecycle and major operational certification milestones that GMAT successfully completed to obtain operational certification for the ACE mission. Operational certification milestones such as gathering of the requirements for ACE operational maneuver planning, gap analysis, test plans and procedures development, system design, pre-shadow operations, training to FDF ACE maneuver planners, shadow operations, Test Readiness Review (TRR) and finally Operational Readiness Review (ORR) are discussed. These efforts have demonstrated that GMAT is flight quality software ready to support ACE mission operations in the FDF.

  4. Perspectives on advance care planning among patients recently requiring non-invasive ventilation for acute respiratory failure: A qualitative study using thematic analysis.

    PubMed

    Smith, Tracy A; Disler, Rebecca T; Jenkins, Christine R; Ingham, Jane M; Davidson, Patricia M

    2017-06-01

    Patients requiring non-invasive ventilation for acute-on-chronic respiratory failure due to chronic obstructive pulmonary disease or heart failure exacerbations may have a poor prognosis underscoring the importance of advance care planning. We aimed to describe attitudes to, and experiences of, discussing the future among patients recently treated with non-invasive ventilation. Qualitative research using thematic analysis. Tertiary teaching hospital. Patients with acute hypercapnic respiratory failure requiring non-invasive ventilation. Individuals recently treated with non-invasive ventilation describe feeling the future is beyond their control and instead controlled by their illness. Participants often recognised their poor prognosis but avoided discussing some difficult topics. The majority preferred not to undergo cardiopulmonary resuscitation but most had not discussed this with healthcare professionals. When participants voiced concerns about their future health to family members, they were met with polarised responses. Some encountered willingness for further discussion, while others met deflection, deterring further conversation. An overarching narrative of 'Looking through my illness to an uncertain but concerning future' unites these themes. This study suggests opportunities and barriers for advance care planning in individuals with chronic disease. Patients' understanding of their prognosis and their attitudes to cardiopulmonary resuscitation suggests an opportunity for advance care planning. Structuring discussions around patients' preferences for care during future exacerbations may foster a sense of control over the future despite illness. The diversity of familial responses to patients' concerns about their future health has implications for advance care planning. These findings have the potential to improve care for patients with respiratory failure and suggest an important ongoing research agenda.

  5. Advance Care Planning: is quality end of life care really that simple?

    PubMed

    Johnson, Stephanie; Kerridge, Ian; Butow, Phyllis N; Tattersall, Martin H N

    2017-04-01

    The routine implementation of Advance Care Planning (ACP) is now a prominent feature of policy directed at improving end of life care in Australia. However, while complex ACP interventions may modestly reduce medical care at the end of life and enable more people to die at home or outside of acute hospital settings, existing legal, organisational, cultural and conceptual barriers limit the implementation and utility of ACP. We suggest that meaningful improvements in end of life care will not result from the institutionalisation of ACP but from more significant changes to the design and delivery of care. © 2017 Royal Australasian College of Physicians.

  6. Advanced Simulation and Computing Fiscal Year 2016 Implementation Plan, Version 0

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

    McCoy, M.; Archer, B.; Hendrickson, B.

    2015-08-27

    The Stockpile Stewardship Program (SSP) is an integrated technical program for maintaining the safety, surety, and reliability of the U.S. nuclear stockpile. The SSP uses nuclear test data, computational modeling and simulation, and experimental facilities to advance understanding of nuclear weapons. It includes stockpile surveillance, experimental research, development and engineering programs, and an appropriately scaled production capability to support stockpile requirements. This integrated national program requires the continued use of experimental facilities and programs, and the computational capabilities to support these programs. The purpose of this IP is to outline key work requirements to be performed and to control individualmore » work activities within the scope of work. Contractors may not deviate from this plan without a revised WA or subsequent IP.« less

  7. Assurance specification documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 4

    NASA Technical Reports Server (NTRS)

    Callender, E. David; Steinbacher, Jody

    1989-01-01

    This is the fourth of five volumes on Information System Life-Cycle and Documentation Standards. This volume provides a well organized, easily used standard for assurance documentation for information systems and software, hardware, and operational procedures components, and related processes. The specifications are developed in conjunction with the corresponding management plans specifying the assurance activities to be performed.

  8. Pedagogical Documentation and Its Relation to Everyday Activities in Early Years

    ERIC Educational Resources Information Center

    Rintakorpi, Kati; Reunamo, Jyrki

    2017-01-01

    Documentation in early childhood education and care (ECEC) institutions has been developed for decades in various contexts. Today, documentation is preferred as an inclusive method of evaluating, planning, and developing ECEC in the curricula of many countries. Qualitative research on documentation has increased in past years, but quantitative…

  9. Developing a Markup Language for Encoding Graphic Content in Plan Documents

    ERIC Educational Resources Information Center

    Li, Jinghuan

    2009-01-01

    While deliberating and making decisions, participants in urban development processes need easy access to the pertinent content scattered among different plans. A Planning Markup Language (PML) has been proposed to represent the underlying structure of plans in an XML-compliant way. However, PML currently covers only textual information and lacks…

  10. Increasing Accessibility to Advanced Education for Under-Represented Albertans. A Discussion Document

    ERIC Educational Resources Information Center

    Online Submission, 2005

    2005-01-01

    In 2005, Alberta's Minister of Advanced Education initiated a comprehensive exercise to establish a new vision for the province's advanced education system. Through the A Learning Alberta initiative, a revised vision and new policy outcomes for Alberta's advanced education system will be articulated. A key question of A Learning Alberta is how to…

  11. 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

  12. Documentation of Dual Sensory Impairment in Electronic Medical Records.

    PubMed

    Dullard, Brittney; Saunders, Gabrielle H

    2016-04-01

    To examine the documentation of sensory impairment in the electronic medical records (EMRs) of Veterans with both hearing and vision losses (dual sensory impairment [DSI]). A retrospective chart review of the EMRs of 20 patients with DSI was conducted. Providers' documentation of the presence of sensory impairment, the use of assistive technology during clinical appointments, and the content of notes mentioning communication issues were extracted from each chart note in the EMR for the prior 6 years. Primary care providers documented DSI in 50% of EMRs, vision loss alone in 40%, and hearing loss alone in 10% of EMRs. Audiologists documented vision loss in 50% of cases, whereas ophthalmologists/optometrists documented hearing loss in 15% of cases. Examination of two selected cases illustrates that care can be compromised when providers do not take note of sensory impairments during planning and provision of clinical care. Sensory impairment is poorly documented by most providers in EMRs. This is alarming because vision and hearing affect patient-physician communication and the use of medical interventions. The results of this study raise awareness about the need to document the presence of sensory impairments and use the information when planning treatment for individuals with DSI. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Planning Ahead: Advanced Heart Failure

    MedlinePlus

    ... transition is made from quantity of life to quality of life, hospice care provides comfort and support to advanced heart failure patients and their families. Hospice care services are often provided in the home by a ...

  14. 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.

  15. Designing Better Camels: Developing Effective Documentation for Computer Software.

    ERIC Educational Resources Information Center

    Zacher, Candace M.

    This guide to the development of effective documentation for users of computer software begins by identifying five types of documentation, i.e., training manuals, user guides, tutorials, on-screen help comments, and troubleshooting manuals. Six steps in the development process are then outlined and briefly described: (1) planning and preparation;…

  16. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... airport layout plan, under § 151.5(a), or the development of plans designed to lead to a project... proposal must relate to an airport layout plan or plans and specifications for the development of a new...

  17. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... airport layout plan, under § 151.5(a), or the development of plans designed to lead to a project... proposal must relate to an airport layout plan or plans and specifications for the development of a new...

  18. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... airport layout plan, under § 151.5(a), or the development of plans designed to lead to a project... proposal must relate to an airport layout plan or plans and specifications for the development of a new...

  19. 14 CFR 151.111 - Advance planning proposals: General.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... airport layout plan, under § 151.5(a), or the development of plans designed to lead to a project... proposal must relate to an airport layout plan or plans and specifications for the development of a new...

  20. 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